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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
Fiftieth Meeting
Table of Contents
Attendance
- Call to Order
- Consideration of Minutes of Previous Meeting
- Review of Requirements for Confidentiality and Conflict
of Interest Procedures
- Future Meeting Dates
- Report of the Director
- CDC International Programs
- Health and Development: A New Strategic Role for Health Research
- Remarks
- Discussion
- Closed Portion of the Meeting
- Review of Application
- Adjournment
The John E. Fogarty International Center for Advanced Study in the Health Sciences (FIC) convened the fiftieth meeting of its Advisory Board on Tuesday, February 5, 2002, at 8:45 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 8:45 a.m. to 12:10 p.m., followed by the closed session, from 1:00 p.m. to adjournment at 3:00 p.m., as provided in Sections 552b(c) (4) and 552b(c) (6), Title 5, U.S. Code, and Section 10 (d) of Public Law 92-463, for the review, discussion, and evaluation of grant applications and related information.[1] Dr. Gerald T. Keusch, Director, FIC, presided as chair.
Board Members Present:
Dr. Cutberto Garza
Dr. Mary Claire King
Dr. Patricia A. Marshall
Dr. Robert E. Shope
Board Members Absent:
Dr. Cora B. Marrett
Dr. Theodore Reich
Dr. Catherine M. Wilfert
Members of the Public Present:
Ms. Phyllis Freeman, McCormack Institute of Public Affairs, University of Massachusetts, Boston
Dr. Stephanie James, Ellison Foundation, Bethesda, Maryland
Dr. M. William Makgoba, Medical Research Council of South Africa, Cape Town
Ms. Angela Sharpe, Consortium of Social Science Associations, Washington, D.C.
Federal Employees Present:
Mr. Ray Atri, FIC/NIH
Ms. Judith Levin, FIC/NIH
Mr. Kevin Bialy, FIC/NIH
Ms. Julie Marquardt, FIC/NIH
Dr. Kenneth Bridbord, FIC/NIH
Mr. Michael McDowell, FIC/NIH
Mr. Bruce Butrum, FIC/NIH
Dr. Kathleen Michels, FIC/NIH
Ms. Jennifer Cabe, FIC/NIH
Dr. Mark Miller, FIC/NIH
Dr. Lois K. Cohen, NIDCR/NIH
Mr. Richard Miller, FIC/NIH
Dr. Ross Cox, CDC
Ms. Parvathi Myer, FIC/NIH
Mr. Eric Dakake, FIC/NIH
Ms. Fil Naldo-Fontelo, FIC/NIH
Dr. Jean Marc Depinay, FIC/NIH
Dr. Rachel Nugent, FIC/NIH
Ms. Irene Edwards, FIC/NIH
Ms. Sherri Park, NICHD/NIH
Ms. Mollie Fletcher, FIC/NIH
Ms. Amanda Porter, FIC/NIH
Dr. Michael Gottlieb, NIAID/NIH
Ms. Charlotte Quinn, FIC/NIH
Mr. George Herrfurth, FIC/NIH
Dr. Tom Reichert, FIC/NIH
Dr. Karen Hofman, FIC/NIH
Dr. Joshua Rosenthal, FIC/NIH
Ms. Cherice Hollaway, FIC/NIH
Dr. Luis A. Salicrup, FIC/NIH
Dr. Sharon Hrynkow, FIC/NIH
Ms. Jill Salmon, FIC/NIH
Mr. Andrew Jones, FIC/NIH
Ms. Emily Smith, FIC/NIH
Dr. Flora Katz, FIC/NIH
Ms. Marcia Smith, FIC/NIH
Dr. Gerald T. Keusch, FIC/NIH
Ms. Janice Solomon, FIC/NIH
Dr. Jeffrey Koplan, CDC
Ms. Rachel Sturke, FIC/NIH
Dr. Richard Krause, FIC/NIH
Dr. Sandy Warren, CSR/NIH
Dr. Jim Lavery, FIC/NIH
Mr. Randolph Williams, FIC/NIH
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OPEN PORTION OF THE MEETING
I. CALL TO ORDER
Dr. Gerald T. Keusch called the meeting to order and welcomed everyone. He introduced several guests: Dr. Jeffrey P. Koplan, Director, Centers for Disease Control and Prevention (CDC); Dr. Ross Cox, Deputy Director, Office of Global Health, CDC; Dr. M. William Makgoba, President, Medical Research Council of South Africa; and Ms. Phyllis Freeman, Professor, Law Center, and Senior Fellow, McCormack Institute of Public Affairs, University of Massachusetts, Boston. He acknowledged several staff members attending from other NIH institute and centers (ICs): Dr. Lois K. Cohen, National Institute of Dental and Craniofacial Research; Dr. Sandy Warren, Center for Scientific Review (CSR); and Dr. Michael Gottlieb, National Institute of Allergy and Infectious Diseases (NIAID). In addition, he welcomed Dr. Stephanie James, Vice President for International Activities, Ellison Foundation, Bethesda, Maryland.
