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September 9-10, 2021, Advisory Board Meeting Summary Minutes

The FIC Advisory Board met via videoconference on September 9-10, 2021, 2021. Dr. Roger Glass presided as Chair.

Present

  • Roger I. Glass, M.D., Ph.D., Director, Fogarty International Center, Chair
  • Janine Austin Clayton, M.D., NIH Office of Research on Women’s Health; ex officio
  • Myron S. Cohen, M.D., University of North Carolina at Chapel Hill
  • Carol Dahl, Ph.D., The Lemelson 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
  • 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
  • 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

  • Blythe Beecroft, FIC
  • Wondwossen A. Gebreyes, DVM, Ph.D., Ohio State University
  • Flora Katz, Ph.D., FIC
  • Peter Kilmarx, M.D., FIC
  • Joseph Kolars, M.D., University of Michigan Medical School
  • Robert Murphy, M.D., Northwestern University
  • Patience A. Muwanguzi, Ph.D., R.N., Makerere University, Uganda
  • Bongani Nkambule, Ph.D., University of Kwazulu-Natal, South Africa
  • Vivian Pinn, M.D., FIC
  • Joshua Rosenthal, Ph.D., FIC
  • Nelson Sewankambo, MBChB, MSc, M.MED, FAAS, FRCP, LLD (HC), Makerere University, Uganda
  • David Spiro, Ph.D., FIC
  • Nidia Trovao, Ph.D., FIC
  • Cecile Viboud, Ph.D., FIC
  • Kristen Weymouth, Executive Secretary, FIC
  • Elizabeth Wilder, Ph.D., NIH Office of Strategic Coordination
  • Shannon Zenk, Ph.D., MPH, RN, FAAN, National Institute of Nursing Research

Welcoming Remarks

Dr. Glass opened the meeting at 12:01 P.M. The solution to the COVID-19 pandemic will be through science with mechanisms like research, innovation, implementation of vaccine strategies, and social distancing. The pandemic has shown the differences in healthcare equity on a global level; global efforts are underway to prepare for the next epidemic. The new ARPA- H initiative will help the NIH to support research and the transformation of promising innovations into products. A new agenda for climate change and health has been announced; FIC has a new focus on health disparities research highlighted by the pandemic. FIC is well- positioned to address these global challenges due to its experience, history of success in training people, links to academic communities, and wide range of knowledge. FIC will announce the Data Science in Innovation program’s award recipients by the end of the month.

Medical Education Partnership Initiative (MEPI) Junior Faculty Research Training Program

Background and Overview

Dr. Flora Katz provided an overview of the MEPI Junior Faculty Research Training Program which is part of a larger initiative that was started in 2012 with PEPFAR and the Common Fund to address an urgent shortage of medical personnel and nurses on the African continent. MEPI is an educational development program comprised of African institutions and U.S. partner institutions. It began with 13 medical schools in Africa and grew to 34 African institutions and 30 U.S. institutions. The Common Fund and other NIH ICs and offices support the MEPI Linked Awards, a linked program with the goal to increase research and research training at MEPI institutions. NIH has also developed the Health Professional Education Partnership Initiative (HEPI), an educational program that leverages the achievements and lessons learned from MEPI with a parallel nursing education program known as Nursing Education Partnership Initiative (NEPI). The PI Council from the original MEPI program grew into AFREhealth. NIH has invested $37 million in 11 African institutions in 8 countries for the MEPI Junior Faculty program. The program trained a large and scientifically diverse cohort together: as many as 30 to 70 fellows were trained at the same time. The MEPI Junior Faculty program has a budget of $600,000 in direct costs, compared with the typical D43 budget of $250,000. It is the only T32-like program for foreign institutions at NIH.

