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May 19, 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-ninth 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. FIC Evolution and Long-Range Planning
7. Resource Trends and Allocations
8. FIC International Programs: Status of International Training and Research Efforts
9. International Relations: NIH-Wide Initiatives and Support
10. International Policy Support to NIH and Other Government Agencies
11. Closed Portion of the Meeting
12. Review of Application
13. Adjournment
14. 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, May 19, 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 12:15 p.m., followed by the closed session for consideration of grant applications until adjournment at 2:30 p.m. Dr. Philip E. Schambra presided as Chair.

Board Members Present:

Dr. Francisco J. Ayala
Dr. Thomas W. Cole, Jr.
Dr. Philip C. Hanawalt
Dr. Samuel L. Katz
Mr. Thomas J. McAndrew
Dr. Thomas E. Malone
Dr. Cora B. Marrett
Dr. Donald O. Nutter

Board Members Absent:

Dr. Margaret A. Chesney
Dr. Marvin Cassman
Dr. Rita R. Colwell
Dr. Carl Kupfer
Dr. Adel A. F. Mahmoud

Federal Employees Present:

Mr. Amar Bhat, FIC/NIH
Dr. Joel Breman, FIC/NIH
Dr. Kenneth Bridbord, FIC/NIH
Ms. Stephanie Bursenos, FIC/NIH
Ms. Paula Cohen, FIC/NIH
Ms. Eileen Conley, FIC/NIH
Ms. Nancy Coulter, FIC/NIH
Ms. Irene Edwards, FIC/NIH
Ms. Lara Eldredge, FIC/NIH
Mr. Robert Eiss, FIC/NIH
Ms. Sheila Feldman, FIC/NIH
Ms. Sylvia Funk, FIC/NIH
Dr. Charles Gardner, FIC/NIH
Ms. Mildred Hatton, FIC/NIH
Ms. Nancy Hazleton, OAM/NIH
Dr. Allen Holt, FIC/NIH
Dr. Sharon Hrynkow, FIC/NIH
Dr. Josefa Ippolito-Shephard, FIC/NIH
Mr. Chris Keenan, FIC/NIH
Dr. Richard Krause, FIC/NIH
Ms. Silvia Mandes, FIC/NIH
Ms. Christina McLauchlan, FIC/NIH
Ms. Ellie Menser, FIC/NIH
Mr. Richard Miller, FIC/NIH
Mr. Sean Murphy, FIC/NIH
Ms. Sharon Nieberding, FIC/NIH
Ms. Linda Reck, FIC/NIH
Dr. Philip E. Schambra, FIC/NIH
Ms. Rita Singer, FIC/NIH
Ms. Linda Staheli, FIC/NIH
Mr. J. Kirby Weldon, FIC/NIH

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, May 19, 1998. He welcomed and introduced three new Board members: Dr. Francisco J. Ayala, Dr. Thomas W. Cole, Jr., and Mr. Thomas J. McAndrew. A fourth new member, Dr. Margaret A. Chesney, was unable to attend the meeting because of a prior commitment. Dr. Schambra noted that Dr. Rita R. Colwell has been nominated as Director, National Science Foundation (NSF), and that the FIC looks forward to her continued participation on the FIC Board. Dr. Neal Lane, current Director of the NSF, has been nominated as the President's science and technology advisor and as Director of the White House Office of Science and Technology Policy (OSTP).

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II. CONSIDERATION OF MINUTES OF PREVIOUS MEETING

The minutes of the Advisory Board meeting of February 3, 1998, 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, 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.

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 commented on several new items and on the agenda for the Board's meeting.

New Items

On May 13, the dedication ceremony was held for the Lawton Chiles International House. Dr. Harold Varmus presided over the dedication with remarks by Governor Chiles.

Dr. Neal Nathanson, of the University of Pennsylvania, has been named the new director of the NIH Office of AIDS Research (OAR). He replaces Dr. William Paul, who left this position in November 1997 to return to laboratory research at the NIH.