Dr. Keusch commented on the small size of the Board, which now has 7 members instead of 12, the normal number. The reduced size is a result of the turnover of membership, a reappointment of one member, and a resignation of one member. Dr. Keusch thanked the four Board members attending the meeting. The FIC forwarded four nominations to the Secretary, Department of Health and Human Services (DHHS), in August and will be forwarding another nomination to replace the member, Dr. Jaime Sepulveda, who resigned. Dr. Stephen Straus, Director, National Center for Complementary and Alternative Medicine, NIH, will join the Board as an ex officio member. It is anticipated that he and another new ex officio member, still to be decided, will attend the Board's May 2002 meeting.
II. CONSIDERATION OF MINUTES OF PREVIOUS MEETING
The minutes of the Advisory Board meeting of September 18, 2001, were considered and accepted unanimously.
III. REVIEW OF REQUIREMENTS FOR CONFIDENTIALITY AND CONFLICT OF INTEREST PROCEDURES
The rules and regulations pertaining to conflict of interest were maintained.
IV. FUTURE MEETING DATES
The following meeting dates were confirmed:
Tuesday, May 21, 2002
Tuesday, September 10, 2002
Tuesday, February 11, 2003
Tuesday, May 20, 2003
Tuesday, September 16, 2003
Dr. Keusch 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
Dr. Keusch reported on personnel changes, the budget, and FIC activities and projects. He invited staff to elaborate on some topics. The Report of the Director, which was mailed to Board members, is appended to these minutes as Attachment 2, Written Report of the Director.
Personnel Changes
Dr. David Satcher is retiring on February 13 as U.S. Surgeon General to become the first permanent director of the National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia. Dr. Donald A. Henderson is the director of a newly created Office of Public Health Preparedness, DHHS, and will be assisted by Dr. Phillip Russell, who will serve as Special Advisor on Vaccine Development and Production.
Dr. Andrew von Eschenbach is the new director of the National Cancer Institute, replacing Dr. Richard Klausner who left the NIH on October 1. Dr. Richard Nakamura is Acting Director, National Institute on Mental Health, replacing Dr. Steven E. Hyman (previously an ex officio member of the Board) who is now Provost, Harvard University. Dr. Glen Hanson is Acting Director, National Institute on Drug Abuse, replacing Dr. Alan Leshner who left the NIH to become Chief Executive Officer, American Association for the Advancement of Science and publisher of its journal, Science. Dr. Keusch noted that the FIC enjoyed extremely close working relationships with Drs. Hyman, Klausner, and Leshner and is striving to establish similar communications and collaborations with their successors. The FIC will continue to work closely with Dr. Raynard Kington who is now Acting Director, National Institute of Alcohol Abuse and Alcoholism, as well as Director, Office of Behavioral and Social Science Research, NIH. He replaces Dr. Enoch Gordis who retired in December.
Within the FIC, Dr. Karen Hofman has been named Director, Division of Advanced Studies and Policy Analysis (DASPA). Ms. Nalini Anand recently joined DASPA to provide legal expertise on policy issues in international health, and Dr. George Herrfurth has joined the Division of International Relations. Dr. Dean Jamison, currently head of the Pacific Studies Group, University of California at Los Angeles, will arrive in 2 weeks for a 2-year sabbatical and will serve as a special advisor to the FIC. The Division of International Services, which provided visa services for NIH's visiting scientists and comprised approximately 20 persons, has been moved to the Office of Research Services, NIH. Dr. Keusch noted that the individuals will be missed, but that the rationale to include the visa operation with other pan-NIH service functions was a strong one.
