Home > About Fogarty > Advisory Board > Meeting Minutes Archives > 02-06-2007 Meeting Minutes

February 6, 2007 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
Sixty-fifth Meeting

 

Table of Contents

1. Call to Order and Introductory Remarks
2. Dates of Future Board Meetings
3. Review of Confidentiality and Conflict of Interest
4. Review of Applications
5. Minutes of Previous Meeting
6. Welcome and Director's Opening Remarks
7. Review of Open Session Agenda
8. Presentation and Discussion of the AITRP Evaluation
9. Fogarty Portfolio Analysis and Environmental Scan
10. Discussion of Aging, Cancer and Chronic Conditions
11. Overview of Fogarty Goals
12. Closing Remarks and Adjournment

The John E. Fogarty International Center for Advanced Study in the Health Sciences (Fogarty) convened the sixty-fifth meeting of its Advisory Board on Tuesday, January 22, 2007, at 8:30 a.m., in the conference room of the Lawton Chiles International House, National Institutes of Health (NIH), Bethesda, Maryland. The closed session was held from 8:30 a.m. to 10:00 a.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] The meeting was open to the public from 10:30 a.m. to 3:45 p.m. Dr. Roger I. Glass, Chair, Fogarty International Center Advisory Board, and Director, Fogarty, presided. The Board roster is appended as Attachment 1.

Board Members Present:

Dr. Karen H. Antman
Dr. Elizabeth Barrett-Connor
Dr. Linda Burhannsstipanov
Dr. Wafaie Fawzi
Dr. Douglas C. Heimburger
Dr. Lee W. Riley
Dr. William A. Vega

Board Members Absent:

Dr. Luz Claudio
Dr. Arthur Kleinman
Dr. Patricia M. Danzon
Dr. Ting-Kai Li (ex officio)

Members of the Public Present:

Dr. Chanza Baytop, Abt
Dr. Elaine K. Gallin, DDCF
Dr. Junius Gonzales, Abt
Dr. Arthur L. Kellermann, IOM
Dr. Dushanka Kleinman, UMD
Dr. Brian Zuckerman, STPI
Dr. Robert Roberts, STPI
Dr. Brian Zuckson, STPI

Federal Employees Present:

Dr. Joel Breman, Fogarty/NIH
Dr. Ken Bridbord, Fogarty/NIH
Mr. Bruce Butrum, Fogarty/NIH
Ms. Tina Chung, Fogarty/NIH
Dr. Lois Cohen, NIDCR
Dr. Sally Eckert-Tilotta, NIEHS
Dr. Henry Francis, Fogarty/NIH
Dr. Dan Gerendasy, CSR/NIH
Dr. Gray Handley, NIAID/NIH
Dr. Joseph Harford, NCI/NIH
Dr. S. Suveshduavan, USDA
Dr. Henning Birkedal-Hansen, NIDCR
Ms. Francine Hill, Fogarty/NIH
Mr. Andrew Jones, Fogarty/NIH
Dr. Richard Krause, Fogarty/NIH
Dr. Danuta Krotoski, NICHD
Dr. Vesna Kutlesic, OD/NIH
Ms. Sonja Madera, Fogarty/NIH
Ms. Judy Levin, Fogarty/NIH
Dr. Yvonne Maddox, NICHD
Mr. John Makulowich, Fogarty/NIH
Dr. Jeanne McDermott, Fogarty/NIH
Dr. Peggy Murray, NIAAA
Ms. Linda Perrett, Fogarty/NIH
Dr. Karen Babich, NIMH
Dr. Christopher Schonwalder, Fogarty/NIH
Dr. Susan Shurin, NHLBI
Dr. Manana Sukhareva, CSR/NIH
Ms. Natalie Tomitch, OAR/OD/NIH
Dr. Ed Trapido, NCI
Mr. Randolph Williams, Fogarty/NIH
Dr. Richard M. Suzman, NIA/NIH

CLOSED SESSION

I. CALL TO ORDER AND INTRODUCTORY REMARKS

Dr. Glass called the meeting to order at 8:30 a.m. and welcomed Dr. Karen Antman who was appointed to the Board in May 2006.

