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Home > Advisory Board > June 7-8 2021 Advisory Board Meeting Summary Minutes Print

June 7-8, 2021, Advisory Board Meeting Summary Minutes

The FIC Advisory Board met via videoconference on June 7-8, 2021. Dr. Roger Glass presided as Chair.

Present

  • Roger I. Glass, M.D., Ph.D., Director, Fogarty International Center, Chair
  • James W. Curran, M.D., Emory University Carol Dahl, Ph.D., Executive Director, The Lemelson Foundation
  • Jacob A. Gayle, Jr., Ph.D., Vice President, Philanthropy/President, Medtronic Foundation
  • Karen Goraleski, M.S.W., Chief Executive Officer, American Society of Tropical Medicine and Hygiene
  • Chandy John, M.D., Indiana University School of Medicine
  • Gregory Germino, M.D., Deputy Director, National Institutes of Diabetes and Digestive and Kidney Diseases; ex officio
  • Gbenga Ogedegbe, M.D., M.P.H., F.A.C.P., Dr. Adolph and Margaret Berger Professor of Population Health and Medicine, Chief, Division of Health and Behavior, Director, Center for Healthful Behavior Change, New York University
  • Steffanie Strathdee, Ph.D., University of California San Diego, Department of Medicine
  • Sten Vermund, M.D., Ph.D., Yale School of Medicine
  • Judith N. Wasserheit, M.D., M.P.H., University of Washington
  • Michelle A. Williams, S.M., Sc.D., Harvard University
  • Mary Wilson, M.D., University of California, San Francisco School of Medicine

Also Present

  • Nalini Anand, J.D., M.P.H., FIC
  • Gwen Collman, Ph.D., National Institute of Environmental Health Sciences
  • Rena D’Souza, DDS, M.S., Ph.D., National Institute of Dental and Craniofacial Research
  • Joshua A. Gordon, M.D., Ph.D., National Institute of Mental Health
  • Peter Kilmarx, M.D., FIC
  • Brandon Kohrt, M.D., Ph.D., George Washington University
  • Joseph Kolars, M.D., University of Michigan Medical School
  • Amit Mistry, Ph.D., FIC
  • Brad Newsome, Ph.D., FIC
  • Iman Nuwayhid, M.D., DrPH, American University of Beirut
  • David Spiro, Ph.D., FIC
  • Cecile Viboud, Ph.D., FIC
  • Susan Vorkoper, M.P.H., M.S.W., 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 P.M. He congratulated Dr. Michelle Williams and Mary Fogarty McAndrew for being recognized and awarded by Research!America. The Biden Administration has placed great emphasis on increasing the budget for science agencies. NIH has been granted a 20% increase in the budget bringing it to $51 billion. $2.5 billion of the new funding will be designated for core funding while $6.5 billion will be earmarked for the Proposed Advanced Research Projects Agency for Health (ARPA-H), which is an advanced research product development award similar to the Defense Advanced Research Projects Agency (DARPA) program. The Fogarty International Center (FIC) will receive a $12.2 million increase from the 2020 budget. The NIH Common Fund’s Harnessing Data Science for Health Discovery and Innovation in Africa (DS-I Africa) program FIC is co-leading with NIH partners will be up for review in the fall board meeting.

NIH Director Dr. Francis Collins has placed a great priority on workforce diversity and the need to support diversity, equity, and inclusion. The NIH UNITE initiative focuses on promoting diversity, equity, and inclusion which will be reviewed and discussed at the Advisory Committee to the NIH Director meeting. This will have impact on all the universities and academic centers where NIH funds research. FIC is focused on democratizing global health research and global health programs. The aim of the program is to come up with guidance documents on case studies on equitable partnerships, a toolkit of best practices, and creative solutions and metrics.

The World Health Assembly (WHA), which was held virtually, focused on women’s and children’s health, non-communicable diseases and health systems, global pandemic preparedness, ACT accelerator for COVID response and vaccines, and global epidemic surveillance and modeling, and building the biomedical workforce. Fogarty’s Fellows and Scholars Program, which sends students for a year of mentored research in low- and middle-income countries (LMICs), had 116 fellows and scholars from 18 different institutes and centers last year. This year there have been 106 candidates chosen with their orientation beginning in July.

NIH is a partner on The Coalition for Africa Research and Innovation (CARI) which includes members from the African Union, African Academy of Sciences, Bill & Melinda Gates Foundation, and the Wellcome Trust. The goal of CARI is to promote increased funding for biomedical research by governments, banks, and philanthropies in the private sector. Dr. Glass acknowledged a summit that John Nkengasong, head of the African CDC, organized on vaccine manufacturing in Africa. Africa does not make any drugs, vaccines, diagnostics, or PPE. NIH has been consulting with Senegal’s Institut Pasteur Dakar to stand up a program for vaccine development, who will be working with Univercell to start vaccine manufacturing with a hope to get COVID vaccines on the market by the end of 2022.

