The FIC Advisory Board met via video teleconference at 12:00 p.m., Roger Glass, Chair, presiding.
BOARD MEMBERS PRESENT
ROGER GLASS, M.D., Ph.D., Director, FIC International Center; Chair
GRETCHEN BIRBECK, MD, MPH, University of Rochester Medical Center
WALDEMAR CARLO, M.D., University of Alabama at Birmingham
MYRON COHEN, M.D., University of North Carolina at Chapel Hill
JAMES CURRAN, M.D., MPH, Emory University
GREGORY GERMINO, M.D., National Institutes of Diabetes and Digestive and Kidney Diseases; ex officio
VIKAS KAPIL, D.O., M.P.H., Centers for Disease Control and Prevention; ex officio
JOHN MONAHAN, J.D., Georgetown University
GBENGA OGEDEGBE, M.D., M.P.H., F.A.C.P., New York University School of Medicine
STEFFANIE STRATHDEE, PhD, University of California San Diego Department of Medicine
JUDITH WASSERHEIT, MD, MPH, University of Washington
MICHELLE WILLIAMS, S.M., Sc.D., Harvard T.H. Chan School of Public Health
MARY WILSON, M.D., University of California, San Francisco School of Medicine
PETER KILMARX, M.D., Deputy Director, FIC
KRISTEN WEYMOUTH, Executive Secretary, FIC
NALINI ANAND, JD, MPH, FIC
DEXTER COLLINS, MPA, FIC
ROBERT EISS, MA, FIC
SATISH GOPAL, MD, MPH, Center for Global Health, NCI
KAREN GORALESKI, MSW, CEO, American Society of Tropical Medicine & Hygiene
JAMES HUBLEY, CIT, NIH
FARID JARROUS, FIC
CHRISTINE JESSUP, PhD, FIC
CHANDY JOHN, MD, MS, Indiana University of School of Medicine
FLORA KATZ, PhD, FIC
JOSEPH KOLARS, M.D., University of Michigan Medical School
MARYA LEVINTOVA, PhD, FIC AMIT MISTRY, Ph.D., FIC
KEITH MARTIN, M.D., PC, Consortium of Universities for Global Health
LAURA POVLICH, Ph.D., FIC
ANN PUDERBAUGH, FIC CHRISTINE SIZEMORE, PhD, FIC
DAVID SPIRO, PhD, DIEPS RACHEL STURKE, Ph.D., FIC
STEN VERMUND, M.D., Ph.D., Yale School of Public Health
CECILE VIBOUD, Ph.D., FIC
Director's Update and Discussion of Current and Planned FIC Activities
Dr. Glass called the meeting to order at 12:03 p.m. He welcomed the Board members and thanked staff for their work in organizing the virtual meeting. He commented that issues of diversity and the persistence of racism are just as critical now as ever. The fact that the COVID-19 pandemic has disproportionally impacted minorities and disadvantaged communities illustrates that achieving social justice is a public health issue. FIC is committed to providing a diverse and safe workplace and identifying the ways that its work and the research it supports can promote racial equity globally.
Dr. Glass described his travel in February 2020. In South Africa, he and Dr. Francis Collins met with Michael Milken to ensure that Mr. Milken includes health in his training of bankers and financiers on growing leaders. Dr. Glass also met with Patrice and Precious Motsepe, founders of the Motsepe Foundation. Precious Motsepe, Chancellor of the University of Cape Town, wants to establish a center of excellence for cancer research in South Africa. This center could link to the National Cancer Institute’s (NCI) activities. In Cairo, Dr. Glass met with Soumya Swaminathan, a World Health Organization (WHO) chief scientist and former FIC grantee who is pushing a global health agenda in each WHO region. Dr. Glass attended the WHO Regional Office for the Eastern Mediterranean (EMRO) conference, which was led by Iman Nuwayhid, Dean of the American University of Beirut’s School of Public Health and a FIC grantee. Dr. Glass also met with Selim Mohamed and Khalid Saeed, FIC grantees who are focusing on trauma and mental health, respectively. These international conferences give FIC the opportunity to learn about interesting international research.
