February 8-9, 2021 Advisory Board Meeting Summary Minutes

The FIC Advisory Board met via videoconference on February 8-9, 2021. Dr. Roger Glass presided as Chair.

Present

• Roger I. Glass, M.D., Ph.D., Director, Fogarty International Center (FIC); Associate Director for International Research, NIH; Chair
• Janine Austin Clayton, M.D., NIH Associate Director for Research on Women’s Health; Director, NIH Office of Research on Women’s Health; ex officio
• Myron S. Cohen, M.D., Director, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill
• James W. Curran, M.D., M.P.H., Dean of Public Health, Rollings School of Public Health, Emory University
• Carol Dahl, Ph.D., Executive Director, The Lemelson Foundation
• Jacob A. Gayle, Jr., Ph.D., Former Vice President, Philanthropy/President, Medtronic Foundation
• Eric Goosby, M.D., Professor of Medicine, University of California, San Francisco
• Karen Goraleski, M.S.W., Chief Executive Officer, American Society of Tropical Medicine and Hygiene
• Chandy John, M.D., Ryan White Endowed Chair in Pediatric Infectious Diseases and Director, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine
• Gregory Germino, M.D., Deputy Director, National Institute of Diabetes and Digestive and Kidney Diseases; ex officio
• Vikas Kapil, D.O., M.P.H., Director, Center for Global Health, Centers for Disease Control and Prevention; ex officio
• Gbenga Ogedegbe, M.D., M.P.H., F.A.C.P., Director, Center for Healthful Behavior Change, New York University School of Medicine
• Steffanie Strathdee, Ph.D., Associate Dean of Global Health Sciences, Harold Simon Professor, University of California San Diego Department of Medicine
• Sten Vermund, M.D., Ph.D., Dean and Anna M.R. Lauder Professor of Public Health, Professor of Pediatrics, Yale University School of Medicine
• Judith N. Wassserheit, M.D., M.P.H., Chair and Professor, Global Health, University of Washington
• Michelle Williams, S.M., Sc.D., Dean of the Faculty, Harvard T.H. Chan School of Public Health, Harvard Kennedy School
• Mary Wilson, M.D., Clinical Professor, Epidemiology and Biostatistics, University of California, San Francisco School of Medicine

Also Present

• Geetha P. Bansal, Ph.D., FIC
• Michael F. Chiang, M.D., National Eye Institute
• Judy Gichoya, M.D., FIC
• Unja Hayes, Ph.D., FIC
• Farid Jarrous, FIC
• Christine Jessup, Ph.D., FIC
• Flora Katz, Ph.D., FIC
• Peter Kilmarx, M.D., FIC
  
• Vivian Pinn, M.D., FIC
• David Spiro, Ph.D., FIC
• Cecile Viboud, Ph.D., FIC
• Kristen Weymouth, Executive Secretary, FIC

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

Dr. Glass opened the meeting at 12:01 PM. He welcomed new Board members Eric Goosby from the University of California, San Francisco; Karen Goraleski from the American Society of Tropical Medicine & Hygiene; Carol Dahl from the Lemelson Foundation; Sten Vermund from the Yale School of Public Health; and Chandy John from Indiana University. Dr. Glass recognized the passing of Drs. James Hakim and David Katzenstein, long standing Fogarty awardees and collaborators in Zimbabwe.

Dr. Glass announced that Mary Fogarty McAndrew, Congressman John Fogarty’s daughter, recently received Research!America’s Gordon and Llura Gund Research Award. Ms. McAndrew has been instrumental in her stewardship of the Fogarty Center over the years. Additionally, Dr. Michelle Williams has been named this year’s recipient of Research!America’s Clear Voice Award.

