The FIC Advisory Board met via Video Teleconference, at 10:00 a.m. EDT, Dr. Peter Kilmarx, Acting Director, presiding.
Present
- Peter Kilmarx, M.D., Chair, FIC
- Carol Dahl, Ph.D., Formerly Lemelson Foundation
- Wondwossen Gebreyes, M.D., Ohio State University
- Gregory Germino, M.D., National Institute of Diabetes and Digestive and Kidney Diseases, NIH (Ex Officio)
- Karen Goraleski, M.S.W., American Society of Tropical Medicine and Hygiene
- Chandy John, M.D., Indiana University School of Medicine
- Vikas Kapil, D.O., M.P.H., Centers for Disease Control and Prevention (Ex Officio)
- Maureen Lichtveld, M.D., University of Pittsburgh
- Robert Murphy, M.D., Northwestern University
- Judith N. Wasserheit, University of Washington
Also Present
- Kristen Weymouth, Executive Secretary
- Nalini Anand, J.D., M.P.H, Director, Division of International Science Policy; Director, Center for Global Health Studies, FIC
- Blythe Beecroft, M.S., Center for Global Health Studies, FIC
- Judy Coan-Stevens, Acting Communications Director, FIC
- Leo Cubillos, M.D., M.P.H., Director, Center for Global Mental Health Research, NIMH
- Flora Katz, Ph.D., Director, Division of Training and Research, FIC
- Amit Mistry, Ph.D., Senior Scientist, FIC
- Bradley Newsome, Ph.D., Program Officer, FIC
- Ambassador John Nkengasong, B.Sc., M.Sc., Ph.D., U.S. Global Aids Coordinator and Special Representative for Global Health Diplomacy, U.S. Department of State
- Raj Panjabi, M.D., M.P.H., Special Assistant to the President and Senior Director for Global Health Security & Biodefense National Security Council, the White House
- Christine Sizemore, Ph.d., Director, Division of International Relations, FIC
- Rachel Sturke, Ph.D., M.P.H., M.I.A., Acting Deputy Director, FIC
- Kaiyuan Sun, Ph.D., Postdoctoral Fellow, FIC
- Celia Wolfman, Policy Analyst, Division of International Science Policy, Planning and Evaluation, FIC
Director's Update and Discussion of Current and Planned FIC Activities
Dr. Peter Kilmarx brought the open meeting to order and gave an update on recent activities of the FIC. Advisory Board Member Sten Vermund has stepped down from the Board after serving for two terms. The Canada Gairdner Global Health Award was presented to Professor Jose Belizan from Argentina for his work on maternal and child health. Dr. Kayla Laserson will lead the CDC's Global Health Center, with Dr. Howard Zucker serving as the Deputy Director for Global Health in the Office of the Director. Dr. Andrey Kuzmichev has joined Fogarty as the Communications Director after a career in the Office of the U.S. Surgeon General; he was previously a postdoc at NINDS. Dr. Monica Bertagnolli, the current NCI Director, has been nominated to serve as the NIH Director, pending Senate confirmation. The Fogarty Director vacancy announcement was released in May 2023, and the deadline is July 14, 2023.
In March 2023 representatives from Fogarty traveled to Kingston, Jamaica for the SUNY-UWI Health Research Consortium Conference. During the same trip they met with Fogarty trainees and helped them to expand their research areas and partnerships with other NIH Institutes. In April, the Consortium of Universities for Global Health (CUGH) featured several FIC-related events, including a keynote address and Lifetime Achievement Award for former Director Roger Glass and several symposia supported by FIC. The 2023 AFREhealth-CUGH-Fogarty James Hakim Award was awarded to Angel Nanteza for her work on mental health in Uganda. One of the plenary sessions focused on reimagining global health in the 21st century, led by Dr. Judy Wasserheit and Dr. Maureen Lichtveld. This session followed up on CUGH's proposed consensus definition for global health in 2009, examining changes in the global health field such as new technologies, governing structures, and crises such as climate change and the COVID-19 pandemic.