FIC Budget
Mr. Richard Miller, Executive Officer, FIC, summarized the status of the Fiscal Year (FY) 2003 budget for the NIH and FIC. He noted that the budget for FY 2002 was recently passed by the Congress and that the President's Budget for FY 2003 was released on February 4. The House hearings on the President's Budget are tentatively scheduled for March, and the Senate hearings for April. The President's Budget requests approximately $27.3 billion for the NIH, or about a 15.7 percent increase over FY 2002. Mr. Miller noted that this request reflects the Administration's intent to complete the promised doubling of the NIH budget over 5 years beginning in 1998. The President's Budget includes approximately $63.8 million for the FIC, which amounts to an 11.3 percent increase over FY 2002 (17.4 percent for AIDS-related activities and 8.4 percent for non-AIDS activities).
Mr. Miller noted that the proposed distribution of dollars across the ICs indicates several priorities for the NIH: cancer research, bioterrorism, minority programs, buildings and facilities, and AIDS research. The total dollars proposed for cancer research across the NIH amount to approximately $5.5 billion, with the National Cancer Institute receiving $4.7 billion, or about a 12.2 percent increase over FY 2002. The proposed budget for the NIAID includes approximately $1.3 billion for bioterrorism, and the budget for the new National Center for Minority Health Disparities would increase by about 19 percent. Funds for NIH buildings and facilities, including the new John Porter Neuroscience Building and new biohazards units, would almost double. Support for AIDS research would increase on average by about 10.0 percent across the NIH, with the FIC receiving the largest percentage increase by far (at 17.4 percent), while support for non-AIDS research would increase by about 8.5 percent overall.
With its FY 2002 budget, the FIC will be able to expand activities in three areas: AIDS, the Fogarty International Research Collaboration Award (FIRCA) program, and the Ecology of Infectious Diseases Program. The FIC will be able to initiate activities in three additional areas: the International Tobacco and Health Research and Capacity Building Program, the International Collaborative Genetics Research Training Program, and the Global Health Research Initiative Program for New Foreign Investigators (GRIP) (re-entry grants). For FY 2003, the FIC envisages expansions in two areas: the AIDS program specifically, the International, Clinical, Operational, and Health Services Research Training Award focused on HIV/AIDS and Tuberculosis (ICOHRTA AIDS/TB), and the GRIP. The FIC anticipates launching new initiatives in three areas: brain disorders; health, environment, and economic development; and stigma research.
In closing, Mr. Miller commented that the total FIC budget, which includes funds provided by partners for FIC programs, will grow from approximately $20 million in FY 1992 to slightly more than $80 million in FY 2003. Over the past 5 years, the total budget has doubled, from slightly less than $40 million in FY 1998 to slightly more than $80 million in FY 2003.
In discussion, the Board expressed surprise that the increase proposed for the FIC in FY 2003 was not disproportionately larger than that for other ICs because of the Administration's increased interest in international issues. Dr. Keusch welcomed the Board's input and noted that other ICs have increased their support for international research, as reflected in FIC's co-funded programs with the ICs. He emphasized, however, that the FIC offers an international perspective that is unique at the NIH and that the expansion of FIC's programs and activities is not limited by the nature of the efforts or ideas, but by the availability of funds.
FIC Activities and Projects
International Advisory Group. Dr. Keusch noted that the FIC has formed the FIC International Advisory Group, to provide input and insight specifically from developing countries and transitional economies. The FIC has invited three individuals to serve on this group: Dr. William Makgoba, President, Medical Research Council of South Africa; Dr. N.K. Ganguly, Director General, Indian Council of Medical Research; and Dr. Jaime Sepulveda, Director General, Instituto Nacional de Salud Publica, Cuernavaca, Morelos, Mexico. These individuals will attend at least one Board meeting each year and consult with FIC and NIH staff as needed and appropriate.
FIC's 35th Anniversary. The FIC will celebrate its 35th anniversary in conjunction with the Board's May 2003 meeting. The FIC will host a symposium and dinner on May 20 following the Board's meeting and continuing symposia on May 21. Dr. Keusch said that the FIC intends to not only celebrate its 35th year, but also and importantly, to highlight global disparities in health and the role of the FIC, NIH, and DHHS in reducing health disparities and generating research that improves health and contributes to the development of scientific capacity in collaborating countries. The FIC will share its planning with the Board and invite the Board's input on this celebratory event.
