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February 03, 1998 Meeting Minutes

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service
National Institutes of Health
John E. Fogarty International Center
for Advanced Study in the Health Sciences

Minutes of the Advisory Board
Thirty-eighth Meeting

 

Table of Contents

Attendance
1. Call to Order
2. Consideration of Minutes of Previous Meeting
3. Review of Requirements for Confidentiality and Conflict of Interest Procedures
4. Future Meeting Dates
5. Report of the Director
6. The State of Science in the Newly Independent States of the Former Soviet Union
7. Cooperation and Reform in the Biomedical Research System in the Republic of Georgia
8. Report of the Long Range Planning Panel on National Library of Medicine International Programs
9. International Training Program in Medical Informatics
10. Closed Portion of the Meeting
11. Review of Application
12. Adjournment
13. Abbreviations

The meeting of the Advisory Board of the John E. Fogarty International Center for Advanced Study in the Health Sciences (FIC) was convened on Tuesday, February 3, 1998, at 8:30 a.m., in the Conference Room of the Lawton Chiles International House, National Institutes of Health (NIH), Bethesda, Maryland. The meeting was open to the public from 8:30 a.m. to 12:04 p.m., followed by the closed session for consideration of grant applications until adjournment at 2:00 p.m. Dr. Philip E. Schambra presided as Chair.

Board Members Present:

Dr. Marvin Cassman
Dr. Rita R. Colwell
Dr. Philip C. Hanawalt
Dr. Samuel L. Katz
Dr. Carl Kupfer
Dr. Thomas E. Malone
Dr. Cora B. Marrett
Dr. Donald O. Nutter

Board Members Absent:

Dr. Thomas W. Cole, Jr.
Dr. Adel A. F. Mahmoud

Members of the Public Present:

Dr. Gerson Sher, U.S. Civilian Research and Development Foundation

Federal Employees Present:

Ms. Frances Anderson, FIC/NIH
Dr. Laura Bautz, NSF
Ms. Susan Bettendorf, FIC/NIH
Dr. Joel Breman, FIC/NIH
Dr. Kenneth Bridbord, FIC/NIH
Ms. Stephanie Bursenos, FIC/NIH
Dr. Lois Cohen, NIDR/NIH
Ms. Paula Cohen, FIC/NIH
Ms. Eileen Conley, FIC/NIH
Ms. Irene Edwards, FIC/NIH
Ms. Sheila Feldman, FIC/NIH
Dr. Jean-Flagg Newton, ORMH/NIH
Dr. Arlene Fonaroff, FIC/NIH
Ms. Sylvia Funk, FIC/NIH
Dr. Charles Gardner, FIC/NIH
Ms. Mildred Hatton, FIC/NIH
Ms. Janet Healy, OD/NIH
Dr. Ruth Johnsson Hegyeli, NHLBI/NIH
Ms. Anne Hill, FIC/NIH
Dr. Sharon Hrynkow, FIC/NIH
Dr. Richard Krause, FIC/NIH
Ms. Silvia Mandes, FIC/NIH
Dr. Michael Micklin, CSR/NIH
Mr. Richard Miller, FIC/NIH
Dr. Philip E. Schambra, FIC/NIH
Ms. Heidi Schwab, FIC/NIH
Dr. Elliot Siegel, NLM/NIH
Ms. Linda Staheli, FIC/NIH
Ms. Jahna Stanton, FIC/NIH
Ms. Sonya Thomas, FIC/NIH
Ms. Natalie Tomitch, FIC/NIH

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OPEN PORTION OF THE MEETING

I. CALL TO ORDER

Dr. Philip E. Schambra, Director, FIC, called the open session of the Advisory Board meeting to order at 8:30 a.m. on Tuesday, February 3, 1998. He introduced and welcomed Dr. Marvin Cassman as a new ex officio member of the Board, and he congratulated Dr. Rita Colwell on her nomination as Deputy Director, National Science Foundation (NSF). [Note: Subsequent to the Board meeting, on February 13, President Clinton nominated Dr. Colwell as Director, NSF.]

In addition, Dr. Schambra noted that Dr. Gro Harlem Brundtland, the former Prime Minister of Norway, was nominated on January 27 as the next Director General of the World Health Organization. A final vote on her nomination will take place at the next World Health Assembly, which will be held in Geneva in May.

II. CONSIDERATION OF MINUTES OF PREVIOUS MEETING

The minutes of the Advisory Board meeting of September 23, 1997, were considered and accepted unanimously.