In March, all travel was halted due to the COVID-19 pandemic. FIC has responded to the pandemic by instituting telework and virtual meetings. FIC holds twice-weekly senior staff meetings and the IC directors also hold twice-weekly meetings. Although the pandemic has changed how FIC conducts business, staff are working harder and are more connected than ever before. The September FIC Advisory Board meeting will also be held virtually.
Ann Puderbaugh, FIC’s Communications Director, updated members on the actions of FIC’s Communications Office in light of the COVID-19 pandemic. In January, after observing COVID-19’s progression in China, the office began collecting resources and publications that it thought might serve the global health research community. The office launched its coronavirus webpage on February 7, which was then added to NIH’s top-level COVID-19 webpage. The webpage’s traffic has skyrocketed during the last three months and is updated daily with new COVID-19-related funding opportunities, COVID-19 research publications, data sharing sites, and other information.
Many former FIC grantees are leading the international COVID-19 response, including Zunyou Wu in China, Bill Pape in Haiti, John Nkengasong from the Africa CDC, and Salim Abdool Karim in South Africa. Salim Abdool Karim and his wife Quarraisha Abdool Karim recently received the Gairdner Global Health Award for their work on HIV in sub-Saharan Africa, and Quarraisha Abdool Karim recently received the Christophe Merieux Prize for her work on prevention of HIV in women and children. Jessica Manning, a recent FIC scholar, and her team in Cambodia were the first to sequence and begin research on COVID-19 in Cambodia.
The pandemic has highlighted FIC’s amazing team and leadership. FIC has adapted to the new working environment and is continuing to support its activities and communications virtually. FIC views COVID-19 both as a disaster and an opportunity to respond with new grants, supplements, partnerships, and training.
Dr. Peter Kilmarx, FIC’s Deputy Director, gave an update on several FIC initiatives. The African Postdoctoral Training Initiative is conducted in collaboration with the NIH Intramural Research Program (IRP), the Bill and Melinda Gates Foundation (BMGF), and the African Academy of Sciences. NIH has selected 10 early-career African scientists from six different countries to join the initiative’s second cohort. Once able to travel, the scientists will work in the NIH IRP for two years. Afterwards, they will receive an additional two years’ support to begin research careers in their home laboratories.
Congress has appropriated $3.6 billion to the NIH for COVID-19 research. COVID-19 countermeasure research initiatives include the White House’s Operation Warp Speed, a public-private partnership with the goal of developing a COVID-19 vaccine by January 2021, NIH’s Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) program, which focuses on vaccine and drug candidates, and NIH’s Rapid Acceleration of Diagnostics (RADx) program, which aims to have millions of tests available per week by late summer or fall of 2020. FIC is involved in the RADx program through the Point-of-Care Technologies Research Network. Dr. Kilmarx has been working with the National Cancer Institute (NCI) and the National Institute of Biomedical Imaging and Bioengineering (NIBIB) on digital health solutions, such as a back-to-work app that uses disease history, symptoms, test results, and contact history to guide readiness for return to work. He encouraged members to keep an eye out for future opportunities in this space.
The African Forum for Research and Education in Health (AFREhealth) has been very active in educating the health workforce in Africa about the COVID-19 response. Dr. Kilmarx encouraged members to attend AFREhealth’s upcoming webinars on this topic. FIC has been working with ESSENCE on Health Research to review investments in health research capacity building and identify opportunities to enhance coordination. Sufficient research capacity is necessary in pandemic preparedness. Last week, FIC and ESSENCE held a well-attended virtual meeting. FIC has developed a simple metric for health research capacity that incorporates a country’s number of grants, publications, and clinical trials versus its health burden.
Dr. Flora Katz, Director of FIC’s Division of International Training and Research (DITR), began by updating members on FIC’s Global Health Program for Fellows and Scholars. The Program is confirming its 2020 class, which consists of about 120 trainees and has support from 14 NIH ICs as well as the Fulbright Foundation. Orientation will be held virtually from July 13 - 17. Due to COVID-19 concerns, trainees will be allowed to choose when and how they start their programs. Dr. Katz then updated members on FIC’s activities around sexual harassment. All NIH awardee institutions are expected to have policies in place to address sexual harassment complaints. With the help of NIH’s Office of AIDS Research (OAR), FIC will be awarding $600,000 in supplemental grants to assist awardee institutions in developing these policies. FIC has also expanded the scope of its Infrastructure Development Training Programs for Critical HIV Research at Low-and Middle-Income Country Institutions (G11) program to include sexual harassment policies and developing offices. FIC has developed a committee to support the NIH Office of the Director’s (OD) recently released anti-harassment initiative framework.