Overview and Perspectives from Program at Makerere University, Uganda

Dr. Nelson Sewankambo gave an overview of the MEPI Junior Faculty Program at Makerere University in Uganda. The NURTURE program at Makerere University is a partnership with Johns Hopkins University and Case Western University. The goals of the program are personalized research training and mentoring for research capacity development, to improve faculty retention, and to improve research career progression. The program supports junior faculty from assistant lecturer to senior lecturer level, offers two-year non-degree mentored research training, and provides opportunities to work in research groups. Fellows are expected to have worked as individual researchers, having participated in group mentorship, and shown career progression by the end of the grant period. Makerere University trained 70 people under this grant and recruited 45 mentors from within the university. The trainings produced 83 publications which acknowledged this grant. Additionally, the fellows were co-authors on 744 publications and investigators on 182 new grants, which has greatly expanded research capacity at the university.

Many fellows have been promoted and some have obtained leadership positions. Several departments that were previously not very active in research are now conducting much more. The Government of Uganda’s newfound interest in supporting Makerere University culminated in the Makerere University Research and Innovations Fund. The fund has so far awarded 567 awards, 27 of which have been awarded to NURTURE fellows or ex-fellows with an additional 43 as fellows participating as co-investigators. Fellows assisted the Uganda National Council for Science and Technology (UNCST) in formulating guidelines for conducting research during the pandemic. The Research Support Centre has developed over the last two years and includes an extension to the medical library where there are 100 seats created for PhD’s to complete their work. Due to the pandemic, however, researchers have written more papers from home.

Research Highlights

Dr. Katz introduced Dr. Patience Muwanguzi, an emergency and trauma nurse and head of the Department of Nursing at Makerere University who joined the NURTURE program in 2018. The researchers observed that men in Uganda were not engaging in HIV testing, care, or prevention and so they conducted a clinical trial to assess the effectiveness of HIV self-testing at men’s worksites. A requirement of the program was to have two manuscripts. The program submitted
nine manuscripts in one year. Dr. Muwanguzi successfully mentored two faculty and three students in research and was appointed to the Editorial Board of the Journal of the Association of Nurses in AIDS Care. She ran the largest vaccination site in the country which immunized 7,000 people in five days. She has also received admission to Washington University’s HIV, Infectious Diseases, and Global Health Implementation Research Institute.

Dr. Katz introduced Dr. Bongani Nkambule from the University of Kwazulu-Natal, South Africa. Dr. Nkambule’s program is called DRILL, Developing Research in Innovation Localization and Leadership in South Africa. Over the past five years, he has been able to publish 46 manuscripts which have been featured in top ranking journals. The fellowship equipped him with writing skills, leadership, and a focus on mentorship. Using preliminary work from the fellowship, he was able to apply for several local grants and for a senior research fellowship through NIH. He was also promoted from senior lecturer to academic leader and recently promoted to associate professorship. The training model provided a good structure for mentorship. Without the supervision workshop, he would not have had the capacity to take in so many students let alone train them and provide them with the best available training and practice in their fields.

Dr. Katz introduced Dr. Margaret Ilomuanya from the University of Lagos, Nigeria. She was awarded the Building Research and Innovation in Nigerian Science (BRAINS) grant in which she studied the development of hyaluronidase sensitive palm oil-based organogel for in vitro release of HIV/AIDS microbicides. Her team was able to use functional materials like processed palm oil to develop novel microbicides inhibit HIV-1. This study was published in Future Journal of Pharmaceutical Sciences. Dr. Ilomuanya described several further collaborations and work that led to her being recognized as one of the top 100 emerging biomedical engineers in Africa. In 2020, she received a local grant for studying the impact of opioid abuse in the healthcare system in southwest Nigeria. She received a fellowship from the Center for Biomedical Research at the Population Council in New York and was offered a consultancy position at the Center for Biomedical Research to work with them on product development for HIV prophylaxis. Currently, she has three students funded under her grant and has over 53 publications.