Multilateral Initiative on Malaria (MIM). The FIC plays a leadership role in mobilizing international resources to focus on specific global health challenges. As the MIM Secretariat, the FIC works closely with NIAID to promote science in sub-Saharan Africa, increase attention on malaria, and develop research capacity in Africa and other malaria-endemic regions. Currently, the MIM is sponsoring a conference in Bangkok, Thailand, to focus attention on vivax malaria. Dr. Keusch noted that the MIM's accomplishments are superb.
Disease Control Priorities in Developing Countries Project (DCPP). Another example of the FIC's ability to develop partnerships to advance critical areas in global health is DCPP. The DCPP will revisit a major study, Disease Control Priorities in Developing Countries, published in 1992. Following the Board's consideration of the feasibility of this activity, during its January 2001 meeting, the FIC continued discussions and established close working relationships with the World Bank and the World Health Organization (WHO), which sponsored the initial study. The three partners are now organizing the new study, which will engage scientists, epidemiologists, and public health experts from around the world to participate in conferences, workshops, analyses, and the writing of chapters. The FIC has agreed to serve as Secretariat, and Drs. Joel Bremen, FIC, and Tony Measham, the World Bank, will serve as co-managing editors of the project. As part of his sabbatical at the FIC, Dr. Dean Jamison will participate in DCPP and in another effort to reanalyze data on morbidity and mortality in Africa, in collaboration with the World Bank.
International Meetings. The Lawton Chiles International House offers an excellent venue for international researchers to meet and work on global health issues. Recently, the FIC hosted several international meetings: the open session of the annual board meeting for the International Vaccine Initiative; Working Group II of the Commission on Macroeconomics and Health; and the advisory group for the Global Alliance for Improved Nutrition (GAIN). Dr. Keusch noted that GAIN will focus on food fortification as a strategy to improve the intake of micronutrient minerals and vitamins among populations in developing countries. With a pledge of $50 million, the Bill and Melinda Gates Foundation is helping to create an international nongovernmental organization to manage the effort. Dr. Keusch represents the nutrition science community at the advisory group meetings. He anticipated that GAIN will be launched in May and begin operation shortly thereafter.
International Tobacco and Health Research and Capacity Building Program. In collaboration with several other ICs, the FIC developed and issued a Request for Applications (RFA) for this innovative program that integrates research and training to address tobacco-related illness and death in the developing world. Dr. Keusch noted that the FIC received a large number of applications, which are being reviewed, and that many groups have requested that the RFA be reissued.
International Clinical, Operational, and Health Services Research and Training Award Focused on Non-Communicable Diseases. Also in collaboration with other ICs, the FIC has funded 14 research and training projects under this first ICOHRTA. The research spans a wide range of topics, including suicide prevention and substance abuse, and four projects included behavioral and mental health issues associated with HIV/AIDS.
ICOHRTA AIDS/TB. In November, the FIC issued a Program Announcement to support planning grants for ICOHRTA programs focused on AIDS and tuberculosis. The program is cosponsored with 10 ICs and the CDC. Elaborating on the program, Dr. Pierce Gardner, Senior Advisor for Clinical Research and Training, noted that it continues FIC's long-standing emphasis on capacity building and builds on the success of FIC's AIDS International Training and Research Program (AITRP). The new program will continue the collaborative relationships between U.S. institutions and developing country institutions but will shift the "center of gravity" increasingly to developing countries, which now have developed sufficient capacity and research maturity to conduct training on-site, set research agendas, and share faculty mentoring. The program will be implemented in two phases: (1) award of 1-year planning grants to the foreign sites, and (2) subsequent comprehensive awards which directly fund an investigator/institution in a developing country. The comprehensive awards will be long-term cooperative agreements, initially for 5 years (renewable) and anticipating 10 or more years. The research areas have been expanded beyond epidemiology and research on prevention, to include clinical, operational, and health services research training. The ICOHRTA thereby integrates prevention and care and includes training for infrastructure support (e.g., data management, establishment of review committees, research administration). Proposals for the first award are due March 19, and the Program Announcement for the second phase is expected during the summer of 2002. In closing, Dr. Gardner suggested that the ICOHRTA AIDS/TB will foster other major international research efforts in AIDS and associated areas, such as mental health and child health.