Dr. Peter Kilmarx described FIC’s involvement with COVID contact tracing in the U.S. Dr. Kilmarx along with Dr. Cecile Viboud posted a webinar in March about the methodologies and research on the exposure notification digital tools. Speakers included representatives from Google and Apple and Christophe Fraser. The Consortium of Universities for Global Health (CUGH) held a successful meeting with robust participation. Dr. Glass and three other institute directors talked about NIH’s role in tackling NCDs as the global health priority. There was a session with updates from the ESSENCE on Health Research Forum on coordinating funding in research capacity building. Metrics of research capacity for use in LMICs were developed by Michael Cheetham and Linda Kupfer and adopted as a way of emphasizing research capacity as an element of pandemic preparedness.

Dr. David Spiro provided an update from FIC’s Division of International Epidemiology and Population Studies (DIEPS). Dr. Kaiyuan Sun has been working with the South African National Institute for Communicable Diseases to analyze disease dynamics of COVID-19 in a household cohort study of 220 households. The study used PCR testing which allowed for variant typing and serological aspects. The study found high rates of infection in unvaccinated cohorts with up to 30% of this group having been infected by April 2021. Prior infection during the first wave was found to be 85% protective against reinfection by the second wave variant. Dr. Nidia Trovao working with 12 universities in Ghana and Nigeria studied 5,000 SARS-CoV-2 genomes from 33 African countries. The study showed relatively limited diversity in lineages potentially due to under sampling. Phylogeographic analysis revealed African viruses clustered close to those from all continents but more notably with viruses from Europe. The Household Air Pollution Intervention Trial (HAPIN), to assess the benefits of a clean cooking intervention with LP gas in four countries, is nearing completion of data collection for exposure and health effects for mothers and children to one year of age. The study indicates that the intervention is working as intended. Initial results will be available in the fall of 2021. Dr. Joshua Rosenthal co-chairs the NIH-wide Climate and Health Working Group with Dr. John Balbus to develop an updated agency wide strategy.

Ms. Susan Vorkoper mentioned that the supplement on childhood obesity across borders is going to be published in Obesity Review. Each article with the exception of the NIH commentary was authored by researchers from different countries. The goal of the project is to highlight synergies between research and catalyze collaborations between U.S. and Latin American scientists on childhood obesity prevention. The National Collaborative on Childhood Obesity Research (NCCOR) will host a two-part webinar. NCCOR will target U.S. researchers. There will be a plenary session at the first Latin American Congress of Research in Physical Activity and Health.

Ms. Nalini Anand updated the group on the Center for Global Health Studies (CGHS) training institute on stigma research that was scheduled for last year but due to COVID it was postponed and converted to a virtual training institute. There is a high demand for the training with over 250 applications. The selected trainees are predominantly junior to mid-level scientists.

Select Fogarty COVID-19 Research Activities

Dr. Cecile Viboud gave an update on the COVID-19 projections. The U.S. has had a focus on short-term forecasts, but it is important to have longer-term projections. FIC is trying to fill that gap with their scenario modeling hub by generating projections for different scenarios of interventions and epidemiology considerations both nationally and state by state. Since December 2020 there have been 6 rounds of projections. The projections are focused on four different scenarios 1) pace of vaccination and limited supply, 2) how vaccination combined with NPI can affect pandemic response, 3) vaccine hesitancy issues, 4) arrival of transmissible variants. In April the FIC group was asked by the Centers for Disease Control and Prevention (CDC) to put together a morbidity and mortality weekly report (MMWR). The latest round of data, from round 5, available is focused on a hesitancy of NPI. In three of the four scenarios things are looking good nationally. One scenario assumed more hesitancy and more NPI showed a possible rebounding in the fall. There has been a recent increase of interest from stakeholders like the CDC, World Health Organization (WHO), and the Council of State and Territorial Epidemiologists. This interest is based on the new variants and questions around waning immunity.

Dr. Judy Wasserheit asked Dr. Viboud if her models focused on questions relating to the return to in person schooling in combination with the anticipated availability of vaccines for the 2- to 12-year-old age group. Currently none of the models are looking at these questions, however models have seasonal factors which include reaching out to schools in the fall due to more contact. The CDC does not expect vaccines for children will be available until November.

