Department of Health and Human Services
Sharon Hrynkow, Ph.D.
John E. Fogarty International Center for Advanced Study in the Health Sciences
On Fiscal Year 2005 President's Budget Request for the National Institutes of Health
April 1, 2004
Mr. Chairman and Members of the Committee, I am pleased to present the President's Budget for the Fogarty International Center for FY 2005, a sum of $67,182,000, which reflects an increase of $1,838,000 over the comparable FY 2004 appropriation.
I welcome this opportunity to relate Fogarty's progress over the past year and proposed plans for FY 2005. Programs at Fogarty, developed with the support and guidance of the Administration and this Committee, reflect our nation's enduring commitment to achieve "a healthy America, in a healthier world." These were the words of the late Congressman John E. Fogarty, Chairman of the House Appropriations Subcommittee from 1951 until 1967, and for whom the center is named. He championed research as the one truly global effort in which all nations can and will join as real partners.
The health challenges facing the United States are many. Among the communicable diseases, AIDS and tuberculosis continue to challenge even the most sophisticated public health interventions. SARS emerged in Asia and washed upon our shores, as did West Nile Virus several years ago. And the emergence of avian flu in Asia and the U.S. is a compelling tale that is a harbinger of probable Asian flu pandemics yet to come. All told, the infectious threats cost our economy dearly. And as chronic disease such as cancer, cardiovascular disease, and mental health disorders increase year after year in the U.S. and world-wide, both treatment and prevention efforts must be applied. These challenges are shared with communities around the world.
To address these challenges, Fogarty supports a broad range of research and training programs, each designed to tackle particular health problems shared by U.S. and foreign populations. Our particular focus is on improving the capacity of communities in poor settings to address health challenges. Accordingly, our emphasis has been on working with scientists and health professionals in low- and middle-income nations on shared health problems. Our programs identify research opportunities best addressed through international cooperation. Fogarty's efforts are multidisciplinary, embracing clinical, epidemiological, basic biomedical and social science research. They are multi-sectoral, closely coordinated with our sister institutes at NIH, the Centers for Disease Control and Prevention, and international organizations with health and development missions, including The World Bank and the World Health Organization. Moreover, the programs enhance foreign relations with governments and communities alike, and advance the historic humanitarian role of our nation. And importantly, our programs promote a global culture of science, founded on equal partnerships between scientists working across borders, in a culture of sharing of scientific information, peer review and sound management policies. Fogarty supports over twenty research and training programs in more than 100 countries, involving more than 5,000 scientists in the U.S. and abroad.
What follows is a selective summary of ongoing and planned Fogarty activities to support NIH international objectives and realize Congressman Fogarty's vision.
Among research accomplishments in the past fiscal year, scientists at the University of North Carolina and the University of Malawi have identified a new and effective means to minimize postpartum transmission of HIV through implementation of an inexpensive two-drug antiretroviral regimen. This is of significance because low-income women in sub-Saharan Africa typically do not obtain medical attention during pregnancy and are usually uninformed of their HIV status until delivery. Effectively deployed, this intervention will mean that more newborn infants will have a chance to grow to be healthy adults, even where the lack of resources and other obstacles to extending medical care limit prenatal care and interventions.
Changing Microbial Threats: HIV/AIDS is a cautionary example. The rapid emergence of new pathogens and re-emergence of infectious disease, believed to have been controlled or contained, presents a disturbing new chapter in the grim evolutionary battle between humans and microbes. This is the result of social and demographic trends, including increases in international travel and trading across borders, and changes in the genetic structure of microbes that increase virulence and transmission, and weaken the efficacy of existing drugs. Among major disease pathogens, malaria has resurged due to resistance of the parasite to available drugs and resistance of mosquitoes to insecticides. Malaria accounts for an estimated 2 million deaths per year with increasing mortality due to drug resistance and HIV-contaminated blood transfusions related to malaria-induced anemia.
Building on the success of the AIDS training program, Fogarty launched in 1996 the International Training and Research in Emerging Infectious Diseases, a training program which builds expertise in microbiology, epidemiology, and laboratory methods as part of a broad effort to combat new and emerging diseases worldwide. Today, that program has been expanded to include other infectious diseases as the Global Infectious Disease Research Training Program, linking U.S. universities with counterparts around the world to advance research projects (through 27 Fogarty awards) and, importantly, to build the next generation of scientists able to combat emerging infections, such as SARS and West Nile Virus. Through this program, Fogarty is helping to address the infectious disease challenges of today while preparing for new pathogens yet to emerge tomorrow, as surely they will.
A powerful new tool for malariologists and other infectious disease researchers concerns the use of sophisticated mathematics to predict the course of an epidemic. Such mathematics, sometimes termed models, can be used to chart the benefits of prevention and control measures. Most recently, mathematical models were used to project the course of the SARS epidemic in Asia, and to develop strategies to limit the spread of the disease. Several years ago, Fogarty established a unit at NIH concerned with the use of mathematical models for control and prevention of several diseases, including malaria. The elements of a malaria prevention program include reducing the population of mosquitoes, treatment of malaria patients, and use of personal protection such as bed nets to prevent mosquito bites. In addition, there is a major effort underway to develop a malaria vaccine. The Fogarty epidemiologists have used mathematical models to determine the best strategy to employ such a vaccine, when it becomes available, along with existing methods of malaria control and prevention. All this must be done within the various complex ecological settings in which malaria occurs. The use of such advanced mathematics in devising the most effective strategies in the study of infectious diseases will surely bring unexpected benefits to human kind. Importantly, through a network of in-house research experts and extramural scientists, Fogarty also employs mathematical models to assist biomedical research and public health policy-makers prepare for and respond to bioterrorism events. In coordination with DHHS, Fogarty has mobilized experts in epidemiology, terrorism-response and public health policy in the context of category A agents including plague, tularemia smallpox and anthrax.