II. DATES OF FUTURE BOARD MEETINGS

The following meeting dates are confirmed:

Tuesday, May 22, 2007
Tuesday, September 11, 2007

Tuesday, February 5, 2008
Tuesday, May 20, 2008
Tuesday, September 9, 2008

The Research Awards Subcommittee will meet on the Monday preceding each Board meeting to review the applications on behalf of the full Board.

III. REVIEW OF CONFIDENTIALITY AND CONFLICT OF INTEREST

The rules and regulations pertaining to conflict of interest were maintained.

IV. REVIEW OF APPLICATIONS

Dr. Glass chaired the portion of the meeting during which the Research Awards Subcommittee reported on its activities. The Fogarty Advisory Board reviewed a total of 99 scored competing applications at its September 12 meeting.^[2] The applications were in the following programs:

• 44 applications for the Brain Disorders in the Developing World: Research Across the Lifespan (BRAIN), out of a total of 47 scored applications, for $7,836,173;
• 18 applications for the Fogarty International Research Collaboration Award-Basic/Biomedical (FIRCA) program , out of a total of 18 scored applications, for $586,370;
• 8 applications for the International Clinical, Operational and Health Services Research Training Award for AIDS and TB (ICHORTA AIDS/TB), out of a total of 8 scored applications, for $2,196,053;
• 22 applications for the International Training and Research Program in Environmental and Occupational Health (ITREOH), out of a total of 22 scored applications, for $ 4,299,791;
• 7 applications for the Fogarty International Collaborative Trauma and Injury Research Training Program (TRAUMA), out of a total of 7 scored applications, for $ 1,044,669;

The Board concurred with the initial review group recommendations for 99 of the 99 applications.

Return to top of page

V. MINUTES OF PREVIOUS MEETING

The minutes of the Advisory Board meeting of September 2006, were considered and approved unanimously.

OPEN SESSION

VI. WELCOME AND DIRECTOR'S OPENING REMARKS

Dr. Roger I. Glass, Director, Fogarty

Dr. Glass welcomed the Board members and guests to the 65th meeting of the Fogarty Advisory Board. He stated that the strategic plan, initiated in August 2006, was progressing well and that a final draft would be available in the Spring. He also noted the importance of a flexible strategic plan. Such a plan would allow the Center to efficiently expand programs should additional resources become available.

Dr. Glass noted that he had visited a number of Fogarty supported training and research programs in South Africa and attended a networking meeting of the AIDS International Training and Research Program (AITRP) grantees. The AITRP program, initiated in 1988, was one of the first of a new generation of research training programs sponsored by Fogarty to provide training for scientists from institutions in low- and middle-income countries to strengthen HIV-related research and public health capacities at their institutions. This long-term investment in capacity building in South Africa has resulted in AITRP researchers occupying major positions of influence and leadership in the South African research community.

VII. REVIEW OF OPEN SESSION AGENDA

Dr. Linda Kupfer, Evaluation Officer, DASPA

Dr. Kupfer noted that shortly after assuming the responsibility of Fogarty Director, Dr. Glass announced a mandate to develop a Fogarty strategic plan, and staff has been focused on that charge since August 2006. A foundational aspect of the strategic planning process is a global health needs assessment, based on 2003 data, an environmental scan of global health investments, and a gap analysis, all prepared by an external, independent firm. (See Section IX.) The effort to develop Fogarty goals has been intense, beginning with a staff retreat in August at which broad issues were discussed and followed by a second staff retreat in September, which addressed the process of building a strategic plan.