Dr. Elizabeth Wilder, Director of the NIH Office of Strategic Coordination that oversees the Common Fund, thanked the group for allowing her to be a part of the presentations and to be able to see the impact that the MEPI grant awards have provided. Dr. Katz introduced Dr. Rob Murphy. Dr. Murphy expressed how impressed he was in the MEPI grantees and provided some background on the grant.

Dr. Carol Dahl asked how NIH can better support people creating devices and gels to bring products to market and reach consumers. Dr. Ilomuanya said the BRAINS grant brought people from the patent office to talk to scientists which provided training on how to write patents. Dr. Chandy John inquired about researchers in universities in Uganda and Kenya not receiving enough time to be able to balance their responsibilities. Dr. Sewankambo mentioned that they are trying to bring people into the institutions that are dependent entirely on self-funding. Makerere University is taking this up slowly though the momentum has been building. Ms. Karen Goraleski expressed her appreciation of the presentations showing very clearly the return on investment. Dr. Judy Wasserheit had a question about lessons learned from MEPI. Dr. Sewankambo talked about One Health at Makerere University. Before One Health it was very tough to encourage anyone to work across disciplines. Dr. Gbenga Ogedegbe congratulated the different teams on their work. All three of the programs should look into leadership programs to train future leaders and focus on interdisciplinary research.

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

Dr. Roger Glass discussed the Fellows and Scholars Meeting held July 12-17 which had 122 fellows attending virtually. 2023 will be the 20th anniversary of the program which has trained nearly 1000 fellows. He highlighted Dr. Dorothy Lombe from Zambia who is leading a group in cervical cancer research. Additionally, Drs. Satish Gopal and Ned Sharpless have published a paper on the importance of global cancer research in the post pandemic period in JAMA.

Dr. Peter Kilmarx provided an update on the African Postdoctoral Training Initiative in which 10 postdoc fellows spend two years working in NIH’s Intramural Research Program followed by two years of support back at their home African institutions. Drs. Glass and Kilmarx published an article in PLOS Medicine on building global health research capacity to address research imperatives following COVID-19. The piece emphasizes the importance of health research capacity as an essential element of pandemic preparedness and as a form of resilience for future health threats. Ezinne Akudinobi is using a bibliometric analysis that looks at authorship of papers funded by FIC concerning Sub-Saharan Africa. 63% of papers funded by FIC about Africa have an Africa-affiliated first author. BMJ Global Health showed that when there is a top U.S. university co-author only 23% of the first authors were from the African country of the paper’s focus.

Ms. Blythe Beecroft provided an update on promoting equity in global health research. The work is focused on decolonization of global health which is now referred to as work to promote equity in global health research. The next steps are to draft an RFI to target information on the main barriers and challenges surrounding equitable research. Also included is a deeper dive on portfolio and data analysis.

Dr. Josh Rosenthal provided an update on climate change research. President Biden has signed several Executive Orders that push for climate and health research. House Appropriation language includes about $100 million in FY 22 to address climate health and equity and there is an executive committee of seven IC directors led by NIEHS Director Dr. Rick Woychik and Dr. Glass. The working group has developed a new strategic framework for climate health plans on a rapid timetable to capitalize on the momentum and advance health and the context of research programs.

Dr. David Spiro provided an update on genomic epidemiology research. The Fogarty SARS-CoV2 genomic epidemiology training workshops are designed to train international partners in small groups with extensive follow up and collaborative efforts. FIC is partnered with Johns Hopkins Applied Physics Lab, which concentrates on laboratory methods and software platform development. FIC focuses on phylogenetic and phylodynamic analysis of pathogen evolution.
Over the years they have partnered with groups like the Africa CDC, the Bill & Melinda Gates Foundations, Pasteur Institute, and the Chilean Embassy. FIC also coordinates with H3 Africa and the Bill & Melinda Gates Foundations in their Next Generation Sequencing Academy to help standardize genomic epidemiology training efforts in Africa. Drs. Nidia Trovao and James Oliseono have lectured in the academy. Upcoming events will cover topics such as the advanced genomic epidemiology and genomic epidemiology of public health labs in Pakistan and targeted genomic epidemiology implementation with workshop participants.

