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FY 2009 Statement of the Director

Fiscal Year 2009 Hearing on Collaborations in Biomedical Research

Statement by
Roger I. Glass, M.D., Ph.D., Director
Fogarty International Center

Witness appearing before the House Subcommittee on Labor-HHS- Education Appropriations

Richard J. Turman, Deputy Assistant Secretary, Budget

March 5, 2008

Mr. Chairman and Members of the Committee:

I am pleased to present the President's Budget for the Fogarty International Center (FIC) of the National Institutes of Health (NIH). The Fiscal Year (FY) 2009 budget of $66,623,000 includes an increase of $65,000 over the FY 2008 appropriated level of $66,558,000.

Over the past several years, Congress has increasingly invested money involving problems of global health, recognizing that investments in health research and training not only improve the health of all, but foster international diplomacy, economic development, and U.S. competitiveness. The John E. Fogarty International Center has been a leader at the National Institutes of Health (NIH) to promote global health research and training, and graduates of Fogarty programs have become key collaborators with U.S. investigators and scientific leaders in their home countries.

Fogarty supports and facilitates global health research conducted by U.S. and foreign investigators, builds collaborations with health research institutions worldwide, and is a primary NIH sponsor of training for the next generation of global health scientists. Fogarty programs encompass infectious diseases, including HIV/AIDS, malaria, and tuberculosis (TB), and link U.S. and foreign institutions in partnerships for training and research. Over the past two decades, these programs have trained local investigators and decision makers in these fields. Some programs target critical non-communicable diseases such as brain disorders and tobacco-related illness, while others build robust research environments overseas, including programs that strengthen capacity in research ethics and informatics for health research.

To take stock of current challenges and plan for the future, Fogarty has developed a Strategic Plan that will guide priorities through FY 2013. This Plan takes us in some new groundbreaking directions, while reinvigorating key areas of current investment.

ADDRESS THE GROWING BURDEN OF NON-COMMUNICABLE DISEASE

According to the World Health Organization (WHO), roughly 388 million people worldwide will die in the next 10 years of chronic, non-communicable diseases if the world does not work quickly to reverse the toll of these largely preventable diseases. Chronic disease is currently responsible for 60 percent of deaths worldwide, and 80 percent of chronic disease deaths occur in low- and middle-income countries. This trend is not only a growing health threat, but is an obstacle to economic development in many countries. In addition, the world's population aged 60 and over, which currently represents slightly more than half the number of 15-24 year olds, is rising sharply and is projected to surpass one billion within two decades. Fatty diets, reduced physical activity, and tobacco use are all on the rise in developing countries. With increasing longevity, the convergence of risk factors and diseases blurs the distinction between "developing" and "developed" countries and calls instead for a common research agenda.

For example, according to the WHO, tobacco is the second major cause of death in the world, killing more than 5 million people each year. If current smoking patterns continue, this number will double by 2020, with approximately 80% of the deaths occurring in developing countries. Fogarty, in partnership with the National Cancer Institute and the National Institute for Drug Abuse, is helping to address this rising epidemic through its International Tobacco and Health Research and Capacity Building Program. This program enhances the ability of scientists in low- and middle-income nations to understand risk factors for smoking uptake, particularly in youth, to develop effective prevention and mitigation programs, and to identify the most effective health service and communications strategies to reduce the negative impacts of smoking on populations. The knowledge gained and interventions developed abroad through the Tobacco Program will also benefit U.S. populations who share common risk factors with low-resource communities in developing countries. In addition, this program's emphasis on developing effective interventions to preempt smoking not only results in a reduction of tobacco-related illnesses in a variety of settings, but could also reduce health care costs.

International research collaborations to study non-communicable diseases in highly endemic areas can accelerate scientific advances on how to prevent and treat these diseases around the world. These activities would build on the strong foundation of infectious disease research in endemic countries and integrate many of the same cross-cutting disciplines and research methodologies used in infectious disease. Recent discoveries also indicate that infectious agents play a role in many chronic diseases, including several cancers and epilepsy. Therefore, understanding the nexus between infectious disease and chronic disease is emerging as a cutting-edge field of biomedical research, and will be incorporated into Fogarty's plans to increase investments in non-communicable disease research and training.