In October there was a stakeholders meeting in Cairo attended by 16 countries, followed by a meeting with the international representatives of the NIH ICs in November and an October meeting at NIH that included a broader mix of stakeholders – ICs, PIs and others interested in the future of Fogarty. Fogarty also solicited feedback from stakeholders through its web site to inform its strategic planning and 85 comments were received, 43 from developing countries. By January 2007, Fogarty staff had pulled together input from the stakeholder meetings, staff retreats, and the web comments and developed the goals and an outline of Fogarty’s new strategic plan.

Dr. Kupfer added that an integral part of program management at Fogarty is an evaluation process, which looks at its programs at least every five years and is also accomplished by an independent contractor working with staff. Evaluations early in the life cycle of a program focus on process and later move to outcomes and impacts as the programs become more mature. The AITRP evaluation below is the latter.

Return to top of page

VIII. PRESENTATION AND DISCUSSION OF THE AITRP EVALUATION

Dr. Junius Gonzalez and Dr. Chanza Baytop, Abt Associates

Background

Dr. Baytop provided a brief overview of the charge to Abt Associates, Inc., which was to conduct an outcome evaluation of the AITRP—a feasibility study of the program was completed by Abt Associates in 2004. The evaluation looked at the challenges and successes of the AITRP – to what extent did the program enhance research expertise among participating foreign scientists, enhance collaboration between U.S. and foreign scientists/researchers, and build capacity for dealing with the AIDS epidemic?

Since the first AITRP grantee cohort of nine in 1988, the program grew to 25 grantees from 17 states by 2004. Also since 1988, the program has trained 1,379 individuals from 83 countries for a total of 1,581 training experiences—some trainees had more than one training experience.

Another indicator of the success of a program is the number of scientific papers published. During the 17-year history of the AITRP, over 2,600 peer-reviewed articles have been published for which a grantee was either first author or co-author. Understandably, about 80% of the articles were written by first cohort trainees (1988), and about 82% of the publications were “high income” in-country journals.

Training

Dr. Gonzales explained that part of the evaluation was to develop a “matched cohort” to compare against AITRP trainees – individuals in similar research positions that were not a part of the AITRIP. In that aspect of the survey tool, there was a clear advantage to being an AITRP trainee. On a satisfaction scale, AITRP trainees were higher in all categories, including satisfaction with current career, ability to secure funding, support by policymakers, and how well the country was responding to the AIDS epidemic.

Dr. Gonzales described four program models in regard to training: (i) long-term training at the U.S. institution (more than 6 months) resulting in either a master’s or doctoral degree; (ii) in-country training where the trainee is enrolled in a local advanced degree program; (iii) a “sandwich” program which allows a trainee to begin work in-country but also take advantage of courses and training in the U.S , which may be recognized by the trainee’s country for purposes of attaining a degree; and (iv) short-term training opportunities that help prepare individuals for a longer-term training program.

All of the training models present challenges, including but not limited to financial barriers involving accounting, delayed payments, and transfer of funds; constraints on the use of NIH funds, the comparatively higher cost of living in the U.S.; and the lack of equitable salaries and/or the lack of research support in the home country when the trainees return. Additional challenges include delays and difficulties in obtaining visas, the lack of a formal networking program to help the trainees maintain contact with other trainees, and the attraction of newly trained researchers by the burgeoning HIV/AIDS treatment infrastructure, drawn by higher salaries and support available in the treatment community.

Since the inception of the AITRP, about half of the trainees have received advanced degrees, mainly at U.S. universities -- 236 doctorates (15% of the total), 518 masters’ (33%) – and 561 received training that did not led to an advanced degree. A small number, 156, have been involved in post-doctoral studies. Africa leads in the number of master’s degrees (44%) obtained, and doctorate degrees and post-doctoral training are about equally distributed among the Americas, Asia and Africa. About half of the non-degree trainees come from the Americas.