Since the Board's previous meeting, the FIC has held networking meetings for FIC's international training and research programs in population and health, environmental and occupational health, and emerging infectious diseases. At these meetings, grantees and trainees meet to exchange information on current projects. Dr. Thomas E. Malone represented the Board at the February meeting for the International Training and Research Program in Population and Health. Dr. Malone reported that this program, now in its third year, is a truly collaborative effort between the FIC and the National Institute of Child Health and Human Development (NICHD). Commenting on the meeting, he noted that the research presentations were superb and that there was a good exchange of information. He congratulated FIC staff for their organization of the meeting, and he encouraged FIC to invite other Board members to these meetings and to consider opening the meetings to the NIH community.

Agenda for the Present Meeting

Dr. Schambra introduced the agenda for the Board's meeting, which consisted of a series of reports from FIC's division directors. The purpose of the reports was to provide FIC's perspective on the "state of the Center" as groundwork for the Board's participation in FIC's transition and future activities. The directors commented on FIC's activities over the past 10 years and opportunities for the future. Dr. Schambra emphasized the importance of the Board's contribution to ongoing and future discussions of NIH's international health research activities.

This focus on the international activities of the FIC and NIH is particular timely for two reasons: (a) Dr. Varmus is raising attention to the importance of international research issues, at the NIH and with other agencies and governments, and (b) international health and international research are at a crossroads. At the NIH, Dr. Varmus has reestablished the position of an Associate Director for International Research who will also serve as Director of the FIC, and a search committee has recommended three candidates for this position. Board members have participated in the search process, and senior FIC staff have met with the three candidates. Also, Dr. Varmus has agreed to FIC's proposal to include discussions on international health at the annual meeting of NIH's leadership, the Leadership Forum, in early September.

Dr. Schambra highlighted three areas of international opportunities which should be explored energetically by the NIH. First, Dr. Gro Harlem Brundtland has just been endorsed by the World Health Assembly as the new Director General of the World Health Organization (WHO). This new leadership will bring new opportunities to strengthen international research through WHO and partner agencies. Second, the World Bank is playing an increasingly important role in global health, following on its 1993 World Development Report which focused on health. The Bank has recently released a new sector-wide strategy on health and is increasingly interested in the contributions of science and science infrastructure to sustainable economic growth. Third, an epidemiological transition is under way whereby chronic diseases are expected to pose an increased burden on societies relative to communicable diseases in the coming decades, as noted in the Global Burden of Disease Study conducted by researchers at Harvard University. The increasing rates of chronic illnesses will present new scientific challenges in the 21st century.

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VI. FIC EVOLUTION AND LONG-RANGE PLANNING

"HOW WE ARE WHERE WE ARE"

Mr. Robert Eiss, Director, Office of International Science Policy and Analysis, FIC, presented an historical perspective of NIH international programs, the evolution of FIC's directions and activities, and FIC planning. He noted that FIC staff rely on the scientific expertise of the Board and the broader scientific community.

NIH International Programs

"What is past is, indeed, prologue" well describes NIH international programs. Two basic tenets have always been: basic research has practical outcomes, and international science is imperative to the progress of science. Beginning with the first Director of NIH, Dr. Robert Kinyoun, NIH has always had a strong international component. Kinyoun himself received training in Berlin and his first discovery, at the Laboratory of Hygiene on Staten Island, was the isolation of the cholera vibrio. Following World War II, Congress authorized NIH to award foreign grants, contracts, and fellowships--an authority not shared by the NSF. Although these awards have historically accounted for less than 2 percent of the overall NIH budget, the rewards from this investment have been immense (viz., identification of the gene for Huntington's Chorea, utilization of Nordic data for studies of DNA inheritance patterns).

In the past 10 years, the number of direct foreign grants has decreased, reflecting the increased competition for NIH support, while the number of domestic awards with foreign components has increased fourfold, which can be attributed in part to new FIC programs. Also, the NIH has expanded its international programs from support of collaborations between individual scientists to support of institutional alliances (e.g., the Human Frontier Science Program, the Civilian Research and Development Foundation, the Middle Eastern Cancer Consortium, the Multilateral Initiative on Malaria).

