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September 7, 2018 Advisory Board Meeting Summary Minutes

National Institutes of Health
John E. Fogarty International Center for Advanced Study in the Health Sciences

Advisory Board
Summary Minutes
Friday, September 7, 2018

The Board met in the Stone House, Building 16, NIH Campus, 9000 Rockville Pike, Rockville, Maryland, at 9:00 a.m., Roger I. Glass, Chair, presiding.

PRESENT:
ROGER I. GLASS, Chair
GRETCHEN L. BIRBECK
ROBERT BOLLINGER
WALDEMAR CARLO
JANINE CLAYTON
ROBERT EINTERZ
KING HOLMES
VIKRAS KAPIL
JOSEPH C. KOLARS
JOHN T. MONAHAN

Also Present
Kristen Weymouth, Executive Secretary
Nalini Anand, FIC
John Balbus, NIEHS
Seetha Bhagavan, CSR
Kevin Bialy, FIC
Michele Bloch, NCI
Joel Breman, FIC
Patricia Brennan, NLM
Ken Bridbord, FIC
Bruce Butrum, FIC
Stacey Chambers, NINDS
Michael Cheetham, FIC
Lois Cohen, NIDCR
Myron Cohen, UNC
Dexter Collins, FIC
Jim Curran, Emory University
Anna Ellis, FIC
Robert Eiss, FIC
Daniel Fitzgerald, Cornell University
Paul Gaist, OAR
Dan Gerendasy, NLM
George Herrfurth, FIC
Christine Jessup, FIC
Flora Katz, FIC
Peter Kilmarx, FIC
Linda Kupfer, FIC
Vesna Kutlesic, NICHD
Christopher Lynch, NIDDK
Yukari Manabe, Johns Hopkins University
Kathy Michels, FIC
Mark Miller, FIC
Amit Mistry, FIC
Robert Newman, CSIS
Jacinta Nwogu, University of Ibadan
Jackie Officer, FIC
Vivian Pinn, FIC
Shana Potash, FIC
Beverly Pringle, NIMH
Ann Puderbaugh, FIC
Josh Rosenthal, FIC
Vanessa Rouzier, GHESKIO
Srinivas Sastry
Nina Schor, NINDS
Peter Schmeissner, HHS
Christine Sekaggya, Makerere University
Katrina Serrano, OD/ORWH
Lana Shekim, NIDCD
Marcia Smith, FIC
David Spiro, FIC
Lisa Stevens, NCI
Leandra Stubbs, NIMH/DAR
Rachel Sturke, FIC
Anne Sumner, NIDDK
Babafemi Taiwo, Northwestern University
Myra Thomas, FIC
Natalie Tomitch, OAR
Judy Wasserheit, University of Washington
Sanah Zia, NICHD

Director's Update and Discussion of Current and Planned FIC Activities

Dr. Glass opened the meeting at 9:03 a.m. Dr. Glass introduced the new members of the Advisory Board: Drs. Myron Cohen, Ggenga Ogedegbe, Mary Harvard, Jim Curran, and Jacob Gayle. Christine Sizemore is the new director of the Division of International Relations. Dr. Glass reviewed what has happened since Fogarty's 50th Anniversary. Dr. Glass recognized Ann Puderbaugh in communications and she showed the committee examples of the communications products produced by Fogarty and the outreach efforts by the communications department.

Dr. Glass traveled to Rwanda from May 28-June 1, 2018. Drones are now delivering blood products to remote areas in Rwanda. Dr. Glass visited the new University of Global Health Equity. He also visited the HAPIN (Household Air Pollution Investigation Network) trial site.

The Surgeon General was on the NIH campus to promote the Take the Stairs campaign with Dr. Peter Kilmarx. Dr. Kilmarx has been heavily involved with naloxone and opioid overdose training.

Dr. Glass traveled to Bangladesh and met with past Fogarty fellows. The fellows were working on better diagnostics for cholera as well as for over 20 enteric pathogens.

Earlier this week, Dr. Glass and three former Fogarty fellows presented to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Advisory Council on the value of global health research. Also, on September 5, Dr. Robert Bollinger received the Raj and Kamla Gupta Professorship in Infectious Diseases.

The 2019 board meetings will be February 11-12, May 13-14, and September 5-6.

Christine Jessup, Emerging Global Leader Award (K43) Concept

The program is a career development award similar to the K01 award. The K43 award provides opportunities for LMIC investigators. To date, 19 awards have been funded. Of the awards made so far, 10 of them have come through Fogarty programs.