In May the INTEREST Conference was held in Maputo, featuring hundreds of attendees and abstracts from the HIV field and representation from Fogarty. Dr. Kilmarx also attended a pre-meeting with 10 AFREhealth experts from across Africa to articulate a post-COVID-19 research agenda. FIC staff also visited Fogarty grantees and trainees in Mozambique to encourage them to increase their partnerships and applications and diversify into more research areas. At the previous Board meeting, the Board encouraged FIC to strengthen its work on global health public communications and addressing the spread of disinformation and misinformation. The NIH Office of Behavioral and Social Sciences Research (OBSSR) has a new working group to explore opportunities in health communications sciences, and Dr. Rachel Sturke represented FIC in the working group to ensure global reach. FIC is also piloting an effort in select grantee networks to make public presentations in the countries where they are working to increase public scientific communication.
FIC's efforts around climate change and health are spearheaded by Dr. Josh Rosenthal, co-chair for the NIH-wide Climate Change and Health Working Group. A notice of funding opportunity (NOFO) for the Climate Change and Health Research Center planning grants was released recently, as well as administrative supplement applications and a Climate and Health Scholars program, and the NIH-supported Research Coordinating Center has been launched.
Dr. Rob Eiss gave an update on FIC's activities on behalf of the NIH Director. The Common Fund concluded its final cycle of support for Human Heredity and Health in Africa (H3Africa). The program was very successful, with over 100,000 consented volunteers, the first genotype microarray developed for Africa, over 700 publications, and a swift move towards translational genomics. Despite this success, there is still a stark ethnicity and scientific gap, with 90% of genome-wide association study (GWAS) volunteers being of European descent. In order to bridge this gap Dr. Francis Collins brought together several African leaders to propose a network of Genomics Centres of Excellence across Africa. Plans for the network have been presented to the American Congress of Human Genetics, the International Congress of Human Genetics, and the heads of several international research organizations, with more updates to come in the fall of 2023. Dr. Eiss also noted that the NIH is working with the National Security Council (NSC) and the European Commission on a permissible legal pathway to restore trans-Atlantic data sharing under the GDPR, as well as with the Department of Health and Human Services negotiating team in Geneva to provide input to the zero draft of the WHO pandemic accord.
Dr. Flora Katz presented updates from the Division of International Training and Research (DITR). Since the last Board meeting, DITR celebrated the 20th anniversary of the Fogarty Global Health Program for Fellows and Scholars, which has sent hundreds of pre- and postdocs for one year of research activities at low and middle income country (LMIC) sites. In April 2023 they were joined by 31 alumni, current and prior faculty and participating ICs for two panel events to discuss the program's impact. Dr. Katz noted that Board members are welcome to join the division's network meetings, where they hear from grantees and discuss issues affecting FIC programs and the global health community. She also presented two Notices of Special Interest (NOSIs), both of which are concerned with increasing diversity, equity and inclusion (DEI) in research training and programs. Responses to both NOSIs are due June 23rd.
Dr. Rachel Sturke presented updates from the Division of International Science Policy, Planning and Evaluation (DISPPE). The Adolescent HIV Implementation Science Alliance (AHISA) held their seventh annual meeting in Lusaka in April 2023, with a focus on sustainability, youth engagement, capacity building, and making implementation science more accessible and usable in low-income countries. They are continuing to collaborate with NICHD's adolescent implementation science program and are in the process of conducting an evaluation of AHISA's model as a way of catalyzing implementation science in LMICs. Their action groups focus on areas including dissemination, special populations, and the whole person approach to youth health. In May 2023 they also published a special supplement in AIDS & Behavior, and this will be launched at the 2023 International AIDS Conference. Dr. Sturke also touched on efforts to strengthen and modernize evaluation and portfolio analysis at Fogarty.