Evolution of FIC

FIC activities account for about 0.2 percent of the total NIH budget. In Fiscal Year (FY) 1998, the FIC celebrates its 30th year. During the first 20 years, FIC supported international biomedical research through individual fellowships [e.g., the Senior International Fellowship (SIF), the International Research Fellowship (IRF), the Scholars-in-Residence (SIR) program]. Two global developments changed this focus: the AIDS pandemic, and the collapse of Communism. In FY 1988, the Congress awarded additional funds to the FIC "...to assist with AIDS research projects in other nations...." With these monies, the FIC established the AIDS International Training and Research Program (AITRP) which soon eclipsed the WHO as the leading international source of research training on the human immunodeficiency virus (HIV) in developing nations. This program was followed in FY 1992 by the Fogarty International Research Collaboration Award (FIRCA), a small grant to support collaborative research with scientists in the Newly Independent States of the Former Soviet Union and in Latin America. FIRCAs have been awarded to a number of members of the National Academy of Sciences, and the FIRCA program was the model for the Howard Hughes Medical Institute's program with Russia. With these two programs, the FIC began to focus on regional and scientific priorities instead of individual scientist exchanges.

FIC Planning

To guide future budgetary decisions, the FIC, at Dr. Schambra's direction, undertook a comprehensive planning process to develop a long-range plan. Several conceptual tenets were adopted which became the framework for the directions taken. The tenets were to: identify priorities based on scientific challenges in international health that require international collaboration; continue emphasis on scientific training of young investigators, but focus on developing nations; pursue activities that augment and do not compete or overlap with the other NIH institutes, centers, and offices; support multidisciplinary approaches; limit competition to scientists who are NIH grant recipients; and develop programs that may draw new resources into international health from other NIH institutes, centers, and offices and from other Public Health Service (PHS) or Federal agencies.

The fields of emphasis selected for new FIC programs reflected public health needs (as indicated by, for example, global disease burdens, leading causes of death, and effects of industrialization), demographic trajectories, and scientific opportunities. These fields of emphasis are: HIV-AIDS; emerging infectious diseases; population and demographic science, including reproductive health; environmental and occupational health; biodiversity; human resource needs in the United States (i.e., minority training); and seed funding for developing nations and former socialist economies (e.g., the FIRCA). Because of its success, AITRP has become the model for most new FIC programs in these areas.

The planning effort was launched in FY 1992 and was conducted internally in close coordination with the Board. A standing committee of the Board, led by the late Dr. Marjorie P. Wilson, helped develop a draft plan, which was reviewed by an external panel chaired by Dr. Barry Blumberg. Comments on the plan were sought from the international representatives of the NIH components. The plan, which was published in FY 1994, was later endorsed by the NIH External Advisory Panel on NIH/FIC International Programs. This panel, which concluded its report in FY 1996, was convened by Dr. Varmus and chaired by Drs. Joshua Lederberg and Barry Bloom.

In closing, Mr. Eiss noted that the new directions being taken by the FIC are closely aligned with the Johnson Administration's initial intent on establishing the FIC, as indicated in a White House press release of July 24, 1968.

Discussion

Commenting on NIH's overall level of support for international activities (less than 2 percent), the Board suggested that it may be informative to obtain comparable figures for other industrialized countries, which may be much higher. A recent study conducted by the RAND Corporation indicates that, even among U.S. Government agencies, investment in international programs is higher than at the NIH, averaging 4 to 5 percent of an agency's total budget.

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VII. RESOURCE TRENDS AND ALLOCATIONS

Mr. Richard Miller, Executive Officer, FIC, summarized FIC funding over the past 10+ years. Referring to the Board's previous discussion, he reported that total NIH expenditures for FY 1997 were $12.8 billion. The distribution of these expenditures was 86.8 percent for extramural activities, 11.6 percent for intramural activities, and 1.6 percent for international activities; FIC funding was 0.2 percent of the total NIH expenditures.

Between FY 1987 and FY 1999 (current dollars), FIC funding for non-AIDS-related research doubled, from $9.4 million to more than $19 million. Funding for AIDS-related research more than doubled, from $4.5 million in FY 1988 to more than $11 million in FY 1999. Beginning in FY 1993, the FIC implemented the Minority International Research Training (MIRT) program in collaboration with the NIH Office of Research on Minority Health. Funds for this program, which is currently being evaluated, increased from $2.3 million in FY 1993 to a high of $7.8 million, leveling off in FY 1998 at $2.7 million. Funds from other NIH institutes, centers, and offices and Federal agencies in support of FIC programs increased from about $400,000 in FY 1990 to about $4.8 million in FY 1997.

