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FIC FY2002 Congressional JustificationTable of Contents
- FIC Program Objectives: Building an Effective Support System for Global Health Authorizing Legislation: Section 301 and 307 and Title IV of the Public Health Service Act, as amended. Reauthorizing legislation will be submitted. Budget Authority:
This document provides justification for the Fiscal Year 2002 activities of the Fogarty International Center (FIC), including HIV/AIDS activities. A more detailed description of NIH-wide Fiscal Year 2002 HIV/AIDS activities can be found in the NIH section entitled "Office of AIDS Research (OAR)." INTRODUCTIONIn remarking on the five-decade partnership between the National Institutes of Health (NIH) and United States universities and research institutions, Lewis Thomas called NIH "in its singular way the finest social invention of the 20th century" (The Fragile Species, Charles Scribner and Sons, 1992). Like all social inventions, the NIH continually must adapt to meet scientific challenges and societal needs. As the NIH component legislated to advance health through international scientific cooperation, the FIC enables the global scientific community to respond to emerging scientific and public health challenges of global importance. FIC's core mission and leadership challenge is to reduce the deepening global disparities in health through science, both as a humanitarian imperative and an instrumental means of reducing poverty. The disparities are stark. Developing nations suffer over 90 percent of the burden of premature mortality as measured in lost years of life. These countries, constituting three-quarters of the world's population, now share a double burden: the persistent cluster of infectious diseases and malnutrition responsible for over 16 million deaths per year, mainly children; and a growing incidence of chronic diseases and disabilities due to increased life spans and new risk exposures which accompany demographic change and industrialization (World Health Organization). Health and Economic Development: An Essential LinkageThe end of the 20th century was a time of increasing global interdependence and prosperity, yet for many developing nations this was a lost decade. Despite consistent reductions in disease burdens in much of the industrialized world, Eastern Europe and Sub-Saharan Africa suffered a marked deterioration in health status and conditions of living. As we begin this new millennium, one out of every five persons lives in absolute poverty. For the poorest regions, such as Sub-Saharan Africa and parts of Latin America, the inability to reduce poverty has a magnified impact on families through the deterioration of general health, living standards and education. A gratifying consensus is now building that the most prescient development policies are those which develop the human potential of a given society. Implicit in this formula is the importance of investments in health as instrumental to societal and economic enrichment. Indeed, a recent review of world mental health commissioned by the Rockefeller and Carnegie Foundations notes that the distinctions between improving health and stimulating economic development are artificial (Desjarlais R, Eisenberg L, Good B, Kleinman, A. World Mental Health: Problems and Priorities in Low-Income Countries, Oxford University Press, 1995). The study is among several to suggest that good health is not an outcome afforded at a point where society has generated enough revenue to pay for it. To the contrary, the health of a population over the long run is an essential determinant of economic productivity. Improving the health status of populations at home and abroad requires a continuing commitment to basic science as well as rigorous clinical, behavioral, and applied studies. To address these needs, FIC forges collaborations with a range of domestic and international partners to pursue three core objectives. The first is to accelerate the pace of discovery and its application by enabling scientists worldwide to generate and share data sets, patient cohorts or special environments and the tools for data analysis. The second is to engage and assist both young and established U.S. investigators to address scientific challenges related to global health and pursue collaborative research in and with the international community. A third and essential objective is to promote the development of highly trained foreign investigators in low- and middle-income countries. These individuals will ideally be positioned to collaborate with U.S. scientists to enhance understanding of disease pathogenesis, anticipate disease trends, or develop interventions of mutual benefit. These objectives form the conceptual basis for current FIC programs, to target strategic priorities for the United States and our global partners. In addition to malaria, tuberculosis, and HIV/AIDS, FIC priorities include emerging infections, the environment, drug discovery from biodiversity, maternal and child health, information technology, genetics, ethics and health as related to economic development. These priorities are