Peter Kilmarx, African Postdoc Training Initiative

Only 2% of NIH intramural research program postdoc fellows are African. The initiative will identify up to 10 African postdoctoral fellows to spend two years at NIH. Training and support will be provided to African researchers and institutional collaboration in research areas of mutual interest will be fostered. The program is funded by the NIH Director's Discretionary Fund, NIH Divisions of Intramural Research, and the Bill and Melinda Gates Foundation (at the candidate's home institution). The initiative is being implemented with the Alliance for Accelerating Excellence in Science in Africa (AESA). The candidates need to be citizens of and currently employed in an African country. The applicants will be on-boarding in January 2019.

Amit Mistry, Advancing Health Research in Humanitarian Crises

The goal of the program is to catalyze timely, high-quality, ethical, and actionable research in humanitarian crises as well as to encourage uptake of evidence into humanitarian policy and practice. Participants include an array of organizations and people: NCI, NIAID, NIEHS, NIMH, NIMHD, NINR, NLM, USAID, CDC, UN, researchers from 13 countries, MSF, IRC, and BRAC. Funding will come from the Wellcome Trust and IDRC. There are certain scientific questions that can only be addressed in humanitarian settings. This presents an opportunity for sharing and learning across different types of crises and health/disease areas. Also, the program will facilitate partnerships between researchers, NGOs, and policymakers. Deliverables include scientific publication, case studies, and outlining the funding landscape.

Thinking about the Global University, Mike Cohen

Global health is a key priority at UNC. This ties in with the notion that one comes to the university as a global citizen. UNC has five health science schools that are near one another and that has led to a culture of collaboration. The business model for the program is based on reinvestment, not on philanthropy. There is a great diversification in the global health program and it is not just focused on infectious diseases. Every one of the health science schools has a dean responsible for global health. The UNC-Malawi partnership has been hugely successful, with UNC being the biggest medical provider in Lilongwe. UNC's pathology training program in Malawi served as the inspiration for the country to build a cancer center. Even so, UNC must constantly justify working outside the US, because it is a public university. The way forward at UNC is to focus on strengths, opportunities, diversification, and contributing to the public good.

Division of International Epidemiology and Population Studies (DIEPS) Updates

Household Air Pollution Investigation Network (HAPIN), Josh Rosenthal

The network is administered by NHLBI, and is a randomized trial working in Guatemala, Peru, Rwanda, and India. Its aims are to demonstrate the health impacts of a randomized LPG (liquid petroleum gas) intervention on health, developing an exposure-response curve for primary and secondary outcomes, and track the relationships between LPG intervention and biomarkers of exposure and health. 3,200 women have been enrolled in the trial. The women are followed from the first trimester of their pregnancy through the child's first year of life. The health of older adult women in a subset of those households is also being followed. The formative research period of the trial has been completed and enrollment has begun. One of the most critical challenges was to ensure that there could be sufficient reductions in exposure with this intervention to even see the possibility of health outcomes. They have gotten down to post-intervention concentrations of PM 2.5 that are close to or below the recommended WHO guidelines. The study will also conduct parallel surveillance for pneumonia and by the end of the first year evaluate the need for additional recruitment based on parallel surveillance.

There is reasonable access to LPG in most of the countries except for Rwanda. The Rwandan government has set a goal of 40% of the country's population to have access to LPG. Right now, LPG is the most scalable solution (much more than solar powered stoves).

Biosecurity and Biosafety in Pakistan, David Spiro

Fogarty is promoting a culture of biosafety in Pakistan. Since 2013 there has been a collaborative effort between the Pakistan Biosafety Association and Pakistan NIH. The idea is to bring biosafety to remote and under-resourced areas of Pakistan. The BioPrism Program trains in-country facilitators that can go to remote areas. Americans are limited to training in Islamabad. The program has set up multiple training workshops. Workshops have been held in every province. Over 750 professionals from 280 institutions have been engaged. 52 master trainers have been produced and training modules are available in English, Urdu, and local languages. Future directions for the program will be PBSA sustainability, collaboration with Pakistani NIH/JHU on genomic epidemiology (MinION), and training of field epidemiology and lab staff on biosafety/biosecurity.

DIEPS has a couple of upcoming workshops: 1) The Epidemiology and Evolutionary Dynamics of Universal Influenza Vaccines on September 19-20 at the Stone House; 2) Training Workshop on Infectious Diseases Dynamics and Evolution in Johannesburg, South Africa December 3-5.

Another program DIEPS is starting is Big Data for Infectious Disease Surveillance and Control in Low Income Countries. This will look at how to use big data methodologies to carve a new science of surveillance and epidemiology in low income country settings.

