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May 22, 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-sixth 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. Training and Capacity Building
8. Non-Communicable and Communicable Diseases
9. Implementation Research
10. Constituency Building
11. Communications
12. Concluding Remarks

The John E. Fogarty International Center for Advanced Study in the Health Sciences (Fogarty) convened the sixty-sixth meeting of its Advisory Board on Tuesday, May 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 9:30 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. Patricia M. Danzon
Dr. Wafaie Fawzi (teleconference)
Dr. Douglas C. Heimburger
Dr. Arthur Kleinman
Dr. Lee W. Riley (teleconference)

Board Members Absent:

Dr. Linda Burhansstipanov
Dr. Luz Claudio
Dr. William A. Vega
Dr. Tin-Kai Li (ex officio)

Ad Hoc Board Members

Dr. Robert Black, Johns Hopkins School of Public Health
Dr. Peter Hotez, The George Washington University & Sabin Vaccine Institute
Dr. Jim Kim, Harvard University School of Public Health
Dr. Arthur Reingold, UC Berkeley School of Public Health

Members of the Public Present:

Dr. Nelson Sewankambo, University of Makerere School of Medicine
Mr. Dustin Colegrove, American Association of Colleges of Osteopathic Medicine

Federal Employees Present:

Ms. Nalini Anand, Fogarty/NIH
Ms. Daniele Bielenstein, Fogarty/NIH
Dr. Joel Breman, Fogarty/NIH
Dr. Kenneth Bridbord, Fogarty/NIH
Mr. Bruce Butrum, Fogarty/NIH
Dr. Peter Billingsley, Fogarty/NIH
Ms. Stacy Chambers, NINDS
Dr. Lois Cohen, NIDCR Consultant
Mr. Robert Dennis, NHGRI/NIH, Contractor
Mr. Pierce Gardner, Fogarty Consultant
Dr. Dan Gerendasy, CSR/NIH
Dr. John Haller, NIBIB
Dr. Karen Hofman, Fogarty/NIH
Mr. Andrew Jones, Fogarty/NIH
Dr. Flora Katz, Fogarty/NIH
Dr. Brenda Korte, NIBIB/NIH
Dr. Danuta Krotosky, NICHD
Dr. Vesna Kutlesic, OD
Ms. Judy Levin, Fogarty/NIH
Dr. Xingzhu Liu, Fogarty/NIH
Ms. Sonja Madera, Fogarty/NIH
Mr. Thomas Mampilly, Fogarty/NIH
Dr. Jeanne McDermott, Fogarty/NIH
Dr. Ellis McKenzie, Fogarty/NIH
Dr. Kathy Michels, Fogarty/NIH
Ms. Sheri Park, NICHD/OCM
Dr. Aron Primack, Fogarty/NIH
Ms. Katherine Serrano, NIBIB/NIH
Dr. Lana Shekim, NIDCD/NIH
Dr. Barbara Sina, Fogarty/NIH
Dr. Manana Sukhareva, CSR/NIH
Mr. Tim Tosten, Fogarty/NIH
Dr. Ed Trapido, NCI/NIH
Mr. Randolph Williams, Fogarty/NIH
Ms. Joan Wilentz, Fogarty Consultant
Dr. Brenda Korte, NIBIB/NIH
Dr. Danuta Krotosky, NICHD
Dr. Vesna Kutlesic, OD
Ms. Judy Levin, Fogarty/NIH
Dr. Xingzhu Liu, Fogarty/NIH
Ms. Sonja Madera, Fogarty/NIH
Mr. Thomas Mampilly, Fogarty/NIH

CLOSED SESSION

I. CALL TO ORDER AND INTRODUCTORY REMARKS

Dr. Glass called the meeting to order at 8:30 a.m. and welcomed the ad hoc Board members.