pursued through a range of program mechanisms, including institutional training grants, cooperative agreements, research grants, fellowships, and multilateral initiatives involving international organizations. Training and career development programs for young Americans, with emphasis on underrepresented minorities, is a core and complementary theme. Although the health needs of developing nations are formidable, the search for solutions at the local level warrants great optimism. One reason is human capital: FIC is successful in identifying research strengths and resources at the local level that motivate intervention programs. A second is the increasing power of the research toolbox: revolutionary methods that have enabled investigators to elucidate molecular mechanisms can now be applied to virtually all fields of clinical investigation and product development. As the President of the Global Health Council, Dr. Nils Daulaire, astutely notes: "it is no coincidence that one of the first to see and harness the economic potential of the computer revolution 20 years ago, Bill Gates, is now investing his fortune in bringing this new health revolution to all the world's people." [Testimony Before the Congressional Subcommittee Foreign Operations 2000]. FIC Program Objectives: Building an Effective Support System for Global Health
SCIENCE ADVANCESThe following represent a sampling of notable FIC developments in FY 2000-2001.Global Interdependence: Building AlliancesGiven the interdisciplinary nature of global health challenges, FIC systematically seeks alliances with sister Federal agencies, international organizations, development agencies, and non-governmental organizations. The AIDS International Training and Research Program (AITRP), led by FIC and in partnership with nine NIH institutes, supports research training that is critical to advancing the AIDS research agenda abroad. For example, with FIC support, investigators at the University of Nairobi and University of Washington have evaluated the rates of HIV transmission to infants through breastfeeding. In the new study, pregnant HIV-infected women joined groups that would either breastfeed or formula feed their infants. Among infants born to mothers in the breast feeding group the risk of becoming HIV infected in association with breast feeding increased by 76% in contrast to the formula fed group. Overall, 44 percent of the HIV infections in infants born to mothers in the breastfeeding group were due to breast milk. This study clearly shows the need to prevent breast milk transmission and has major implications for development and deployment of public health interventions in resource-poor settings. Additional studies are now underway to address the related and complex social and economic implications on infant feeding. Currently, Russia is experiencing one of the sharpest increases in HIV incidence in the world, however very little is known about the Russian population's understanding and perception of HIV infection and risk behaviors for HIV infection and other sexually transmitted diseases. Research by a Russian investigator and colleagues from the University of Wisconsin at Madison and Yale University in St. Petersburg, Russia has shown that knowledge of personal risk does not necessarily translate into action to reduce this risk. However, among men who have sex with men, at least one third are bisexual and despite negative attitudes towards condom use, an intention to practice safer sex was expressed. These studies highlight some of the similarities of the spreading HIV epidemic in Russia with the long standing epidemics in other parts of the world. However, the unique cultural, social, political and economic changes in Russia will require the adaptation of known prevention interventions and the recognition that new interventions may need to be developed to address both the general and high risk populations. Through these new collaborations the group in St. Petersburg is up to the challenge. The relevance of training for program success has been characterized by Dr. Salim Abdool Karim for the South African context in a recent editorial in Science as follows: "For less developed countries to move beyond serving merely as field sites to become full research partners, there must be a commitment to building local research capacity. The Fogarty Center's AIDS training programs in southern Africa provided models that deserve emulation for this purpose." (Science 2000; 288:2129) Another compelling example of alliance building by FIC is the Multilateral Initiative on Malaria (MIM). Established in 1997, the goals of this alliance are to increase malaria research and research capacity by Africans in the endemic countries of Africa. At the same time MIM promotes an integrated approach to malaria prevention and control through coordination of research efforts with those related to patient management, rational drug use, and monitoring and evaluation of control measures. As the MIM Secretariat, FIC has worked closely with National Institute of Allergy and Infectious Diseases, the National Library of Medicine, international partners and scientists