President Biden signed several executive orders that will influence the direction of the Fogarty Center over the next couple of years. These actions halt the United States’ withdrawal from the World Health Organization (WHO) and rescind Schedule F policies on political appointees. In addition, President Biden has announced that the U.S. will be rejoining the Paris Climate Accord. The new Administration is also rescinding the Mexico City policy that banned government funding of nonprofits that provide abortion information and ending the 1776 Commission. Dr. Anthony Fauci, who is serving as the Chief Medical Advisor to the President, will be the U.S representative to the WHO. Additional science team members of the Biden Administration are Eric Lander, Director of the Office of Science and Technology Policy, Frances Arnold, Maria Zuber, and Alondra Nelson. At the Department of Health and Human Services (HHS), Dr. Francis Collins will be continuing his role as NIH Director, Dr. Rochelle Walensky will be the head of the CDC, and Dr. Janet Woodcock will be the head of the FDA.

By the end of the previous Administration, NIH was moving forward with an initiative called UNITE to increase gender equality, diversity, and inclusion at NIH. Dr. Glass also noted the creation of a group called 8CRE, which is composed of minority NIH employees who came together to send a letter to the NIH Director detailing their proposed eight changes for racial equity to create a workplace free of racism and discrimination at NIH. Dr. Glass acknowledged the need to change the culture at NIH into one that better embraces diversity, equity, and inclusiveness.

Dr. Glass updated the group on the Data Science and Innovation for Health in Africa Program. FIC planned to have 250 to 300 people at the meeting in person and by the time they had to cancel the meeting they discovered over 2,200 registrants signed up for the meeting. A robust collection of grant applications for this program will be reviewed shortly by the Center for Scientific Review (CSR) and will come for secondary review by the Board in August of 2021.

Dr. Collins and FIC are working on the Coalition for Africa Research and Innovation (CARI), which is a partner with four other institutions active in Africa: the African Union, African Academy of Science, the Bill & Melinda Gates Foundation, and the Wellcome Trust. There is a small team supporting Elioda Tumwesigye, the Minister of Science and Technology and Innovation in Uganda, who is head of the Special Technical Committee of the African Union to make recommendations on science, technology, and innovation. AFREhealth hosted a program of seminars and symposiums on COVID with Dr. Jean Nachega and Sabin Nsanzimana.

Dr. David Spiro provided an update on work the Division of International Epidemiology and Population Studies is doing with the Johns Hopkins University Applied Physics Lab. In order to address the gap in genomic sequencing, an attempt is under way to strengthen regional capabilities to build out a global network of genomic surveillance. The genomic response to SARS had over 100,000 sequences made in a short amount of time. The Oxford Nanopore portable sequencer could be helpful to low- and middle- income countries (LMIC). A genomic epidemiology training program was created with two in-person trainings convened before the pandemic with partners from Pakistan and South Africa. After the pandemic hit, they were prepared to develop a virtual training. There have been 120 students trained from 16 institutes in 11 countries. There are now 10 hours of pre-recorded lectures that have been posted.

Dr. Peter Kilmarx is working with Dr. Linda Gail-Bekker on the INTEREST working group. About a third of NIH publications have a foreign author and those with a foreign author have a higher citation index score. The most common foreign authors are Chinese investigators. They placed the sequence of the COVID-19 strain on the internet early on which allowed all the vaccine work to proceed. Drs. John Nkengasong and Glenda Gray from Africa and Zunyou Wu in China are Fogarty grantees that are current world leaders to the COVID response. Fogarty and the Bill & Melinda Gates Foundation have partnered together often and are partnering on two major programs on sickle cell disease and HIV on a global scale. Dr. Judy Wasserheit mentioned that Fogarty is co-sponsoring a satellite session at the Consortium of Universities for Global Health conference on implementation science capacity building on March 2, 2021.

Select Fogarty COVID-19 Research Activities

Dr. Cecile Viboud gave a brief update on the modeling for COVID-19 with a focus on vaccination and non-pharmaceutical intervention (NPI). Fogarty has been working with Dr. Yu at Fudan University. The group is simulating the trajectory of a new outbreak in China showing different cases and scenarios of NPI and vaccination. If there is no intervention, the transmission rate is very high at 2.5. The vaccine program-only simulation also shows that vaccines alone are unable to control the outbreak. It is really the interaction between the strength of NPI and the pace of vaccination that will determine the benefits of vaccination programs. Fogarty has built a Scenario Modeling Hub released in January in partnership with Johns Hopkins, Penn State, MIDAS Network, and CDC. It provides short-term projections over a four-week time window combining estimates from 35 different teams. The models show that as interventions are gradually stepped down there will be a resumption of cases in spring of 2021. The resurgence in deaths and hospitalizations will be more moderate because the vaccination programs prioritize high risk groups.