Dr. Gonzales noted that the trainees spoke very favorably of AITRP mentoring, commenting that mentors not only supported them in their research programs, but helped them develop partnerships and collaborations, worked with them to obtain funding, and generally maintained a continuing interest in their professional and career development.

Building Capacity

The AITRP capacity building model is based on a “foci of research” concept and involves development of highly centralized networks within specific geographic areas (down to a city level). This helps to develop a “critical mass” of researchers, enhances a structured mentoring process and enhances the efficient development of research resources and infrastructure, therefore helping to retain researchers. For example, in Peru there are three leading scientists in three research areas who recruit AITRP trainees and supervise the overall research agenda. In Uganda, there is a long-standing and strong partnership between Case Western University and Makerere University, which has developed positive political support and has contributed to public health policy.

There are advantages and disadvantages. The foci model (i) increases the ability to obtain funding, (ii) produces well-trained scientists, (iii) reduces researcher loss because of the available resources and support, (iv) facilitates the development of a strong in-country research capacity, and (v) promotes regional collaborations. On the other hand, some disciplines may be excluded if not a part of the research focus and research may be limited by the infrastructure available to the network. Overall, the foci model can promote an exclusivity that inhibits opportunity.

Other obstacles to capacity building in some areas include difficulty in obtaining funding, competing demands for trainee talent (other usually clinical treatment opportunities versus a lack of research job opportunities and low salaries), lack of time to write research results articles and to develop grant applications, and a lack of appreciation and commitment by policymakers for research programs and results. When asked about future needs, responses focused on three areas – increased research on service systems for combating AIDS, policy research, and a focus on the combination of efficacy and effectiveness research.

While the data clearly demonstrated the importance of collaborations and partnerships, it also revealed a lack of networking among regional AITRP programs that could enhance collaborations. In addition, potential new sources of support should be expanded; and more “inter-modal” partnerships (e.g., between industry and non-governmental organizations (NGO) should be encouraged. Moreover, partnerships are often PI-based, and therefore tend to exclude non-academic players that may be involved in the HIV/AIDS research arena.

Summary

The messages that resonated among the AITRP grantees and collaborators were in the areas of responsiveness of funding and training, mentoring, and translational research. They said: (i) funding and training must be responsive to country policies and resources; (ii) the program must continue to emphasize good mentoring, try to overcome the limited opportunities for translational research, promote greater participation in and visibility for trainee-PI-IC collaborations; and (iii) the program must support trainee efforts to publish their work. On the “to do” list, trainees need better access to independent funding, an improved “connectedness” process to develop better networks of researchers, help in creating new partnerships and an enhanced opportunity to contribute to the policymaking process at all levels.

Recommendation

Based on the evaluation of the AITRP, it was recommended that Fogarty consider the following:

1. Development of standard mentoring guidelines under AITRP;
2. Provision of bridge funds to assist trainees in their transition from trainee status;
3. Development of strategies to enlist other funding partners (industry, NGOs, foundations, etc.) for AITRP, and
4. Development of methods that facilitate a more efficient use of resources (e.g., economies of scale, cost effective policies, multi-site collaborations, increased use of the Internet for both on-line training and enhanced communications among researchers.

Discussion

In response to questions asked by members of the Board, Dr. Bridbord stated that the program is currently funded at slightly over $14 million (about $18 million including co-funding). On the issue of publications, he added that a very high percentage of the papers were submitted by trainees as first author. Dr. Gonzales noted that in some instances, respondents felt the publications had little impact on promotion or anything else.

Asked about the rate of trainees returning to their country of origin, Dr. Gonzales stated that the average rate is about 85%; but that in some countries political factors (tensions, restrictions, etc. may substantially reduce the rate of return. He added that, especially from the first AITRP cohort, a number of trainees have attained positions of leadership.