III. REVIEW OF REQUIREMENTS FOR CONFIDENTIALITY AND CONFLICT OF INTEREST PROCEDURES

Dr. Schambra thanked the Board members for providing their updated Confidential Financial Disclosure Reports to the FIC.

IV. FUTURE MEETING DATES

The following meeting dates were confirmed:

Tuesday, May 19, 1998
Tuesday, September 15, 1998

Tuesday, February 9, 1999
Tuesday, May 18, 1999
Tuesday, September 28, 1999

Dr. Schambra asked Board members to inform Ms. Irene Edwards, Executive Secretary, of any scheduling conflicts they may have with the future dates. All subcommittees of the Board will meet on the Monday preceding each Board meeting.

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V. REPORT OF THE DIRECTOR

The written Report of the Director was distributed previously to Board members, was available at the meeting, and is appended to these minutes as Attachment 2. Dr. Schambra highlighted several items related to personnel changes, program developments, and regional activities. Additional details can be found in his written report. Mr. Richard Miller, Executive Officer, FIC, reported on the FIC budget.

Personnel Changes

Dr. Schambra reported that Dr. William Paul has left the position of Director, Office of AIDS Research (OAR), NIH, to return to full-time laboratory research. Dr. Jack Whitescarver, who is Deputy Director, OAR, is now Acting Director. An active search is being conducted nationwide for a new director for the office.

At the FIC, Ms. Natalie Tomitch has joined the Division of International Relations (DIR) as Program Officer for Russia and the Newly Independent States. Dr. Kathleen Michels will join the FIC in February as a Health Scientist Administrator in the Division of International Training and Research (DITR); she will have responsibility for the Fogarty International Research Collaboration Award (FIRCA), the Senior International Fellowship Program, and fellowships sponsored by the Government of Japan. Dr. Schambra noted with regret that Dr. Jean Flagg-Newton, formerly in DITR, has left the FIC to become Special Assistant for Administration in the Office of Research on Minority Health, NIH.

Program Developments

AIDS International Training and Research Program (AITRP). Dr. Schambra reported that the FIC received more than 40 letters of intent in response to the Request for Applications (RFA) published in September; an estimated 25 applications are expected by the February 18 deadline. The National Institute of Allergy and Infectious Diseases (NIAID) will assist FIC in the initial scientific review of the applications. With the support of the participating agencies and institutes, the FIC expects to continue to fund about 12 grantees, which would include three to four new awards as well as competing renewals.

International Training and Research Program in Emerging Infectious Diseases (ITREID). Thirteen new awards were made in Fiscal Year (FY) 1997 under this program, which is supported by the FIC, NIAID, National Institute of Dental Research, and Office of the Director, NIH. Modeled after AITRP, this program supports research training for scientists in developing countries who are working in partnership with U.S. investigators.

International Training Program in Medical Informatics. The FIC, in collaboration with the National Library of Medicine (NLM), will be hosting a workshop on February 24 to help define a new International Training Program in Medical Informatics to be implemented in FY 1998. (See section IX below for additional information on this initiative.)

International Training and Research Programs in Population and Health, and Environmental and Occupational Health. The FIC and the National Institute of Child Health and Human Development will convene a network meeting of grantees and trainees under the International Training and Research Program in Population and Health on February 11-12, to enable awardees to exchange information on current projects. A similar network meeting of awardees under the International Training and Research Program in Environmental and Occupational Health is scheduled to take place March 3-4, convened by the FIC, the National Institute of Environmental Health Sciences, and the National Institute for Occupational Safety and Health and the National Center for Environmental Health of the Centers for Disease Control and Prevention (CDC).

Scholars-in-Residence Program. This program has undergone a restructuring based in part on discussions with Dr. Harold Varmus, NIH Director, Dr. Michael Gottesman, NIH Deputy Director for Intramural Research, and others. In general, the newly renamed "Fogarty Scholars Program" has been more closely aligned with the NIH Intramural Research Program (IRP). Specific changes include the following: Scholars will be nominated by chairs of NIH Special Interest Groups of the IRP and by directors of NIH institutes and centers (ICs); funded directly by the ICs; and obtain laboratory and office space from the ICs.

Dr. Schambra noted that the program is still evolving and that the FIC wholeheartedly supports the redirection of the program. Dr. Richard Krause, Senior Scientific Advisor, FIC, serves on the NIH committee that is addressing these changes.