Dr. Amit Mistry updated the Board on the Common Fund's Harnessing Data Science for Health Discovery and Innovation in Africa (DS-I Africa) program. As part of their effort to foster partnerships and grow the Consortium, they recently hosted a networking event that featured non-academic organizations outside of the Consortium. More broadly, they have worked with awardees and the Coordinating Center to form a Partnerships and Outreach Working Group, continued coordinating with major research funders, and continued to engage with private sector and government entities. The Consortium also participated in the recent Data Science Africa event and is working on a health workshop to participate in the Deep Learning Indaba event in Ghana in September 2023. The next DS-I Africa Consortium meeting will take place in November 2023 in Rwanda.
Ms. Judy Coan-Stevens presented updates from the Office of Communications. She and Dr. Kilmarx met with NCI leadership in April 2023 to discuss ways that Fogarty can support the National Cancer Plan, which speaks to cancer as a global issue. The Office of Communications will build awareness about the Plan and global work on cancer in publications and digital media, as well as developing talking points on global cancer for NIH and HHS leadership. The office also supported the Global Health Program for Fellows and Scholars anniversary with digital and social media outreach, including the publication of a book of 40 alumni interviews.
Dr. Christine Sizemore spoke about recent work in the Division of International Relations (DIR). Avani Hegde recently joined the team as a program analyst. The third cohort of fellows has been selected for the African Postdoctoral Training Initiative (APTI), which is implemented by the African Academy of Sciences, NIH, and the Bill and Melinda Gates Foundation. At a formal signing event at NIH, Dr. Larry Tabak and Korea Health Industry Development Institute President Dr. Cha signed an MOU to renew the Korean Visiting Scientist Training Award program (KVSTA). This effort was led by Tina Chung. Ranjan Gupta is leading an effort to expand cooperation and collaborative discussions with the Indonesian Ministry of Health, with Dr. Tabak and Indonesian Minister of Health Budi recently agreeing to formalize discussions. DIR also hosted recent ministerial visits with Colombia, Thailand, South Africa, and the European Commission on behalf of NIH.
Dr. Kaiyuan Sun presented an update from the Division of International Epidemiology and Population Studies (DIEPS) on the RSV maternal vaccine. There are currently several RSV vaccine and monoclonal antibody products in development targeting pregnant women, pediatric and elderly populations, with many of these product candidates in the late stages of clinical trials and market approval. In the U.S., several products are expected to be approved in 2023, including one extended half-life monoclonal antibody for infants by Sanofi and AstraZeneca, one maternal vaccine by Pfizer, and two vaccines for older populations by Pfizer and GSK. Dr. Sun presented a mathematical model that DIEPS designed and used to project the reduction of RSV infant hospitalization through maternal vaccination.
Dr. Kilmarx noted that FIC has recently held sessions with senior staff for leadership training and strategic planning, as well as a teambuilding activity with all staff members to increase the resilience and cohesion of the Fogarty team.
Ms. Goraleski noted that hearing from division and office leaders demonstrated Fogarty's wide-ranging skill set and mission. Dr. Wasserheit asked whether the Climate Change and Health Research Center P20s would continue to be made available after the current year, how best to provide input on the NIH efforts around the draft WHO accord, and whether there were any lessons to learn from DS-I Africa when launching similar activities in other regions. Dr. Gebreyes asked whether NIH and FIC have a good understanding of the definition of underrepresented groups in the context of individual countries. Dr. Lichtveld asked about how the Climate and Health Scholars were integrated into different ICs. Dr. John asked what the next steps were for H3Africa and how internal Fogarty findings, such as those related to RSV in Dr. Sun's presentation, are disseminated to practitioners working in the field.
Dr. Katz said that there is currently no intention to reissue the P20 grants, but they are hoping to follow them with larger hub-type grants. Each IC uses the Climate and Health Scholars program differently, but the overall intention is to bring in expertise in climate change and health to inform NIH. Fogarty is working with a scholar from Boston College who specializes in annotation research, and he is leading an effort to put together case studies on adaptation and climate change. She agreed that underrepresented groups are defined differently by country, and FIC does not have a uniform definition, though they are hoping to learn more from grantee submissions and begin conversations within countries about underrepresented populations.