II. DATES OF FUTURE BOARD MEETINGS

The following meeting dates are confirmed:

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 of 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 Closed Session during which the Research Awards Subcommittee reported on its activities. The Fogarty Advisory Board reviewed a total of 75 applications at its May 22.^[2] The applications were in the following programs:

• 5 applications for the AIDS International Research Training Program (AITRP) out of a total of 7 applications, for 1,386,495;
  
• 17 applications for the Fogarty International Research Collaboration Award (FIRCA), Basic Biomedical (BB) and Behavioral and Social Sciences (BSS) out of a total of 22 applications, for $452,837;
• 5 applications for the Fogarty International Clinical Research Scholars Resource and Support Center (FICRs) out of a total of 5 applications, for $15,225,015;
• 9 applications for the Global Infectious Disease Training Program (GID) out of a total of 9 applications, for $1,124,548;
• 13 applications for the Global Research Initiative Program for New Foreign Investigators (GRIP) out of a total of 19 applications submitted, for $654,000;
• 2 applications for the Planning Grants for International Malaria Clinical, Operational & Health Services Research Training (Malaria ICOHRTA) out of a total of 2 applications, for $48,000;
• 20 applications for the International Tobacco and Health Research and Capacity Building Program (TOBACCO) out of a total of 26 applications submitted, for $6,017,617;
• 2 NIH Pathway to Independence Award (K99) Special Actions for a total of $163,909; and
• 2 International Research Ethics Education and Curriculum Development (BIOETH) Special Actions out of 2 applications for $473,970

The Board concurred with the initial review group recommendations for 75 of the 75 applications.

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OPEN SESSION

V. MINUTES OF PREVIOUS MEETING

The minutes of the Advisory Board meeting of January 12, 2207, were considered and approved unanimously.

VI. WELCOME AND DIRECTOR'S OPENING REMARKS

Dr. Roger I. Glass, Director, Fogarty

Dr. Glass welcomed Board members and guests. Contrasting Fogarty with its sister NIH institutes and centers, he noted that the Center was the smallest of 27 institutes and centers, with a budget of $68 million. Unlike the research programs of most institutes, the majority of Fogarty funding supports research training and institutional capacity building in middle- and lower-income countries. The AIDS International Training and Research Program (AITRP), which was implemented in 1988, has contributed substantially to the development of a number of leaders in the global AIDS research community; and other Fogarty programs have helped to build collaborations between U.S. and foreign institutions, provide support for young scientists returning to their home countries, as well as support research training in disease areas such as malaria, tuberculosis, etc. One Fogarty program, the Ecology of Infectious Disease Program, links the NIH and the National Science Foundation to support infectious disease research internationally.

Dr. Glass reported that the development of Fogarty’s new strategic plan was ongoing. Research training and capacity building in infectious disease research will remain an integral part of Fogarty’s focus; however, the Center will also seek to encourage investments in mental health, cardiovascular disease, cancer related to tobacco use. Fogarty has a small intramural research effort that could potentially provide synergy to its extramural programs by expanding the epidemiology and population sciences focus (including modeling work on flu, polio, diarrheal diseases and malaria) to include modeling in the area of implementation science.

The new strategic plan will encompass three important areas: 1) training U.S. and foreign health scientists to participate in the globalization of health research and care; 2) investing in sustainable capacity in both people and institutions in developing world countries to facilitate their participation in the globalization of health research; and 3) building expertise and capacity in implementation science to accelerate application of research knowledge on a global scale.

Accordingly, Board members and ad hoc members were asked to provide their perspectives on and lead the discussion in three broad areas of emphasis within the new draft strategic plan—research training and capacity building, non-communicable and communicable diseases, and implementation research. All Board members were asked to provide input and discuss the areas of constituency building and communications.

VII. TRAINING AND CAPACITY BUILDING

Dr. Robert Black, Dr. Peter Hotez, Dr. Arthur Reingold

Noting that the draft Fogarty strategic plan reflected an expansion of current programs with special emphasis in areas with limited funding support such as non-communicable diseases, Dr, Black viewed the new Plan as more tactical than strategic. Fogarty was asked to consider assessing its role in relation to the NIH as a whole as a starting point as well as to focus on both its strengths—the things the Center does well—and its weaknesses—the things that Fogarty does not tackle as well as it should. The Plan should reflect a balance between research effort, clinical needs, and training; and aspects of the Plan should be sensitive to the limitations of research infrastructure (i.e., post-award research administration) in developing country institutions. Participation in public-private partnerships with important funders such as the Bill and Melinda Gates Foundation and similar foundations was also recommended.