Dr. Rachel Sturke, Deputy Director of FIC’s Division of International Science Policy, Planning and Evaluation (DISPPE), updated members on the Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA). AHISA recently received additional funding from OAR and now has 26 teams across 11 countries and hopes to use this funding to extend its reach and support more in-country implementation science activities. Examples of these activities include establishing formal mentoring relationships for implementation science and incentivizing these relationships in the context of locally-led work. AHISA is looking forward to continued progress on sustainable, local efforts.
Rob Eiss, Senior Advisor to Dr. Glass, updated members on the current global health research activities of the NIH Office of the Director. The ongoing collaborations between NIH and the Bill & Melinda Gates Foundation (BMGF) are coordinating roughly ten working groups and have recently launched an initiative to develop inexpensive, safe, and effective gene-based cures for sickle cell disease and HIV to be used in sub-Saharan Africa. Over the next four years, NIH and BMGF intend to invest $400 million in this initiative, with aims to go to clinical trials in the next 7-10 years. The initiative aims to leapfrog current financial and infrastructure demands by developing in vivo approaches. Over the next four years, NIH and BMGF will focus on better understanding the HIV reservoir harboring pro-virus HIV DNA and identifying vectors and delivery systems that can precisely target in vivo as well as gene-edit hematopoietic stem cells. NIH and BMGF have organized an HIV reservoir consortium with 40 labs and 5 teams to work on this project and will support companies in the in vivo and ex vivo gene therapy space. Next steps include preparing for clinical trial readiness and infrastructure in sub-Saharan Africa, developing formal public-private partnerships, developing target product profiles (TPP), and thinking through the program’s complex ethical considerations.
In coordination with the UK Medical Research Council, Wellcome Trust and others, NIH in 2018 assembled some 60 plus large-scale prospective cohort studies into a project-based consortium, encompassing over 20 countries. The goal is to create a global network for translational research that will utilize large cohorts to enhance understanding of the biological, environmental, and genetic basis of disease and to improve clinical care and population health. Cohorts were invited to join the consortium based on four criteria: consented 100K participants or more; available biospecimens; the potential for longitudinal follow-up of participants; and population-based i.e. disease agnostic. The consortium encompasses a broad diversity of participants with varied demographics, samples, ability to follow up - utilizing both traditional and molecular epidemiology for data collection The executive secretariat is housed at the Global Genomic Medicine Collaborative (G2MC) Workstreams include promoting interoperability and data harmonization to allow cohorts to do collaborative and replication studies, developing a cross- cohort app to allow investigators to conduct high-level metadata searches, demonstrating the value of cohorts by developing polygenic risk scores , and contributing to the COVID-19 research response.
Dr. Vermund asked if FIC is effectively communicating its message to the public or if it should pursue any initiatives related to science/health communication and advocacy. Dr. Glass responded that he will take this issue under advisement and discuss it at the next Board meeting. Ms. Puderbaugh suggested revisiting interactions with the BMGF and the Research America ambassador program. Dr. Wasserheit commented that NIH and BMGF’s sickle cell cures collaboration provides an opportunity for capacity building and asked what plans are in place to build in-country capacity. Mr. Eiss responded that NIH and BMGF want to engage African institutions at the pre-clinical level but at this moment are focused on translational challenges. They are discussing the possibility of engaging the HIV Prevention Trials Network (HPTN) and other HIV-related networks. NHLBI’s Sickle Cell Pan-African Research Consortium could potentially be ramped up to provide a clinical trials infrastructure. Mr. Eiss expects there will be further planning on building out clinical trials infrastructure.
Harnessing Data Science for Health Discovery and Innovation in Africa (DS-I Africa) Updates
Dr. Glass introduced Dr. Laura Povlich, Program Officer in DITR, to provide an update on DS-I Africa.