Global Alliance for Chronic Diseases Program Concept

Dr. Brad Newsome updated the group on the Global Alliance for Chronic Diseases Program Concept. There are limited concerted efforts to address NCDs like PEPFAR does for HIV/AIDS. The Global Alliance for Chronic Diseases (GACD) pulls together 15 of the world’s largest international biomedical research funders. Over the past 10 years NIH has funded 6 disease-specific announcements with over $220 million in grant funding to over 110 grants. The research programs have been focused on hypertension, diabetes, lung diseases, mental health, and cancer. NCD’s account for 63% of annual deaths with 80% of the deaths occurring in LMICs. Through the GACD, 1,200 researchers have been funded through six research calls.

FIC does not support the programs financially rather serving the function of administrative lead with Dr. Glass serving on the Strategy Board for GACD. FIC is proposing a change to the administrative structure to better meet the cross-sectional needs. The proposal is to fund awards through standing PARs through an R01 clinical trial and a bi-phasic R61/R63 and then utilize yearly notices of special interest to highlight the focus areas over the next few years. This will be done through 5-year awards with $500,000 per year in direct costs. FIC is proposing funding research on NCD prevention in adolescents and other vulnerable
life stages in 2021, with plans in 2022 to fund research on impacts of urban environments in NCD risk, and in 2023 to fund research in management integrated for multimorbidities. This will still involve joint writing of the solicitations along with GACD partners. This will use a PAR and NOSI setup to launch three years of funding announcements through R01s, R61s, and R63s.

Dr. Greg Germino asked if there is a requirement that proposals had to have a funded partnership with an LMIC investigator and Dr. Newsome said that it is not a requirement.

Health Research in Humanitarian Crises, Disasters, and Public Health Emergencies Project Update

Dr. Amit Mistry updated the group on the project by exploring the topic and asked for input on the role of NIH and FIC within this space. This project has been going for four years and has supported and helped to put together a set of case studies on describing how the research was done and why it was important. The collection will have 23 papers describing studies done in 27 different settings across the globe. They are published in Conflict Within Health and BMC Public Health. The Global Forum on Humanitarian Health Research will be a networking mentorship forum for early to mid-career investigators that will take place in November.

Research Highlights

Iman Nuwayhid and Brandon Kohrt, scientific co-chairs, provided a description for unique considerations as well as scientific opportunities in the field. Dr. Nuwayhid is a professor at the American University of Beirut in Lebanon. He talked about his experiences in Lebanon as a researcher and administrator. Humanitarian crises have been absent from the public health attention and have often been seen as localized problems. Humanitarian crises, disasters, and public health emergencies have impacts on the regional and global level and are a serious global health security threat. 12 out of 22 countries in the Eastern Mediterranean Region (EMR) are suffering from armed conflict and EMR hosts the highest proportion of those in need of humanitarian support which equates to more than 60% of the world’s refugees. Lebanon hosts the highest number of refugees per capita in the world while going through its own humanitarian crisis. Humanitarian crises impact the livelihoods of institutions and systems especially when there is an influx of people leaving. COVID-19 highlighted the need for global collaboration to solve public health problems. Dr. Nuwayhid stressed the importance of building capacity and protecting the capacity of institutions to conduct research in the appropriate way.

Dr. Kohrt is the Director of Global Mental Health and a Professor at George Washington University. The biggest question has been why we need health research in humanitarian crises. Humanitarian crises often are not localized problems but issues on both a regional and global level. There was a 42% increase of people being affected by humanitarian crises from 2019 to 2020. One in five people exposed to a humanitarian conflict and war eventually develops a mental health problem. Humanitarian crises provide a unique opportunity to do new research and develop implementation science in terms of how interventions are designed and delivered. The National Institute of Mental Health (NIMH) developed a tool to monitor what happens when non-specialists deliver psychological interventions. USAID has invested in making quality and competency assessments a global good through the WHO’s Ensuring Quality in Psychological Support (EQUIP) platform. NIMH took an intervention used in Kenya, Nepal, and
Pakistan and adopted it for use in the U.S. Only 10% of active clinical psychologists and 16% of active clinical psychiatrists are from underrepresented minority communities.

Discussants:

Dr. Joshua Gordon, NIMH Director, and Dr. Michelle Williams from Harvard University responded to the presentations. The approach NIMH takes with its intervention sciences is to get down to the mechanism of how things work. Dr. Gordon stressed the importance of the need for capacity building and research training in humanitarian crises. The vulnerable communities when hit by disasters and pandemics will again be the most vulnerable showing where NIMH should direct its resources. It is vitally important to build resilience in the affected populations and focus on what can be done to bring treatment to these communities. The United States has its own refugee crisis and HHS, including support from NIMH, is directly involved in the care of the unaccompanied minors.