The Emerging Epidemics of Chronic Disease: By the year 2020, chronic disease is expected to contribute 60 percent of the global disease burden. The toll in the U.S. is already enormous: for example, obesity has more than doubled from 15 percent during 1976-1980 to 31 percent in 1999-2000, and 65 percent of adults ages 20 to 74 were overweight to obese in 1999-2000. As populations age, and risk exposures shift due to environmental and dietary factors, non-communicable diseases are estimated to become a leading source of disability and premature death in developing nations as well. Tobacco-caused disease and death is a major concern in the U.S. and globally. In the U.S., while picking up the habit of smoking is on the decline in most groups, in young girls it is on the rise (The World Bank). In low- and middle-income nations, as wealth increases in urban settings, smoking commencement in youth, and particularly in girls, is rising at alarming rates (The World Bank). To address this challenge, Fogarty launched in 2002 its International Tobacco and Health Research and Capacity Building Program. While in its early stages, our expectation is that research will lead to new interventions that will benefit U.S. communities as well as those around the world.
There is a growing awareness of the burden on health inflicted by trauma and injury both in the U.S. and worldwide. The numbers are startling: more than 1.2 million people are killed in traffic accidents annually, and millions more are injured or disabled. Deaths from all types of injuries, including war and domestic violence, are projected to rise from 5.1 million in 1990 to 8.4 million in 2020, with road traffic injuries as a major cause for this increase, with millions more sustaining injury that results in life-long disability. In response to the growing epidemic of trauma, Fogarty is initiating a new research and training program. Among the features of the program will be training across the range of basic to applied sciences, the epidemiology of risk factors, acute care and survival, rehabilitation, and the long-term mental health consequences. Possible research areas will include development of low-cost synthetic blood products and diagnostic imaging tools, identification of behavioral intervention strategies, particularly in youth and other high-risk groups, and health services research to determine cost-effective measures for emergency care in low-income settings. The new knowledge from the program will benefit not only developing countries but, as low-cost and effective strategies are identified, communities in the United States.
Preparing the Next Generation of U.S. Global Health Leadership: While Fogarty works to build capacity and train young scientists in the developing world, critical steps have been taken to ensure that U.S. investigators at a formative stage in their careers also have opportunities to engage in international research projects. The Center will enhance and expand two programs to bring the next generation of U.S. scientists more fully into the global culture of science. The first of these, the International Research Scientist Development Award (IRSDA) program, provides post-doctoral training for four years, two of which must be spent conducting research in a developing country. Nearly 20 U.S. scientists are now being supported as IRSDA trainees. Addressing an earlier step in the career path, Fogarty has recently teamed with the Ellison Medical Foundation to create a second program, the new pre-doctoral clinical research training program for U.S. medical and public health students. Under this program, students will spend a year in a developing country conducting NIH-sponsored clinical research under the mentorship of an experienced foreign investigator and a collaborating research team. The first students to be selected will begin the program this summer.
Enhancing Opportunities for Women in Science: NIH's goal to bolster the nation's intellectual capital includes attracting more women to careers in science, both to build a new generation of talented scientists and to ensure that research issues germane to women's health are addressed. Fogarty has extended this important goal to international programs. At an October 2003 colloquium on career path issues facing women in the life sciences, including women in the developing world, Fogarty and its co-sponsors, the NIH Office of Research on Women's Health and the National Institute of Environmental Health Sciences, invited perspectives on opportunities in advancing career issues for women in the life sciences from a community of scientists, administrators and science funding agencies. To follow up on the recommendations, Fogarty and its partners have agreed to: collect data on developing country women in science and their career paths; support workshops to develop skill sets for women scientists in the developing world that will better enable them to take on leadership roles within health research and/or policy settings; and develop and implement strategies to effectively use the Internet and other information technologies to support networking and mentorship.
Advancing the NIH Roadmap: Global Positioning: Fogarty supports programs linked to each of the three main Roadmap themes -- New Pathways to Discovery, Research Teams of the Future, and Re-Engineering the Clinical Research Enterprise. In particular, to improve the clinical research enterprise, Fogarty supports two new programs aimed at training developing country professionals in clinical, operational and health services research. These programs represent a new approach to enhance clinical research, and pave the way for new partners, namely those in low- and middle-income nations, to work more closely on mental health, and on AIDS and TB with U.S. counterparts. In support of Roadmap themes of new approaches and new pathways to discovery, Fogarty is also supporting studies to identify the impact of environmental degradation on economic development and human health. These programs link social scientists, including mathematicians and economists, with clinicians and medical researchers to provide new insights and strategies to tackle urgent global health challenges.
Conclusion: Mr. Chairman, global challenges require a global response. Collective action is not only an economically rational approach to global health research challenges, but a scientific and humanitarian imperative. With the continued support of this Committee, Fogarty will accelerate both research discoveries and applications through international cooperative action to the benefit of the United States and to global communities. "A healthy America in a healthier world" has never been as important as it is today. Thank you.