DS-I Africa is a trans-NIH initiative that aims to explore how advances in data science applied in the African context can spur new health discoveries and catalyze innovation in healthcare, public health, and health research. DS-I has four funding initiatives: creation of a consortium that consists of research hubs focused on high-priority and region-specific health problems, formation of data science training programs, exploration of the ethical, legal, and social implications of data science and innovation research, and formation of an open data science platform and coordinating center to facilitate data sharing and other interactions within the consortium. Dr. Povlich hopes the consortium will spark innovation and facilitate sustainable impact. The consortium will hold two symposia to facilitate networking and discussions. NIH recently published four notices of intent (NOI) to publish funding opportunity announcements (FOAs) for the four funding initiatives described above. Dr. Povlich anticipates that the FOAs will be published in July and have receipt dates in late November. She encouraged members to share these FOAs with their networks.
Dr. Glass introduced Dr. Amit Mistry, Senior Scientist in DISPPE, to present updates on the upcoming DS-I Africa virtual symposium. The symposium platform aims to build an online networking community through a highly interactive website that will foster networking and discussions as well as allow any users to create and submit posters and lightning talks. The symposium is planned to last a week and a half in mid-August and will begin with a webinar to launch the FOAs. Other events include pre-recorded keynote talks from government and private sector leadership and a series of interactive panel discussions on topics such as entrepreneurship and research capacity. Staff are also planning a networking marketplace as well as a series of scientific and topical webinars to take place after the main events in August. The networking community website will be open and staff consultations will be available during the entirety of the events.
Real Time Genomic Epidemiology for SARS-CoV-2
Dr. Glass introduced Dr. David Spiro, Director of the Division of International Epidemiology and Population Studies (DIEPS), to present on genomic epidemiology research on COVID-19 in Africa. Among numerous research studies in response to the COVID-19 pandemic, DIEPS has a real-time genomic epidemiology of SARS-CoV-2. Technology has made real-time genomics surveillance a reality. There are now tens of thousands of SARS-CoV-2 published sequences from across the globe. The sequences allow researchers to quickly determine the origin of novel introductions of the virus to countries, detect cryptic transmission chains, and monitor the evolution of SARS-CoV-2.
DIEPS has jumpstarted its genomic epidemiology training programs in order to facilitate local, real-time surveillance of COVID-19 outbreaks. DIEPS has conducted virtual training in Bangkok and Colombia. DIEPS has been funded by FIC and the Department of State to run two virtual trainings on genomic epidemiology. One training will be with African partners, the other with institutes in Pakistan. The funding will also allow DIEPS to conduct follow-up work with investigators post-training and to conduct advanced training in laboratory and bioinformatic methods. DIEPS continues to participate in a number of collaborative projects.
FIC Global Injury and Trauma Research Training Program (D43)
Dr. Glass introduced Dr. Marya Levintova, Program Officer in DITR, to present the program concept. The global burden of trauma and injuries continues to be pervasive. FIC’s Global Injury and Trauma Research Training Program is a five-year RFA that is now in its 14th year. The program has eight awards, seven of which are awarded to U.S. institutions. One is a direct foreign award. The program covers a broad range of topics, although there has historically been more focus on traffic injuries. Thus far, the program has resulted in 257 publications on topics ranging from traffic injuries to interpersonal violence.
FIC is the only entity in the world that provides this funding and support for capacity building, training, and research in trauma and injury. Dr. Levintova would proposes that the program emphasize two areas in its next iteration: humanitarian crises and natural disasters. She is also considering proposing that PIs who are resubmitting and have received two previous cycles of funding shift the leadership to their LMIC partner.
Members expressed support for emphasizing humanitarian crises and natural disasters. Dr. Williams encouraged asking the National Institute of Environmental Health Sciences (NIEHS) to sign on to this program. Dr. Kolars expressed support for shifting leadership to the LMIC partners. Dr. Wasserheit commented that the program could incorporate injuries resulting from interactions between governments and marginalized communities. Dr. Curran suggested that GITRTP partner with the U.S. State Department. This partnership would be particularly relevant for humanitarian crises.