In discussion, Dr. Keusch noted that the program has elicited tremendous interest and cooperation in that it builds clinical research capacity by linking the delivery of care with clinical research and policy and program development. The FIC anticipates awarding perhaps a dozen planning grants in FY 2002 and perhaps half a dozen comprehensive, linked awards in FY 2003; with additional awards each succeeding year, the FIC may fund 18 awards over a 5-year period. The FIC intends that the ICOHRTA will draw in additional funds from other sources (e.g., international organizations, foundations, government) to support capacity building and help foreign sites coordinate programs within their countries.
Dr. Kenneth Bridbord, Director, Division of International Training and Research, noted the excellent collaboration with both NIAID and CDC during the development of the ICOHRTA. He also noted FIC's enthusiasm at being invited by the NIAID to partner on an International Centers for Excellence in Research (ICER) effort that would establish a first-ever cooperative agreement in training, which would be awarded to U.S. institutions to support comprehensive clinical research training across all ICER sites. He suggested that this partnership could serve as a prototype for other FIC efforts to build sustainable research capacity in developing countries.
The Board commented that the ICOHRTA is a perfectly timed and exciting initiative, and the members complimented FIC for organizing this complex and critical program.
Genetics Initiative. Dr. Karen Hofman, Director, DASPA, reported on an RFA that the FIC issued in November in partnership with seven ICs and the WHO for an International Collaborative Genetics Research Training program. The aim is to create innovative research training programs within existing scientific collaborations between researchers in industrialized and developing countries. The FIC has received approximately 20 letters of intent, and applications are due March 25. Initial review will be conducted in July, with second-level review by the Board in September. In contrast with the ICOHRTA, applicants must be able to demonstrate the potential for sustainability by having an ongoing collaboration with a foreign site or a parent grant from the NIH or other funding source and some indication that foreign trainees will have support when they return to their home country. In this more technologically based program, individuals will be trained in genetic epidemiology, population genetics, molecular epidemiology, clinical genetics, statistical genetics, and bioinformatics. Expertise also will be developed in the ethical, legal, and social implications of human genetics research. Training can be short- or long-term and at the pre-master's degree, doctorate, or postdoctoral level. Dr. Hofman noted that the program is unique in that none of the 24 current NIH training programs in genetics has an international component focused on developing countries.
Dr. Keusch added that the next meeting of the FIC Global Forum on Bioethics and Research will be organized by the Pan American Health Organization in conjunction with its 100th anniversary. Genetics and Bioethics will be the Forum's focus at this year's fourth meeting, to be held in Brasilia in November 2002.
Global Health Research Initiative Program for New Foreign Investigators. Dr. Sharon Hrynkow, Deputy Director, reported that the FIC, in collaboration with five other ICs, developed the GRIP initiative following up on the Board's discussion at its May 2001 meeting and subsequent consultations. The overall aim of this pilot program is to address the "brain drain" issue. The intent is to increase the number of scientists from developing countries who participate in NIH training programs, provide them supplementary experience to improve their grantsmanship capabilities (to write a competitive R01 research grant proposal), and provide research support on a competitive basis on their return to their home country. The program is available only to investigators from developing countries, either intramural investigators or extramural trainees who are associated with FIC research capacity-building awards. The GRIP award will be an R01 modular-type grant for $50,000 per year for up to 5 years, to be divided equally for salary support and research support; the investigator's home institution is expected to support half of the investigator's salary. Applications are due by April 19, and initial review will be conducted by the CSR. Dr. Keusch anticipated that additional ICs, which have expressed interest in the program, will participate in 2003.
Mathematical Modeling of Infectious Diseases. Dr. Mark Miller, Associate Director for Research, FIC, described FIC's initial efforts to apply mathematical modeling to infectious diseases and potential microbes used as biological weapons. The FIC established the Division of Epidemiology and Population Studies a year ago to focus on building biomedical capacity and on economic analyses of population-based public health interventions. Staff first addressed mathematical modeling of influenza and malaria. On December 13-14, the FIC, in conjunction with NIAID, hosted a consultation, which involved experts in mathematical modeling as well as senior policymakers, to consider the role of mathematical modeling in understanding the transmission of infectious agents and to foster communication between these groups. The FIC is discussing with other ICs and U.S. Government departments the possibility of collaborating on initial activities to demonstrate the applicability of this tool to understanding biological weapons agents. Dr. Keusch noted that the discussions at the consultation indicated that modeling is an effective approach because it helps to pose and sharpen questions that may not be considered otherwise. The Board commented that an effort in this area has exciting possibilities and that the FIC could identify other resources to support this.