The distribution of funds among FIC's extramural programs reflects the evolution of FIC programs described previously by Mr. Eiss. In FY 1987, all the funds supported three individual fellowship programs (the SIF, IRF, and SIR programs). In FY 1999, about

75 percent of the funds support programs focused on global health threats (e.g., AIDS, emerging infectious diseases, biodiversity, and the population and environment programs). Mr. Miller presented a timeline that specified the programmatic and budgetary changes in FIC's portfolio since FY 1987. Examples of the changes made are the reduction and refocusing of the IRF program in FY 1993; the establishment of the International Cooperative Biodiversity Groups (ICBG) and MIRT programs in FY 1993; and the phasing out of FIC support for the SIR program beginning in FY 1997. The changes reflect the recommendations of various review and evaluation groups, the interests of Congress, and new opportunities identified by the FIC and NIH.

FIC's total expenditures each year consist of funds appropriated by Congress and funds received from other NIH components and Federal agencies. In FY 1997, total expenditures amounted to about $35 million, of which about $16 million was from appropriations and about $19 million was from other sources (including about $12 million from the NIH's OAR). Other NIH components and Federal agencies provided support for six FIC programs.

Currently, the FIC is staffed by 72 full-time-equivalent positions distributed among three divisions (Division of International Relations, Division of International Advanced Studies, Division of International Training and Research) and three offices (Office of the Director, Office of International Science Policy and Analysis, and Office of Administrative Management and International Services). Organization charts were provided to the Board and were available at the meeting.

Mr. Miller directs the Office of Administrative Management and International Services. This office handles administrative and budgetary matters for the FIC and, through the International Services Branch, provides immigration and visa services for the NIH scientific community. The branch comprises approximately 30 percent of all FIC staff. The branch provides services for about 3,150 foreign scientists in the NIH intramural program--about one-third of the scientific staff of the intramural program. The foreign scientists come from more than 90 countries, with about 75 percent of the total coming from 10 countries. The countries represented by the most scientists are, in order, Japan, China, Italy, Germany, and Korea.

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VIII. FIC INTERNATIONAL PROGRAMS: STATUS OF INTERNATIONAL TRAINING AND RESEARCH EFFORTS

Dr. Kenneth Bridbord, Director, Division of International Training and Research, FIC, described FIC's international training and research programs. These are: AITRP, International Training and Research Program in Population and Health, International Training and Research Program in Environmental and Occupational Health, International Training and Research Program in Emerging Infectious Diseases (ITREID), FIRCA, ICBG, and International Training Program in Medical Informatics. A handout summarizing each program was provided to the Board and was available at the meeting. Now in its tenth year, AITRP is the longest-running program and is the model for most of the other programs. In all programs, the FIC promotes the concept of co-management with other NIH components, with the FIC contributing its special experience in training and capacity building.

AITRP

The mission of AITRP is to train international health professionals in research on prevention of HIV infection. AITRP awards are made to U.S. institutions to support research and training in the United States and other countries. For its third 5-year cycle, the FIC recently received 24 applications for review; the fact that 16 of these applications are new proposals indicates the great interest in this program within the U.S. academic community. The main characteristic of the program is its flexibility in offering a range of training opportunities for individuals who have or do not have previous research experience. These individuals may engage in short- or long-range training, within the United States or another country, to obtain specific didactic or advanced research skills. Long-term relationships are established between institutions to encourage continuing collaborations and in-country support of individual trainees. About 90-95 percent of the long-term trainees return to their home countries.

Over the first 9 years of AITRP, more than 1,300 trainees from more than 90 countries have received training in the United States. In addition, AITRP is the largest single program for HIV and AIDS training of health professionals and researchers in developing countries, serving about 41,000 individuals through 598 courses in 60 countries. Former AITRP trainees and collaborators occupy key leadership positions in the global HIV/AIDS effort and are key contributors to the global HIV/AIDS science base. The AITRP's capacity-building focus and other NIH efforts in HIV and AIDS are mutually reinforcing. The AITRP has benefited existing programs and has stimulated additional research efforts and opportunities [e.g., through HIVNET, Preparation for AIDS Vaccine Evaluation (PAVE), International Collaborations in AIDS Research (ICAR), and U.S. research grants with foreign components]. Dr. Bridbord estimated that the NIH devotes about $40 million each year for research on HIV/AIDS in developing countries, of which about $10 million is allocated by the FIC for the institutional AITRP awards.