International Research Scientist Development Award (IRSDA, K01)
Dr. Glass introduced Dr. Christine Jessup, Program Officer in DITR, to present the program concept. The IRSDA program is FIC’s longstanding mentored career development award for early career U.S. scientists who are pursuing research careers in global health. IRSDA is an important component in the global health career development pipeline. It provides U.S. investigators, advanced post-docs, and junior faculty with the opportunity to have protected time under the mentorship of U.S. and LMIC mentors to conduct research in-country and to conduct career development activities that will support the launch of their independent global health research careers and continued collaboration with LMIC scientists, as well as ensure that they become competitive for major independent research grants. In its 20 years, IRSDA has supported almost 90 early career investigators. As of 2017, IRSDA has distributed awards in 33 countries covering a wide range of topics and IRSDA alumni have published over 1500 peer-reviewed publications. IRSDA has supported lasting collaborations with LMIC partners. 43% of IRSDA alumni have successfully received additional NIH research funding. Over 85% of IRSDA alumni have remained in the field of global health and have secured funding through a number of other ICs.
Dr. Jessup would propose the continuation of the IRSDA K01 program with current requirements that candidates must be U.S. investigators with no independent funding who will commit 75% of their efforts to the K01. IRSDA is unique in that it requires participants to have both a U.S. and LMIC mentor and to spend at least 50% of their effort in-country. This is critical to support sustained international research collaboration and to help research results be implemented in the country’s policy or practice. Dr. Jessup would propose two budget changes: a salary increase from $75,000 to $100,000 per year, and an increase in research support from $30,000 to $40,000 per year. NIH and FIC offer a number of flexibilities to support the transition and retention of early career investigators, including allowing changes to effort levels, leave of absences, and changes to an appointment status. FIC allows flexibilities around in-country requirements on a case-by-case basis.
Dr. Strathdee expressed support for IRSDA and asked if it could have more than one review cycle per year. Many trainees don’t submit applications to IRSDA due to the long wait time between cycles. Dr. Jessup responded that IRSDA has been unable to support additional review cycles and that the number of applications it receives annually does not warrant multiple receipt dates. However, IRSDA could explore this possibility again. Dr. Strathdee suggested increasing capacity by asking other study sections to also review applications. Dr. Wasserheit commented that the 43% success rate of IRSDA alumni receiving additional NIH funding seems low, and asked what the target rate is. Dr. Germino commented that the 43% success rate is comparable to the National Institute of Diabetes and Digestive and Kidney Diseases’ (NIDDK) programs. He noted that 85% of IRSDA’s alumni remain in the field of global health and have secured independent funding. Dr. John commented that some researchers are unable apply to IRSDA due to its six month requirement. Dr. Vermund said that he has seen this issue as well, but thinks, given that IRSDA is NIH’s only K01 award that is explicitly designed to help participants live and work overseas, it should keep its six month requirement.
FIC's COVID-19 Activities
Dr. Glass introduced Dr. Cecile Viboud, Senior Research Scientist in DIEPS, to give the presentation. Dr. Viboud gave an overview of COVID-19 modeling research using data from China, South Africa, and the U.S. China is characterized by its intense interventions of social distancing and contact tracing and detailed data on the nature of COVID-19 transmission. FIC has collaborated with Dr. Hongjie Yu from Fudan University to access this data. In order to understand COVID-19’s transmission dynamics, researchers examined changes in the reproduction number, a measure of transmission intensity, using data from the ten Chinese provinces with the most cases. Researchers found that the reproduction number increased in the second half of January. By the end of January, when strict interventions were implemented, researchers found a rapid decrease in transmission rate. The rate went below the threshold of one, meaning that the epidemic was controlled. Researchers have used population surveys taken before and during the outbreak to examine the impact of social distancing on contacts between individuals. The survey responses show a 7-10 fold decrease in daily contacts due to social distancing, as well as a change in the types of contact and the age groups one has contact with. Mobility data shows a decrease in mobility due to social distancing orders.
Contact information can be fed into transmission models to show the impact of different interventions. For example, simulation models show that school closures reduce transmission and decrease the peak of the epidemic. However, a large fraction of people are still infected by the end of the outbreak, showing that school closures are not enough of an intervention to control the outbreak. Dr. Kaiyuan Sun has been leading an effort to examine detailed contact tracing data from Hunan. The data shows that the outbreak is spread across the province and demonstrates heterogeneity in terms of secondary cases. Dr. Sun and his group have been examining predictors of transmission by researching both cases and their contact.