For additional details on personnel changes, the FIC budget, and FIC activities, see the written Report of the Director (Attachment 2).
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VI. CDC INTERNATIONAL PROGRAMS
Dr. Jeffrey P. Koplan, Director, CDC, described CDC's interests and activities in international health. He noted that, historically, the CDC has been a domestic organization with little designated international activity or focus. During his tenure over the past 3.5 years, Dr. Koplan has sought to make international activities more explicit, encouraging all units to be more active globally. He noted that health is not simply a domestic concern and that programs that address health problems benefit all and contribute to everyone's well-being worldwide. Guiding CDC's efforts internationally is its Office of Global Health, which handles operational, technical, and policy issues. Institutes and offices within each center support a range of activities, which include short- and long-term technical and financial assistance and an intramural Visiting Scientist program. Much of CDC's staff has overseas experience which it brings to these activities. Dr. Koplan emphasized that the CDC, and the United States, benefit daily from these international exchanges. Currently, the CDC has approximately 165 individuals overseas in 45 countries.
Dr. Koplan cited examples of CDC's international programs and noted that they offer many opportunities for collaboration with the FIC. The CDC has efforts in immunization (e.g., eradication of polio and measles), infectious diseases (e.g., surveillance of malaria, tuberculosis, influenza and establishment of new, international emerging infectious disease centers), occupational safety and health, environment, birth defects, and chronic non-communicable diseases (e.g., control of tobacco use, behavioral risk factors in adults). CDC's activities are conducted in collaboration with countries and international organizations such as WHO. For example, the CDC collaborates extensively with China, which recently established a public health institution coined the "Chinese CDC." Among its activities with WHO, the CDC provides significant staffing and financial support to combat tobacco use. CDC units also support specific efforts in health statistics (the National Center for Health Statistics), epidemiology (the Applied Epidemiology Training Program), management training (at the CDC), and HIV/AIDS (providing technical assistance in approximately 25 countries through the Global AIDS Program).
Dr. Koplan emphasized that international health and relationships with global partners are integral to public health. The CDC aims to do as much as it can to improve public health worldwide through collaborations with international agencies. Natural linkages have been, and can be, forged on specific projects with the NIH, DHHS, other Federal agencies, and international and nongovernmental organizations. Dr. Koplan noted that the CDC is eager to increase its interchange with the NIH and the FIC.
In discussion, Dr. Keusch said that opportunities to review organizations' activities are useful and can stimulate collaborations. The CDC's Office of Global Health now participates in NIH's regular meetings of IC international representatives.
VII. UPDATE ON FIC INTERNATIONAL AIDS PROGRAMS
Ms. Phyllis Freeman, Professor, Law Center, and Senior Fellow, McCormack Institute of Public Affairs, University of Massachusetts, Boston, addressed the topic of global public goods and the role of research in reducing health disparities and hastening development in low- and middle-income countries. She summarized changes in the development community's perception of global public goods, drawing from a paper prepared for the WHO's Commission on Macroeconomics and Health by the Working Group on Global Public Goods. The Commission's report, entitled Investing in Health and Development, was issued on December 20, 2001. Professor Freeman and Dr. Mark Miller, FIC, prepared a paper on knowledge about scientific capacity for health as a global public good. In her remarks, Professor Freeman emphasized that health researchers currently have an unprecedented opportunity to make a contribution to the development field.
Professor Freeman noted that the Commission's perception of global public goods initially included research, but only in the sense of commodities (e.g., research tools, vaccines, drugs). She and Dr. Miller chose to focus the attention of the working group also on the role of knowledge for solving problems in the field, for example, in scaling up effective programs against HIV, TB, and malaria. The authors argued for a broader definition of research, to mean scientific capacity of all sorts needed to improve population health.