Given the limitations of the Fogarty budget, the most practical source of partners for Fogarty is within the NIH; and the most notable successes include partnerships with the National Institute of Child Health and Human Development (NICHD) and with the National Institute of Allergy and Infectious Diseases (NIAID). Fogarty plans to expand collaborations with the other NIH ICs, in particular seeking to expand research training efforts in areas less well served compared to HIV/AIDS (i.e., cardiovascular disease, cancer, and mental health to name a few).

Fogarty has a challenging task in developing a strategic plan because of its broad international constituency and limited budget. For example, Dr. Hotez noted that the draft strategic plan does not reference the NIH Roadmap, which promotes cutting edge research and translational research. If Fogarty focused on cutting edge research and translational research, specifically for diseases and the effects of poverty on health in the developing countries, the Center could make a contribution to the NIH Roadmap that no other institute appears to be making. It was recommended that Fogarty develop a key objective in its plan that was uniquely appropriate to the Center’s experience and culture. Such an objective could potentially serve as the developing world component of the NIH Roadmap. It was also recommended that Fogarty lay the foundation in it’s new strategic plan for significantly increasing its NIH budget allocation.

Dr. Glass agreed that the NIH Roadmap is important to the strategic plan, and noted that discussions with the NIH Director are ongoing to look at how Fogarty can help other institutes expand their roles in global health care programs.

Also in regard to training and capacity building, there may be a role for Fogarty in encouraging a change in the focus of training curricula at schools of public health. Dr. Hotez opined that public health students are not taught the hard science needed to contribute to global solutions of public health needs. The schools tend to focus on the soft sciences – communications, policy and management, health promotion, physical therapy – but are notably lacking in courses that represent science technology. Courses typically offered in school of public health 50 to 75 years ago such as bacteriology, parasitology, entomology, etc., are the nuts and bolts courses that are needed to understand diseases of poverty in developing countries. Fogarty could support the inclusion of important and appropriate disease technology courses in schools of public health. Another area that needs strengthening is the participation of schools of public health graduates and post-graduates in public-private partnerships of the types that have burgeoned since the creation of foundations like the Gates Foundation. Dr. Hotez used the example of malaria vaccine development, which involves a broad range of technologies, to explain his use of the concept “science technology.” He noted that malaria vaccine development initially requires biomedical research, a lab-based process; but then it progresses through quality assurance, scale-up manufacturing, clinical testing, dealing with regulatory issues, clinical trials, the challenge of cost effective access (economics), financing strategies and global distribution. He added that most of the skills required to accomplish these processes are not taught in public health schools.

Following up on the theme of training and capacity building in schools of public health, Dr. Black mentioned India’s plan to create 15 new schools of public health over the next five years—India now has one school of public health. It may be prudent for Fogarty to consider the implications of such an initiative, such as recruitment of faculty, an increase in Internet-based education and training, and a need for U.S. institutions to redefine their roles in the training process.

Dr. Reingold suggested that the strategic plan might focus too sharply on biomedical solutions – understandably since NIH is the leading biomedical research resource of the U.S. The biomedical component is important, but developing countries also need solutions that are social, political and economic. Programs that partner with other disciplines, such as law, business, and engineering are essential. The Fogarty Director acknowledged the challenges inherent in operating within an institution that successfully focuses on the advancement of biomedical science, but noted that Fogarty has the experience to help in getting the benefits of science into the world health community.

Dr. Barrett-Connor highlighted three dilemmas in the public health arena compared to basic science. First, the real successes in public health in the developing countries have not employed cutting edge science, but have been in relatively commonplace programs – getting immunization programs up and running and consistently supplied, making clean water available, improving local sanitary conditions, distributing oral saline to reduce diarrhea. Second, public health must continue to do its job even when the basic science world becomes involved in more glamorous activities, such as gene research. Third, there is a dilemma concerning who to train in developing countries—the focus could well be the individuals who will become the ministers of health, since they may have more impact in selling health care programs to their governments.