in developing countries to generate and support new research programs in the field and increase essential research output and local research capacity to complement the more operational World Health Organization Roll Back Malaria strategy. FIC has also implemented a new malaria research and training program, now linking institutions in Kenya, Mali, Senegal, Uganda, and Zimbabwe. FIC has recently established a similar coalition related to ethical considerations in international research. Increasingly, the scientific community and public are presented with complex questions concerning the social and ethical dimensions of international research and the application of discoveries. Despite elevated public awareness, no platform has existed for individuals from the developing world who are responsible for the application of bioethical principles to have a public dialogue on these issues with colleagues from around the world. FIC therefore conceived of and organized the Global Forum on Bioethics in Research, working initially with the World Health Organization (WHO) and the Pan American Health Organization. Following the inaugural Forum in Bethesda in 1999, where 120 scientists and ethicists, mostly from developing countries, met together with research funders, mostly from industrial nations, a larger network of partners has formed. The Forum held its second meeting in Thailand last year and will continue, with Forum 3 in The Gambia, West Africa in 2001; Brasilia in 2002; in Europe in 2003; and, in North America in 2004 already planned. Forum participants have been instrumental in providing guidance for the establishment of an FIC training program to improve institutional capabilities on bioethics and ethics research in regions which increasingly are sites of population-based research, including sub-Saharan Africa and Southeast Asia. In FY 2000, FIC made eight awards for this training program, creating a critical network for international bioethics training and serving as a beacon for other agencies to promote capacity building in this area. In many cases, international collaborative efforts work not only to advance critical lines of research but also to bridge gaps and strengthen cultural understandings. With FIC support, the University of Washington is collaborating with Tel Aviv University in Israel and Bethlehem University in the Palestinian Authority to map and clone the genes responsible for different types of inherited deafness. The incidence of preverbal deafness is high in the Middle East region, and may be due to environmental factors or to genetic mutations in any one of more than 100 genes, each of which codes for a protein involved in the development, structure and function of the inner ear. This science, pursued through novel studies conducted through novel mechanisms will lead to a better understanding of the biology of hearing and the potential for new interventions to reduce deafness. Despite political tensions in the region, the U.S.-Israeli-Palestinian cooperation continues undeterred. Confronting our "Unfinished Agenda" - The Continuing Burden of Malnutrition and Childhood DiseaseIt is estimated that 350-500 million people throughout the developing world, especially infants and young children, are at grave risk due to marginal access to a basic diet and confounding demands on their nutritional intake posed by frequent infections. Deficiencies of micronutrients lead to anemia, blindness, cretinism and low birth weight. Half of the deaths in the developing world are associated with malnutrition. A better understanding of the relationship between nutrient intake and chronic and infectious disease is a strategic research need to improve health intervention strategies. FIC is pursuing several lines of investigation related to health and nutrient intake. For example, to address one of the most common global nutritional problems, iron deficiency, that leads to impaired psychomotor development and scholastic achievement in the young and reduced work capacity and poor obstetric outcomes in adults, FIC-supported scientists at the University of North Carolina and partners at the Chinese Academy of Preventive Medicine in Beijing have developed a mathematical equation to estimate bioavailability of dietary non-heme iron. This model predicts iron status by correcting for the dietary intake of enhancers (ascorbic acid, animal food sources, and vegetables and fruits) and inhibitors (rice, beans, and tea) of iron absorption. Such tools can improve estimates of the combined effect of multiple dietary factors on iron bioavailability and will enable public health officials to refine population-based assessments of nutritional anemia. Such information serves as a valuable guide for the development of effective public health interventions, as shown in China and other countries. An increasingly worrisome trend in the burden of childhood disease is the rise of asthma in both industrialized and developing nations, due to sensitizing agents in the environments. In efforts to elucidate the physiological conditions that lead to asthma and to develop potential interventions, scientists at the University