Regional Activities

Dr. Schambra noted that regional activities, as described in his written report, are an important part of FIC's program efforts on behalf of the NIH and the Federal Government. These activities, whose focal point within FIC is its Division of International Relations, will be highlighted at the Board's next meeting, in May 1998.

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FIC Budget

Mr. Richard Miller said that the NIH was pleased with the visibility it received in the President's State of the Union message. In his message, the President proposed a 21st Century Research Fund and the largest funding increase in history for the NIH and NSF. Additional evidence of broad interest in the NIH includes a recent speech by the Vice President which highlighted the NIH's activities and the support for NIH of a number of Senators and Congressmen involved in the NIH budget appropriations. Mr. Miller reviewed the proposed budget for FY 1999, the distribution of FIC's budget, and FIC funding trends from FY 1981 to FY 1999. (See Attachment 3 for details on the budget.)

FY 1999 Budget. For the NIH, the FY 1999 President's Budget proposes a total budget of $14.8 billion, which is an increase of 8.4 percent (~ $1.1-1.2 billion) over the FY 1998 budget; the increase in FY 1998 was 7 percent (~ $900 million). For the FIC, the President's Budget proposes a budget of $30.4 million, an increase of 7.5 percent (~ $2.1 million) over FY 1998; the increase in FY 1998 was 6.7 percent (~ $1.8 million).

Allocation of the increase in the FY 1999 NIH budget continues to highlight Dr. Varmus' six areas of research emphasis: biology of brain disorders, new approaches to pathogenesis, prevention strategies, therapeutics/drug development, genetics of medicine, and advanced instrumentation. Approximately $600 million is distributed in these areas. In addition, the budget includes $132 million for new infrastructure initiatives (shared instrumentation, research training) for the extramural program. The training initiatives include an increase in stipends for pre- and postdoctoral National Research Service Awards and renewed emphasis on clinical research training. Two other initiatives reflect administration and congressional interest in cancer research and diabetes research. All of these emphases form the basis for the proposed allocations to the ICs. Components that would benefit in particular include the National Center for Research Resources, National Institute for Human Genome Research, and National Cancer Institute.

For the FIC, significant increases are proposed in three program areas: AITRP (increasing about $700,000), ITREID (about $500,000), and the new medical informatics program (about $450,000). Funding would be reduced for the Scholars program, reflecting the changes already mentioned by Dr. Schambra. Mr. Miller noted that funding priorities have changed for the FIC over the past 5 years, shifting from individual fellowship programs to institutional awards for building research capacity in developing countries. This shift reflects future directions outlined in FIC's long-range plan, which places emphasis on programs that respond to global health threats. Implementation of new programs in population and health, environmental and occupational health, and emerging infectious diseases, and the new medical informatics program, are part of this response.

Since FY 1981, the FIC budget for non-AIDS programs, in constant dollars, has been relatively stable, except for a slight increase in recent years because of reduced inflation and greater growth. For the FY 1999 congressional appropriation hearings, the Board received FIC's congressional justification and NIH's briefing materials for the press. The House Appropriation Subcommittee hearings for the NIH are scheduled to begin on March 10 and the FIC is scheduled to testify on March 18.

Discussion

Dr. Schambra noted that the NIH leadership and particularly Dr. Varmus deserve enormous credit for the increases in the NIH budget over the past 3 years and the major expansion anticipated, which would amount to a doubling of the budget over the next 5 years. The Board emphasized that Dr. Varmus has been instrumental in "building bridges" throughout the Government and, backed by research scientists, has made an extraordinary difference for the NIH and other science agencies. Dr. Krause encouraged the Board members to peruse FIC's congressional justification, which includes useful references to recent publications on global health challenges.

One of the themes of Dr. Varmus' tenure has been interagency interaction and collaboration. Asked to comment on FIC's collaboration with other agencies on emerging infections, staff noted that FIC is engaged in substantial dialogue with the CDC, U.S. Agency for International Development (USAID), and other agencies participating in various Government coordinating committees that are addressing this concern. With CDC and NIAID, the FIC will cosponsor an International Conference on Emerging Infectious Diseases, March 8-11, in Atlanta, Georgia. Also, the FIC has invited CDC and USAID to cosponsor an RFA for competing supplements to AITRP and ITREID awards to combat the growing worldwide threat of tuberculosis.