Dr. Sewankambo, dean of the Makerere University School of Medicine (Uganda), remarked that leadership training was important for developing professionals who could potentially occupy positions such as director of medical services in health care institutions. He also highlighted the benefits of Fogarty’s south-to-south programs, one of which involves bioethics training. It was noted, however, that grounding in areas of social and economic importance—biostatistics, policy, cost/benefit analysis, etc. as well as leadership training was necessary if implementation research was to become a major Fogarty objective.

Fogarty was also strongly encouraged to develop a conceptual framework for global health in its strategic plan and to place itself in the center of that framework. Although the NIH spent more than $700 million outside the U.S., last year compared to Fogarty’s contribution of $60 million, Dr. Kleinman noted that Fogarty has a comparative advantage over the other NIH institutes and centers in particular in terms of its understanding of and experience in the practical side of global health. He also opined that implementation research may be the key role for Fogarty in the future, which means movement toward a greater focus on biosocial sciences than the current programs reflect. Such programs would be aimed at administrators who will be the key players in translational science.

Dr. Kim continued with the translational science theme by elaborating on the two types of translational science and by highlighting the type of training needed. He noted that “bench to bedside” translational research was well managed by the NIH research process, but that it also required more funding than Fogarty could comfortably manage. On the other hand, “bedside to body” translational research is an area that Fogarty can effectively support, but it requires training that includes leadership, management, operations, epidemiology, anthropology, sociology, etc.

The Board also discussed the advantages of establishing a “Friends of Fogarty” organization. Such organizations host events that support the Center and create cash awards/prizes for individual researchers, etc. It was also noted that the NIH Foundation, a non-federal organization, is able to raise funds and expend them on projects approved by the Foundation’s board of directors.

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VIII. NON-COMMUNICABLE AND COMMUNICABLE DISEASES

Dr. Karen Antman, Dr. Elizabeth Barrett-Connor, Dr. Arthur Kleinman

Dr. Barrett-Connor posed a key question: whether to focus on the short-term benefits of saving children’s lives now (infectious diseases) or spending on programs that the children may not live long enough to experience a benefit (non-communicable diseases -- cardiac disease, anti-smoking, diabetes). She suggested it could be a balancing act, but that a practical aspect is the propensity of programs to prefer a short-term result. Dr. Sewankambo conceded that the major and most visible problem is infectious diseases, but remarked that the non-infectious diseases—hypertension, diabetes and, as young people consume fast foods, obesity—are beginning to garner notice. Currently, the programs at Makerere in non-communicable diseases and disorders are very small.

Dr. Antman drew the group’s attention to WHO data that showed heart disease and cancer as the major causes of death in developing countries, and mental illness as the major cause of morbidity. Dr. Kleinman added that it was unnecessary to defend the importance of research in the areas of heart disease and cancer in the developing world because of the immense data that show the burden of such diseases. In addition, commenting on his experience in China, Dr. Kleinman noted that implementation is a major issue. In the mental health field, there are effective interventions for depression and hypertension, but there are no effective programs to deliver the solutions. Ninety percent of individuals with depression are neither diagnosed nor treated, and the rate of suicide in China is 2.5 times greater than in the U.S. In regard to mental health and related areas, NIMH has limited resources committed in the developing world and NIAAA has significantly more resources committed; however, Fogarty could still play a role in promoting the NIH response to mental health and related conditions and diseases by identifying issues and facilitating implementation. By integrating non-communicable diseases into the strategic plan, Fogarty would signal objectives beyond its traditional infectious disease role.

Following up on the theme of a need for balance between communicable and non-communicable diseases, the Disease Control Priority Project (DCPP) was mentioned good tool for facilitating a practical approach to decision-making concerning the appropriate balance between communicable and non-communicable diseases. The DCPP seeks to contribute substantially to global initiatives to improve the health of all peoples by providing a multidisciplinary understanding of these fundamental issues and challenges, and by providing effective interventions for the range of communicable and non-communicable diseases and conditions and risk factors. Dr. Glass agreed, noting that the DCPP might also help Fogarty in increasing interest in global health among the institutes.