Dr. Eiss said that Advisory Board members are welcome to offer perspectives on WHO treaty issues that are within NIH's purview; the outcomes are uncertain, but this is an opportunity for NIH to present and embed new ideas on public-private partnerships related to pandemic preparedness and response. Regarding next steps for H3Africa, the team is proposing a hub and spoke model with ten potential Centers of Genomic Excellence. The challenge will be to expand the base of funders, and they would like to reach out to overseas development agencies and progressive philanthropic organizations and generate commitments from African governments.
mHealth Analysis
Ms. Celia Wolfman and Dr. Brad Newsome presented an interim analysis of the Mobile Health: Technology and Outcomes in LMICs (mHealth) program. This trans-NIH program supports exploratory and developmental research to study the development, validation, feasibility, and effectiveness of innovative mHealth interventions and tools specifically suited for LMICs. Its goal is to catalyze innovation through multidisciplinary research that addresses global health problems, develop an evidence base for the use of mHealth technology to improve clinical and public health outcomes, and strengthen mHealth research capacity in LMICs. The program is in its ninth year and has funded over 100 awards from over 1,000 applications using two funding mechanisms: an R21 clinical trial optional mechanism used from 2014 to 2019, and an R21/R33 phased innovation award mechanism launched in 2020.
So far 118 awards have been funded across five funding opportunity announcements (FOAs), with six Institutes and three OD offices participating in the program. The program has had a total investment of nearly $44.4 million, with the nine ICOs contributing $21.4 million or 48% of program funding. mHealth grantees have conducted research in 42 LMICs, and in the latest FOA in 2021, over 71% of awards involved at least one African site. To date, more than 269 articles have been published with support from the mHealth grants, with a relative citation ratio (RCR) of 1.73. Thirty-six clinical trials have resulted from mHealth grants, as well as five pending patents, and 34 mHealth grantees have applied for 82 different R01 or R01-equivalent grants at least one year after their mHealth award was funded, with 19 grantees receiving funding. Dr. Newsome noted that both of the NIH Technology Accelerator Challenge prizes to date have been awarded to mHealth grantees.
Dr. John said that in the future it would be helpful to see a presentation on how this program is being implemented and changing health in LMICs. Dr. Newsome agreed and noted that they do not have enough information to assess applicability at this time. Dr. Lichtveld asked about the program's capacity building in LMICs. Dr. Newsome said that most of the portfolio is focused on training awards, which have specific criteria for capacity building training. The research programs give grantees more latitude to define capacity building in ways that will best serve specific communities. Dr. Dahl asked if the program had ongoing activities to provide additional assistance when translating mHealth solutions into sustainable programs. Dr. Newsome said that that is a constant challenge, and it is part of the reason that the program requires diverse partnerships outside of academia to tackle issues around sustainability. Dr. Dahl asked if Fogarty could consider something similar to I-Corps in the U.S. to assist foreign investigators. Dr. Katz said that several years ago NIH and NSF discussed extending I-Corps to LMICs, and it is worth thinking about how to secure that kind of technical assistance.
Ambassador Dr. John Nkengasong, U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy, U.S. Department of State
Dr. Nkengasong summarized his involvement with NIH, his work in the HIV and global health space and his contributions to the COVID-19 response in Africa. In December 2019 an emergency operations center (EOC) had already been established to respond to the Ebola outbreak in North Kivu. As reports of COVID cases in Asia increased, Dr. Nkengasong instructed the Africa CDC in Addis Ababa to activate the EOC. Prior to the outbreak of COVID in Africa, Dr. Nkengasong and his team established basic diagnostic and epidemiology training in Senegal, and those who received that training were able to respond when the first COVID cases emerged in Egypt in February 2020. In order to address the need for clinical trials Dr. Nkengasong set up a network of COVID-19 clinical trial facilities, as well as a coordinating group with WHO Africa. As new information emerged on the clinical spectrum of the disease they also worked with networks like PANDORA to examine and communicate data in a timely fashion.