In addition, the FIC has collaborated with the Department of Defense (DoD), although this interface could be strengthened. In September 1996, DoD joined the FIC and other national and international agencies in cosponsoring the International Colloquium on Ebola Virus Research, and both DoD and CDC were invited to contribute support for the 13 initial awards under the ITREID program. Dr. Schambra noted that the FIC has responded to one of the recommendations of the External Advisory Panel to Review NIH/FIC International Programs by moving strongly to formalize existing and new collaborations across the Government.

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VI. THE STATE OF SCIENCE IN THE NEWLY INDEPENDENT STATES OF THE FORMER SOVIET UNION

Dr. Gerson Sher, President and Executive Director, U.S. Civilian Research and Development Foundation (CRDF), described the state of science in the former Soviet Union (FSU), international efforts to respond to the situation, CRDF collaboration with the NIH, and current and future needs. Since the breakup of the Soviet Union in 1991, there has been a crisis of science funding in Russia, and the scientific community in Russia and abroad has struggled to find the necessary funds to maintain the science infrastructure. The NIH has a long history of scientific cooperation with the FSU, and this cooperation continues. In 1996, Vice President Gore and the Russian Prime Minister announced a $1.4 million program to support U.S.-FSU joint projects in biomedical and behavioral sciences funded by the NIH and the CRDF. The FIC contributes to this cooperation through its support of the FIRCA and International Research and Training programs.

State of Science in the FSU

Dr. Sher noted that science in the FSU was one of the chief casualties of the 1991 "revolution," and that the consensus now in the FSU countries is that a fundamental change has taken place that will have far-reaching effects, not only politically and economically, but also on the conduct and support of scientific research. A series of articles by Laurie Garrett, which appeared in Newsday, cite some indicators of the current situation, which include the devastating effects on public health-an even more serious and urgent problem than the effects on science.

Expanding on the science indicators as they apply to Russia, Dr. Sher said that the number of active scientists conducting research in Russia, as well as other FSU countries, has decreased by 80 to 90 percent; the actual funding of science institutions decreased by about 80 percent between 1991 and 1994; only 30 percent of the funds budgeted in 1998 for science was actually received by science institutions; and the budget of the Russian Academy of Sciences for foreign journal subscriptions decreased from $11 million in 1991 to $1 million in 1994.

These figures tell only part of the story. The major story is the collapse of the FSU's centrally managed, lavishly funded, and privileged system of science. Previously, about 70 to 80 percent of the FSU's science budget was funded by the Ministry of Defense, and research was isolated from education and production. The best research, especially fundamental research, was conducted in the approximately 600 institutes of the U.S.S.R. Academy of Sciences (about 400 of which were within Russia), and these institutes were maintained separately from universities, which did not have access to modern science techniques and equipment. Science funding was provided directly to institute directors who allocated their resources in a top-down manner. This structure led to an entitlement mentality and a conservative scientific intelligentsia. As Russia moves away from a command economic system, this structure and the values supporting it are being challenged in the same ways as the rest of Russian society. New ways of supporting science and new methods of funding are of great interest. The research institutes, which still exist, will assume another form.

Why should the international scientific community care? First, the FSU has many very talented scientists who are products of one of the best educational systems in the world. The quality of science education continues to be very high and reflects the great prestige given to science and science occupations. Second, Russia is a vast country that has huge problems, especially in public health, which offer opportunities for translational research. Third, collaborations with FSU scientists could promote global security by encouraging them to change the focus of their research from biological and chemical weapons to nondefense-related areas.

International Response

The response of the world community to the situation of science in the FSU has been much better than generally perceived. Major programs have been launched by international governmental organizations (e.g., George Soros' International Science Foundation, the European Union's International Association for the Promotion of Cooperation with Scientists from the Newly Independent States of the FSU, the International Science and Technology Center), the private sector (e.g., the Wellcome Trust, Howard Hughes Medical Institute), professional societies (e.g., American Physical Society, American Astronomical Society, American Chemical Society). Many of the efforts have been supported collaboratively by the FSU countries.

The response of U.S. Government agencies has been varied, and efforts by the biomedical research community have been fragmented. Dr. Sher noted, however, that NIH programs for FSU scientists have been exemplary, particularly the FIC's FIRCA program. He congratulated the NIH and FIC for developing this program which is viewed as a pioneering and successful effort to provide onsite support in the FSU and to establish and maintain contact with FSU scientists. The program became a model for subsequent programs launched by the NSF, the International Science Foundation, and other organizations.