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FORGING NEW GROUND IN IMPLEMENTATION SCIENCE

A one-size-fits-all approach is not effective in diverse cultural, economic, political and religious settings. Therefore, there is an urgent need to ensure that researchers receive training to bridge the gap between "what we know" and "what we do." We need to identify the most effective ways to translate research findings into practice. Fogarty will advance this area of science, by identifying the tools, methods, and training needed to build an "implementation science" research workforce.

Some Fogarty programs are already making inroads in this field. For example, we recognized that in addition to supporting HIV/AIDS research, to help programs such as the President's Emergency Plan for AIDS Relief and the Global Fund to Fight HIV/AIDS, TB and Malaria to be sustainable, countries would need scientists with the research skills to overcome implementation barriers as prevention, care and treatment programs are rolled out and scaled up in their countries. To this end, Fogarty's International Clinical, Operational, Health Services Training Awards for AIDS and TB have begun strengthening the skills of scientists in low- and middle-income countries to conduct research around the implementation of promising HIV and/or TB interventions at the population and health care system levels.

In particular, despite the targeting of resources invested by the U.S. government in addressing the global HIV/AIDS epidemic, infection rates continue to rise. According to the WHO, for every person who is in treatment, six people become newly infected. Building an international implementation science workforce is critical to effective implementation of prevention interventions in the hardest hit endemic countries. Lessons learned in such low-income settings can also inform the use of HIV prevention services here at home. Fogarty is also supporting the President's Malaria Initiative (PMI) in a small, but critical way, through grants in Malawi and Uganda. Several tools to prevent and treat malaria are available and proven; however, how to best deliver malaria interventions to large numbers of vulnerable people and evaluate their impact remains a challenge. Therefore, expanding malaria clinical training and developing expertise in operational and health services research is an urgent priority. Grantees are planning comprehensive research training programs that help build capacity in PMI countries to address the challenges of malaria control, and to translate research findings into policy and interventions.

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INVESTING IN FUTURE LEADERS IN GLOBAL HEALTH RESEARCH

Biomedical research has always been an inherently international enterprise. Many significant scientific advances have resulted from research conducted by teams of scientists working across international borders. In this era of globalization, this trend will not only continue, but will likely become stronger. It will also require a well-trained cadre of U.S. health scientists who are able to work seamlessly in diverse settings. If we are to continue to lead in biomedical research, then U.S. researchers must be encouraged to effectively participate in international science.

For these reasons and in response to the soaring interest in global health at U.S. academic institutions, the Fogarty International Clinical Research Scholars Program provides highly motivated U.S. medical and graduate students in the health sciences the opportunity to experience one year of mentored clinical research training at distinguished low- and middle-income research institutions. Each U.S. student is paired with a foreign student, who also receives training as an equal partner. Training sites are located in a variety of countries, including Bangladesh, Brazil, China, Haiti, India, Kenya, Peru, South Africa, Thailand, and Uganda. This program to date has supported nearly 100 U.S. scholars and a comparable number of foreign students. The program has now been extended to provide similar support for individuals at the end of their medical residency or during post-doctoral fellowships. Several NIH Institutes have now enthusiastically joined this program; therefore, the research projects conducted by the scholars have expanded to address specialties that reflect the particular missions of these Institutes, such as cardiovascular disease and cancer.

Congressman John E. Fogarty, after whom our Center was named, was prescient in arguing the needs and rewards of global health research a half century ago. Fogarty is extending his vision, given that international trade, travel and the Internet have created a truly integrated and interdependent world. Fogarty has set an ambitious course for the years ahead, addressing emerging areas of science and shifting disease burdens, and helping to build the global health research workforce in the U.S. and around the world. We envision a world in which numerous centers of research excellence in the developing world will support a skilled scientific workforce that understands how to improve health outcomes and systems through rigorous research. These centers will be linked with each other through the open exchange of data and information and communications technologies. Working towards this vision moves us closer to the ideal of global health, one that reflects the aspiration of every human being on the planet to live a long and healthy life.

