Research Capacity Building Programs of the Fogarty International Center, NIH International Affairs Committee Infectious Diseases Society of America San Juan, Puerto Rico June 21, 2002 Joel G. Breman, M.D., D.T.P.H.

Senior Scientific Advisor Fogarty International Center

Fogarty International Center

Science for Global Health

Mission

To promote and support research and research training internationally to reduce disparities in global health

NIH International Research Expenditures Fiscal Years 1994 to 2000 Fiscal Year 2000 140,000,000 120,000,000 100,000,000 80,000,000 60,000,000 40,000,000 20,000,000 0 1994 1995 1996 1997 1998 1999 2000 Visiting Program Direct Foreign Research Awards Foreign Components of Domestic Awards Training Grants Research = $203 million (66%) Training = $103 million (34%)

NIH Overall Expenditures on Tropical Infectious Diseases

Tropical Medicine Total Malaria TB Diarrheal Diseases Dengue Chagas Disease Pathogen sequencing (FY 01-02) Multilateral Initiative on Malaria Overall $195,548,00 57,833,000 56,039,000 54,578,000 7,060,000 10,119,000 60,000,000 900,000 $255,400,000

Fogarty International Center

Funding for Infectious Diseases & Other Programs Fiscal Year 2000: $35 million Other Programs:

FIRCA Biodiversity Informatics Environ & Occ MCH Career Dev Bioethics Others

44% AIDS: 38% Bioterrorism: 1% Malaria: 2% ABC/ICIDR: 3% Emerging Inf Dis: 5% Ecology Inf Dis: 4% TB: 3%

Fogarty International Center Programs and Collaborating Partners Fiscal Year 2000 Funding NIA FIC CDC FIC CDC FIC FIC NCCAM Population and Health $1.8 million Environmental and Occupational Health $2.0 million Emerging Infectious Diseases $2.7 million Research Bioethics $1.4 million NICHD NIEHS NIDCR NIAID NIAMS NHLBI NCMHD NIDA FIC NHLBI NCI Biodiversity $3.9 million NIMH NIAID USDA FIC NIAID FIC NIAID NCI NIAAA NIDCR NSF Ecology of Infectious Diseases $1.5 million NIEHS OAR AIDS International Training and Research $15.1 million NSF NCMHD NHLBI NIMH HRSA NIDA NICHD NINR FIC Maternal and Child Health $1.3 million NICHD FIC Tuberculosis $1.5 million USAID FIC $1.4 million NLM Medical Informatics NIAID NIAID FIC MIRT $5.5 million NCMHD

Fogarty International Center

Science for Global Health Major Training and Research Sites

Fogarty International Center

Science for Global Health Research Training Mechanisms

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Long-term training * pre- and post-doctoral training in U.S. institutions (duration: minimum 9 months)

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Short-term training * focused workshops and technology transfer (duration: several days to several weeks)

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Research performed preferentially in-country

Fogarty International Center

Science for Global Health Program Objectives

• • •

Train leaders in science and public health Establish centers of excellence in home countries Promote long-term collaborations between U.S. and foreign institutions

• •

Facilitate outstanding scientific research focused on problems of developing countries Facilitate trainees assuming positions of responsibility, authority, and influence

Fogarty International Center

Science for Global Health AITRP Accomplishments, Fiscal Years 1988-1998 FY88-93 FY94-98 Total Long-term training epidemiology and post-doctoral trainees countries In-country activities courses trainees countries 654 59 264 16,624 30 1,027 84 451 29,804 inc 1,681 98 715 46,428 65

Fogarty International Center

Science for Global Health AITRP-Supported Achievements (examples)

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China: Identified plasma donors at risk for HIV

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Kenya: Uncircumcised males at risk for HIV 1 and genital ulcers

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Uganda: Nevirapine injection to HIV-positive pregnant woman and neonates associated with 48% decrease in perinatal transmission

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Uganda and Haiti: Prophylaxis with INH and rifampin reduced TB and AIDS in HIV-positive persons

Fogarty International Center

Science for Global Health AITRP-Supported Achievements (examples) 2

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Vietnam: Subtype E (not Thai B) identified as main subtype among injection drug users and commercial sex workers

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Georgia: Develop National AIDS Prevention Program and National Blood Safety Program

International Clinical, Operational, and Health Services Research Training Award for AIDS/Tuberculosis (ICOHRTA - AIDS/TB)