Dr. Nidia Trovao talked about several projects that resulted from capacity trainings of genomic epidemiology to scientists in LMICs. There are more than 5 million sequences available in public and semi-public genetic databases. Many countries in Africa and Asia have no sequences available. Through trainings and collaborative efforts with participants FIC was able to generate SARS-CoV-2 genomic data and use phylogenetics and phylodynamics to gain insight to the evolutionary history and transmission dynamics of SARS-CoV-2 in Pakistan and Africa. Patients in December were infected with at least 4 different lineages, and those lineages were introduced to the country at different occasions throughout 2020 from the U.S. and Saudi Arabia. FIC collaborated with scientists at Aga Khan University in Pakistan to successfully implement Oxford nanopore technologies in the locale. Phylodynamic analysis determined that patients between December 2020 and February 2021 were infected with lineages including B.1.1.7., which is the Alpha variant of concern first identified in the UK. A project from the University of Ghana, Helix Biogen, and other groups in Nigeria used all available genetic data for 33 African countries as well as epidemiological data throughout the first year of the pandemic. They observed that the average number of COVID cases and deaths in Africa was below the global average, and there was very limited testing in Central and Middle Africa. With more than 780 lineages circulating globally only 143 were identified in the continent, with different lineages dominating over time.

The team is working with COV-IRT COVID-19 International Research Team to receive COVID-19 tests that will be used to assess zero prevalence in children, staff in universities, students, blood
donors, and healthcare workers. They have sequenced 550 COVID samples from Mexico and Ghana and is continuing to work on SARS-CoV-2 evolutionary and transmission dynamics in collaboration with NIH Portugal, University of Yucatan in Mexico, and Institute Pasteur in Ivory Coast.

Dr. Glass mentioned that many people who provide COVID leadership in other countries can trace their legacy to Fogarty training or grants programs. In the next few weeks, he will be participating with Vera Songwe, the director of the UN Economic Commission for Africa, and Aigboje Aig-Imoukbuede, who leads the African Business Coalition for Health, to encourage African investors to invest in the health sector. African countries addressing COVID have not been able to make diagnostics, drugs, vaccines, or devices and this is an effort to change that. The CUGH meeting will hold its next meeting in April. The 2022 FIC board meetings are in February, June, and September.

Dr. Cecile Viboud provided an update on the COVID-19 projections in the U.S. The goal is to provide six-month projections of cases, hospitalization, and deaths in the U.S. by state. Since the project was initiated in December 2020, they have gone through nine rounds. Initially they focused on the size of vaccine supply and NPIs before moving into hesitancy and most recently into waning immunity. The Delta variant showed a very fast rise in July and August. The team’s projections have changed quite a bit; in past projections they were either well aligned or slightly pessimistic. In June some changes were made with mask mandates being lifted, and the team made assumptions about the effectiveness of the vaccine against infection and the severity of Delta. They had trouble estimating the Delta resurgence but were very good at estimating which states would be most affected in the U.S. Many of their graphs have been used by CDC to promote vaccination in different states. The states in the southern and western parts of the U.S. were the most affected by the Delta variant. Many vaccinated individuals will have partial loss of immunity which provides moderate protection against infection but still has strong protection against hospitalization and death. At the end of the project period of December, January, and February they predict that instances will stabilize at a higher level due to people who are only partially immune and can get reinfected. It is possible that an even more transmissible variant than Delta could emerge and start circulating in the U.S. There is no good candidate for what is circulating globally, but this scenario cannot be ruled out and this can be considered a good stress test in the amount of immunity built up in the U.S. population. The team’s projections are available publically on their website, and some of those projections have been shown during presidential briefings and used by the CDC.