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Name:	Roger I. Glass, M.D., Ph.D.
Present Position:	June 2006 to Present:   Associate Director for Int'l. Research and Director, Fogarty International Center Department of Health and Human Services National Institutes of Health
	1986-2006   Chief, Viral Gastroenteritis Section, Respiratory and Enterovirus Branch Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases Centers for Disease Control & Prevention (CDC)
	1996    Clinical Professor, Division of Infectious Diseases Department of Pediatrics, Emory University School of Medicine
	1986-1996   Clinical Associate Professor, Division of Infectious Diseases Department of Pediatrics, Emory University School of Medicine
	1991-present   Adjunct Professor, Division of International Health School of Public Health, Emory University
Education:	1963    Graduated from The Lawrenceville School, Lawrenceville, NJ 1963-67   Harvard College, (magna cum laude A.B.), Cambridge, MA 1967-68   Fulbright Fellowship, Argentina-Brazil (Univ. of Buenos Aires) 1968-72   Harvard Medical School, (M.D.), Boston, MA 1970-72   Harvard School of Public Health, (M.P.A.), Boston, MA 1972-73   Internship: Cambridge Hospital (Harvard Medical School), Cambridge, MA 1974-76   Resident in Internal Medicine - Mount Sinai Hospital, New York, NY 1984   University of Goteborg, Goteborg, Sweden, (Ph.D.), Prof. Jan Holmgren
Board Certification:	1976   American Board of Internal Medicine 1977   American Board of Preventive Medicine 1983   American Board of Epidemiology
Medical Licenses:	Georgia, New York, New Jersey, Maryland
Languages:	French, Spanish, Russian, Portuguese, Bengali
Military Service:	1977-present, U.S. Public Health Service, Medical Director (0-6)
Societies:	American Epidemiology Society American Society for Virology American College of Epidemiology - Fellow Society for Epidemiologic Research Infectious Disease Society - Fellow American Association for Advancement of Science American Society of Microbiology American Academy of Microbiology American Association of Physicians
Honors and Other Special Scientific Recognition:	1967-68   Fulbright Fellowship, Univ. of Buenos Aires, Argentina 1976   Chief of Medicine, Research Award, Mt. Sinai Hospital 1980   Alexander D. Langmuir Prize, CDC 1983   William Jump Award, Department of Health and Human Services 1988   Commendation Medal, U.S. Public Health Service 1994   James H. Nakano Citation, National Center for Infectious Diseases 1994   Outstanding Service Medal, U.S. Public Health Service 1996   Outstanding Unit Citation, National Center for Infectious Diseases 1998   Children's Vaccine Initiative, Geneva-Pasteur Award for Recent Contributions to Vaccine Development - Rotavirus Vaccine 2000   Secretary's Award for Distinguished Service (DHHS) 2003   Membership, Institute of Medicine, U.S. National Academy of Science 2007   Charles C. Shepard Lifetime Scientific Achievement Award (CDC)
Special Projects:	1972-78   Work with the U.S.-U.S.S.R. Joint Committee on Environmental Health Research 1973-74   Sysin Institute for General and Communal Hygiene, Moscow (5 months) 1976   Institute of Nutrition for Central America and Panama (INCAP) Research on the health consequences of natural disasters (Dr. J.J. Urrutia) (2 months) 1978   Evaluation of the famine in Zaire, (CDC) (2 months) 1979   Health surveillance for Cambodian refugees arriving in Thailand, International Committee of the Red Cross (ICRC) (2 months) 1982   Control of cholera in Aceh Province, Indonesia (2 months) 1991   Epidemiological Evaluation of the effects of the cyclone in Bangladesh, UNICEF 1992   Survey- Humanitarian assistance in the Newly Independent States of the former U.S.S.R., USAID/Department of State 2001   Bioterrorism Engagement Program - Studies in Russia with former bioweaponeers
Patents:	Astrovirus sequence and its application for use in diagnostics and vaccines (1993-CDC) Neonatal rotavirus strain 116E for use as a rotavirus vaccine (1994-CDC)
Research Areas:	Epidemiology of infections, enteric diseases, cholera, rotavirus, and viral agents of gastroenteritis; Vaccinology and new vaccine development and testing; Assessment of the disease burden of enteric infections; Virology and virus diagnostics; Food- and water-borne diseases and their control; Global Health

Department of Health and Human Services
Office of Budget
Richard J. Turman

Mr. Turman is the Deputy Assistant Secretary for Budget, HHS. He joined federal service as a Presidential Management Intern in 1987 at the Office of Management and Budget, where he worked as a Budget Examiner and later as a Branch Chief. He has worked as a Legislative Assistant in the Senate, as the Director of Federal Relations for an association of research universities, and as the Associate Director for Budget of the National Institutes of Health. He received a Bachelor's Degree from the University of California, Santa Cruz, and a Masters in Public Policy from the University of California, Berkeley.

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