Dr. Wasserheit wanted to know how the team was thinking about being able to transfer its models to be used at a more local level. Dr. Viboud said that, right now, the model’s main target is the national level, although it is making projections at the state level. A number of the modeling teams are working directly with some states but for other states there are no connections to the models. There is currently no interaction between modelers and decision-makers at the local level, but progress is being made to reach that level. The U.S. government also has plans to build a new modeling prediction agency that can work closely with state’s governors and mayors. Dr. Wasserheit suggested the modeling teams work with Dr. Harvey Fineberg’s modeling consortium.

Program Concepts: Ecology and Evolution of Infection Diseases Initiative (EEID)

Dr. Christine Jessup gave the presentation on the EEID. This program is led by the National Science Foundation (NSF). Out of a growing list of human pathogens, 60% are zoonotic; it has been estimated that 75% of recently emerging infectious diseases are of animal origin. There is a need to predict and interrupt transmission and to improve control strategies of these infectious diseases. The EEID program has been administered by NSF and Fogarty since 2000 and includes trans-NIH partnership with NIAID, NIGMS, and Fogarty. Since 2000, 180 EEID awards have been granted, with 61 of those coming from NIH and 24 having been Fogarty awards, involving work in over 20 LMICs.

There have been several instances where the network of grantees worked on emerging infectious diseases modeling, such as avian influenza, Zika, and, ultimately, SARS-CoV-2. Investigators are funded through R01 research awards, and both U.S. and international institutions are eligible. The grant budgets are approximately $500,000 per year in total costs. The overall program budget is $17 million, of which FIC funds one grant directly per year. The overall process is led by NSF but involves NIH CSR participation to be compliant with both agencies. The participating partners select and directly fund priority projects that are aligned with their mission areas. To date, 45 of the awards involve work in LMICs. All of Fogarty’s awards involve global health research. Out of the 24 awards from Fogarty, there have been over 700 publications generated. The community of grantees is poised for disease event response and is working with the policy sector.

Dr. Jessup recommended that Fogarty continue to participate in the program by supporting awards relevant to their mission. There will be a need to renew the NSF-NIH memorandum of understanding in the coming months.

Dr. Sten Vermund asked whether there was a way to pivot the solicitation of awards to certain diseases or whether it is up to the research community. Dr. Jessup said that the program has been successful in supporting a broad range of infectious diseases in order to apply findings in a multidisciplinary way to better understand transmission dynamics. Dr. Chandy John asked if there was a way to find capacity within LMICs to model bioinformatics and spatial analysis type of work. Dr. Mary Wilson mentioned that many elements sound like CDC’s One Health with multidisciplinary involvement. She asked whether there is interaction in those areas. Dr. Jessup said that many of the grantees already work that area as part of the program, but they can look to enhance those efforts. Dr. Goosby asked whether the program is looking at the planetary health issues implications of infectious diseases. Dr. Jessup responded that there is space in the program for projects looking at those questions however there are currently no projects specifically tackling that issue.

Global Health Program for Fellows and Scholars

Dr. Glass introduced Dr. UnJa Hayes to deliver the presentation. The purpose of the program is to foster the next generation of global health scientists as well as to build a network of global health researchers. The program provides one year of research training for U.S. and LMIC pre- and post-doctoral trainees. It has evolved over the years, starting as administrative supplements that supported training of pre- doctoral trainees and later expanding to include post-doctoral trainees. Over its lifespan, the program has supported over 1,300 pre- and post-doctoral trainees in work that has led to over 2400 peer- reviewed publications. The research training has occurred in over 130 collaborating institutions in 41 LMICs.

