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Our Role in Global Health
Photo by Richard Lord for Fogarty
The Fogarty International Center advances the
National Institutes of Health (NIH) mission by supporting and facilitating global health research conducted by U.S. and international investigators, building partnerships between health research institutions in the U.S. and abroad, and training the next generation of scientists to address global health needs.
marked its 50th year of advancing science for global health. Fogarty trainees have become scientific leaders and decision-makers and are now training the next generation of researchers in the U.S. and other countries. Collectively, these efforts have helped build international science networks that are actively tackling emerging infectious diseases and other health problems that affect us all. Fogarty is an integral component of NIH - training scientists for global health research, fostering international research networks, and strengthening the research infrastructure abroad that NIH relies upon to support vital research.
Fogarty’s work benefits America in many ways. For example, training scientists in developing countries equips them to study pandemics at their point of origin, quickly contain outbreaks, and prevent or limit the spread of disease to the United States, thereby ensuring our nation’s safety and security.
Fogarty programs also extend the reach and competitiveness of U.S. universities where there is high demand for international research opportunities. Currently, Fogarty supports over 500 research and training projects involving 100 universities. Roughly 80 percent of Fogarty grants are awarded to U.S. institutions and nearly all Fogarty awards involve U.S. researchers. These U.S. institutions partner with research institutions in low- and middle-income countries (LMICs), helping to build long-term relationships that provide scientific and training opportunities for both partners. Fogarty-facilitated collaboration with international researchers helps these American scientists remain globally competitive and at the forefront of scientific discovery.
Global health research also pays dividends through scientific breakthroughs that result in new treatments that can benefit Americans suffering from the same conditions. Important discoveries in cancer, HIV/AIDS, brain disorders, and child health were based on research conducted in LMICs and are now the basis of treatments in the United States.
Fogarty’s approach is to enable scientists to conduct research where health problems are most prevalent and find solutions with global relevance. In fiscal year 2020, Fogarty will continue to strengthen the scientific workforce in the United States and abroad to conduct research with global impact and address the existing and future threats that affect us all.
Innovations and Discoveries
Strengthening the Biomedical Research Workforce
Since its establishment, Fogarty has supported training for more than 6,000 scientists who represent a diverse and talented biomedical research workforce in the U.S. and abroad prepared to address emerging and future global health challenges. For example, Fogarty’s
Global Health Program for Fellows and Scholars supports U.S. university consortia to provide collaborative, mentored research training in LMICs for researchers from both the United States and LMICs. Recently, Fogarty placed a
clinical psychologist who trained at the Morehouse School of Medicine in Atlanta in Liberia, making her the first-ever Fogarty Fellow in the country. She used her fellowship to study the mental health and psycho-social challenges facing communities and individuals affected by the Ebola outbreak. The findings from her fellowship can inform how care is provided following large-scale health emergencies or natural disasters, which is relevant to Liberia as well as disaster-affected communities in the United States.
Investing in the training of global health researchers often has a multiplier effect. For example, in 2011 a Fogarty Fellow and
neurologist from Harvard University conducted his fellowship in Zambia, a country that only had three neurologists for a population of more than 14 million. He continued to work in Zambia after his fellowship and recently helped establish Zambia’s first-ever neurology training program to help address this gap.
Past Fogarty trainees are now playing instrumental roles in research funded by other Institutes and Centers at NIH. In 2005, a Peruvian infectious disease specialist received advanced training at the University of Washington through Fogarty’s AIDS International Training and Research Program. The researcher is now a widely-respected infectious disease researcher and was recently selected to
lead a trial site in Peru studying the safety and effectiveness of a vaccine for the Zika virus developed by the National Institute of Allergy and Infectious Diseases (NIAID).
Building on Basic Science
Fogarty-supported researchers are translating basic science into clinical knowledge, innovation, and improved health. For example, a novel treatment for hydrocephalus is revolutionizing how the condition is treated and is lowering costs in resource-poor and high-income countries alike. Hydrocephalus is the accumulation of fluid in the brain that is typically treated by the placement of a shunt to drain excess fluid. However, these shunts generally fail within two years, requiring a costly, emergency surgery. Fogarty-supported research in Uganda showed that a novel treatment for hydrocephalus eliminates the need for shunt placement without affecting the neurological development of children. The investigator behind this discovery, a pediatric neurosurgeon from Boston Children’s Hospital, has helped spread the technique, which is now being implemented in major pediatric neurosurgery centers across the United States. The innovative treatment lowers costs and reduces the morbidity and mortality of children who are no longer dependent on shunts for their lifetimes.