Data does not show any difference in infectiousness by age or gender. Contact in the household is most favorable to transmission, followed by contacts in the family and transportation system. Health care settings were found to be the least favorable to transmission. However, the impact of household contact varies throughout the epidemic. The risk of transmission within the household increased later in the epidemic as social distancing was put in place. Researchers believe that social distancing intensified contact within the household. Every additional day of contact was found to increase transmission risk by 10%. Most transmission events were found to occur in the household and with family, with social contact and transportation accounting for much less transmission. However, social contact and transportation were the settings that contained the most heterogeneity between individuals. Social distancing eliminated much of this heterogeneity. Patients were found to be very infectious early in their infection cycle. Researchers estimate that 45% of transmission is pre-symptomatic. This data can be used to evaluate the impact of different interventions. COVID-19 is difficult to control with contact tracing alone because of the amount of transmission that occurs in the pre-symptomatic phase. It is important to pair contact tracing with other interventions such as social distancing and teleworking or masks wearing, as the synergistic effects of these interventions can stop transmission.
In South Africa, FIC has been exploring the use of digital surveillance to evaluate the COVID-19 outbreak. Digital surveillance mines information from web searches and social media to understand the status and trajectory of an outbreak. Surveillance data lags compared to real-time data and so doesn’t always reflect the true rate of infection. Nowcasting can be used to remedy this lag. There will be data correction as the epidemic proceeds. FIC is collaborating with South Africa’s National Institute for Communicable Diseases and the South African Centre for Epidemiological Modelling and Analysis (SACEMA) to use these approaches to model weekly patterns in influenza-like illness in South Africa. The best model thus far combines reported cases in past weeks and Google search terms. FIC is training colleagues in South Africa to develop these approaches and recently expanded this project to train colleagues with the Pakistan NIH. In South Africa, medical claims data show a surge in respiratory diseases early in the COVID-19 pandemic that decreased once the lockdown was implemented. Now that the lockdown will be lifted, researchers are interested to see if the number of COVID-19 consultations will increase, particularly in the age group in which HIV might be dominant.
There has been much discussion about the true mortality burden of COVID-19 in the U.S. and whether interventions have been justified. Testing in the U.S. has ramped up slowly, which may cause the true number of cases to be underreported. Due to social distancing, there may be a decrease in other causes of death such as traffic accidents. However, due to COVID-19 fears, people may fail to treat conditions that, when untreated, lead to death. The excess mortality approach can be used to calculate the full impact of the COVID-19 pandemic in the U.S. This approach compares the U.S.’s total mortality during the COVID-19 pandemic with its seasonal baseline. Researchers estimate that the U.S. had a total of 112,000 excess deaths attributed to COVID-19 as of May 16th. However, this impact differs based on location.
FIC is collaborating with NIH, National Science Foundation, Centers for Disease Control, and other institutes to combine different models’ projections to understand which interventions are most effective. The team has designed an epidemic scenario to test four different interventions: maintaining a stay-at-home order for six months after May 16th, two scenarios that reopen workplaces based on the White House’s reopening guidelines, and immediately opening workplaces. The modeling teams have been asked to project, for the next six months, the intensity of the epidemic, possibility of a new outbreak, and cost of the intervention. The project’s goal is to rank interventions across models. The first results should be ready in the next two weeks. The project aims to expand to other realms such as geography.
Dr. Cohen asked about the impact of mask use in China. Dr. Viboud responded that, at this point, researchers do not have a way to estimate the impact of masks. Dr. Sizemore asked if researchers have had to account for any coverage biases when incorporating social media into South African surveillance data. Dr. Viboud responded that researchers are investigating this issue and are incorporating coverage that is from different provinces and in different languages. Members asked how one can incorporate nuances in the modeling into estimations of returning to work and how to return to work. Dr. Viboud responded that models with more granular data can evaluate more nuanced return-to-work information. The U.S. project she discussed earlier will evaluate broader measures of returning to work.