IX. FOGARTY PORTFOLIO ANALYSIS AND ENVIRONMENTAL SCAN

Dr. Brian Zuckerman, Science and Technology Policy Institute

Fogarty launched its strategic planning process by commissioning the Science and Technology Policy Institute to conduct a needs assessment to identify global health research and capacity building priorities. The focus of the needs assessment included Fogarty and the entire global health community – federal and specifically NIH international activities and the activities of about forty funders outside the federal system with interests similar to Fogarty’s. An integral component of the needs assessment was the review of the entire Fogarty portfolio—research and training activities—of which AITRP constitutes about 80% of Fogarty funding.

Three broad areas of interest emerged: (i) current and projected disease burden in developing countries, including where biomedical research and research capacity-building effort are taking place; (ii) the innovation spectrum and where Fogarty might contribute; and (iii) geographical differences between developed and developing countries, as well as within developing countries.

Looking at disease burden, the World Health Organization (WHO) predicted a shift in the future toward non-communicable diseases such as heart disease, stroke and cancer; mental health; and mortality related to HIV/AIDS. The Fogarty mission is substantially invested in HIV/AIDS and basic science research, which is not necessarily specific to HIV/AIDS or infectious disease. Of other infectious diseases, Fogarty has mainly invested in tuberculosis and malaria related research. Non-communicable diseases—tobacco and drug abuse, neurological disorders and aging, mental health, non-infectious diseases and maternal health—command the smallest share of the Fogarty funding. Dr. Zuckerman noted that mental health included depression, the major worldwide mental health category, and other conditions; and heart attacks were separated from other cardiac conditions.

About 50 percent of NIH funding identified as “international” supports HIV/AIDS related activities; and the remaining 50 percent supports research on communicable diseases (mainly malaria), non-communicable diseases (cancer, non-infectious disease, reproductive/perinatal, and cardiovascular disease), with a small part designated as basic science research. The international research funding level at NIH is about $170 million, plus contributions in lesser amounts by a number of public and private organizations—the $170 million does not include Fogarty training funds. A much greater amount is spent for clinical trials and behavioral interventions by organizations such as the Bill and Melinda Gates Foundation.

Dr. Zuckerman added that total NIH funding for HIV/AIDS research is nearly $3 billion, of which $80 million, or about 3%, is spent on developing country programs in the broad areas of training support for in-country scientists, collaborations between the U.S. scientists and developing country scientists, direct research in developing countries, and support for labs and other research related infrastructure. One significant observation was that developing country research capacity was most improved in areas where the NIH invested funds in parallel with Fogarty training funds.

Overall, two-thirds of NIH funding—HIV/AIDS and non-HIV/AIDS related—goes to developed countries abroad and one third to developing countries. And approximately half of the latter goes to Sub-Saharan Africa and about one third goes to Latin America. In comparison, about one-third of Fogarty total funding supports training and research related activities in Africa and Latin America respectively, with the remainder (approximately 33 percent) distributed in other parts of the world. Overall, ten countries receive about half of Fogarty funding and 20 countries receive about two-thirds of Fogarty funding. There appeared to be no correlation between the number of Fogarty trainees and the senior international collaborators when matched with the NIH TTS database—the analysis did not go beyond the lead international collaborator level, however. An attendee at the meeting commented a much greater number of trainees would have been revealed if the analysis went beyond the lead collaborator level in the various programs.

In regard to research infrastructure in developing countries, it was clear that other Federal agencies such as the Center for Disease Control and Prevention (CDC) and the Department of Defense (DoD) and private organizations contributed substantially to physical infrastructure. U.S. involvement, however, is typically directed at infectious diseases. A comparison of Fogarty to other funders clearly reveals a focus on the training of scientists in developing countries. Fogarty is by far the leader in producing researchers at the master’s and doctoral level, and is a leader in career development among such trainees.

The global health research environmental scan also revealed a strong correlation between GDP and level of publications, especially when the richer developing countries were compared to their developed country counterparts. There were some exceptions – some Southeast Asian countries had a lower publication rate than expected, and some very poor African countries had a higher rate, in some cases, because of very productive individual researchers.