Dr. Nkengasong outlined three categories of workers that are critical in dealing with a pandemic and global health security threat: experienced epidemiologists that can collect good data and do contact tracing; public health experts with management and policy understanding, who can analyze data and brief politicians regularly; and people with a background in clinical trials and clinical management and research. Information evolves and becomes outdated very quickly, and in the absence of reliable sources, there is a greater risk that the public will receive incorrect information. Dr. Nkengasong highlighted the importance of PEPFAR's previous practice, which allowed room for senior members in partner countries to be trained through programs like Fogarty and return to their countries with broader exposure and an understanding of clinical trial capacity. This type of investment is necessary to prepare countries for global health security. In the midst of COVID Dr. Nkengasong launched the Kofi Annan Global Health Leadership Programme, which gives epidemiologists, doctors, and public health experts the skills to take a multi-sectoral approach in responding to public health emergencies like pandemics.
Dr. Kilmarx noted that in 2022 Secretary of State Antony Blinken announced his intent to establish a Bureau of Global Health Security and Diplomacy, with Dr. Nkengasong as its leader. He asked about the status of the Bureau and what Fogarty's priorities should be around research and clinical trial capacity building. Dr. Nkengasong said that Secretary Blinken notified Congress of his intention to create the Bureau in December of 2022, but the introduction of a new Congress delayed further action for some time as members submitted questions and suggestions. It is the Secretary's intent to launch the Bureau by the end of July 2023. The specific role of the Bureau in relation to HHS, USAID and NSC is still being developed, but Dr. Nkengasong highlighted the value of the Bureau as an instrument to coordinate the global health security narrative and vision for the entire U.S. government. In terms of Fogarty's capacity building, Dr. Nkengasong emphasized sustainability and a continuum that brings people who have been trained back to their home countries and keeps them in the system. He also mentioned the importance of behavior research and the gap between products that are developed during outbreaks, such as vaccines, and uptake of those products. Dr. Kilmarx asked what Dr. Nkengasong saw as future priorities in the area of health professional education. Dr. Nkengasong said that a nursing leadership program was a top priority for PEPFAR, especially given the close contact that nurses have with patients on the frontline during outbreaks.
Dr. Lichtveld asked how they should approach global health in the midst of epidemiological and political changes. Dr. Nkengasong said that they need to better define global health and its distinction from international health, and to be more intentional in promoting bidirectional learning. The current global health architecture also needs to be reimagined, and this will involve synergizing efforts and listening to regions' aspirations. He added that they should look at funding partnerships with the private sector with the understanding that good public health practice leads to good global health and good global health security.
Dr. John asked what Fogarty and the American Society of Tropical Medicine and Hygiene (ASTMH) have done well in training young LMIC scientists to become leaders in the field, and what Fogarty can do to help advance nursing research and fully realize nurses' abilities in places where they have not previously been recognized. Dr. Nkengasong said that it is important to include nurses in clinical care teams and increase their curriculum, and he noted that there is a difference between current capacity building for public health experts versus leaders; the Africa CDC is considering an African Epidemic Service (AES) program to develop the leadership skillset. Dr. Wasserheit asked how NIH and Fogarty should think about research training as it relates to determinants beyond health, such as climate change, that also play a role in global health security. Dr. Nkengasong agreed that they need to look at the intersectionality of problems like health, climate change, and food insecurity and these issues need to be central to the training of new public health leaders. Dr. Gebreyes asked how One Health could fit into this approach, and Dr. Nkengasong said that the challenge is implementing One Health at the country level in a seamless way.