Advancing Global Oncology Research
Dr. Glass introduced Dr. Satish Gopal, Director of NCI’s Center for Global Health (CGH), to give the presentation. Dr. Gopal thanked the Advisory Board for the opportunity to present at today’s meeting. Dr. Norman Sharpless, Director of NCI, hoped to be at today’s meeting but unfortunately was unable to attend. NCI’s connection to FIC runs deep. NCI’s mission is to lead, conduct, and support cancer research across the U.S. to advance scientific knowledge and help all people live longer and healthier lives. NCI’s FY20 budget is $6.25 billion. NCI’s leadership strongly supports global health. The CGH coordinates NCI’s global health activities and is the only unit whose primary focus is global health. Next year, NCI will be celebrating the 50th anniversary of the National Cancer Act of 1971. The Act constituted the NCI in its current form and instructs the NCI Director to act with an explicitly global focus by establishing an international cancer research database, supporting international cancer research that will benefit the American people, and supporting the training of American scientists abroad and vice versa. The CGH was established in 2011 to develop an appropriate research strategy to help incorporate cancer control into global health programs, foster relevant research activities throughout NCI’s intramural and extramural divisions, and work closely with potential collaborators that have displayed an interest in shared objectives.
The CGH has recently refreshed its organizing vision and mission. It supports the NCI mission by advancing global cancer research and by coordinating NCI engagements in global cancer control. The CGH has four primary goals: to support innovative and impactful research that addresses key scientific issues in global cancer control and/or leverages unique scientific opportunities that are afforded by global collaboration, to support global cancer research training, particularly in LMICs, that enable impactful global scientific collaboration, to promote the integration of current scientific knowledge in global cancer control, and to represent the NCI and promote engagement with key partners in global cancer control.
Much of the research in cancer control opportunities are a byproduct of increasing global cancer burden, with LMICs most impacted. Projections show an expected 60% increase in worldwide cancer burden due to population aging and growth alone. The proportional increase is much higher in LMICs than in high-income countries. There is extreme global heterogeneity in cancer incidents, which yields opportunities to comparatively study different cancers. It will be difficult to make progress on cancers that specifically occur with high frequency in LMICs if researchers don’t study cancer control within these environments.
12% of NCI’s FY19 extramural global portfolio consisted of awards with international components, and there were relatively few direct international awards. NCI hopes to address this issue moving forward. The NCI’s two intramural divisions have a substantial amount of international work. Most international work is concentrated in high-income countries, but a significant proportion of work occurs in LMICs. CGH hopes to increase the amount of work done in LMICs. NCI’s geographic research is fairly vast and touches on all continents. Going forward, CGH will focus on building on current opportunities and realizing new ones.
Since its inception, the CGH has supported 192 grants, grant supplements, and research contracts with collaborators from 62 countries. Two-thirds of these are in CGH’s in-house portfolio and a third are part of CGH’s coordination of trans-NIH or NCI initiatives. CGH has supported cancer research training for more than 150 individuals from more than 50 countries through the Division of Cancer Prevention’s summer curriculum, the Short Term Scientist Exchange Program (STSEP), and co-funding through many of FIC’s training programs. CGH’s Affordable Cancer Technologies Program supports translational research to adapt technologies to address cancer in LMICs. Several of the technologies studied have made significant progress towards commercialization and adoption. CGH is thinking through ways to modify and reissue the program. Mark Parascandola leads a program focused on tobacco cessation, HIV and comorbidities in LMICs. This program has been developed in close collaboration with the Office of AIDS Research, the Office of HIV and AIDS Malignancy (OHAM), and the Division of Cancer Control and Population Sciences (DCCPS). The program recently received approval for a new NCI U01 funding opportunity announcement (FOA), which will be released soon. The FOA will aim to bring together trans-disciplinary teams to adapt tobacco cessation interventions for people living with HIV in LMICs. This program will be conducted parallel to one with a domestic focus, allowing for scientific exchange between the two programs. Paul Pearlman has led NCI participation in a number of bilateral co-funded research programs. NCI has been able to support a number of cancer applications through these mechanisms.
The NCI supports the Cancer Center Program (CCP) and currently recognizes 71 centers around the U.S. that meet the program’s rigorous standards. Nearly half of these centers have a designated global oncology program. Kalina Duncan and Mishka Cira have led CGH’s effort to periodically survey cancer centers on projects outside of the NIH funding portfolio. CGH is working to catalyze the growth of global oncology at these centers.