When looking at publication levels across countries by size, Fogarty trainees authored approximately 3 percent of the papers published in the larger developing countries. And although the publication rates were lower in the smaller countries (i.e., less than 3 percent), it was still respectable, mainly coming from major institutions such as Makerere (Uganda). Fogarty influence, while existing in larger countries, is clearly an important factor in the smaller less rich countries such as Haiti, Uganda, Malawi, Zambia, Kenya and Peru. In addition, publication rates were especially higher at centers of excellence—there are 29 centers of excellence in 16 developing countries. Overall however, there was a definable publishing gap among small and large countries that might serve as an indicator of the need for additional investments.

Discussion

Dr. Glass commented that the annual report on NIH global investments, discontinued several years ago but now in the process of revival, should help in understanding the contribution of the extramural and intramural programs to global health research and training. For example, up to 90% of the intramurally supported trainees are from abroad, and most return, adding to capacity. It was also noted that other NIH extramural programs, including program projects and centers of excellence provide support for researchers from low-income countries, none of whom was included in the data presented. Dr. Glass noted that most NIH-supported centers focus on infectious diseases, and few expend substantial resources on cancer, aging or cardiovascular disease in the developing world – a point that might be considered in developing the Fogarty strategic plan. There was also a brief discussion about aging and neurodegenerative disorders; and, it was noted that most NIH funding for those areas of research come from the categorical institutes.

In response to a comment that the World Bank had highlighted the problem of injury and trauma—now accounting for 15% of DALYs and expected to increase by 2030, Dr. Zuckerman agreed that injury and trauma are important and noted that Fogarty has perhaps the only large-scale training program relating to injury prevention in the world.

There was a brief discussion about the lack of data-sharing networks that reach into the low and middle income countries, specifically in epidemiology, demographics and the social sciences. For example in Zambia, a number of large foundations and NGOs work on malaria but seldom get together to share data and information. NIH, through Fogarty, could take a leadership role in promoting data sharing.

In closing, Dr. Glass reminded the group that infectious diseases would continue to be a primary concern in regions such as Africa; but in countries like China and India, the population is aging and the concern is moving toward non-infectious disease – cardiovascular disease, cancer, mental health. This must be kept in mind as the Fogarty strategic plan takes shape.

Return to top of page

X. DISCUSSION OF AGING, CANCER AND CHRONIC CONDITIONS

Dr. Suzman of the National Institute on Aging expressed concern that, although some of the health issues related to aging were included in the draft goals to be discussed, the subpopulation itself was not identified. The health consequences that burden later life are often related to failures in the earliest years—there is good evidence, for example, that malnutrition in early childhood is a factor in the onset of diabetes in later years. Dr. Suzman also noted that NIA is a leader in health-related economic research. The Institute is currently involved in a cooperative effort with WHO and the European Union to develop a survey infrastructure that would cover more than two-thirds of the world’s older populations. Fogarty might consider investing in that effort. He also recommended two National Academies’ reports—Preparing for an Aging World: The Case for Cross-National Research, and Aging in Sub-Saharan Africa—as invaluable resources on world aging issues.

Dr. Suzman commented that the diminishing funding line was an obstacle that most NIH institutes and centers experienced in developing international projects. He noted that Fogarty could be most effective in such an effort by leveraging its funds to create an incentive. Co-funding from Fogarty might encourage a decision to proceed when, without even a symbolic contribution from Fogarty, there would be a minimal chance for approval.

Dr. Harford of the National Cancer Institute commented that aging is the dominant risk factor for cancer and tobacco-related disease. For example, AIDS survivors are beginning to have age-related diseases, like cancer and cardiovascular disease, because they are living longer and smoking, but these conditions are related more to lifestyle than to AIDS. Cancer research may best be done in developing countries where the populations are aging more rapidly, and where cancer is often diagnosed at a later stage. There are also some cancers, like Kaposi’s sarcoma, that can no longer be studied in the U.S. because it has become so rare.