AITRP's success is reflected in the development of research careers for foreign and U.S. investigators, the building of research and public health capacity (based on indicators such as the number of publications authored or coauthored by AITRP trainees in respected peer review journals and the number of other research awards facilitated), and the contributions to scientific knowledge (examples are listed in the handout). Drawing on its experience and success with AITRP, the FIC will be participating in two new trans-NIH groups on HIV/AIDS: the FIC and OAR will co-chair an NIH-wide coordinating committee on HIV/AIDS, and the FIC and NIAID will co-chair an internal NIH co-management group for the AITRP.

Other FIC Programs

Dr. Bridbord briefly summarized the status of each of FIC's other international training and research programs. In collaboration with NICHD, the FIC supports seven awards under the program in population and health. In collaboration with the National Institute of Environmental Health Sciences and the Centers for Disease Control and Prevention, the FIC supports 13 awards under the program in environmental and occupational health; the Environmental Protection Agency also is interested in co-sponsoring this program. In the first year of a collaboration with the National Institute of Allergy and Infectious Diseases (NIAID) and the National Institute of Dental Research, the FIC supports 13 awards under the ITREID program. The ICBG program is in its second 5-year funding cycle and, although the U.S. Agency for International Development (USAID) may not continue to contribute to this program, other potential partners, including the Agricultural Research Service of the U.S. Department of Agriculture, are interested; twenty-two applications were recently reviewed in study section, and about $3 million will be available to support the next round of awards.

The FIC recently released Requests for Applications (RFAs) for three additional programs. An RFA, entitled "Tuberculosis International Training and Research Program," invites applications for supplements to existing AITRP and ITREID program awards. An RFA, entitled "International Training in Medical Informatics," which is co-sponsored with the National Library of Medicine, invites applications for establishment of model training programs for African scientists and health professionals. An RFA, entitled "Actions for Building Capacity in Support of ICIDR Program," invites applications from applicants who also are applying to NIAID's International Collaborations in Infectious Disease Research (ICIDR) program. The receipt date is in June 1998 for the first two RFAs and in September 1998 for the third RFA. Copies of the RFAs were distributed to the Board and were available at the meeting; they are also available on the NIH web site.

Discussion

The Board asked about the extent of FIC's partnership with USAID on international research efforts and about ways of assessing the effectiveness of capacity building. Staff noted that FIC has considerable interaction with USAID (e.g., in development and initial support of the ICBG program, FIC's tuberculosis initiative, and support of other NIH and PHS activities) and that FIC is invited periodically to participate at USAID meetings to discuss issues of mutual interest. Staff also noted that the FIC is developing an evaluation approach for assessing the impact of FIC programs at the country level and the types of conditions that make capacity-building efforts particularly effective. The FIC has secured outside funding for the evaluation and has convened a working group of the NIH components participating in AITRP to help design a pilot evaluation study for AITRP.

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IX. INTERNATIONAL RELATIONS: NIH-WIDE INITIATIVES AND SUPPORT

Ms. Linda Staheli, Acting Director, Division of International Relations, FIC, summarized the functions and responsibilities of her division. A handout which highlighted certain activities was provided to the Board and was available at the meeting.

The Division of International Relations is the "diplomatic arm" of the NIH, acting in many ways like a small Department of State. It is the only FIC division that is subdivided along geographic lines, with program officers responsible for FIC activities in various regions of the world. The division's mission is twofold: to provide services to the NIH scientific community and its international programs , and to support NIH's participation in discussions of the U.S. Government's foreign policy and health policy agendas. Division staff collaborate with NIH institutes and centers (ICs) to "build bridges" between the NIH scientific community and the health and foreign policy communities in the United States and throughout the world; interact with OSTP and the Department of State; and coordinate NIH interests with the larger international public health community [e.g., the U.S. Department of Health and Human Services (DHHS), WHO, USAID, The World Bank]. Staff are proactive, alert to new opportunities that may be of interest to the NIH.