Dr. Williams stressed the importance of understanding for whom we do the research and how we will have the desired impact regarding humanitarian crises research. She discussed how important it is for health communication. Middle-income people are able to leave their community when a storm is coming, but there are no processes ready to be deployed for low-income communities that do not have the luxury of being able to pick up and move quickly. There is a strong need for research into managing crisis response for low-income communities during humanitarian crises.

Moderator:

Dr. Steffanie Strathdee moderated the discussion and talked about how important it is to focus not just on internally displaced persons but also forced migrants. Dr. Wasserheit brought up how it would be helpful for the FIC to engage National Institute of Allergy and Infectious Diseases Centers for Research in Emerging Infectious Diseases (NIAID CREID) for pandemic preparedness and response. Dr. Kohrt mentioned that the notion of needing mental health response in other emergency responses is important and should be codified in emergency responses in the U.S. Dr. Gwen Collman mentioned that NIEHS started a program after the Gulf Oil Spill called Disaster Research Response (DR2). They have a worker training program national response team to go into a disaster area after an acute disaster with FEMA and other agencies to give training to workers who are cleaning up in the areas.

Dr. Strathdee mentioned that humanitarian organizations don’t have the bandwidth to take on research tasks. She asked the panel to provide some lessons learned from negotiating the need for bandwidth in the middle of the crisis. Dr. Kohrt mentioned that it doesn’t work during the middle of a crisis. There is a need to build that up before a crisis so when one occurs the people can be there on the ground. Dr. Nuwayhid mentioned that international organizations are becoming more engaged in research. He recognized that protracted crises provide time for the engagement. During acute crises researchers usually step out and leave it to the NGOs.

Dr. Chandy John brought up that there was not much about prevention in the presentations. He stressed that in crises many things are often repeated, and it would be proactive to try and prevent them, which starts with a strong foundation by improving health systems.

Dr. Dahl had a concern that the number of crisis situations will increase and talked about how forward thinking about how tools will be used in the future is important. Dr. Kohrt mentioned that during COVID mental health services shifted toward an increasing use of technology. Dr. Williams mentioned that during COVID, the U.S. found that communities without the bandwidth got left behind when it came to technology. Dr. Wasserheit stressed the need to examine research systems to meet the time needs without compromising the safety and quality. Dr. Gbenga Ogedegbe talked about how during COVID everyone was happy to move to digital healthcare, but it widened the disparities. There was no preparedness in ensuring telemedicine provided intended care in a low-income community.

Dr. Kohrt brought up that the research has to be ongoing. It is vital not to just do research immediately or after a crisis. It is important to continue to work with the communities looking to see if the interventions have a long-standing effect.

National Institute of Dental and Craniofacial Research’s Global Health Research

Dr. Glass introduced Dr. Rena D’Souza, Director, of the National Institute of Dental and Craniofacial Research (NIDCR). NIDCR was founded as the National Institute of Dental Research in 1948. The primary goal was to take care of the oral health needs of the troops coming back from World War II and those preparing to be deployed. In 1998 staff at the NIDCR proposed the name change to include the craniofacial elements of the portfolio. NIDCR is the third oldest institute. The budget is about $500 million per year of which 80% is used for extramural research. NIDCR has an intramural research program where fellows are trained in clinical research and are able to run clinical trials.
Dr. D’Souza mentioned that oral diseases rank among the most common diseases in the world. Over 3.5 billion people are affected by oral diseases. Caries are the most common oral disease and the most common reason for missing school. Cleft lip and palate and Down Syndrome are some of the most common congenital disorders. The acceptance of oral health being pivotal to general health has been adopted by the WHO’s priority agenda. It has been proposed for oral healthcare incorporated into a universal healthcare package. Oral health cannot be ignored much longer. Oral health professionals create relationships with patients and can play a role in counseling, conditioning, and combatting social determinants. Dr. D’Souza has placed an emphasis on NIDCR being nimble and prepared for the future.

Dr. D’Souza highlighted a salivary gland biologist, Blake Warner, who collected samples for COVID testing and accessed autopsy tissues. He investigated the role of the oral gut access in the dissemination of COVID. The work showed the virus can attach to different parts of the oral cavity and has the ability to enter the salivary glands and divide prolifically so that viral sheds could be detected in saliva. This work was published in Nature Medicine. She also highlighted a researcher, Peter Burbelo, who developed an antibody detection method for detecting COVID in saliva. NIDCR collaborates with several other institutes to provide training around the globe. The institute also has a project ongoing that is supporting a point of care device to detect head and neck cancers using a nasopharyngoscope. NIDCR has a training program that now allows international scholars to use National Research Service Award (NRSA) fellowships. This change in policy allows institutions to budget for two stipends a year for international scholars to remain in the United States.