It was also noted that the experience with AIDS had changed the developing world’s perception of chronic disease in terms of its health agenda. Given this change in direction, Fogarty could become involved with the second part of implementation research mentioned earlier—bedside to body, particularly in the HIV/AIDS area. There are substantial funding opportunities to support chronic disease management.

IX. IMPLEMENTATION RESEARCH

Dr. Patricia Danzon, Dr. Jim Kim

Expanding the definition of implementation science was recommended, especially since its import in the strategic plan was mainly biomedical. Dr. Danzon noted several opportunities to integrate implementation research into Fogarty’s programs: (i) add a training component to existing programs; (ii) add an implementation research requirement to future program proposals; or (iii) consider horizontal intervention, building a health care capacity that includes not only disease focus, but a more general approach to providing broad community health care services. The latter is in contrast to Fogarty’s usual approach of vertical integration disease by disease.

Fogarty might also want to approach the Center for Medicare & Medicaid Services (CMS), the Agency for Health Care Research and Quality (AHRQ)—both support implementation research— or other funders to promote implementation research in developing countries. Funding is available from a number of major foundations (i.e., Kaiser, Robert Wood Johnson) for implementation research.

A secondary issue related to implementation science—the need for qualified people to accomplish it—was discussed. There is a shortage of professionals in the implementation science field and the universities have not yet created a curriculum to provide the needed expertise. Dr. Hotez noted that Fogarty could be a catalyst of change in this area, perhaps by sponsoring a global health summit for students and university officials to help them understand the importance of implementation science. Business school and industry representation could also be included in such an effort.

Dr. Kim agreed that it would be appropriate to supplement the implementation programs of CMS and AHRQ—both agencies have limited budgets—to effectively create a “National Institute for Health Care Delivery,” with both U.S. and developing world responsibilities. The current concern about the high cost and low quality of U.S. health care may give Fogarty an opportunity to weigh in and help define the research issues that are also related to health care in developing countries. Two major AIDS programs in Uganda were described to highlight the importance of implementation research. One program revolves around a dedicated, individual physician whose mission is to provide antiretroviral therapy to as many individuals as practical; however, the program has minimal adherence monitoring or patient follow-up. The second program is community-focused, probably reaches fewer patients, but has an infrastructure that provides a high level of patient care (including delivering drugs to outlying areas) and adherence monitoring. Although both programs appear to be effective, there has been no research to identify the characteristics of each that are most effective. The same is true of other programs in Uganda – the experience and the lessons learned are not being documented and shared.

To develop effective implementation research program a sequence of events is required: from the biomedical solution, through scale-up, and delivery. Unfortunately even in the U.S., the health care system is woefully behind the business community in identifying all of the steps involved in delivery, especially dealing with policy. Another requirement for effective implementation research is a good source of experimental information.

Responding to Dr. Heimburger inquiry as to whether the proliferation of NGOs, which usually focus on implementation/delivery, offered a good source of experiential information, Dr. Sewankambo (Makerere University Medical School, Uganda) commented that the NGOs, which have proliferated in Africa, are less effective than initially proposed. Some NGO’s dwarf the health ministries they are supposed to serve in terms of funding. Yet, many have strayed from their original missions and have used funding for purposes unintended by the funder.

In a discussion about developing country perceptions about developed country-led research efforts, the Board noted that many African institutions perceive U.S. university research, which is often accompanied by quality health care services as a one-way proposition—little is shared with developing country institutions and there is little motivation to help those institutions improve once the research effort is over. Dr. Sewankambo agreed, noting that NIAID has conducted quality research and provided excellent health care, but leaving behind an improved health care system has not been part of the programs. Noting the long history of failures by developing countries to raise the quality of care locally pursuant to research efforts in low-income countries, Dr. Kleinman suggested that Fogarty could contribute by developing a “non-extraction” approach to implementation research.

Dr. Sewankambo also noted that the current level of enthusiasm for global health found in developed countries does not exist in Africa. On the other hand, global health is becoming a very hot issue among U.S. university students, many of whom are taking the initiative to create support organizations and many actively pressure the universities to get on board. Even if willing, Dr. Hotez noted, universities are finding it very challenging to recruit experienced professors who have actually worked in developing countries.