There is a Clean Cooking Implementation Science Network supported by Fogarty and the NIH Common Fund - the goal is to advance understanding of how to implement evidence-based clean cooking interventions in low and middle-income countries.

The last item Dr. Spiro highlighted was a 10-year $40 million study on the effects of enteric pathogens, nutritional and socio-economic status on childhood development. Sites for this study were in Bangladesh, Brazil, India, Nepal, Pakistan, Peru, South Africa, and Tanzania. The data will be released on the open access platform ClinEpiDB.

Center for Global Health Studies Projects

Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA), Rachel Sturke

The platform was launched in 2017 with the goal to enhance effective use of evidence to overcome implementation challenges related to HIV prevention and treatment. AHISA is made up of 15 teams from 11 countries. The teams consist of NIH-funded scientists that bring along an in-country research partner. Next steps for AHISA will focus heavily on implementation science capacity building. AHISA is partnering with UNICEF, with the idea of providing a virtual platform to exchange ideas and best practices. Initially the platform was funded by OGAC with additional funding from OAR in 2018.

Expected deliverables include: 1) Making Implementation Science Work for Children and Adolescents Living with HIV, part of the CIPHER/WHO Special Issue, Mind the Gap: Filling Knowledge Gaps in Pediatric and Adolescent HIV for an AIDS Free Generation; 2) Inform funding opportunities, prevention, and treatment through a comprehensive care continuum for HIV-affected adolescents in resource constrained settings. Also, AHISA will conduct webinars hosted on UNICEF's community of practice.

HIV/NCD Integration Project: Enhancing HIV/AIDS Platforms to Address NCDs in Low-resource Settings, Linda Kupfer

There has been a lot of success in treating people with HIV which has allowed them to age. The goal of the project is to bring together researchers, implementers, and policymakers to articulate practical goals, approaches, and related research agendas to support LMICs as they strive to sustain and enhance the gains in HIV/AIDS prevention, care, and treatment and address the rising burden of chronic NCDs. Over four years, the project brought together over 100 stakeholders to analyze the landscape, develop a research agenda, and produce a supplement documenting it all. This was led by NIH/FIC with CDC, USAID, and 12 NIH ICOs. The project was partially funded by PEPFAR.

Fostering Data Powered Health: the NLM Strategic Plan 2017-2027, Patricia Brennan

The National Library of Medicine has been involved in every biomedical discovery in the last 50 years. NLM tries to stay up to date with emerging infections and work closely with the NIH to make sure that the most recent information is available for scientists studying in these areas. Medline Plus is a resource for laypeople. The NCBI also serves as a hub for the International Nucleotide Sequence Database Collaborative.

The Lister Hill Center is trying to improve in-field image analysis in low resourced environments by applying machine-learning techniques to do an evaluation and interpretation of images. Other projects NLM has been involved with include deep learning/AI based disease screening in digital chest x-rays, deep learning for cervical cancer screening, and malaria screening. Looking at imaging material that deals with depth and three-dimensional images that have often been displayed as two-dimensional is an exciting area as well.

NLM has made a commitment to Sub-Saharan Africa. It has created a network of medical libraries, and helped with the African Journals Partnership Project, trying to make in-country journals robust and accessible. There are now nine African journals indexed in Medline. There are health information specialist training sites around Africa and a health informatics master program in Morocco.

The NLM strategic plan has three parts: 1) Accelerate discovery and advance health through data-driven research; 2) Reach more people in more ways through enhanced dissemination and engagement; 3) Build a workforce for data-driven research and health.

In terms of access, NIH is in support of open access as quickly as possible. There is support from the White House. This is going to require a long dialogue with publishers. Having data repositories connected to articles is critical. The future of librarians is as a connector point to data.

Fogarty's HIV Research Training Program: Envisioning the Future

Flora Katz, Director, DITR

The goals of the program are to build capacity in LMICs to address the AIDS epidemic, support research training, and address the comorbidities of HIV. There are three components to the program, a planning grant (D71) for developing a training program, workforce training grant (D43) in designing and conducting research, and the Infrastructure development (G11) grant to support research activities. Dr. Katz posed a couple of questions to the board regarding the program: 1) What are the gaps/what is missing? 2) Can the programs be enhanced?