Because the published literature on developing and sustaining scientific capacity for health in lower-income countries was minimal, the authors reviewed the far more substantial literature on science and technology for development in countries at all levels of development. In contrast to other sectors of the economy long considered "strategic" (e.g., agriculture, energy), the role of health research in development was rarely studied or even mentioned in national science and technology plans. Since the Industrial Revolution, "strategic" sectors have been those considered key for economic growth and military pursuits. Attention to the role of research or "knowledge generation" in sectors perceived as strategic heightened during World War II. Economists, sociologists, and historians studied the impact of research investments and technological innovation and how to strengthen scientific capacity to meet national objectives. Industrial countries commonly assembled statistics and fashioned methodologies for measuring improvement, especially since World War II. Developing countries followed suit with the support of the United Nations Educational, Scientific, and Cultural Organization (UNESCO). Because the health sector was not seen as strategic by either industrial or developing countries, collection of data and analysis of the contribution of health research to reducing the burden of disease lag far behind.
The importance of regional and global cooperation in science and technology for the development of lower-income countries has been recognized only recently (since the 1970s). Even now, few countries (e.g., Canada, Sweden) feature research in their international development assistance programs. The Swedes, in particular, are developing empirical evidence of the role of knowledge in economic development.
Since the 1970s, health researchers have taken steps to include health sciences in the development agenda and, in 1990, the Commission on Health Research and Development exhorted countries to spend 2 percent of their health expenditures on research. But, more than 10 years later, only two countries (Brazil and Cuba) have approached this target. In a new paper, Professor Freeman and four co-authors recommend that health specialists analyze the lessons learned from other areas of science and technology over the past 50 years and apply these lessons to research to improve population health and reduce health disparities. The report of the WHO Commission implicitly elevates health to become a strategic sector based on recent economic evidence that health influences income and can speed economic growth and development. (Since the 1970s, economists have been convinced of the reverse, that income influences health.) The Commission calls for increased investment in health (largely health services) and for establishment of a global health research fund.
A broadened understanding of the potential role for health in economic development portends a new strategic role for health research in hastening development in low- and middle-income countries. New efforts are being mounted to evaluate the contribution of research to population health, health systems, and reduction of disparities. Already, the WHO has committed its 2004 World Health Report to health research; the WHO's Tropical Disease Research Programme has recently formulated a new strategy for integrating the development of research capacity throughout its portfolio of research and product development; and other organizations (e.g., the FIC, the Wellcome Trust) are considering how best to evaluate their research programs.
In closing, Professor Freeman highlighted several global challenges that have not yet been addressed, but need attention. Specific challenges include determination of how best to evaluate the contribution of health research and how to convey this information to policymakers and investors in national and global development efforts; development of consensus in the health community on the definition of research and researcher, the purposes of research and of developing research capacity, and the intended beneficiaries of these activities; development of statistical data on the health research conducted within lower- and middle-income countries; agreement on measurable objectives for, and indicators of, research success; and development of methodologies to evaluate research at different levels (individual, program, institution, "national health research systems," regional and global collaborations). Professor Freeman concluded by quoting from Steven Dedijer, who wrote in the 1950s that, "looking through the various national statistical yearbooks, one is impressed by how many countries have felt the need to count their donkeys and how few their scientists." She pointed out that this statement continues to be true for health researchers, even as analytical attention has been brought to sectors earlier perceived as essential for national development.
In discussion, the Board commented on other sources of historical information on the linkage between research and health. The Board noted the importance of including all stakeholders (e.g., ministries of economics, finance, and planning) in discussions of the definition of health research and the relationship between health and development. The Board suggested that organizations such as the FIC could play a catalyst role to involve these stakeholders.
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VIII. REMARKS
Dr. M. William Makgoba, President, Medical Research Council (MRC) of South Africa, Cape Town, described the organization and programs of the MRC and related some lessons learned from doing research in South Africa. He noted that the MRC is a blend of the NIH (research) and the CDC (public health) models and that it is focused on building a healthy nation through research. The MRC is one of eight components in South Africa's Science Council System. It receives 9 percent of the government's appropriation for science, which accounts for 60 percent of the MRC's total budget of about R(rand)$250 million; 40 percent comes from collaborations with foreign and international organizations, including the NIH and WHO. The MRC has 511 full-time staff and about 1,000 associated staff shared with universities in South Africa, who work in 47 intramural and extramural units jointly owned by the MRC and the universities. The MRC has three locations: Pretoria, Durban, and Cape Town.