Fogarty’s Global Health Matters newsletter highlights research done by trainees. The program is built on a consortia model with six consortia currently being funded. Each consortium consists of four partner institutions. The program started with FIC funding only, but the current iteration has four funding partners and 11 Institutes that provide ad hoc funding to support trainees whose research supports their institutions. Participation in the program by men and women is about equal, but participation by

U.S. minorities has been low. The program hopes to continue to grow by expanding the scope of research areas and garnering more support by the ICs. The program proposes LMIC trainees spend 2 to 3 months at a U.S. site engaging in research or training experience.

Dr. Vermund noted it is controversial to pivot to only include post-docs. He was curious if there were enough programs and members to make this pivot towards post-docs. Dr. Hayes said that there will still be U.S. pre-doctoral trainees supported through the Fulbright Fogarty Program. Dr. Flora Katz added that some pre-doctoral trainees could complete their degree in June and would qualify as a post-doc and can join the program right after their training ends. Dr. John said that his program has seen successes through both the pre-doc and post-doc trainees that went through the program. He also mentioned that the time in the U.S. site for LMIC programs may make it difficult for some fellows, like women with small children, to come to the U.S. for a number of months. Dr. Wasserheit asked if there is a way to help monitor the support researchers receive when they get back to their home countries to remain fully productive. Dr. Katz mentioned that one of the advantages of focusing on the post-doc population is that there are two K awards available for this population, with the K43 available to LMIC researchers. Dr. Greg Germino said that the program has been important for NIDDK since they generally do not have much of a global outreach otherwise.

Reducing Stigma to Improve HIV/AIDS Prevention, Treatment, and Care (R21)

Dr. Geetha Bansal gave the presentation on the renewal concept for the HIV-associated stigma program that began in 2017. The first awards were made in 2018. She thanked the Office of AIDS Research and funding partners from NIMH, NICHD, NCI, and NIDA. The fourth round of grants is currently up for review and will be awarded after the June Advisory Board meeting.

In 2017, Fogarty had the opportunity to start a new HIV research program and they decided to focus on HIV-related stigma. The goal of the program has been to stimulate research on interventions to reduce HIV/AIDS-associated stigma and the impact it has on persons living with HIV (PLWH) in terms of prevention, treatment, quality of life, among other factors. FIC has a goal to double the number of studies funded through the program focused on LMICs.

Dr. Bansal listed some of the topic areas covered in the program, such stigma reduction interventions that link to increased care-seeking behavior, reducing the impact of stigma on adolescent and youth health in regions where new infections seem more prominent, strategies to cope with the complex burden of stigmatization of HIV and other comorbidities or co-infections, and reducing the effects of stigma on and/or by family members or caregivers of PLWH. In the last three rounds, 42 applications came from 26 different countries, of which 10 were ultimately funded. In 2018, there were 35 applications from 17 different countries and 9 applications awarded. This past May, Fogarty received 35 applications from 19 different countries and 8 applications were awarded. In 2021, FIC has received 26 applications that are now ready to be reviewed, from 13 different countries. In total, there have been 27 awards from 112 applications that came from 18 different countries.

Dr. Bansal said that there continues to be a need for stigma reduction interventions. The objectives of the program remain, 1) to reduce stigma as a factor, 2) to eliminate or mitigate the aspects of stigma that limit beneficial health outcomes for PLWH and at-risk individuals and communities, 3) to explore the effects of intersectionality and layered stigma, and 4) to conduct pilot studies to determine the feasibility of stigma reduction interventions related to HIV prevention, treatment, care, and quality of life. Fogarty is looking into expanding the grant timeframe from two years to three years so that the program can generate more meaningful data and avoid projects getting stuck in the early stages. The main goal is to build research capacity in the LMIC countries focused on stigma research. There have been two network meetings that have brought investigators together to discuss various aspects of the program.

Dr. Vermund asked, given the intention to expand to three years, whether Fogarty could establish a small R01 program. Dr. Bansal said that a small R01 program awarding $400,000 over three years is the exact type of program they are thinking of. Dr. James Curran asked whether this program can’t be broader to consider a more systemic or structural approach. Dr. Bansal said that some of the PIs wanted to move into making-policy recommendations and explore social determinants of health. She said that it is important that PIs make sure their projects are related to the missions of NIH. Dr. Steffanie Strathdee noted that successful applicants from these programs are connected to D43s and Fogarty Scholars in- country.