ICOHRTA - AIDS/TB Emphasizes integration of therapy and care with prevention efforts and Builds capacity to support the integration of clinical, operational, and health services research

ICOHRTA - AIDS/TB

Fosters Major NIH International

• • • • • •

AIDS Research Efforts:

Prevention Trials Network Vaccine Trials Network Comprehensive International Program of Research on AIDS (CIPRA) Popular Opinion Leaders International Centers for Excellence in Research Partnerships for HIV/AIDS Research in Africa

ICOHRTA - AIDS/TB Fosters Major USG and Other International AIDS Research Efforts:

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CDC Global AIDS Program

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USAID Rapid Response (LIFE) Initiative

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Bill & Melinda Gates Foundation

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Elizabeth Glaser Pediatric AIDS Foundation

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Academic Alliance for AIDS Care and Prevention in Africa

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amFAR

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Global AIDS, TB, and Malaria Fund

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UNICEF, UNAIDS, and WHO AIDS and TB Programs

Fogarty International Center

Countries in Emerging Infectious Diseases Program, 2001 Haiti Mexico Guatemala Ecuador Peru Bolivia Lithuania Czech Republic Hungary Latvia Armenia Russia Kazakhstan Poland Georgia China Mali Ethiopia Pakistan Belize Nicaragua Ghana Kenya India Philippines Venezuela Brazil Malawi Indonesia New Guinea Paraguay Chile

ITREID Collaborations

• •

U.S. principal investigators: 13 Countries: 36

– – – –

Americas: 12 Eastern Europe: 10 Asia: 8 Africa: 6

ITREID Accomplishments FY 1998 1999 2000 2001* Total

Pre/post-doctoral trainee years 48 100 93 74 315 In-country -Courses -Trainees -U.S. faculty participation 33 2589 46 25 1130 60 26 1473 41 26 1045 38 110 6237 185 *2001, partial data: new countries are Bangladesh, Estonia, Rwanda, and Sri Lanka

ITREID Accomplishments

continued

Scientific Output and Awards, FY 2000

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Science progress

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Presentations, 104 Publications, 109 (submitted, accepted, published)

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Awards

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FIRCA award received by trainee from Czech Republic to work on C. parvum (NY State Dept of Health) Best poster European Society of Virology, molecular epidemiology of hepatitis C in Czechoslovakia (UC Berkeley)

ITREID Pathogen Foci

Bacterial Diseases

Bartonella bacilliformis Corynebacterium diphtheriae

Leptospira

Mycobacterium tuberculosis, M. avium Streptococcus pneumoniae

STDs (chlamydia, gonococci)

ITREID Pathogen Foci

Parasitic Diseases

Entamoeba histolytica

Leishmania

Plasmodium falciparum, P. vivax Schistosoma hematobium

Trypanasomes

ITREID Pathogen Foci

Viral and Rickettsial Diseases Dengue “Diarrhea” and El Niño Human papilloma virus Rickettsia prowazakii and R. felis

Fogarty International Center

Science for Global Health Principles for Capacity Building and Sustainability

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Long-term commitment * National * Institutional * Trainee

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Re-entry grants for trainees

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Diversified program themes

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Mentoring and networking

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Dual appointments for faculty

Global Health Research Initiative Program (GRIP) Purpose: Eligibility: Support Level: Combat “brain drain” – re-entry grants Support the best science and the best scientists to work on global health challenges Young scientists from resource-poor nations completing NIH-supported training in U.S. after returning home (NIH, academic centers, D43 programs) $50,000/year for up to 5 years for salary and research costs

Future and Focus of FIC Research Training Programs

• • • •

In-country research, re-entry awards Organization of scientific workshops by trainees Promotion and tracking of trainees’ careers Special attention to:

– –

Bioethics Good clinical practice involving human subjects

Fogarty International Center

Science for Global Health Principles for Capacity Building and Sustainability



Long-term commitment * National * Institutional * Trainee



Re-entry grants for trainees



Diversified program themes



Mentoring and networking



Dual appointments for faculty

Fogarty International Center

Science for Global Health Principles for Capacity Building and Sustainability (2)

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South-to-South collaboration

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Sustained linkages

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Contribution of resources from all partners

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Leverage resources for added support

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Connectivity via modern IT systems

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Centers of excellence in home countries

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Mutual benefits known to all

FIC Website:

http://www.nih.gov/fic