of New Mexico Health Sciences Center and the National Autonomous University in Mexico City are defining the pathways in the chain of events that lead to allergic reactions or asthma. By studying the pathways from allergen binding to the allergic reaction, researchers hope to understand mechanisms that control these events in order to interrupt them. The team has described a new approach to isolate the allergic-reaction-signaling pathway that engage the immune system via mast cells. Scientists have pinpointed specific target enzymes that act as key players in transmitting the signal to release inflammatory substances that mediate the symptoms of an allergic response. This knowledge will provide tangible leads for the development of new drugs to block the action of these enzymes and mute or prevent severe and sometimes lethal allergic reactions involved in asthma. Taking Steps to Cope with the Continually Changing Threat of Microbial DiseaseThe widespread use and misuse of anti-microbial drugs has led to changes in genetic structure of pathogens that increase transmission or weaken the efficacy of existing drugs. Preventive strategies to slow emergence rely on investigations of influences on the spread of microbial resistance and approaches to monitoring resistant strains. Through program efforts at 16 United States universities working with international partners, FIC is advancing research and training to understand the impact of infectious diseases and to develop tools to detect and treat them. A critical program focus for FIC is tuberculosis. Among major drug resistant infections, tuberculosis silently accounts for one-quarter of all avoidable adult deaths in the developing world. For each year there are an estimated eight million new cases of clinical tuberculosis, and three million deaths. A major problem in developing countries is their limited capacity to use conventional diagnostic tests because of high costs and equipment demands. As a consequence, drug susceptibility testing is rarely performed despite the rapidly rising rates of multiply drug resistant TB strains (MDRTB). MDRTB can spread, undetected, from person to person as well as across borders. With FIC support, a consortium of U.S. and Peruvian scientists developed a rapid and reliable method for detecting tuberculosis for use by health officers in developing countries. The test, called "microscopic observation broth-drug susceptibility assay" (MODS), detects tiny amounts of the tuberculosis bacteria in patient sputum samples using a simple light microscope within 9 days compared with 3-4 week results by traditional culture methods. This same method can also be used to determine drug resistance. Use of this rapid, inexpensive and sensitive method should improve the capability to detect and properly treat tuberculosis including drug resistant mutants in developing country health facilities, thus blocking the spread of this killer infection. Monitoring the Impacts of Environmental ChangeFactors in disease emergence are directly or indirectly influenced by environmental change such as climate variability. For example, the El Niño phenomenon, the warming of the Pacific Ocean that occurs every 2 to 7 years, has been linked to outbreaks of dengue fever, malaria, and cholera, but its effects on the epidemiology of non-cholera diarrhea have not been well studied. A team of researchers from the Johns Hopkins School of Public Health and their colleagues at the National Institute of Health in Lima, Peru and Catholic University in Santiago, Chile have assessed the causal effect of climate change on disease. They examined hospital records for over 57,000 children from 1993-1998 to assess the correlation between weather patterns and incidences of childhood diarrhea. Admissions during the El Niño season increased by 200% above expected norms in 1997-1998 alone. They also estimated that hospital admissions due to diarrheal disease increased by more than eight percent with every one degree centigrade rise in temperature. These results suggest that due to global warming and other local factors, diarrheal disease cases could potentially increase by millions worldwide in relation to the increase in ambient temperature. Since diarrhea already causes one billion disease episodes and three million deaths annually in children under 5 years old worldwide, understanding the effects of weather variability on the epidemiology of infectious diseases is potentially important factor in planning preventive public health strategies in advance of future El Niño episodes. In response to the need to better understand the conditions and factors affecting the environmental alterations caused by humans that result in emerging infections, and to move beyond better surveillance and rapid response to prediction and prevention of emergence, FIC established an interagency, interdisciplinary research program in FY 2000 on ecology and infectious diseases. The first 12 projects supported by this interdisciplinary program will assess how large-scale man-made environmental events such as habitat destruction, urban sprawl, water pollution, introduced species and agricultural