In 2006, a Fogarty Fellow in Zimbabwe began work to develop and test a novel, low-cost intervention to address widespread depression. In a country with very few psychiatrists, he trained local grandmothers to deliver talk therapy in public “friendship benches.” His 2012 Fogarty Fellowship at the University of California, Berkeley enabled him to build evidence around the intervention and improve the program. More recently, a randomized control trial funded by Grand Challenges Canada showed that the approach is remarkably effective, and it is now being adapted and deployed in other countries with shortages of mental health professionals. Additionally, community health workers and peer counselors in New York City recently began using the model to help address the high demand for mental health services.
The global effort to combat the HIV epidemic has given millions of people access to antiretroviral therapies, allowing them to live longer with HIV. However, a growing number of people living with HIV (PLHIV) are also acquiring non-communicable diseases (NCDs) as they age. In response to this trend and with support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), Fogarty launched “Research to Guide Practice: Enhancing HIV/AIDS Platforms to address NCDs in sub-Saharan Africa”. This effort maximizes the impact of investments the U.S. Government has already made in HIV care in sub-Saharan Africa and builds the evidence base necessary to integrate NCD prevention, care, and treatment into existing HIV care platforms. The project recently developed a research agenda that provides scientists, implementers, and policy makers with a wealth of information which can inform their research questions and investments regarding integrated HIV/NCD care. Another important outcome from this project is the development of mathematical models to predict the burden of NCDs in PLHIV in select countries, which can also inform decision-making at the policy level. Findings from this project can also be utilized to inform NCD care for populations beyond PLHIV both here in the United States and abroad.
Chronic exposure to infectious disease-causing enteric pathogens has a harsh impact on child nutrition and may also lead to cognitive and related developmental deficits. Better understanding of the complex relationships between intestinal pathogens and malnutrition is important to improving the health of children in developing countries as well as in the United States. Fogarty is partnering with the Bill & Melinda Gates Foundation to support an international network of scientists across multiple institutions that recently generated one of the largest, high-quality datasets on the relationship between environmental exposure to pathogens and child development. Findings from this study can inform public health interventions and nutrition strategies for children in the United States and abroad.
Transformational Tools and Technologies
Fogarty-supported researchers have recently made significant advances in developing and harnessing low-cost technologies to improve health. For example, a grantee from Fogarty’s Mobile Health: Technology and Outcomes in Low- and Middle-Income Countries (mHealth) program recently developed and evaluated a smartphone decision support system that assists traditional birth attendants in Guatemala in identifying pregnancy and birth complications during home deliveries. Use of this mHealth tool resulted in more mothers being referred to health care facilities for complications, helping reduce maternal and perinatal mortality.
Fogarty-supported training also enables the development and advancement of innovative tools and technologies. For example, Fogarty-supported research at the University of Virginia led to the development of an inexpensive, anti-bacterial water filter to help prevent childhood diarrheal disease. Recently, a post-doctoral fellow involved in this research project followed it up with additional field tests to improve the filter and recently built a business around it, with current operations in Haiti, Dominican Republic, Mexico, India, Thailand, Uganda, Zambia, and other countries.
Exploring the Next Frontier
Fogarty is preparing for emerging and future threats to global health by building capacity for research and supporting cutting-edge research. Cancer is the second leading cause of death in the world, causing about one in every six deaths. Cancer research in LMICs, where most cancer deaths occur, enables learning that can also improve strategies for the prevention, screening, and treatment of cancer in the United States. Two Fogarty Fellowships and a grant administered by Fogarty and associated with the Medical Education Partnership Initiative (MEPI) helped address this need by building capacity in Malawi for cancer research. MEPI is a partnership between the Office of the U.S. Global AIDS Coordinator, the HIV/AIDS Bureau of the Health Resources and Services Administration, and several NIH Institutes. The grant in Malawi helped catalyze cancer research through improved cancer registries, specialized training, development of a cancer clinic, and establishment of the country’s first pathology lab. Two Fogarty Fellows in Malawi further stimulated the field through their research and networks. Together, these investments laid the groundwork for important publications on HIV-related malignancies and subsequent research grants, as well as the establishment of the Malawi Cancer Consortium, a collaboration between the University of North Carolina at Chapel Hill, the National Cancer Institute (NCI), and several Malawian institutions. The Consortium is now one of the most productive cancer clinical research programs in a low-income country and contributed to recent discoveries in cancer immunotherapy and low-dose chemotherapy.