Some of the primary functions of the division include representation of the NIH and liaison with other agencies (e.g., OSTP), information exchange (e.g., convening of bimonthly meetings with the IC's international representatives, development of an international web site on NIH's Intranet, fostering and providing speakers on opportunities for international collaborative research), and leveraging of NIH's international funds and identification of other resources (e.g., the Indian rupee fund, Middle East Regional Cooperation Program) to support NIH international activities. Other primary functions include provision of expert services (e.g., notifying U.S. embassies of NIH's foreign awards, conducting special ad hoc peer review panels as needed), troubleshooting of problems (e.g., assessing the potential impact of U.S. sanctions against a country), handling of foreign requests for information and visits to the NIH, negotiation and/or facilitation of international biomedical agreements, development and coordination of ICs comments on science and health policies (e.g., for the World Health Assembly), and development of communications tools (e.g., country pages and opportunity pages to brief NIH and DHHS officials).

Ms. Staheli noted that the NIH is entering a new era of collaboration, moving from formal bilateral agreements to other, less formal arrangements. Although formal agreements have served as important mechanisms for overcoming political, economic, or cultural obstacles to scientific cooperation, the need for these mechanisms has decreased as scientific exchange and communication have become more democratic. Also, the NIH is now more selective, entering into agreements that have a clear sense of purpose. Nevertheless, many agreements are longstanding. In FY 1996, for example, the NIH participated in 35 science and technology agreements, 12 health agreements, and 52 memoranda of understanding. An increasingly popular approach is the use of political frameworks (e.g., the Gore-Chernomyrdin Commission, the Gore-Mubarak Commission, the Gore-Mbeki Binational Commission, the U.S.-Japan Common Agenda) to foster a broad base of collaborative activities.

Ms. Staheli highlighted five initiatives in which division staff are active. Under the Gore-Mubarak agreement, the division coordinates U.S.-Egypt biotechnology activities on behalf of the FIC and NIH; the activities are supported, at $2 million per year, by monies from USAID and the Egyptian Government. Another example of FIC's ability to utilize leveraged resources from other sources is NIH's cooperation with the Japan Society for the Promotion of Science (JSPS); on behalf of the FIC, the division negotiated the agreement with JSPS to award 2-year fellowships for Japanese scientists working in the NIH intramural laboratories, thus reducing NIH's costs for these personnel. Division staff also worked with the U.S. Civilian Research and Development Foundation to establish a program to fund travel awards and workshops and to peer review proposals for collaborative research grants with scientists in the countries of the former Soviet Union.

In addition, division staff are assisting the ICs in identifying potential opportunities for support of collaborations with European scientists, to be funded through the recently signed U.S.-E.U. Science and Technology Agreement. One of the more active collaborations which division staff are facilitating is the U.S.-Mexico Cooperative Biomedical and Behavioral Research Program, co-funded by the NIH and Mexico's National Council of Science and Technology (CONACYT). Through this collaboration, Mexico is supporting a number of Pan American fellows in NIH laboratories. A similar agreement was recently signed with Chile.

In closing, Ms. Staheli said that the FIC is excited about opportunities for developing closer partnerships with WHO and The World Bank. She invited the Board members to communicate directly with division staff through their e-mail addresses, as provided in the handout.

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X. INTERNATIONAL POLICY SUPPORT TO NIH AND OTHER GOVERNMENT AGENCIES

Mr. Robert Eiss described the functions and activities of FIC's Office of International Science Policy and Analysis. Citing a whimsical simile offered by Lloyd Holly Smith, he noted that the staff, in its planning, functions much like "hedgehogs," identifying and burrowing into a very specific territory, whereas in the policy realm, the staff functions much like "foxes," reconnoitering and surveying the field swiftly and broadly, noting what fences come up or come down in the conduct of international research.

Elaborating on staff's work with international policy issues, Mr. Eiss highlighted four types of activities: preparation of substantive reports for interagency policy forums; analysis of, and comment on, legislative issues; monitoring of developments in international agreements that pertain to health and science; and development and facilitation of innovative strategies for international health research. One of the major forums in which the FIC participates is the National Science and Technology Council (NSTC) administered by OSTP. For the past three Administrations, Dr. Schambra has represented the NIH on NSTC's Committee on International Science, Engineering, and Technology (CISET). The FIC staff have prepared substantive reports on four issues addressed by CISET, including a report on emerging infectious diseases which led to a President's policy directive in this area.