Responding to the Fogarty Director’s inquiry about prevention versus treatment, Dr. Sewankambo confirmed the efficacy of prevention programs but continued that there is limited impact of such programs in Africa, perhaps because of lack of access to the programs. Dr. Glass commented that the NIH tends to focus more on biomedical solutions compared to solutions contingent upon knowledge gained in the implementation and social sciences.

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X. CONSTITUENCY BUILDING

The Fogarty Director reported that the Center’s constituency has been enhanced by the Framework Program. The program involves about twenty universities that were encouraged to involve multiple disciplines, including business and law, in their global heath efforts. The Board recommended that Fogarty consider working with advocacy groups with an interest in global health to help build its constituency. It was noted, however, that global health advocacy is very fragmented, partly because a major part of that advice is represented by the more than 60,000 loosely connected NGOs in the field.

Noting the burgeoning interest in global health on American campuses, the Board suggested that Fogarty consider developing informational support for students—what courses to take, information about funding and internships, information about career opportunities, etc. Leveraging the Framework grants and sponsorship of workshops on issues of interest to specific groups—students, provosts, deans, etc., were also noted as effective means of building a constituency.

The creation of a new field or entity related to global health was also mentioned as a means of building a constituency. The potential steps for building a new field included: 1) building an intellectual foundation (such as one derived from the DCP2 data); 2) creation of an agenda that fits the needs of the target beneficiary (e.g., an institution like Makerere University); 3) conceptualizing a new training program; 4) establishing new relationships with developing countries that demonstrate a clear understanding of their internal needs; 5) nurturing communities of health care practices that share with each other; and 6) convening meetings.

XI. COMMUNICATIONS

While communications was not included in the current draft of the strategic plan, there are important considerations that must be addressed, including but not limited to: distance learning, remote diagnosis and consultation, networking and even virtual centers of excellence. Board members suggested (i) convening a meeting of stakeholders from African institutions to discuss their own special needs, (ii) convening a bilateral meeting of U.S. and African representatives using the capabilities of the Internet were also suggested, and (iii) establishing an expert panel to provide advice to the Fogarty Director also suggested as communications related items. It was also suggested that a good first step for inclusion of communications in the Fogarty strategic plan could be a review of the technology and perhaps a workshop to look at how IT could be applied to international training and research programs.

There was a brief discussion about IT in developing countries; and responding, Dr. Sewankambo of the Makerere University Medical School (Uganda) explained that his institution had started an IT program ten years ago. He noted that IT was well established on the university campus and available to students elsewhere in the country. Participation was spotty, however, because of access and/or availability issues and different levels of experience and knowledge about using the Internet. One of the Board members had a similar experience and suggested that progress could be facilitated by including engineering and computer science departments in IT capacity building efforts. Harnessing student power to facilitate setting up IT systems was also recommended as a consideration.

The challenge of keeping the Fogarty web site current was noted. Board members were invited to visit the site to access the bi-monthly newsletter, Global Health Matters, and to submit comments and suggestions. Responding, one of the Members remarked that, as challenging as it might be to keep information current, the web site must be kept current.

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XII. CONCLUDING REMARKS

Dr. Roger Glass

In closing, the Fogarty Director invited a brainstorming approach to any ideas the Board members would like to add to the record. There was a number of suggestions:

• What is required to develop implementation science?
• Define translation science beyond the NIH biomedical concept.
• Hold a meeting on global health curriculum for undergraduates (and even courses at the high school level).
• Expand the discussion of acute versus chronic disease.
• Explore the transition from communicable to non-communicable disease research and training.
• Explore how Fogarty can make a unique contribution to the NIH Roadmap.
• Explore how to engage universities more broadly than they are now under the Framework Program.
• Define Fogarty’s comparative and/or competitive advantage.

Dr. Glass closed the meeting by expressing his appreciation to all those who attended and participated.

There being no further business, the meeting was adjourned at 3:00 p.m.

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Abbreviations Used in the Minutes

Fogarty International Center Advisory Board Roster

(All terms end January 31)

May 2007

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

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^[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.

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