Dr. Kilmarx, Acting Director, presiding, the FIC Advisory Board met in building 16 on the NIH Campus in Bethesda Maryland and via videoconference on June 2, 3:00 p.m. to 5:00 p.m. EDT for the closed session, and on June 3, 9:00 a.m. to 12:30 p.m. for the open session.
Present
- Dr. Clement Adebamowo, Director, Cancer Epidemiology Division, Department of Epidemiology and Public Health, University of Maryland School of Medicine
- Dr. Chris Beyrer, Director, Duke Global Health Institute, Gary Hock Distinguished Professor in Global Health, Professor of Medicine, Research Professor of Global Health, Duke University
- Dr. Otis Brawley, Bloomberg Distinguished Professor of Oncology and Epidemiology, Johns Hopkins University
- Dr. Benjamin Chi, Vice Chair for Research and Innovation, Department of Obstetrics and Gynecology, Distinguished Professor, Global Women's Health, Interim Director, Center for Women's Health Research, Adjunct Professor, Epidemiology, University of North Carolina
- Dr. Wondwossen Gebreyes, Hazel C. Youngberg Distinguished Professor, Molecular Epidemiology, Executive Director, Global One Health Initiative, the Ohio State University
- Dr. Jennifer Kates, Senior Vice President, Director of Global Health & HIV Policy, KFF
- Dr. Maureen Lichtveld, Dean of the Graduate School of Public Health, Professor of Environmental and Occupational Health, Jonas Salk Chair in Population Health, University of Pittsburgh
- Dr. Robert Murphy, Executive Director, Institute for Global Health, John Philip Phair Professor of Infectious Diseases, Northwestern University
Ex Officio Members Present:
- Dr. Gregory Germino, Deputy Director, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health
- Dr. Satish Gopal, Director, Center for Global Health at the National Cancer Institute, National Institutes of Health
- Dr. Jane M. Simoni, Director, Office of Behavioral and Social Sciences Research, National Institutes of Health
Also Present
- Dr. Jayanta Bhattacharya, Director, National Institutes of Health
- Dr. Nancy Kass, Deputy Director for Public Health, Phoebe R. Berman Professor of Bioethics and Public Health, Berman Institute of Bioethics; Professor of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
- Dr. Stephen Morrison, Senior Vice President and Director, Global Health Policy Center, Center for Strategic and International Studies
- Kristen Weymouth, Executive Secretary, Fogarty International Center
Acting Director’s Update and Discussion of Current FIC Activities
Dr. Peter Kilmarx, FIC Acting Director, welcomed the participants to the open session and outlined the day's agenda. He spoke about his travel to the INTEREST HIV research meeting in Namibia. He chaired an Oxford-style debate with the resolution that the risks of AI use for healthcare delivery in resource-poor settings outweigh the benefits. An NIH-funded team at the University of Namibia is studying the mental health effects of extreme drought like the one that recently affected the country. Namibia has reached a goal where 95% of its people with HIV have been diagnosed, 95% of that cohort are in treatment, and 95% of the treatment cohort have a suppressed viral load, which is a goal the UN has set for 2030.
Dr. Kilmarx described his recent research with Shirley Kyere developing metrics for pre-COVID research output and how well that predicted COVID-related research productivity. Metrics included pre-pandemic and COVID-related publications and clinical trials. COVID burden, human development index, GDP, and populations were considered as covariants. They found that pre-COVID research capacity was the strongest predictor of COVID research output.
Dr. David Spiro, Director of the Division of International Epidemiology and Population Sciences, introduced a study in collaboration with the University of Washington studying the burden of respiratory disease and vaccine effectiveness in King County, Washington.
Dr. Kilmarx introduced communications resources, including messaging on how Fogarty programs benefit the health of Americans, engaging American researchers, in non-communicable diseases, bioethics, and many other areas.
The next in-person FIC Advisory Board meeting is in September. The Global Alliance for Chronic Diseases network meeting will be held in Kigali, Rwanda in June. A meeting of the Heads of International Research Organizations is to be held in Seoul, South Korea, and Dr. Kilmarx will attend with NIH Director Dr. Bhattacharya.
State of Global Health and Health Security
Dr. Stephen Morrison, Senior Vice President and Director, Global Health Policy Center, Center for Strategic and International Studies (CSIS)
Dr. Stephen Morrison described the current global health and health security environment as a historic reset, emphasizing the need to align international health engagement with the Administration’s priorities of national security, fiscal discipline, efficiency, and technological innovation. He underscored that programs focused on HIV, immunization, supply chains, infectious disease control, and biothreat preparedness directly advance U.S. national security by strengthening allied capacity and preventing cross-border threats. He noted that recent disruptions, including restructuring of foreign assistance, budget pressures, and calls for reform, reflect deeper public skepticism following COVID-19 and growing demands for accountability and measurable results.