Among the legislative items followed by office staff are two issues that have major implications for NIH: immigration and labor demand, and foreign access to U.S. inventions. For various forums, FIC staff have assessed, and continue to assess, the potential impact on the NIH of suggested amendments to U.S. immigration law. FIC staff also continue to study the complexities of balancing economic competitiveness and international cooperation. Mr. Eiss noted that U.S. census data indicate that immigrants are only marginally over represented in the biomedical sciences (11.7 percent of scientists and engineers in the United States are foreign-born) and that one-fifth of the 96 Nobel laureates who had NIH support for their research discoveries are foreign born. The NIH supports policies that enable U.S. investigators to recruit foreign nationals on a selected basis, based on the diverse and specialized needs in the biosciences.

Office staff also follow two types of international agreements: trade negotiations (e.g., the General Agreement on Tariffs and Trade, or GATT), and science and technology agreements (particularly, aspects pertaining to intellectual property). For the former, staff were able to change the text of the GATT Code on Subsidies and Countervailing Duties to give "green-light" status to NIH Cooperative Research and Development Awards and Small Business Innovation Research awards. With regard to intellectual property, the issues which staff follow include national differences in interpretation of patentable life forms, protection for U.S. process patents, piracy of patents and reverse engineering of U.S. pharmaceuticals by foreign entities, and patenting of the raw material of research experimentation.

Office staff have been instrumental in the development of FIC's innovative extramural strategies for combating global health threats. In this area, staff also have advocated increased activity or new mechanisms for the NIH as a whole. One example is FIC's involvement in the development of NIH's malaria initiative by convening two initial meetings, which helped focus on malaria, and by providing essential support for the major meeting in Dakar, Senegal.

In closing, Mr. Eiss suggested that the type of international collaboration under way for malaria could be contemplated for other health threats and would help mitigate the accelerating reduction of bilateral assistance, or "donor fatigue," to developing nations. Some strategies to reverse this trend, which have been discussed, include "front-end" funding through public support for research and development in industry, tax relief analogous to that given for development of "orphan" drugs, collaboration between the public and private sectors, and "debt-for-nature swaps" whereby developing nations exchange long-term debt payments for preservation of natural ecosystems. FIC could be influential in informing policy decisions and discussions in all these areas.

Discussion

In response to a question about the level of U.S. investment in malaria research, FIC staff said that the U.S. currently spends about $55 million, of which about $30 million comes from the NIH (most from NIAID) and the rest from USAID and other agencies. As indicated by a survey conducted by the Wellcome Trust in 1993, the United States is the major contributor worldwide of research funds for malaria. The new initiative is stimulating increased contributions from other G-8 countries and increased attention from multilateral organizations such as WHO and The World Bank. The Board noted that, even with the increased resources, the level of investment for diseases such as malaria and HIV/AIDS, which have enormous public health and economic impact, "is pathetic." The Board also expressed concern about the lethargy of response to innovative health strategies, such as debt-for-nature swaps which was first suggested in the early 1980s.

In closing, Dr. Richard Krause, Senior Scientific Advisor, FIC, and the Board commended and applauded Dr. Schambra for his redirection of the FIC over the past 10 years by mounting a set of broad research initiatives with strong training components directed to major scientific and health needs. Dr. Schambra thanked Dr. Krause and noted that these accomplishments could not have been made without the contributions and support of FIC's staff and Board.

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XI. 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.

XII. REVIEW OF APPLICATION

A total of 51 applications requesting $1,402,968 in FY 1998 funds were reviewed by the FIC Advisory Board as follows:

• 17 applications for International Research Fellowship (IRF) awards requesting $521,000;

• 7 applications for Senior International Fellowship (SIF) awards requesting $220,750;

• 22 applications for FIRCA awards requesting $536,642; and

• 5 applications for AIDS-FIRCA awards requesting $124,576.

The Board concurred with the initial review group recommendations for 51 proposals, recommending $1,402,968.

XIII. ADJOURNMENT

The meeting was adjourned at 2:30 p.m. on May 19, 1998.

XIV. ABBREVIATIONS

Abbreviations Used in the Minutes

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