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FIC FY2003 Congressional Justification

Table of Contents

Authorizing Legislation: Section 301 and 307 and Title IV of the Public Health Service Act, as amended. Reauthorizing legislation will be submitted.

Budget Authority:

  2001 Actual 2002 Appropriation 2002 Current Estimate 2003 Estimate Increase or Decrease
Current Law BA $50,472,000 $56,940,000 $56,918,000 $63,380,000 $6,462,000
Accrued Costs $405,000 $435,000 $435,000 $453,000 $18,000
Proposed Law BA $50,877,000 $57,375,000 $57,353,000 $63,883,000 $6,530,000
FTE 71 79 79 79 0

This document provides justification for the Fiscal Year 2003 activities of the Fogarty International Center, including HIV/AIDS activities. A more detailed description of NIH-wide Fiscal Year 2003 HIV/AIDS activities can be found in the NIH section entitled "Office of AIDS Research (OAR)."

The President's appropriations request of $63,833,000 for this account includes current law adjusted by assuming Congressional action on the proposed Managerial Flexibility Act of 2001.


In accepting the Presidency of the American Philosophical Society, Thomas Jefferson noted that, "the brotherly spirit of science unites into one family all its votaries of whatever grade, and however widely dispersed through the different quarters of the globe." Today, in the wake of the events of September 11, 2001, we are again reminded of the great need to work in partnership with colleagues around the globe. In his speech before the U.N. General Assembly in November 2001, President Bush called for governments to press on with an agenda for peace and prosperity in every land. "My country is pledged to investing in education and combating AIDS and other infectious diseases around the world. Following September 11, these pledges are even more important. In our struggle against poverty and despair, we must offer an alternative of opportunity and hope." As the NIH component legislated to advance health through international scientific cooperation, FIC has always been dedicated to these goals. Indeed, FIC will redouble its efforts to support scientific activities to reduce health disparities between rich and poor countries, and advance scientific understanding for the benefit of all. If ever there were a time to generously share our knowledge and our expertise to improve health with the poor and underserved around the world, it is today.

FIC, conceived of by the late Congressman John E. Fogarty of Rhode Island, is dedicated to reducing disparities in global health through the support of international research programs and the training of scientists around the world. Since its establishment in 1968, FIC has embodied Congressman Fogarty's vision that "disease knows no boundaries" and, more importantly, that "the benefits of medical research should also know no boundaries." To this end, FIC plays a unique role in the efforts to decrease disparities in global health status by supporting more than 100 U.S. institutions working with scientists in more than 90 nations, and by collaborating with a diverse set of international partners, including the World Health Organization (WHO) and the World Bank. The resulting multi-disciplinary efforts include clinical, epidemiological, basic biomedical, and behavioral research. In addition, these programs build much needed bridges between U.S. scientists and partners around the world to address the burden of disease in the developing world; indeed, they create long-lasting friendships and a deeper understanding of the American people, including our willingness to share our knowledge and expertise with all.

Increasingly, FIC is focused on the poor and transitional economies that experience over 90 percent of the global burden of disease and premature mortality. These countries, constituting three-quarters of the world's population, share a double burden: the persistence 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 longevity and new risk exposures that accompany demographic change and industrialization (Murray CJL, Lopez AD, eds. The Global Burden of Disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. United States: The Harvard School of Public Health; 1996). Even as new advances reduce the burden of AIDS, malaria, tuberculosis, and other infectious diseases, the developing world will encounter the same menaces as the developed world in the form of chronic non-communicable diseases, such as diabetes and cardiovascular disease, dementia and psychiatric disorders, cancer and degenerative diseases, and the huge disease burden due to increased tobacco use.

FIC, therefore, supports a broad agenda to build research capacity in poor nations while advancing critically needed research on global health issues of concern to both collaborating partners. FIC's communicable diseases programs, including AIDS, TB, malaria, and other emerging and re-emerging infectious diseases, train young scientists from the developing world. FIC programs provide them with the tools needed to better understand and ultimately control these diseases, while preparing them to return home to build much-needed national capacity. New programs that target the growing burden of non-communicable disease in the developing world, such as mental illness, also link clinical research with the necessary operational and health services research to ensure that new knowledge will quickly be translated into public health policy and practice.

In our drive to increase knowledge, improve health, create a better life for people, and in this manner help to ensure global political stability, we are aware of the pervasive influence of poverty for many countries. The end of the 20th century was a time of increasing prosperity in the industrialized world. In contrast, for many developing nations it was a period of loss C economic decline, and deterioration in health status and conditions of living. Because health is essential to economic productivity, FIC has partnered with four NIH institutes and the World Bank to research the essential linkage between health status and economic development. This program breaks new ground, and will provide new methods, analytic frameworks, and empirical macro- and micro-economic data to plan resource allocations and to guide development and deployment of health interventions.

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 succeeds in identifying people with ability and the desire to use the training they receive to improve the health of their nation. Another cause for optimism 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. These enormous strengths --- human and intellectual capital --- offer hope that health disparities can be diminished and that the overall health of all humans, regardless of their place on the planet, can be improved.