Dr. Raj Panjabi, MD, MPH, Special Assistant to the President and Senior Director for Global Health Security & Biodefense National Security Council, The White House
Dr. Panjabi shared his perspectives on global health research and capacity building as it contributes to health security, as well as two of his guiding principles: the idea that no condition is permanent, and the importance of meeting people and communities where they are. He spoke about his childhood as a refugee from Liberia and his return to the country many years later, and the importance of investing in people and communities that are closest to the problem in order to improve public health. For Dr. Panjabi, part of this community-based approach involved working with teams at USAID and the CDC to reverse policies that prevented U.S. government funds from being used to pay community health workers. He noted that many national and international policies on pandemic preparedness and response focus on the idea of investing in people, including the public health, clinical, and research workforce.
Dr. Kilmarx asked Dr. Panjabi for his perspective on the U.S.'s role in the global response to COVID. Dr. Panjabi said that the biggest successes have been around demonstrating global leadership and mobilizing financing for the global response. Speed and equity remain the biggest issues, with low-income countries lagging behind in vaccination, testing and treatment access. As variants and subvariants evolve, it is vital to remain focused on three pillars: vaccinating the hardest to reach and highest risk individuals; scaling and integrating testing and treatment in the primary healthcare system; and ensuring that the world is prepared for the next variant and the next pandemic threat. This requires a stronger system with decentralized manufacturing, and financing available on day zero of a pandemic so that LMICs can purchase vaccines, tests and PPE.
Dr. Kilmarx asked Dr. Panjabi to give an overview of the current landscape of pandemic preparedness, the U.S.'s role in that landscape, and the new WHO treaty currently being negotiated. Dr. Panjabi said that in September, heads of state will meet at the United Nations with the goal of producing a political declaration on pandemic prevention, preparedness and response. When it comes to financing, it is critical to make sure that LMICs have ongoing partnerships, and the U.S. has recently put forward two initiatives: to increase the number of countries that the U.S. invests with on global health security from 19 to more than 50 by 2025; and to work with other nations to support another 50 countries. This last initiative will involve working with the G20 to stand up a Pandemic Fund at the World Bank. Part of the current conversation at the WHO involves negotiating the rules about countries' obligations to prevent, prepare for and to build capacity to respond to public health emergencies when they do occur. The draft pandemic accord is largely focused on medical countermeasures, given the inequities in access among countries.
Dr. Kilmarx asked where clinical research capacity fits into these discussions and what Fogarty's priorities should be in terms of building capacity for pandemic preparedness. Dr. Panjabi said that he hoped Fogarty would build on its tradition of investing in trainees and noted that several Fogarty trainees had been instrumental in COVID research. During COVID, the focus on stopping transmission and reducing morbidity and mortality hinged on safe, rapid, localized clinical research trial capacity, which is something that must be developed and cultivated before a public health emergency begins, and Fogarty's work is vital to these efforts.
Dr. Robert Murphy noted that it was difficult to work internationally at the beginning of the COVID pandemic and asked how global components can be incorporated more efficiently and quickly if another respiratory pandemic occurs. Dr. Panjabi said that clear, bold targets need to be set to create simple, unifying goals, and this could be part of the conversation with other countries around the WHO pandemic accord. Dr. John asked about ways of maintaining preparedness in the absence of another public health crisis and getting ahead of misinformation and disinformation. Dr. Panjabi said that investing in current outbreaks such as HIV and malaria strengthens the same systems that will be vital in the next public health crisis. Investing in communities and community health workers also helps to combat the distrust and misinformation that often emerges around global and public health.
Promoting Global Health Research Equity
Ms. Nalini Anand and Ms. Blythe Beecroft spoke about Fogarty's collaboration with seven other ICs in the NIH Working Group on Promoting Equity in Global Health Research. In 2018, a larger conversation emerged in the global health community around the decolonization of global health. 2020 saw an increase in data and a larger number of publications looking at the definition of research equity, and related initiatives including the ESSENCE Good Practice Document, the COHRED Research Fairness Initiative, and the Cape Town Statement. The NIH Working Group published a request for information (RFI) in 2022, seeking input on how best to promote global health research equity and the role that NIH can play in achieving this goal.