Advancing Global Eye Disease Research, Dr. Michael Chiang, Director, National Eye Institute

Dr. Glass introduced Dr. Michael Chiang, the new Director of the National Eye Institute (NEI). He also introduced the head of global health research at NEI, Dr. John Prakash.

Dr. Chiang began by discussing his background growing up in a family of engineers and later studying electrical engineering in college. While in college he discovered that being able to build a machine and use it to treat people sparked a desire to become a clinician scientist. He originally had aspirations to become a neurosurgeon in order to model the brain using computers. However, he was later exposed to ophthalmology at Massachusetts General Hospital and after three years decided he wanted to become an ophthalmologist. Around this time was when the medical field was moving towards electronic health records, which also brought him to the field of informatics. He got involved with the American Academy of Ophthalmology and chaired its medical information technology committee. He went to Portland, Oregon, in 2010, to begin work at the Oregon University of the Health Sciences. There, he worked with a team who built out a system using artificial intelligence for retinopathy of prematurity diagnosis which went on to receive breakthrough device approval from the Food and Drug Administration.

Through the American Academy of Ophthalmology, he worked to build the IRIS Registry which has the goal of collecting eye exam data from as many patients in the country as possible. The project started in 2011-2012 and has gathered a data set of 400 million eye exams from 75 million unique patients. The American Academy of Ophthalmology set up analytic teams around the country and gave them the data to try to spur knowledge discovery. The Oregon trainees were expected to help screen eye exams which led to the creation of an extensive vision screening program in rural Oregon. The university also developed a program to build collaborations with universities in Myanmar and Thailand to build clinical programs. This work has helped develop technologies to screen eyes and has led to multiple collaborations with sites in India, Nepal, Mongolia, among other locations.

NEI is involved in training programs and international grants around the world. The Institute has 10 grants where the primary is somebody who is from a foreign institution. There are 209 grants that are collaborations in which awards are granted to a U.S. institution that have key personnel from a foreign country. Through these international programs Dr. Chiang hopes to address the same healthcare disparities that could be found in rural Oregon.

Dr. Glass noted that there is a mobile health program supported by Fogarty at MIT working on being able to refract eyes and look at cataract maturation using handheld cell phones. Dr. Strathdee mentioned that the GloCal training program supports a researcher from UCLA who has conducted a project on trachoma prevalence and risk factors for blindness in Peru.

Dr. Janine Clayton asked Dr. Chiang to comment on the issues related to sex and gender and its interface with race and ethnicity in terms of global vision impairment and blindness. She also asked him what he thought about children regularly spending vast amounts of time on electronic devices and how the rates of myopia increasing internationally would affect refractive error rates over time. On the first issue relating to sex and gender, Dr. Chiang said that there is a need for more data. On the second topic, data shows that myopia is becoming an epidemic, especially in places like Asia where the rate is up to 90%, and will be a much greater problem in 50 years when this cohort of people begin to develop issues like retinal detachment and cortical neurovascular degeneration.

Dr. John noted the difficulty certain fields experience in attempting to connect to the global health perspective. Providing opportunities is key to furthering this effort. Dr. Chiang said that people who work in these narrower fields who are interested in global health may be overlooked in the overall program they belong to. He invited suggestions from the Board on how to get the projects of investigators in more niche fields promoted to boost collaboration opportunities.

Closing Remarks

Dr. Glass closed by reiterating that Fogarty has been actively involved in helping to address the COVID- 19 pandemic and will continue to be involved for many years because the pandemic will be with us long- term. The change in presidential administration has helped push forward the equity agenda on underrepresented minorities, an initiative NIH has been working on for years. Dr. Glass thanked the Board members for their time and wisdom and thanked the staff for their diligent virtual work over the past year.

Dr. Glass adjourned the meeting at 3:03 p.m.