Dr. Makgoba noted that four strategic values guide the MRC: learning, innovation, sustainability, and human rights (including equity and ethics). Research is organized into six national programs: molecules to diseases (basic science), health systems and policy, infection and immunity, non-communicable diseases (e.g., cancer, high blood pressure, diabetes, obesity), environment and development, and women and children's health. MRC's objectives are to conduct research in areas of local relevance and impact (e.g., tuberculosis, HIV/AIDS); develop strategic alliances with universities, for capacity building; provide credible information and promote science; invest in refurbishment of equipment and new technology; abide by principles of good corporate governance; and accelerate and maintain initiatives that will transform research and society.
MRC activities are also influenced by the New Economic Program for African Development (NEPAD), a continental partnership focused on three areas of health research: infection disease, informatics, and biotechnology. Dr. Makgoba noted that South Africa has 10 percent of the world's HIV-infected individuals but less than 0.01 percent of the world's population; supports the recommendations of the Economic Commission for Africa concerning the "digital divide"; and recently adopted a national biotechnology strategy and has established three bioinformatics centers and a biotechnology information center.
Regarding research in Africa, Dr. Makgoba emphasized the following points: (a) Science cannot be conducted satisfactorily without paying attention to politics; (b) good intentions must be backed by a sound theoretical basis or foundation; (c) processes are more important than the end product; (d) for sustainability, research investors should focus on institutions, not on individual investigators; (e) accountability, especially regarding finances, may be lacking; (f) the autonomy of institutions and principal investigators is not the same as in the United States and will vary by project and affect operations; and (g) funding agencies such as the NIH should ensure that institutions and investigators "buy into" the research proposed. Dr. Makgoba noted that the NIH must remain accountable for the use of U.S. taxpayers' monies and he encouraged the NIH to collaborate only with institutions that share common values and purposes with the NIH.
IX. DISCUSSION
In response to questions from the Board, Dr. Makgoba said that South African policymakers are perceiving the influence of health on economic development more strategically and are beginning to address the HIV/AIDS problem at the individual level. The Board emphasized the need for South Africa's political leaders to recognize the epidemic of HIV/AIDS, which is now the leading cause of death in South Africa, and the quality of science available to address this devastating health (and economic) problem. Commenting on partnerships in capacity building, Dr. Makgoba encouraged funding sources to require institutions in developing countries to jointly invest in these efforts from the beginning; to focus on "doable" (i.e., relevant and applicable) projects; and to include within projects long-term (2-3 years) in-country research training. He reemphasized the importance of collaborations between institutions (not individuals), to ensure sustainability. Institutional collaborations and regional forums could be instrumental in fostering "real" partnerships. The need to strengthen interfaces among government, academia, and the private sector in both industrialized and developing countries also was emphasized.
In closing, Dr. Keusch thanked Dr. Makgoba for his insights and pledged that the FIC will listen and work collaboratively with institutions and investigators in developing countries to learn from them and to continue to aggressively pursue, in collaboration with others, FIC's mission of "Science for Global Health."
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
Dr. Sharon Hrynkow chaired the remainder of the meeting during which the Research Awards Subcommittee reported on its activities. A total of 87 scored competing applications were reviewed by the FIC Advisory Board at the February 5 meeting.[2] The applications were in the following programs:
14 applications for the International Malaria Research Training Program (IMRT), out of a total of 14 applications;
44 applications for the Fogarty International Research Collaboration Award (FIRCA) program, out of a total of 44 applications;
6 applications for the HIV/AIDS Fogarty International Research Collaboration Award (AIDS-FIRCA) program, out of a total of 6 applications;
23 applications for the Ecology of Infectious Diseases Program (EID), out of a total of 68 applications
The Board concurred with the initial review group recommendations for the 87 applications.
XII. ADJOURNMENT
There being no further business, the meeting was adjourned at 3:00 p.m. on February 5, 2002.
[1] Members absent themselves from the meeting when the Board discusses applications from their own institutions or when a conflict of interest might occur. The procedure applies only to individual applications discussed, not to en bloc actions.
[2] Applications that were noncompetitive or unscored or were not recommended for further consideration by initial review groups were not considered by the Council.
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