The working group completed an in-depth analysis of the responses to the 2022 RFI and is working on drafting a public summary report. They received 186 responses, with 37% coming from LMIC respondents. 70% of responding organizations were academic institutions, with NGOs, government agencies, professional associations, and other groups contributing as well. The majority of responses came from the North American region, with sub-Saharan Africa as the second most common region. Several key thematic areas were highlighted in the responses: partnerships, including the role of LMIC partners being elevated and an emphasis on respect and cultural sensitivity; funding limitations and structures, including the 8% indirect cost rate as an impediment to equitable conduct of research; scientific capacity and administrative and structural capacity; priority setting, including a call for more support for local agenda-setting and using funding to address local disease burden; data access and ownership; and peer review, with a need for greater LMIC representation in study sections. Other areas of note included: an emphasis on transferring leadership from high-income country (HIC) to LMIC partners; authorship and publications; specific research areas and topics of interest to LMIC partners, such as social determinants of health and implementation science; a greater call for community engagement; and a focus on disseminating data to communities where research is conducted.
Dr. Leo Cubillos, Director for the Center for Global Mental Health at NIMH, provided his thoughts on the RFI responses. He said that for NIMH, the responses provide a roadmap to conceptualize and act upon the barriers and challenges to equitable global mental health research. He also noted the level of disaggregation and multiplicity of ideas that were received, and he highlighted two data points that he found particularly interesting and informative for future discussion: the fact that the majority of respondents were from HICs and that the geographic region that was most represented was North America.
Dr. Wasserheit noted that many of the domains explored in the RFI responses were part of larger questions about the nature of the field of global health in the 21st century. When discussing equity in global health it is important to agree on a common goal, and that in turn requires robust partnerships grounded in mutual benefit, trust, and respect. She suggested that these three elements be incorporated in further discussions, particularly around the fair distribution of financial resources, priority setting, and data access and ownership. She added that academic global health needs models that empower and support faculty in U.S. institutions and LMIC institutions. There are ways to promote joint leadership and recognition, such as having funding agencies explicitly encourage co-principal investigators (PIs) with appropriate funding allocations.
Dr. John asked about the disproportionate number of respondents from North America and plans to collect more input from LMIC colleagues. Ms. Anand said that in order to figure out next steps, the working group will not rely solely on the responses to the RFI; by convening focus groups, additional consultations, and workshops they can ensure greater LMIC input and participation and dive deeper into the thematic areas that were identified. Ms. Beecroft added that the work group coded each response by the respondent's origin. Dr. Lichtveld noted that it is important for junior faculty to have a focus that is more specific than global health, and that a lack of data infrastructure is a limiting factor for LMICs. Ms. Anand said that they would discuss the second point with the working group to explore what NIH and Fogarty can do to bolster LMIC data infrastructure.
Dr. Germino shared that NIDDK's Advisory Council recently published a report looking at health equity research in their Institute, which touched on several of the same themes as the RFI responses. He noted that for NIDDK, those themes appeared in the context of national rather than global health, mostly due to limited resources and an abundance of health inequities within the IC's mission area in the U.S. Ms. Anand noted that the eight ICs in the working group were chosen based on the extent of global footprint in LMICs, but they will be reaching out to additional ICs as they move through the process. Dr. Dahl highlighted the importance of involving LMIC investigators in the review process and added that it is even more important for them to be involved in strategic thinking about NIH and Fogarty. She also noted that issues of decolonization and inequity extend beyond research, and that it would be helpful to include people who are knowledgeable about downstream implementation to make sure that research is translated into impact.
Closing Remarks
Dr. Kilmarx thanked the Board members and Fogarty staff for their time and input into the meeting. There being no further business, the meeting was adjourned at 1:59 p.m.