Ms. Goraleski expressed her confidence in Dr. Viboud’s work, which is referenced by media outlets and the U.S. government. Dr. Wasserheit mentioned a possible method for building capacity for this type of research in LMICs and asked if there is a way to create a fellowship arrangement to bring LMIC investigators to laboratories at NIH and then support them afterwards. Dr. Viboud mentioned that they have hosted modelers in LMICs and provide training activities within the division. She mentioned that building a modeling hub is difficult as even in the U.S. there are only 10 teams that can do all the work to build a big modeling hub. Another option would be to ask U.S. teams to model data from other countries. Dr. Spiro mentioned that Dr. Viboud is doing work with digital disease surveillance trainings in Africa. She had a conference before the pandemic in Ethiopia in coordination with the Africa CDC that brought together people from 14 nations in Africa. She also received a grant from the State Department to do digital disease surveillance training in the Democratic Republic of Congo. Dr. John mentioned that AMPATH has partnered with the Regenstrief Institute to do disease modeling, primarily in the HIV space.

National Institute of Nursing Research Update

Dr. Glass introduced Dr. Shannon Zenk, Director of the National Institute of Nursing Research (NINR). He noted her work as a visiting scholar in Rwanda and her research on social equities in health. She was previously a Nursing Collegiate Professor in the Department of Population Health Nursing Science at the University of Illinois Chicago (UIC) College of Nursing, and a fellow at the UIC Institute for Health Research and Policy.

Dr. Zenk provided an update on the National Institute of Nursing Research. She became interested in communities and how resources and risks were distributed across communities and the implications for people’s health while practicing as a nurse. Spending time in patients’ homes as a home healthcare nurse case manager highlighted the tremendous differences in the experiences of patients in her case load. In her research, Dr. Zenk and her colleagues have used geographic information system (GIS) technology and generated evidence that revealed injustice in the distribution of food and built environment resources across communities. In particular, they have found that low income and Black communities have less access to healthy foods.

They launched a large U.S. study that involved over 3 million veterans for up to 7 years. The study integrated electronic health record data and administrative data from the Department of Veterans Affairs with multiple sources of environmental data. Her team found some evidence of stronger associations with diet of activity space environments compared to residential environments. They have expanded their research to evaluate the impact of community investments and policy changes on the environment and health behaviors. The 2009 WIC Food Package Revision dramatically expanded the inclusion of healthy foods in the package to improve nutrition for WIC clients.

Dr. Zenk and her colleagues are moving as fast as they can to advance science that will improve the nation’s health and achieve health equity. The country faces an ongoing deadly pandemic, as well as persistent health equities which are not completely understood and have insufficient solutions. Nursing science is centered on people and of all the health professionals, nurses spend the most time with people in a wide variety of clinical and community settings. The recently released Future of Nursing report discusses at length the influence of systemic racism and social factors in health and equities. NINR funded research is critical for the evidence base needed for nursing interventions and achieving the future of nursing goals relating to health equity. Most of Dr. Zenk’s research directly involves people, with over 75% of NINR funding supporting clinical research. More than a third of NINR’s budget supports prevention research, with 81% of prevention projects addressing primary prevention and half of prevention studies including a randomized intervention, compared to 17% at NIH as a whole. Additionally, 32% of NINR’s funding focuses on research to eliminate health disparities with 16% going to science to improve the health of women. NINR is working to maximize the impact of nursing science by tackling the nation’s most pressing health challenges and discovering solutions in all of the clinical and community settings where nurses practice. A holistic approach that includes addressing the realities of people’s lives and living conditions or the social determinants of health is critical.