NIDCR has supported the Emergency Global Leader Award, which is a K43 program and has a grant planned for the Fogarty HIV Research Training Program. Additionally, they have the D43 mechanism to enhance research in non-communicable diseases. The Educational Partnership Initiative has helped support 15 dental-related programs and 4 projects in HIV/AIDS research. NIDCR’s global health program has supported over time different fellows and dentists. The program was placed on hold for a couple of years. The program offers one year of training in dental health sciences followed up by a two-year fellowship.

Dr. Ogedegbe mentioned that, at New York University, they couldn’t find a partner in Ghana for a training grant. They have had recurring grants renewed over time, but he is not certain that the global health focus is tightly integrated in terms of research. Dr. D’Souza mentioned that a problem is that the oral cavity is still loosely linked to the rest of the body. Dr. Wasserheit talked about the dental program at University of Washington (UW) which is spearheaded by Tim DeRouen. Ana Lucia Seminario, from UW, has focused some of her work in Kenya. Dr. D’Souza mentioned that in the area of global research NIDCR does not have that many requests for application (RFAs) out currently. There are a lot of possibilities across the implementation sciences spectrum. She mentioned that anyone who follows up with NIDCR should try to contact Lillian Shum, Director of Extramural Research.

Dr. Mary Wilson asked Dr. D’Souza a question about dental caries in the Native American population and whether there are any research collaborations. Dr. D’Souza mentioned that NIDCR had centers for disparity. One of those centers was at the University of Colorado and looked at dental caries in Tribal Nations. Teeth are valuable for biological records and there are signs that reflect factors like environmental toxins which can be identified by inspecting the teeth. NIH has an agreement with Tribal Nations and Dr. D’Souza is interested in partnering with NIEHS to look at the influence of environmental toxins on certain populations.

Dr. John talked about the AMPATH Program at the Indiana University School of Dentistry, which has mostly involved education instead of research. He was interested in what global training initiatives NIDCR supports. Dr. D’Souza brought up the T90 stipends and the fellowship they offer but there is not any training designed with the International Association for Dental Research (IADR) in mind. She suggested partnering with IADR to get that going.

Dr. Glass asked whether there is another helpful tool like fluoridation to help prevent caries or periodontal disease. Dr. D’Souza mentioned that probiotics and engineered biofoams that coat the tooth surface may be additional tools, however oral health is highly influenced by nutrition. Dr. Sten Vermund mentioned that NIDCR was very influential in some of the early HIV work. He asked if there could be an internal RFA to solicit oral health projects to help stimulate oral health research in LMICs through Fogarty’s developing country trainees. Dr. D’Souza mentioned that there is huge interest in NIDCR to develop different ways to promote oral health research. Dr. Lois Cohen mentioned that, all over the world, there are different optimal levels of fluoride. Some countries have opted for different methods like milk fluoridation. Dr. D’Souza brought up silver diamine which will be very helpful for arresting decay in a tooth that has already begun. Dr. Cohen talked about global meetings NIDCR has funded on oral manifestations of HIV.

Dr. Joseph Kolars talked about his program at University of Michigan and how it relates to global dental health. The Michigan Dental School has been a partner in the Center for Global Health Equity. There has been a push for interprofessional education to bring different perspectives to common problems that often affect the poor.

Closing Remarks

Dr. Glass asked board members for input into what they would like to see at the next board meeting. Dr. Vermund suggested a discussion on climate change and health. Dr. John said he is looking forward to the discussion on democratization of global health. Dr. Glass hoped Dr. John would be part of the discussion as Indiana University has been a pioneer with the AMPATH model. Dr. James Curran would like to hear about how the budget turns out and how NIH has crafted itself under the new administration. He additionally would like to have another discussion with Steve Morrison from the Center for Strategic and International Studies. Ms. Karen Goraleski suggested that the board hear from Eric Lander from the Office of Science and Technology (OSTP) at the fall board meeting.

Dr. Glass mentioned that FIC has been teleworking for a year and a half now. He expressed hope that the FIC Board could meet in the Stone House for the early 2022 board meeting. Dr. Vivian Pinn thanked the board for a wonderful meeting with a lot of interesting information discussed. Dr. Ken Bridbord expressed his gratitude to see how far FIC has evolved and how much progress they have achieved. Dr. Joel Breman talked about how he found the discussion on refugees to be very enlightening.

Dr. Glass adjourned the meeting at 2:58 p.m.