Among the benefits of all the efforts to sustain science in the FSU, three are notable: money, triage, and reform. In 1994 and 1995, for example, the programs of the International Science Foundation accounted for 10 percent of Russia's entire budget for basic research. Also, because of their emphasis on competitive, peer-reviewed grants for individual, small-to-medium projects, the programs have "weeded out" the least-effective scientists and rewarded the best scientists. In addition, the programs have provided encouragement and support for development of a research-funding system based on competitive peer review, thereby shifting the focus of future research support in the FSU.

NIH-CRDF Collaboration

The CRDF is a private, nonprofit organization authorized by Congress and established by the NSF in 1995. George Soros provided initial funds of $5 million as an unrestricted gift to the U.S. Government, which were matched by another $5 million from DoD. The NIH contributed $1 million, which was matched by $500,000 from the DoD contribution specifically for biomedical research. With this NIH-DoD support and collaborating funds from the Government of Ukraine, the CRDF awarded grants to 41 U.S.-FSU research teams under an NIH/CRDF Biomedical and Behavioral Sciences Competitive Grants Program. The success rate for applications was less than 10 percent. Dr. Irma Gigli, a former Board member, chaired the review panel. (A list of the grants and investigators was provided to the Board members.) Since September 1997, when the 41 awards were announced, the CRDF has awarded an additional five grants, supported by about $200,000 provided directly from IC budgets and, recently, the CRDF awarded another three grants supported by about $200,000 from the DoD.

In addition to this collaboration, the NIH and CRDF jointly organized a preliminary competition for research development projects, which indicated a number of interesting opportunities in Russia and other FSU countries. The NIH also participated in the first program initiated by the CRDF, which was to support basic research collaborations in the biological sciences and engineering; Dr. Krause chaired the review panel for this activity.

Dr. Sher noted that the CRDF has taken over the Grant Assistance Program from the International Science Foundation to ensure that grant monies are received by the scientists themselves. Through this program, the CRDF administratively transfers its funds directly to scientists in the FSU; for a 7 percent fee, CRDF also can transfer monies for nonprofit research purposes from third parties.

Current and Future Needs

Dr. Sher said that the bailout phase for scientists in the FSU is over, American dollars do not buy as much as they did in 1993, and major Western support for scientists' salaries and other needs is understood to be short term. Current and future support are needed in four major areas: infrastructure, education, access to the international science literature, and scientists' travel and communications. Specific infrastructure needs include basic laboratory equipment and instrumentation (e.g., culture media, computers). Dr. Sher noted that the FIRCA program continues to be extraordinarily important in providing the resources for purchasing these items. With regard to education, much attention is being given to the relationship between research and education. With a generous grant from the MacArthur Foundation and collaborative support from Russia, the CRDF, for example, is planning a major 5-year, $60 million program to promote basic research in the universities of Russia; this program, known as Integrating Graduate Research and Education (IGRE), is modeled after NSF's approach to development of scientific technology centers and may be expanded to other FSU countries.

Access to foreign science journals and the ability to travel and communicate globally also are essential. Dr. Sher noted that professional societies have helped FSU scientists attend international meetings in various ways (e.g., waiving registration fees, paying for airline tickets). The continuation of longstanding collaborative programs has been the "lifeblood" of FSU research institutions by enabling scientists to maintain their contacts in the West. However, two modifications are needed: increased focus on young investigators and opportunities for the next generation of scientists, and reentry supplements for fellowships supporting FSU scientists abroad to provide the resources needed to upgrade their laboratories and thereby encourage them to return home.

Discussion

Dr. Sher commented on the methods used by CRDF to ensure that the intended scientists receive the monies awarded. The Board noted that the substantial, positive contributions of Russian investigators and CRDF's careful monitoring of their reports already attest to the success of the NIH/CRDF grant program. Dr. Sher said that follow-up of grantees and careful review of their reports are very important. The Board also noted that the CRDF is engaged in a bold effort to link scientific research with economic development. Commenting briefly on the lessons learned, Dr. Sher said that this linkage is a challenge that is easier perhaps for a private, nonprofit organization that can be more aggressive and risk-oriented than most Federal agencies.