The rich genetic diversity of African populations likely holds clues to better health for humans across the globe. Until recently, African researchers and African populations had largely been left out of genomics studies, thereby limiting the impact of this field of work. In response to this need, Fogarty, the National Human Genome Research Institute (NHGRI), and the National Institute of Environmental Health Sciences are co-leading the Human Heredity and Health in Africa (H3Africa) program, in collaboration with the NIH Common Fund, eleven other NIH Institutes and Centers, the Alliance for Accelerating Excellence in Science in Africa, and the Wellcome Trust. Recent activities of H3Africa enabled African scientists to develop and use advanced genomics and bioinformatics tools to better understand relationships between genetics, environment, disease, and medicine in Africa. For example, an H3Africa-funded scientist conducted a genomic analysis of the recent Lassa fever outbreak in Nigeria suggesting that rats were responsible for the spread of the disease. The analysis helped Nigerian officials combat the spread of the disease and will help researchers develop a vaccine against it. H3Africa scientists have also made important contributions to genomics research related to high blood pressure, stroke, obesity, and hearing loss.
Strengthening the Biomedical Research Workforce
Building on decades of research training experience, the Fogarty International Center will continue to invest in current and future leaders in global health research, strengthening the long-term capacity of research institutions to become sustainable platforms for cutting-edge science, and catalyzing meaningful collaborations between and among institutions in the United States and abroad.
For American researchers, Fogarty offers interdisciplinary and cross-cultural experiences, enabling them to understand the diverse health challenges and opportunities of working in low-resource and international settings and establish partnerships with local researchers to tackle complex global health issues. Fogarty’s Fellows and Scholars program, the Fulbright-Fogarty Fellowship, and the International Research Scientist Development Award offer mentored, research training experiences overseas on health conditions that are not easily studied in the United States. For example, recent Fellows have studied unique health problems such as a rare, pediatric eye cancer in Ethiopia and the connection between skin infection and rheumatic heart disease in Uganda. In FY 2020, Fogarty will continue to provide these types of experiences to enable fellows to become leaders in their fields and contribute to global health research throughout their careers.
Fogarty also supports research training of scientists in LMICs who, with their intimate knowledge of the local context, are uniquely poised to make discoveries with global relevance. Fogarty continues to support training in health areas such as brain disorders, chronic non-communicable diseases, HIV/AIDS, infectious diseases, mHealth, and trauma and injury. Past Fogarty-trained investigators are now leaders in academic institutions and ministries of health in their home countries and are now training the next generation of scientists and leaders in their countries, leading to a compounded return on scientific investment. For example, former Fogarty grantees from the AIDS International Training and Research Program have gone on to develop robust training programs at their home institutions. These Fogarty grantees, along with their own trainees, are making an enormous impact on virtually every area of HIV/AIDS science, including discoveries that have informed treatment protocols now used in the United States. Fogarty will continue to support the training of LMIC scientists as they become global health research leaders in their countries and contribute to science with global relevance.
Looking to the future, Fogarty has recently partnered with the African Academy of Sciences and the Bill & Melinda Gates Foundation to launch the African Postdoctoral Training Initiative (APTI). APTI fellows will train in priority health areas in NIH laboratories and then return to their home countries to become scientific leaders and help train the next generation of investigators in their communities.
Fogarty also prioritizes research and research training for chronic, non-communicable diseases (NCDs), which are becoming increasingly prevalent in LMICs as well as the United States. Alzheimer’s disease, for example, is the sixth leading cause of death in the United States and its prevalence is rising rapidly in LMICs. Fogarty trainees from the United States and abroad are conducting important Alzheimer’s disease research, often through research funded by other NIH Institutes and Centers. For example, Fogarty trainees in Colombia are contributing to the National Institute on Aging’s (NIA) first-ever prevention trial for Alzheimer’s disease in Colombia investigating whether a drug can delay or stop the disease. NIA is also providing supplemental research funding to several Fogarty grantees to expand their research training programs to include Alzheimer’s disease and related dementias. For example, the University of Maryland, Baltimore will work with an institution in Nigeria to improve training on ethics in Alzheimer’s research. Another supplemental award will integrate Alzheimer’s research into an HIV/AIDS research training project in Uganda while a third award will emphasize dementia research in studies with rural populations, also in Uganda. Looking to the future, Fogarty will continue to prioritize research and research training for high-priority NCDs that affect people in LMICs and the United States.
Building on Basic Science
Fogarty is committed to building on basic science research and ensuring that proven health interventions are translated, implemented, and brought to scale. Therefore, Fogarty prioritizes implementation science, which is the study of methods to promote the integration of research findings and evidence into healthcare policy and practice. Implementation science improves the effectiveness and efficiency of the research process and encourages the implementation of policies and programs that are based on robust scientific evidence.