intensification all contribute to the emergence and spread of emerging infectious diseases in animals and humans. Making the Transition from Molecular Medicine to Tropical HealthThe landmark scientific event of 2000 was the establishment through international cooperation of the first reference sequence of the human genome, the continuing source book for new discoveries. Among multiple benefits, the project will provide new insights into individual susceptibilities to infectious and chronic disease, helping us to understand the pathogenesis of common disease and leading to completely new approaches in preventive medicine. A variety of approaches from mouse genetics to genome scanning of families are now being deployed to identify a large range of candidate genes for studies of infectious disease susceptibility in humans. For example, over a dozen genes have been implicated in susceptibility to malaria alone, with implications for the development of protective vaccines. With FIC support, scientists at Case Western Reserve and the Institute of Medical Research in Papua New Guinea (PNG) have discovered a new mutation in a gene for the Duffy blood group which reduces susceptibility of red blood cells to malaria caused by Plasmodium vivax. This parasite must interact with Duffy blood group factor on cells in order to infect them. Genetic epidemiologists have demonstrated that individuals with two copies of the mutant gene are resistant to P. vivax infection. Targeting the parasite's Duffy binding protein and its interaction with Duffy blood group may be a productive strategy for developing a vaccine for vivax malaria. The insights from this study not only suggest that is feasible but represent a conceptual model for addressing the more virulent malaria parasite, P. falciparum. Deploying State-of-the-Art Computing and Communications TechnologyProviding access to reliable health and scientific information is a cost effective and achievable strategy for sustainable improvement in health care and research capacity. Many developing nations are entering a period of technological change, which will result in a transition from a more traditional library system to reliance on electronic access to international data networks through individual workstations. Technologies such as fiber optics and satellite telecommunication networks, including the Internet, will ultimately evolve as the technical backbone to the scientific and health care community in these countries. In collaboration with the National Library of Medicine and NIAID, FIC is making use of new technologies to meet such needs as epidemiologic surveillance, improvements in clinical practice, distance learning, and the construction of scientific "collaboratories" to share information, software, and computing capabilities and conduct electronic peer review. For example, medical academicians in Kenya are developing a model electronic medical record system at Mosoriot Health Center, the sole medical provider for a population of 50,000. The Mosoriot Medical Record System will store information on clinic visits, diagnoses, and treatments provided to adults and children in more than 40,000 separate outpatient visits per year. This system will allow health risk data to be linked to outcome data from subsequent outpatient visits, turning Mosoriot into a laboratory for clinical and epidemiological investigations on a range of health care issues of import to the region and globally. MEETING GLOBAL HEALTH AND RESEARCH NEEDSGlobal Networks and Local Worlds: Building Research CapacityTo prepare scientists in low- and middle-income countries of the world to address their health and research needs, continued investments are needed in research training programs. At the same time, in order to prepare the future generation of U.S. specialists in fields such as parasitology, infectious disease immunology and health conditions predominant in resource-poor settings, scientists must be linked to centers of research excellence in regions with endemic burdens early and continually in their career. These centers must possess the laboratory infrastructure, clinical and field capabilities required for a comprehensive study of disease etiology, pathogenesis, prevention and control. U.S.-supported research laboratories overseas have played an historic role in the discovery and monitoring of infectious disease, the understanding of the systemic effects of micronutrient deficiencies and other global health problems and have provided a locus for the training of U.S. and local professionals. However, over the past several decades the number of these multidisciplinary facilities has declined, leaving a gap in our capacity to train U.S. scientists on key global health issues and to build strong research infrastructure in low- resource settings. FIC will expand its efforts in FY 2002 toward the development of such "centers of research excellence" by continuing to strengthen promising institutions in Africa, Latin America, the Caribbean, and Asia. The intent is to better prepare the capacity for U.S. scientists and counterparts in developing nations to conduct basic research