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VII. COOPERATION AND REFORM IN THE BIOMEDICAL RESEARCH SYSTEM IN THE REPUBLIC OF GEORGIA

Dr. Richard Krause reported on a visit to the Republic of Georgia in October 1997 to assist the Ministry of Health in its reorganization of Georgia's biomedical research system. Dr. Krause led a small NIH team consisting of Dr. Karl Western, NIAID; Dr. Kenneth Walker, Emory University School of Medicine and consultant to the NLM Board of Regents; and Mr. Amar Bhat, FIC. The visit was undertaken at the request of the Georgian Minister of Health. The NIH effort focused on stimulating U.S.-Georgian cooperation in HIV/AIDS and emerging and reemerging infectious diseases. The FIC was also asked to advise the Ministry of Health on biomedical research resources and priorities.

Dr. Krause noted that many of the generic problems described by Dr. Sher in the previous presentation also apply to Georgia. Dr. Krause summarized the organizational problems faced by Georgia's biomedical research system and the recommendations offered by the NIH team. He also offered a brief cultural perspective on Georgia.

The Georgian Ministry of Health consists of 32 different research institutes housed in separate buildings, many of which include hospital beds for patients. This complex structure serves a small country of only 6 million people. Two of six institutes of the Academy of Medical Sciences of Georgia are concerned with biomedical research. During the visit, the NIH team met with institute directors to learn about challenges and obstacles in conducting medical research in Georgia. Dr. Krause noted that, of the institutes they visited, only one had the facilities and equipment necessary to conduct modern research in immunology.

The NIH team offered eight observations. Dr. Krause noted that the Minister of Health was pleased to hear these observations and noted he would request assistance from the West to begin to implement critical activities. In brief, the NIH team proposed that the Ministry of Health consider efforts to (1) assess Georgia's biomedical research system; (2) prepare an inventory of its resources; (3) establish broad research priorities and new scientific directions; (4) strengthen existing contacts between Georgian and Western scientists; (5) obtain support for training of young Georgian scientists in Western laboratories; (6) enhance the research environment (e.g., renovate laboratories, increase the research budget); (7) strengthen procedures for submitting, reviewing and funding research grant proposals; and (8) foster contacts between Georgian and U.S. and European scientists.

Dr. Krause noted that the Ministry of Health initiated peer review of grant proposals this year and has funded some small, 1-year research grants. Commenting on collaborative activities, he noted that no Georgians are currently working in NIH laboratories, although one is expected this spring to work in the laboratories of the National Human Genome Research Institute. Also, in collaboration with the NIAID and other ICs, the Ministry of Health is planning a workshop on HIV/AIDS and emerging and reemerging infectious diseases, which will be held in Tbilisi in May 1998.

Showing slides of the visit, Dr. Krause noted that Georgia has a beautiful landscape, a very old culture, and a population talented in the arts. At the crossroads between Asia and Europe, it has been exposed to many diverse influences throughout its history. Most of the young scientists are fluent in English, Russian, and often German, as well as the Georgian language. Since the collapse of the FSU, there has been a tremendous "brain drain" of Georgian scientists to Russia. To rebuild for the future, Georgia will have to focus on developing a younger generation of scientists by enabling them to train in Western laboratories. In closing, Dr. Krause said that he anticipated that the Ministry of Health would follow up on the NIH recommendations and that Georgia would be able to make the necessary transition.

VIII. REPORT OF THE LONG RANGE PLANNING PANEL ON NATIONAL LIBRARY OF MEDICINE INTERNATIONAL PROGRAMS

Dr. Elliot R. Siegel, Associate Director for Health Programs Development, NLM, reported on long-range planning at the NLM. He summarized NLM's planning approach and reviewed the report and recommendations of the NLM Long Range Planning Panel on International Programs. In May 1995, the NLM Board of Regents chartered this panel to advise NLM on the relative priority of its international activities and responsibilities and to assist in the development of strategies consistent with NLM's mission and resources. The panel's report was published in January 1998, has been accepted by the NLM Board of Regents, and will be disseminated as an NIH publication. Prepublication copies of the panel's report and Executive Summary were provided to the Board.

Dr. Siegel said that planning at the NLM is a "bottom-up" function in that the expertise is provided from outside NLM and is conducted under the aegis of the NLM Board of Regents. The current report is the fifth focused planning report issued by NLM since 1985 when NLM undertook a comprehensive, long-range planning effort for the entire library, which coincided with the arrival of Dr. Donald Lindberg as Director of NLM. Each planning report since this initial effort is an update on specific topics addressed in the 1985 plan. The reports have influenced NLM programs and budgeting. For example, NLM developed both the Visible Human Project and the National Center for Biotechnology Information (NCBI) based on the recommendations and advice of the planning panels.