Looking ahead, Dr. Morrison emphasized that reform efforts are likely to prioritize streamlined management, smaller budgets and staff, integrated (rather than single-disease) approaches, and time-limited, results-oriented overseas investments tied to geopolitical interests. He stressed that rapid, orderly reform demonstrating verifiable outcomes will be essential to restoring public trust. Technological innovation, particularly AI and biotechnology, will be central to maintaining U.S. leadership. At the same time, fiscal constraints and scrutiny of federal spending will shape health research investments. He highlighted risks to U.S. global influence—including strained relations with China, uncertainty around WHO engagement, and shifting diplomatic priorities in Africa—while noting that sustained leadership in science, global partnerships, and biosecurity remains critical to protecting American health, economic strength, and strategic interests.
Challenges and opportunities in global research ethics and FIC bioethics training programs
Dr. Nancy Kass, Deputy Director for Public Health Phoebe R. Berman Professor of Bioethics and Public Health, Berman Institute of Bioethics; Professor of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
Dr. Nancy Kass outlined major ethical challenges and evolving priorities in global research, framing the discussion around the tension between cultural relativism and universalism, particularly how researchers should respond when local practices conflict with their own moral standards. She revisited the 1990s debate over placebo-controlled HIV trials in low- and middle-income countries after it was shown that antiretroviral therapy dramatically reduced mother-to-child transmission. The controversy centered on cost, feasibility, and what constituted an appropriate “standard of care,” raising broader questions about whether ethical research simply requires avoiding harm or also ensuring equity and justice. Dr. Kass emphasized that strong research ethics depends on understanding the scientific and contextual nuances of study design.
She then described ongoing debates about researchers’ obligations beyond the confines of a study, especially in settings with limited healthcare infrastructure. These include what care is owed to participants and their families during research, whether investigators must provide ancillary care, and whether there is an ethical duty to ensure continued access to successful interventions for participants, placebo groups, or even the wider community after a study ends—and who bears responsibility for that support. She also highlighted emerging ethical issues in genetics, biobanking, and artificial intelligence, including governance of stored specimens, decision-making authority over data access, equitable inclusion of investigators from source countries, and concerns about AI’s role in scientific authorship.
Dr. Kass stressed that researchers from the global north have a responsibility to conduct research ethically in partnership with local collaborators who can help translate ethical principles into practice. She described her leadership in bioethics training initiatives in sub-Saharan Africa, including mentoring both researchers and institutions and helping to establish the African Bioethics Consortium in 2014 to expand regional capacity. Finally, she noted the short- and long-term ethical and reputational consequences of abruptly ending research or aid programs, particularly the prohibition against abandoning patients without transition plans, and concluded that while “do no harm” is widely accepted, interpretations of respect and ethical boundaries differ across cultural contexts.
Dr. Jayanta Bhattacharya, Director, National Institutes of Health
Dr. Bhattacharya said he is absolutely committed to a robust portfolio of international research. He spoke of the failures of the American and international public health establishments during the COVID-19 pandemic. He cited an April 2020 report from the UN World Food Program estimating that economic dislocations caused by lockdowns would cause 100 million people to starve. He said lockdowns have a tremendous impact on the poor, the working class, and children, and have fueled global inequality.
NIH must address the decline in public confidence in science. A Pew study found that 1 in four Americans do not believe that scientists work in the interest of the public. Even with tremendous advances in science, it has not translated into broad population health improvement in the United States and around the world, and Dr. Bhattacharya says NIH must do better.
He called the Make America Healthy Again (MAHA) initiative a tremendous and important opportunity for NIH to remember its mission of research to advance the health and longevity of the American people. NIH must address the decades-old reproducibility crisis in science. There are systemic flaws in the way research is published and evaluated that guarantee that many findings will not replicate, including failure to support replication work by independent teams and a lack of reward for prosocial cooperation and sharing of data.
Dr. Bhattacharya said that the culture of science punishes failure too much, and NIH must allow researchers to take risks and allow people to pick themselves up with a new idea and move on.
He asserted scientific evidence that the COVID pandemic was started by research, partially NIH-funded, aimed at preventing pandemics. There has been much debate about the etiology of the pandemic, and he said the research-origin theory has been denigrated. He would like to ensure public oversight of the small fraction of NIH's portfolio that has the potential to cause harm. He also advocated an auditing program to monitor what the U.S.'s international partners are doing.
Dr. Bhattacharya said he wants to restore free speech to science, asserting that dissenting views were not tolerated during the pandemic. Many lost their careers as a consequence of speaking their mind. Science must be more tolerant of disagreement and learn to embrace it.
Q&A
Dr. Bhattacharya said the lack of infrastructure to hold sub-awardees responsible invites abuse. American scientists must be trained to work in foreign settings. Dr. Bhattacharya referred to Dr. Kass' presentation about ethics in international research. Foreign researchers must also be trained to work with Americans. This capacity-building allows Americans to address research questions of importance. There is a national security overlay to this regarding counties of concern. What benefits can the American taxpayer expect from collaboration with foreign researchers?
Dr. Bhattacharya asserted that science reporting is using the shift to higher security as a cudgel against the Trump administration to allege that it does not support science, citing a recent article in Science News he called "pure misinformation." He said the NIH is and will continue to be the largest and most important funder of biomedical sciences in the world.
Adjourn, Dr. Peter Kilmarx
Dr. Kilmarx thanked all the speakers and participants and adjourned the meeting at 12:33 p.m.