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Striving for equity in global health research collaborations at NIH

March 5, 2024

Photo of Dr. Peter Kilmarx smilingRead recent blogs and articles from Acting Fogarty Director Dr. Peter Kilmarx. I'm happy to report that NIH is working to promote equity across its global health research activities. A new update from an internal working group describes several relevant initiatives already taking place. Among the highlights is Fogarty's own plan, begun just last year, to provide current grant recipients with additional funding to promote diversity, equity, and inclusion (DEI) in research training programs. To do our part in creating more diverse global health research teams, Fogarty earmarked more than $1.7 million to distribute as administrative supplements (additional monetary support for currently funded grants). So far, our recipients have used the funds to support the training of: Health workers from the semi-nomadic Turkana tribe in Kenya; indigenous, Quechua-speaking neuroscientists in Peru; women working as junior faculty in trauma and injury research in the Middle East; and junior and mid-career scientists from underrepresented minorities in India. This is a start with more to be done.

The NIH Global Health Research Equity Working Group has representatives from nine NIH Institutes and Centers and a mission to encourage and enable global research collaborations grounded in a shared vision among all partners, with equitable input and decision-making throughout the research process. These collaborations need to focus on fair access to data and research outcomes, shared benefits, and bi-directional learning and capacity strengthening. NIH established the group in 2021 and issued a Request for Information (RFI): Promoting Equity in Global Health Research in May of that year. Reactions, captured in the Report on Request for Information on Promoting Equity in Global Health Research, fell into six buckets. Respondents expressed concerns about 1) equitable partnerships; 2) funding limitations and structures; 3) scientific and administrative capacity needs; 4) research priority setting; 5) data access and ownership; and 6) peer review processes.

Bill Pape reviews information on a mobile device with three researchers in a hallway Photo courtesy of Bahare Khodabanda/ Weill Cornell Medicine

For example, RFI feedback identified a lack of training in grants management as a barrier to applying for and administering NIH grants. The Working Group's update noted that the Global Infectious Disease Research Administration Development Award from the National Institute of Allergy and Infectious Diseases (NIAID) aims to address this issue for their global research community. The award supports advanced training in NIH grants policy, financial management, and compliance with NIH scientific reporting requirements for senior administrators from institutions in low- and middle-income countries (LMICs).

NIH's peer review process also raised concerns among respondents to the RFI, who suggest it potentially reflects reputational and seniority bias. Applicants who've previously received NIH funding, authored high-impact papers, and/or had opportunities to visit NIH are believed to be more likely to receive funding. Moreover, well-established LMIC investigators and institutions are perceived to dominate the NIH LMIC grantee pool. NIH's new Simplified Peer Review Framework for NIH Research Project Grant (RPG) Applications, slotted to go into effect in January 2025, focuses on the scientific and technical merit of grant applications with the investigator's expertise and resources rated solely on whether they are sufficient to conduct the research.

Additionally, RFI respondents shared several strategies for achieving equitable partnerships, including recommendations related to NIH application requirements. Relatedly, the National Institute of Mental Health (NIMH) has embedded components of equitable partnerships into a recent funding opportunity aimed at improving mental health outcomes in LMICs. For studies to be considered for funding, key personnel will need to have sufficient knowledge of the social and cultural contexts of the LMIC where their work takes place. Grant recipients are required to design their projects in collaboration with in-country partners so that research priority-setting is locally driven.

This photograph shows a field researcher from Universidad del Valle de Guatemala (UVG) using a mobile data collection tool for greater efficiency, during door-to-door interviews, for an antimicrobial resistance (AMR) research project in Quetzaltenango, GuatemalaPhoto courtesy of CDC/ Nicholas S. Tenorio.

In its update, the Working Group also acknowledges that equitable global research is an on-going effort. Accordingly, it's been developing next steps to address the barriers and challenges cited in the RFI, in other peer-reviewed and gray literature, and in numerous consultations with LMIC and U.S. investigators. Fogarty is one of nine Working Group institutes defining these next steps alongside National Cancer Institute; National Heart, Lung, and Blood Institute; National Institute of Allergy and Infectious Diseases; Eunice Kennedy Shriver National Institute of Child Health and Human Development; National Institute of Environmental Health Sciences; National Institute of Mental Health; National Institute of Neurological Disorders and Stroke; and National Library of Medicine.

Equitable partnerships and a diverse workforce amplify the impact and robustness of scientific research, while also increasing the probability that the health needs of all populations within each society will be addressed. I'm so proud of Fogarty's leadership in helping the NIH advance equity throughout the research process. This has been one of my highest priorities as acting director.

More Information

Updated March 15, 2024

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