Concerning co-funding and NCI, Dr. Harford noted that the Institute might be more receptive to a proposal for funding if there was some assurance that, from the whole funding effort, some of the research would be directed to grants that would complement the Institute’s mission. For NCI to contribute to a project that would have no cancer-related research would be a hard sell.

Dr. Shurin, deputy of NHLBI, stated that her institute conducts a substantial amount of co-funded research, but a key ingredient of most of those agreements is joint intellectual support as well—both parties actively participating in the conduct of the research.

It was suggested that the definition of “lower income” be expanded to include “underserved communities,” because the latter populations (e.g., U.S. Native Americans) are typically ineligible for the kind of research that Fogarty supports. There was also a comment that NIH, perhaps with Fogarty’s support, should address the issues that arise in regard to IRB reviews that can stymie research and/or make it more expensive.

Dr. Maddox commented that NIH institutes actively engaged in global health research usually have international offices and an international agenda that reflects their mission. And while a study conducted in a developing country usually have, as part of its rationale, a local urgent public health need, it is also expected that those in the U.S. population affected by the disease or disorder under study might receive benefit from the study results. In such studies in developing countries, NICHD tries to identify Fogarty-trained researchers to participate. The creation of that cadre of well-trained researchers seems to be an appropriate outcome of Fogarty’s mission to respond to public health needs in developing countries.

XI. OVERVIEW OF FOGARTY GOALS

Dr. Linda Kupfer, Evaluation Officer, DASPA

Introduction

Through the strategic planning process, five major goals were developed in the following priority areas: global health research capacity in low and middle income countries, implementation science, domestic and international global health research and research training programs, and communications.

Goal I: Build Sustainable Global Health Research Capacity in Low and Middle Income (LMI) Countries

The fiscal environment and legislative provisions have eliminated the possibility that FIC will fund any new or existing centers of excellence, but there could be an effort to develop another model, “foci of research,” which do not require physical infrastructures. Training researchers from abroad to help develop in-country capacity would be an integral part of such an initiative.

One option is to base “foci of research” in an existing program (like FIRCA) or to develop virtual centers of excellence. It was noted that virtual centers might bring researchers together, blurring boundaries in a positive way that would facilitate coordination across borders. Two challenges were also noted – funding for virtual centers and turf related issues. It was suggested that coordinating the efforts of funding institutions might overcome some of the issues that deter cooperation at the investigator level.

Goal II: Promote "Implementation Science (IS) in Low and Middle Income Country Settings to Facilitate Adoption of Evidence-Based Research Findings into Routine Practice in Communities and Populations

To support Goal #2, it was recommended that FIC establish implementation science training and create implementation science research programs. There seems to be a dearth of individuals well-qualified in implementation science and more training programs might be needed. At the same time, it should be understood that effective implementation programs may take from five to ten year to succeed.

While there are many barriers—cultural and behavioral—to bringing the valid results of research into broad public use globally, successful experiences in one location have the potential of informing the process of implementation in others. The challenge is identifying the significant barriers first. In addition, one aspect of effective implementation at the international level is the essential involvement of the local government and communities, and considerations of politics and policy and even diplomacy. In addition, it would be Fogarty’s role to support the country’s efforts in such an initiative. Accordingly, it may be helpful to enlist the support of a neutral entity, like WHO, at the implementation stage; and the inclusion of local clinicians and clinical researchers in the implementation process would also be invaluable.

Implementation research is not so much a question of ethical responsibility as a question of how research evidence is translated into practice, and what role Fogarty can play in that process. Fogarty is in a position to transcend the specifics and support a philosophy that goes beyond burden of disease and into the area of public health improvement.