Sudha Sivaram is leading a new D43 program that aims to address the lack of global cancer research training support for U.S. scientists and the lack of opportunities for cancer research training in LMICs. Program applications are due on July 24th. CGH has worked closely with the Center for Cancer Training and Office of Cancer Centers to create a dedicated NCI global research training program. Other research programs include the STSEP, which supports two-way exchanges between non-U.S. scientists and researchers in the NCI’s Intramural Division. CGH also supports conferences and scientific meetings through an R13 mechanism.
CGH and Project ECHO have had a longstanding collaboration to create dissemination platforms for global cancer control. These platforms facilitate virtual knowledge exchange communities of practice. The collaboration has allowed CGH to increase familiarity with evidence-based national cancer control planning principles and strategies, utilize evidence, and identify gaps in data to inform the national cancer control plan and strengthen the interactions and collaborations among the diverse group of individuals working in global cancer control. NCI benefits from partnerships with members of the global cancer control community. The next Annual Symposium on Global Cancer Research is planned for March 2021. This meeting allows NCI to connect with the broader global health community.
OHAM, led by Robert Yarchoan, and DCCPS, led by Robert Croyle, support a number of activities that extend internationally. For example, OHAM supports the AIDS Malignancy Consortium, which uniquely spans high income and low income countries. DCCPS’ global portfolio includes initiatives focused on obesity, implementation science, cancer surveillance, global tobacco control, and behavioral research. The Division of Cancer Epidemiology and Genetics (DCEG), led by Stephen Chanock, supports initiatives such as the African Esophageal Cancer Consortium, which is a collection of African sites that is conducting harmonized epidemiologic and etiologic studies on esophageal squamous cell carcinoma to discover why it occurs so frequently in many African countries. Amy Kreimer has DCEG’s work on cervical cancer vaccination. NCI recently completed accrual to a large, randomized study in Costa Rica that has the potential to change worldwide vaccination strategies. Over the course of several decades, NCI has been able to move from association studies between HPV and cervical cancer to optimization of inquiry supported by NCI in the global health space can accomplish significant things. Mark Shiffman has led efforts to use images collected in Costa Rica and machine learning approaches to detect CIN2+.This novel method out-performs current cervical cancer screening strategies and is now being validated in additional settings, additional women, and in the context of HIV. Optimizing cervical cancer vaccination and screening would substantially accelerate some of WHO’s cervical cancer elimination targets.
NCI and FIC collaborate on programs such as the Mobile Health: Technology and Outcomes in LMICs program, International Tobacco and Health Research and Capacity Building Program, and GEOHealth program. CGH is leading NCI participation in the DS-I initiative. NCI largely modeled its D43 program after FIC’s D43 programs. NCI continues to participate in D43, K01, K43, and R25 programs funded by FIC. NCI has collaborated with FIC to conduct workshops in a number of key global health scientific areas.
Dr. Vermund suggested that FIC pursue a strategy of encouraging and helping ICs to adopt and stand up a D43 mechanism as a way to help build global training support. Dr. Ogedegbe expressed his concern that if researchers don’t address translation of evidence-based interventions into practicable applications, they will be unable to reduce global disparities. He added that the building of institutional capacity needs to be focused across Africa, not just within one specific region or country. Dr. Strathdee commented that it would be great to extend the RFAs for tobacco cessation on HIV to SARS-CoV-2 survivors, as well as include vaping and marijuana use. Dr. Gopal responded that NCI is interested in adding electronic cigarettes to these RFAs. He added that although the COVID-19 pandemic began largely after the program was developed, it would be interesting to create supplemental funding opportunities to better understand the interaction between COVID-19 and tobacco cessation. Dr. Carlo commented that it would be beneficial to have a community of investigators in LMICs and that NCI could participate with FIC grantees to help do so.
Dr. Glass thanked members, presenters, and staff for their time and participation. He reiterated FIC’s mission to build the groundwork for global health and international collaboration. The next Board meeting will be virtual and is scheduled for September 10-11, 2020.
There being no further business, Dr. Glass adjourned the meeting at 3:03 p.m.