studies and to evaluate potential vaccines, diagnostics and therapeutic agents across a range of communicable and non-communicable diseases of mutually shared priority. Emphasis will be placed in linking core areas as clinical trials and observational study design, utilizing modern genetic technologies to address endemic diseases, advanced studies in bioethics, biostatistics, specialized courses in epidemiology, outcomes research, pharmacokinetics, computer-based training for data management and analysis, and grantsmanship. FIC will continue to expand efforts to ensure that young scientists in the developing world, particularly women, are included in these efforts. Clinical and Operational ResearchBy the year 2020, projections from the World Health Organization indicate that non-communicable diseases will contribute up to 60 percent of the world's burden of disease. Increases in chronic conditions such as mental health disorders, tobacco-related diseases including cancer, pulmonary and cardiovascular diseases, hypertension, diabetes and asthma will add to the already unacceptable burden of illness caused by infectious diseases. In FY 2002, FIC will expand its existing effort to build clinical and operational research capacity on chronic diseases to include a new effort aimed at addressing clinical and operational research needs on HIV/AIDS, TB, and malaria. The program, to be developed with partners at the NIH, will strengthen the global capacity to conduct clinical and operational research necessary to understand disease causes, characterize disease burdens, and to discover and evaluate practical and affordable therapeutic or preventive interventions. Proposed institutional and capacity-strengthening training programs will be designed to fill specific gaps in needed expertise and to establish a critical mass of trained scientists and health professionals able to work cooperatively on clinical and operational research issues in developing countries. This in turn will assist developing nations to apply new discoveries to clinical and public health practice. Mental Health Disorders: A Silent EpidemicWith rapid urbanization, shifting employment patterns, changing disease trends and other destabilizing factors, the cohering structures of family and community are eroding in many developing nations. As family support and coping capacity disintegrates, individuals afflicted with behavioral or mental disorders are marginalized by society and stigmatized. Although the burden of illness resulting from behavioral disorders is enormous, it is underrepresented by conventional public health statistics that focus on mortality rather than morbidity or dysfunction. According to an innovative World Bank survey which accounts for years lived with a disability caused by disease as well as premature death, mental health and behavioral disorders are already a leading cause of lost years of quality life. Since most mental health disorders have their onset in adulthood, the demographic transition in growing adult populations will result in sharp increases in overall burden, already estimated to be 34% of global disability. FIC proposes to expand its activities in FY 2002 to examine the causes and consequences of mental heath disorders, with a focus on low- and middle-income nations. These activities will include support of epidemiological studies to understand prevalence and distribution of mental disorders and at-risk populations and evaluation of community-based interventions in terms of effectiveness and cost. The Tobacco EpidemicDespite the continuing devastation caused by infectious diseases, tobacco consumption remains the leading cause of preventable deaths and disability in adults. Currently, 7.5 percent of the world's 53 million annual deaths are attributable to tobacco use. If present smoking patterns persist, there will be 10 million tobacco related deaths annually by 2020, roughly equivalent to the current combined mortality for TB, malaria, diarrheal disease and pneumonia. Notably, 70 percent of this annual increase is expected to occur in developing nations. In addition to the human costs associated with tobacco related morbidity and mortality, there are enormous economic costs, including medical care for treatment of tobacco-related diseases, absenteeism from work, decreased productivity, and lost income due to early mortality. A World Bank study concludes that the impact of tobacco related losses on the world economy exceed the total current health expenditures in all developing countries combined. In collaboration with multiple NIH institutes, FIC proposes to launch a comprehensive public health research approach to diminish the initiation of tobacco use in low- and middle-income nations. There is a dearth of information on incentives and disincentives for tobacco use in youth and young women in particular, how messages are perceived and then impact on behavior and actions, and on levels of understanding of tobacco as a health risk. These data are critical to the development of culturally targeted prevention and cessation programs. Moreover, little is known about the importance of tobacco smoke as