Goal III: Expand Research and Research Training Programs to Address the Increasing Burden of Non-communicable Diseases in Low and Middle Income Countries

Fogarty has determined that there are immediate opportunities to expand funding in non-communicable diseases through the FIRCA and GRIP programs in trauma, child health, violence and abuse of women and children, environmental health, obesity, diabetes, mental health, nutrition, AIDS-related conditions, research on prevention, diagnostics and training technology, and behavioral interventions.

Goal IV: Advance Global Health Research and Research Training Domestically

To support this goal, Fogarty seeks to facilitate the development of career paths in global health research for U.S. trainees and to add global health to the NIH agenda, and this includes expanding the Roadmap agenda to include global health. There was a brief discussion about various programs that might support the goal.

Goal V: Strengthen the Effectiveness of the Fogarty International Center

Based on key recommendations from the strategic planning process, the focus is to improve communications within the NIH and internationally, strengthen collaborations and partnerships within and beyond NIH, and to develop best practices for research and grants administration in the developing world.

There was a suggestion that the Fogarty senior staff might benefit from attending institute council meetings.

Dr. Glass closed the meeting with a proposal. An interesting project might be to select a limited area of a foreign country with a relatively high morbidity/mortality rate, and create a broad intervention that would target many of the diseases and conditions that affect the area. The primary objective would be to determine if the intervention significantly reduced the morbidity/mortality rate.

Return to top of page

XII. CLOSING REMARKS AND ADJOURNMENT

There being no further business, the meeting was adjourned at 4:20 p.m.

Abbreviations Used in the Minutes

Fogarty International Center Advisory Board Roster

(All terms end January 31)

September 2006

Roger I. Glass, M.D., Ph.D. (Chair) Director, Fogarty International Center and Associate Director for International Research	Luz Claudio, Ph.D. (2010) Associate Professor Department of Community and Preventive Medicine Mount Sinai School of Medicine One Gustave L. Levy Place New York, NY 10029	Arthur Kleinman, M.D., M.A. (2009) Esther and Sidney Rabb Professor and Chair Department of Anthropology Harvard University Cambridge, MA 02138
Karen H. Antman, M.D. (2010) Provost and Dean Boston University School of Medicine 715 Albany Street, A Boston, MA 02118	Patricia M. Danzon, Ph.D. (2008) Ceilia Moh Professor Health Care Systems Department The Wharton School University of Pennsylvania Philadelphia,PA 19104-6218	Lee W. Riley, M.D. (2007) Professor of Infectious Diseases and Epidemiology School of Public Health University of California Berkeley Berkeley, CA 94720
Elizabeth Barrett-Connor, M.D. (2008) Professor and Division Chief Division of Epidemiology Department of Family and Preventive Medicine University of California, San Diego La Jolla, CA 92093-0607	Wafaie Fawzi, M.D., Dr. P.H. (2007) Associate Professor of Nutrition and Epidemiology Department of Nutrition Harvard School of Public Health Boston, MA 02115	William A. Vega, Ph.D. (2009) Professor Psychiatry Robert Wood Johnson Medical School Piscataway, NJ 08854
Linda Burhansstipanov, Ph.D. (2010) President/Executive Director Native American Cancer Research Corp. (NACR) Native American Cancer Initiative, Inc. (NACI) 3022 South Nova Road Pine, CO 80470-7830	Douglas C. Heimburger, M.D., M.S. (2008) Professor, Division of Clinical Nutrition and Dietetics Departments of Nutrition Sciences and Medicine University of Alabama at Birmingham Birmingham, AL 35294-3360

EX-OFFICIO Member Ting-Kai Li, M.D. (2010) Director National Institute on Alcohol Abuse and Alcoholism National Institutes of Health, Bethesda, MD

EXECUTIVE SECRETARY Jean Flagg-Newton, Ph.D. Office of the Director Fogarty International Center National Institutes of Health Bethesda, MD 20892

---

^[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, unscored, or not recommended for further consideration by initial review groups were not considered by the Board.

Return to top of page