Yukari Manabe, Professor of Medicine, International Health and Molecular Microbiology and Immunology, Johns Hopkins University; Christine Sekaggya, Postdoctoral fellow, Infectious Diseases Institute (IDI), Makerere University, Kampala, Uganda

Dr. Manabe said that everything that happens at the institute revolves around capacity building. The institute has applied the capacity building pyramid to research capacity building such that there are now independent Ugandan researchers. Since the opening of the institute there have been over 600 publications. Between 2008 and 2013, IDI wrote its first strategic plan. IDI broadened its focus to include things like tuberculosis, streptococcus, and other opportunistic infections. Dr. Sekaggya is working on TB/HIV co-infection using PK/PD research to look at treatment outcomes. She found that isoniazid and rifampin levels are generally low in patients that are co-infected. She is looking at high dose alternatives for both isoniazid and rifampin.

Babafemi Taiwo, Gene Stollerman Professor of Medicine, Chief, Division of Infectious Disease, Northwestern University; Jacinta Nwogu, Professor, Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Ibadan

Dr. Taiwo presented some of the key research domains that Ibadan is focused on. What the project is trying to do is to build capacity in brain disorders among people living with HIV. Three main areas are interdependent to have a robust infrastructure: mental health, translational and clinical research, and developing a neuropsychological core. Many of the studies that were being done required exportation outside of the country in order for the analysis to occur. In the next few years Nigeria will develop a complement of fully trained neuropsychologists that will do the analysis of the data locally. There is tremendous pressure for professionals to not return to Nigeria after their training. There needs to be a way to make sure that the advancements in the field and professionals remain local. Therefore, it is important that as much of the training occurs locally as possible. Over the next year Dr. Nwogu will go to the University of Liverpool for training and then to the University of California, hopefully get a grant, and then bring the fruits of her training to Nigeria.

Daniel Fitzgerald, Professor of Medicine and Director, Center for Global Health Weill Cornell Medical College; Vanessa Rouzier, Chief of Pediatrics, GHESKIO, Port-au-Prince, Haiti

The Weill Cornell Medical College and Haiti collaboration started with the Cornell Class of 1975. The Fogarty program has populated the leadership of AIDS programs in Haiti. Many former Fogarty trainees have gone on to work in the Haiti ministry of health. Many Fogarty trainees are now leaders in the PEPFAR program in Haiti as well. Dr. Rouzier gave comments about GHESKIO in Haiti. GHESKIO had the training and experience to confront the many challenges in Haiti. It is critical to have local institutions that are excellent like GHESKIO to keep and attract talent and resources in the country. An area where the agenda needs to be pushed forward is HIV and TB vaccines. There are two R01 grants in Haiti tackling cholera. Fogarty support allows GHESKIO to provide outstanding clinical care and conduct research that changes the lives of patients.

Discussion

Dr. Cohen asked about salaries. Dr. Rouzier said that not only salaries but the debt that comes with training and then working in a country other than the US often makes physicians ineligible for debt repayment programs. Perhaps promoting adjunct positions at US universities for NIH grantees working abroad would be helpful in order to make them eligible for debt repayment programs. The salary question is a daunting one.

Dr. Rouzier said that the poverty of a country should not be a deterrent to trying research in the country. The foundation for research and capacity can be laid by one Fogarty grant.

Dr. King asked about the rest of the Caribbean. Dr. Rouzier said that GHESKIO partners with everybody and is influential in the region. It is the only BSL-3 lab in the Caribbean.

Dr. Tomitch (OAR) said that the Office of AIDS Research is authorized to oversee the entire AIDS research portfolio. Comorbidities are becoming more of a focus within OAR.

Dr. Dieffenbach (NIAID) said that training is about creating a cadre of investigators that can be trained, do, lead, and train the next generation. As the programs continue and become more sophisticated there needs to be a metric to measure their performance. It would also be helpful to see how CFAR interacts with the programs.

Dr. Taiwo said the K43 grant encourages their trainees to write grants and to transition to independence. Fogarty could help even more with the transition from dependence to independence.

Dr. Curran said that there should be a strong focus on fostering leadership among younger researchers. Dr. Wasserheit said it would be great to discuss how there could be additional support. The whole trajectory of providing training needs to be examined. Researchers also need institutional commitment in their home countries, like getting a paid university position upon return. Dr. Cohen said that some of the best people are leading the CTUs. The relationship with the CTUs is critical.

Dr. Curran said that HIV is a chronic disease, and that looking at disciplines and skills rather than diseases might be a good way to go forward. Dr. Manabe added that you need people that can take their research into practice and policy. Dr. Schor said that what people should be taught is how to acquire and integrate new knowledge.

Dr. Bollinger said that Fogarty must think creatively about how to incentivize good mentorship as well as the issue of sustained funding.

Dr. Glass closed the meeting at 2:52 p.m.