a risk factor for the already high burden of childhood respiratory infections and the spread of TB in developing nations. The disease burden of tobacco is of such magnitude that even minor epidemiological differences among populations may have significant implications. Implications of Stigma on Public Health OutcomesStigma is rarely thought of as a contributing factor in perpetuating disease. Yet, by limiting the use of diagnostic services, reducing access to care, or dissuading the involvement of individuals in research trials, stigma is found to play a major role in poor health status and outcomes. Illustrative examples of how stigma has a negative impact on public health are found in individuals at risk for HIV infection but who refuse to be tested for fear of being stigmatized, and individuals with mental illness who are unable to seek help or from purchasing much needed medications for fear of exposure. The impact of stigma is significant not only for the affected person but oftentimes is felt by the family and community. Time spent on caregiving for those who could otherwise be treated, for example, can reduce household income significantly. Given that AIDS, other infectious diseases, and mental disorders will continue to represent a major share of the world's burden of disease into the coming decades, FIC, working in partnership with other NIH ICs and U.S. agencies, will launch a research initiative to support the study of the causes and consequences of stigma, both in the United States and internationally. It will begin with efforts to identify the major stigma related theories and lessons learned with respect to successful approaches and barriers to de-stigmatization including educational, legal and social interventions. This endeavor will examine the behavioral underpinnings of stigma and how these are expressed in different diseases and in the same disease occurring in different cultures and geographic settings. Concurrently, it will be essential to investigate the usefulness of stigma in preventing abuse of alcohol, use of cigarettes and drugs, for example, in contrast to its more deleterious effect in diseases such as epilepsy and mental illness. It will also address the methodologies and designs that are used to perform the research. By conducting basic research in social systems, epidemiological research on the impact of stigma, and behavioral and social science research on the expression of stigma, new strategies for interventions can be identified and ultimately tested and policies implemented. CONCLUSIONBiomedical science is by nature a futurist pursuit. The financial and human investments we make today affect the lives of subsequent generations. Through its partnership with Congress, by its mandate to demonstrate international leadership, and based on its vast experience and history of accomplishment, FIC shares a public trust to pursue and adapt scientific knowledge to realize greater equity in global health. BUDGET POLICYThe Fiscal Year 2002 budget request for the Fogarty International Center is $56,449,000, including AIDS, an increase of $5,967,000 and 11.8 percent over the FY 2001 level, and $13,167,000 and 30.4 percent over FY 2000. A 5-year history of FTEs and funding levels is shown in the graphs below: One of NIH's highest priorities is the funding of medical research through research project grants (RPGs). Support for RPGs allows NIH to sustain the scientific momentum of investigator-initiated research while providing new research opportunities. The Fiscal Year 2002 request provides average cost increases for competing RPGs equal to the Biomedical Research and Development Price Index (BRDPI), estimated at 4.3 percent. Noncompeting RPGs will receive increases of 3 percent on average for recurring direct costs. In FY 2002, total RPGs funded will be 222 awards, an increase of 40 awards over the 2001 Estimate, the highest annual total ever awarded. The Fiscal Year 2002 request includes funding for 150 other research grants. The FIC plays a critical role in enduring that the United States meet current global health challenges and prepares for future challenges. The increase request in the Research Management and Support mechanism will provide the FIC essential resources to enhance its scientific leadership to meet these challenges. Specifically, the increase will allow or the development and scientific management of the new research initiatives described in the section entitled "Meeting Global Health and Research Needs," the expansion of the recently established in-house epidemiology and policy development program, the support of international conferences and workshops that bring together U.S. and foreign scientists to identify research needs and opportunities relevant to the United States, low- and middle-income countries, and the global community. The mechanism distribution by dollars and percent change are displayed below: Graphs1. FTEs by Fiscal Year
2. Funding Levels by Fiscal Year(Dollars in Millions)
3. FY 2002 Estimate Percent Change from FY 2001 Mechanism
4. FY 2002 Budget Mechanism(Dollars in Millions)
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