NINR co-chairs the NIH Common Fund program which is focused on transformative health disparities research. Two RFAs were released this spring, with one for minority serving institutions and one for a wider variety of institutions. They have begun planning for a complementary program focused on health disparities in Fiscal Year ’23 in conjunction with the Office of Research on Women’s Health, Tribal Health Research Office, and the National Institute on Minority Health and Health Disparities. NINR is also developing a trans-NIH climate change and human health initiative in conjunction with NIEHS, FIC, NICHD, NIMH, and NIMHD. They are leading the formation of a new trans-NIH group to strengthen NIH’s support of social determinants of health research. NINR has funded several impactful studies that are improving health around the world, some of which have been featured in FIC’s Global Health Matters. NINR-funded research showed that filtering water through a sari cloth nearly eliminated cholera bacteria in drinking water. Another study in Jamaica found that including mothers in HIV prevention education for their daughters can reduce the daughter’s risk of HIV infection. An additional study on a prototype lab-on-a-chip in Rwanda test found that the prototype functioned as well as standard laboratory testing. This year NINR was able to help support two Fogarty global health fellows and scholars: Dr. Abigail Link is focused on patients with meningitis in a Ugandan infectious disease center, while Ivan Segawa will focus on the uptake and acceptability of nurse led PrEP delivery for adolescent girls and young women in a family planning clinic in Uganda. NINR funds research in a number of countries such as Argentina, China, Australia, Israel, New Zealand, Ghana, Kenya, Malawi, and South Africa covering subjects such as sickle cell disease, HIV, tuberculosis, and cancer screening.

As an undergraduate student Dr. Zenk spent a month in northern Nigeria learning about economic development. Nurses on the trip visited several hospitals and clinics to understand more about health and healthcare in the country. While she was a faculty member at UIC, she also participated in the Rwanda Human Resources for Health program developed to address the shortage of highly qualified nurses and other healthcare workers. She discussed her experience spending several weeks in Kigali and working with nursing faculty at the University of Rwanda in developing their research ideas. She was also able to participate in Rwanda’s first International Conference in Nursing and Midwifery.

Dr. Myron Cohen mentioned that the University of North Carolina at Chapel Hill collaborates with the nursing school in Malawi, which is located near their campus. It is important to focus on support for nurses both in the U.S. and in resource constrained countries. Dr. John talked about the AMPATH program in Kenya and research programs in Uganda and noted that in many countries nurses are not given the same respect as they are in the U.S. Dr. Zenk mentioned that NINR is also concerned about that issue and as a research institution they can help elevate all the discoveries that nursing science has made and will make to help with the understanding of the role of nurses and nursing science. Dr. Wondwossen Gebreyes mentioned that at Ohio State University the health sciences are all involved in One Health, and they have quite a lot of students and faculty in nursing involved with related research. Ohio State has a nursing training program to build capacity in Ethiopia which includes a graduate student program. They have been working on a training program with two universities in Ethiopia which will include graduate students.

Dr. Michelle Williams noted that Harvard does not have a nursing school but there is a large number of nursing schools around the area. They started a program with the Africa CDC as their anchor partner in Africa to provide leadership training at the ministerial level. Dr. Joe Kolars brought up the University of Michigan’s nursing school, which works in collaboration with groups in Thailand and other parts of Asia. They also often work with PAHO and South America. Much of the collaborative work right now is not in Africa. Dr. Murphy noted that at Northwestern they do not have a nursing, dental, or public health school but that all the universities they are affiliated with in Mali and Nigeria have nursing schools, and there was some training involved with MEPI. He also mentioned that Northwestern has close collaborations with UIC. Dr. Mary Wilson asked Dr. Zenk whether she sees training integrating global health or development of a particular track that will have defined goals around global health. Dr. Zenk mentioned that it is important to keep an open mind when it comes to training approaches and to consider multiple possibilities, including global health. Dr. Steffanie Strathdee commended NINR for supporting the Fogarty International Clinical Scholar’s Program, which helps attract senior professional students to global health.

Closing Remarks

Dr. Glass thanked the Board members and speakers for the dynamic discussions and noted that the pandemic has brought unique opportunities for promoting research and interventions in global health and the solutions will be gained through global collaborations. The next FIC meeting will be held in February 2022.  

There being no further business, Dr. Glass adjourned the meeting at 2:43 p.m.