The NLM Long Range Planning Panel on International Programs was chaired by Dr. Donald Frederickson, former Director of the NIH and currently an NLM Scholar in Residence. The panel members and consultants included leaders from the scientific community, U.S. Government, international publishing community, and telecommunications industry, as well as representatives from NLM's 21 International MEDLARS Centers, which are the historical underpinnings of NLM's international programs. The panel met three times during 1996-97. Dr. Schambra served as an ex officio member of the panel and chaired a session on regional information needs and resources.

In an introduction to the panel's report, Dr. Frederickson describes a "whirlwind of changes" that are taking place and are affecting NLM's international programs, especially the function and activities of the MEDLARS centers. He notes the need for new relationships and the changes arising with global access to computers and communications technologies. For example, through the Internet, anyone anywhere in the world can access NLM's electronic databases. This availability includes free access to MEDLINE via PubMed, a new search service initiated in June 1997. Dr. Siegel noted that the NCBI web site, which houses PubMed, received 1 million "hits" during January, accommodated 350,000 searches a day during that month, and will likely average 500,000 searches a day by June 1998. Access to this site already has increased tenfold since it was initiated in June. Dr. Siegel estimated that about 35 percent of the users are foreign and that this percentage will increase. For comparison, he noted that about 53 percent of the literature in MEDLINE is foreign and that this proportion has been relatively constant since 1879 when Index Medicus was first created.

Other factors influencing NLM's international activities include alterations in the political landscape (e.g., emergence of the Newly Independent States of the FSU), changes in economically developed regions (e.g., Asia), and increased international sensitivities toward the United States in some quarters. The NLM will also reconsider the concept of MEDLARS centers, identify areas of needs and opportunities for particular regions, and adopt a perspective that is more global and "non-NLM centric."

Following the introduction, the panel report presents three overall objectives and seven specific recommendations for NLM's international programs. The three objectives are to: (1) strengthen and expand global access to the world's health-related literature, (2) chart new routes to biomedical knowledge and its use, and (3) enable NLM to fulfill its international mission. The recommendations fall under these three objectives. Under objective 1, the panel recommends that NLM expand its international partnerships and review its relationships with the MEDLARS centers. The NLM will be seeking new roles and opportunities for collaborative activities with the centers and other organizations and will be exploiting new publishing forms made possible by the World Wide Web.

Under objective 2, the panel recommends that NLM foster collaborative development of molecular biology information resources (e.g., GenBank) and promote open exchange of this information. Dr. Siegel said that NLM already is heavily engaged in developing these partnerships and that this activity will be accelerated. The panel also recommends that NLM offer its informatics expertise to research areas that will flourish from increased communication and access to information. Dr. Siegel noted that, with the panel's encouragement, NLM has already begun to contribute to the Multilateral Initiative on Malaria in Africa by acting as a facilitator, catalyst, and technical advisor for communications and information dissemination and use. Through collaboration with other Government agencies, the international research community, and development agencies and organizations, NLM has been able to inform others about its capabilities and gain a better understanding of information needs globally. NLM's participation in this initiative will serve as a prototype for other NLM projects that may be initiated in developing regions.

Under objective 3, the panel recommends that NLM play a leadership role in establishing bibliographic and preservation standards for electronic publications in medicine, collaborating in the development and offering of informatics training for U.S. and foreign students, and participating in policy debates on global information issues (e.g., intellectual property rights, privacy, confidentiality, security, public access). With regard to training, Dr. Siegel highlighted a new FIC-NLM initiative in medical informatics (see section IX below).

In a final recommendation, the panel notes the need for additional financial resources to support implementation of its recommendations and, specifically, several high-priority initiatives which are listed at the end of the panel's report. The panel estimates that an additional $20 million will be needed annually.

Discussion

The Board noted concern about the increasing number of commercial databases that are not accessible by the scientific community and encouraged NLM to participate in resolving the issues involved. Dr. Siegel noted that NLM and the panel are well aware of the issues and that a trans-NIH approach is needed to craft a reasonable strategy for the NIH. Commenting on NLM's interaction with the private sector, he said that, although NLM researchers collaborate individually with software companies, NLM's role in software development for libraries has been primarily to create tools that others could exploit.