Fogarty continues to support research and research training in implementation science across its extramural programs related to topics such as non-communicable diseases, mental health, trauma and injury, and infectious diseases. For example, Fogarty-supported investigators at Emory University are integrating implementation science into training programs for tuberculosis research (TB) in the countries of Georgia and Ethiopia. Both countries have high burdens of multi-drug resistant TB, which is one of the top ten causes of death worldwide. By integrating implementation science into this program, trainees are better able to produce research findings that will be translated into public health policies and practices.
Building on its investments in implementation science research and training, Fogarty continues to catalyze interactions between researchers, program implementers, and policymakers to maximize public health outcomes and improve the return on investment from U.S. Government programs, such as PEPFAR. An example of this is the Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA) - a Fogarty-convened network. AIDS is the leading cause of death of adolescents in Africa, with young women twice as likely to acquire HIV as young men. However, there have been very few studies on treatment and care for this age group, resulting in a poor understanding of how to best implement health services for them. AHISA is a network of NIH-funded scientists conducting relevant implementation research and their in-country partners, including key government representatives, research collaborators, and other stakeholders. Through these collaborations, AHISA enhances the effectiveness of PEPFAR by promoting the use of evidence to improve the prevention, screening, and treatment of HIV among adolescents. Looking to the future, Fogarty will continue to seek out opportunities to leverage implementation science and facilitate greater collaboration between researchers, program implementers, and policymakers to enhance the effectiveness of U.S. Government programs.
Transformational Tools and Technologies
Fogarty continues to stimulate innovation in the development and implementation of low-cost tools, medical devices, and other technologies with the potential to transform global health. For example, Fogarty’s mHealth program supports research to develop or adapt innovative mobile and wireless technologies specifically suited for low- and middle-income countries (LMICs) as well as the study of the effectiveness of interventions delivered through phones and tablets for improving health. An mHealth program grantee from Duke University is currently studying the feasibility, acceptability, and impact of a smartphone app designed to improve adherence to pre-exposure prophylaxis (PrEP) among HIV-positive youth in Thailand. The study is poised to help inform how social media and game-based mechanics can be used to improve adherence to PrEP medications, which may also be relevant for other medications and in other countries, including the United States.
Fogarty recently partnered with the National Institute of Biomedical Imaging and Bioengineering (NIBIB) on a grant to support the launch of a new research center led by Northwestern University focused on the development of low-cost, point-of-care technologies to improve the diagnosis, treatment, and management of HIV/AIDS in rural parts of Africa. The program targets the development and testing of technologies that improve the detection and monitoring of HIV as well as related complications, such as tuberculosis, hepatitis, diabetes, heart disease, and certain cancers. Technologies developed through this program can also be useful for rural areas of the United States, where access to health care facilities and equipment is limited.
Fogarty’s in-house research unit is expanding use of computational modeling, real-time genomic sequencing, and Big Data to better understand disease transmission and outbreak dynamics of threats such as influenza, Ebola, and more. These tools can help improve the effectiveness of vaccines and vaccination strategies and inform the U.S. response to future pandemics.
In FY 2020, Fogarty will continue to harness innovative tools and technologies to advance science with global impact.
Exploring the Next Frontier through Strategic Partnerships
Fogarty serves as a focal point for global health at the NIH, engaging with and supporting other NIH Institutes and Centers by leveraging our investments to advance their research agendas for global health. In addition to robust partnerships across the NIH, Fogarty also works closely with the other Agencies in the U.S. Government. For example, Fogarty partners with the National Science Foundation and the Department of Agriculture on the Ecology and Evolution of Infectious Diseases Initiative, which supports interdisciplinary research on the relationship between environmental factors and the emergence and transmission of infectious diseases.
Beyond the U.S. Government, Fogarty partners with key external public and private entities to further the global health research agenda. For example, Fogarty and other NIH Institutes and Centers collaborate with the South African Medical Research Council to fund U.S. and South African scientists studying HIV/AIDS, tuberculosis and HIV-related comorbidities, and cancers. The partnership harnesses the scientific expertise of both countries, strengthens South African research capacity, and facilitates long-lasting partnerships between U.S. and South African investigators.
Fogarty also leads NIH representation in the Global Alliance for Chronic Diseases (GACD) - a group of 13 international research funders, such as the UK Medical Research Council, the Canadian Institutes of Health Research and the Indian Council of Medical Research. GACD supports research projects that address the prevention and treatment of chronic diseases in vulnerable populations around the world. By engaging a diverse group of funding organizations, GACD is better able to facilitate sharing of best practices, develop international collaborations, and promote complementarity in global health research funding.
In FY 2020, Fogarty will continue to leverage complementary interests and strengths of its partners to advance global health research.
Adapted from the
fiscal year 2020 justification of budget request for the John E. Fogarty International Center for Advanced Study in the Health Sciences.
Updated March 2019