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IX. INTERNATIONAL TRAINING PROGRAM IN MEDICAL INFORMATICS

Dr. Joshua Rosenthal, Program Director for Biodiversity and Medical Informatics, Division of International Training and Research, FIC, described the new International Training Program in Medical Informatics that the FIC is developing in collaboration with NLM. The FIC proposed this program based on its own long-range planning effort and a recommendation by the External Advisory Panel to Review NIH/FIC International Programs. The purpose of the program is to train scientists from developing countries in the management of biomedical information and in communications technologies. Through this program, the NIH will help low- and middle-income nations make the transition to computer-assisted data access and management systems and electronic communications utilizing individual work stations.

Dr. Rosenthal noted the critical changes that computer-assisted information processing and communication have made for medical research and health care in the developed world. While there has been explosive growth in the availability and use of these computer-based tools among developed nations, large portions of the developing world continue to fall further behind. Yet, informatics tools offer opportunities for developing countries to "leap frog" over traditional barriers to development and access the tremendous resources of the developed world. One of the greatest needs for researchers in developing countries has always been access to international scientific literature, a need that could now be greatly facilitated through the Internet. The costs and difficulty of traveling to international meetings also could be diminished by using the Internet to communicate and share data with scientists throughout the world.

National and international organizations already have ad hoc and site-specific efforts to provide Internet access to institutions in developing countries. The "Leland Initiative," for example, is one effort funded by USAID to "wire up" African countries to the Internet. Dr. Rosenthal noted that the NIH aims to complement these efforts by facilitating the training of scientists from these countries in the use of scientific and medical information systems. A broad range of skills will be in great demand, including basic computer and Internet skills and more advanced skills such as biostatistics, geographic information systems, and use of genome sequence databanks.

To support this training, the FIC has allocated $750,000 in FY 1999 for the International Training Program in Medical Informatics. Dr. Rosenthal noted that the program is explicitly supported by Dr. Varmus and that additional funding is welcomed from other partners for activities of mutual benefit. He also said that the FIC may allocate about $300,000 in FY 1998 to "jump start" the program by funding administrative supplements on existing NIH grants. Initially, the program will be focused on scientists and health professionals in Africa, a region where the immediate needs and opportunities are perhaps the greatest; subsequently, the FIC and NLM hope to expand the program to other areas of the world.

On February 24, the FIC and NLM will cosponsor a workshop to help define the program before issuing an RFA. The workshop participants will include African and American scientists, informatics experts, and grantees who have been involved in other FIC training programs overseas. Representatives are invited from different regions of Africa and a range of scientific areas. The questions to be addressed include the following: What skills should be transferred? Who should be trained? In what form and setting should the training take place? How much and what type of follow-up investment in software and hardware will be needed? How will success be measured?

Discussion

The Board noted that information exchange is a "two-way street" and that the new training program provides a tremendous opportunity to also access scientific and medical databases in African libraries and institutions. Dr. Rosenthal agreed, saying that the possibility of integrating the proposed training with larger, ongoing efforts in Africa to compile and coordinate databases is being discussed. The Board encouraged the FIC to highlight potential benefits that could accrue to the United States from this type of collaboration by compiling a portfolio of specific examples from different countries. The members noted also that the information obtained could be used to help construct a powerful, historical database on African diseases.

X. CLOSED PORTION OF THE MEETING

This portion of the meeting was closed to the public in accordance with the determination that it was concerned with matters exempt from mandatory disclosure under Sections 552b(c)(4) and 552b(c)(6), Title 5, U.S. Code and Section 10(d) of the Federal Advisory Committee Act, as amended (5 U.S.C. Appendix 2).

There was a discussion of procedures and policies regarding voting and confidentiality of application materials, committee discussions, and recommendations. Members absented themselves from the meeting during discussion of and voting on applications from their own institutions or other applications in which there was a potential conflict of interest, real or apparent. Members were asked to sign a statement to this effect.

XI. REVIEW OF APPLICATION

A total of 45 applications requesting $1,266,555 in FY 1998 funds were reviewed by the FIC Advisory Board as follows:

• 12 applications for International Research Fellowship (IRF) awards requesting $373,900;

• 8 applications for Senior International Fellowship (SIF) awards requesting $278,000;

• 19 applications for FIRCA awards requesting $455,455; and

• 6 applications for AIDS-FIRCA awards requesting $159,200.

The Board concurred with the initial review group recommendations for 32 proposals, recommending $900,872.

XII. ADJOURNMENT

The meeting was adjourned at 2:00 p.m. on February 3, 1998.
NOTE: A complete set of open-portion handouts is available from the Executive Secretary.

XIII. ABBREVIATIONS

Abbreviations Used in the Minutes

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