In reflecting on the U.S.' role in achieving these lofty goals, the words of biologist Lewis Thomas seem particularly apt today. In his book, The Fragile Species (1992), Thomas reflects that, "We have an obligation to assure something more like fairness and equity in human health. We do not have a choice, unless we plan to give up being human."

FIC Program Objectives: Building an Effective Support System for Global Healt

  • Build interdisciplinary skill base required to meet global health challenges, emphasizing modern analytic tools of cell and molecular biology, genetics, bioinformatics, behavioral research, epidemiology, and rigorous clinical research methodologies.

  • Provide necessary material resources, including the infrastructure for communications and computing and dissemination of information.

  • Address the importance of equity and social justice and increase capabilities in bioethical reasoning and practice.

  • Promote intrasectoral alliances among research and development agencies, emphasizing partnerships for the application of research in-country.

  • Establish working relationships for national programs for disease control to help ensure the relevance of research priorities and application of findings.

  • Promote the capacity to assess multiple factors on incidence, severity, and outcome of endemic problems, including behavioral and economic influences.

  • Deploy program strategies, which limit the potential for "brain drain" in view of current economic constraints in many low- and middle-income countries.

  • Take long-term perspectives to pursue a systematic and comprehensive approach to capacity development through the gradual creation of regional "centers of excellence" in Asia, Africa, and Latin America.


The following science advances represent a sampling of notable FIC developments in FY 2001-2002.

Collaborative International Efforts to Control Infectious Diseases

The World Health Organization (WHO) estimates that 50 million people contract dengue infection every year. Two-fifths of the world's population is at risk as a result of this endemic disease in more than 100 countries. However, dengue is not only a concern for low- and middle-income countries around the world, but also for U.S.- Mexico border communities and perhaps more of the U.S. south in the future as the range of the mosquito that transmits dengue becomes larger. Although eliminated 40 years ago in South America, the mosquito has recently been found again on the continent along with a second strain that also carries the dengue virus. Researchers from Harvard University and Brazil correlated a series of dengue outbreaks in Brazil with data on the density of the vector mosquito in order to understand transmission dynamics, and inform policies to prevent and control infections. Investigators analyzed data on anti-dengue activities such as removal of mosquito breeding containers, the treatment of the containers with larvicide, and the spraying of a potent insecticide. Retrospective analysis showed that each outbreak was preceded by relaxed monitoring and source-reduction activity. Since dengue remains suppressed as long as the breeding sites of the vector mosquitoes are reduced, these studies indicate that larvicidal source-reduction measures constitute the most efficient mode of preventive intervention.

Malaria, another infection borne by a mosquito vector, causes close to 3 million deaths annually, primarily among children under the age of five living in sub-Saharan Africa. To better control and prevent the spread of malaria, it is critical to understand the behavior of the mosquitoes transmitting the disease (Breman JG, Egan A, Keusch GT. The intolerable burden of malaria: a new look at the numbers. American Journal of Tropical Medicine and Hygiene. 2001; 64(1-2 suppl):iv-vii). Their feeding patterns vary widely by species and geographic location and one important question has been the source of food for the developing mosquito larvae. Therefore, FIC-supported investigators from Harvard University and their counterparts in Ethiopia recorded the type of food ingested by the larval stage of the vector mosquito, the distribution of maize pollen in the vicinity, and the physical appearance of the water where mosquitoes breed. The researchers found that maize pollen is the food source for mosquitoes, suggesting a link between the intensity of malaria transmission and maize culture. Although the elimination of maize is not practical in Africa because of its importance as a food crop, the genetic modification of maize plants to alter pollen production may provide a potentially potent anti-malarial intervention tool.

Drug-resistance to available malaria drugs continues to challenge public health workers around the world. Understanding the cellular and molecular mechanisms that underlie the development of drug resistance is paramount to ensuring that existing therapies continue to be effective and that new effective therapies can be developed once resistance is detected for existing drugs. Researchers from the University of Washington and the Kenyan Medical Research Institute examined whether selection pressure for resistance against a commonly used malaria treatment drug combination, pyrimethamine plus sulfadoxine, was greater than for short-acting drugs. The study demonstrated that the commonly used drug combination exerts a stronger selective pressure for resistance than a short-acting treatment. These findings suggest short-acting treatments should be considered in malaria control and prevention strategies to address the more than 3 million annual deaths related to malaria worldwide.

Penicillin was once the major weapon against Streptococcus pneumoniae (the pneumococcus), an important cause of severe pneumonia in children under the age of five, and responsible for 1 million deaths each year (World Health Organization. Investing in Health Research and Development. Report of the Ad Hoc Committee on Health Research Relating to Future Intervention Options. Geneva: 1996). In many parts of the world, low dose oral penicillin treatment is now ineffective against the emerging drug resistant strains of the pneumococcus. Particularly in developing countries, where poverty and poor health care infrastructure contribute to the elevated rates of life-threatening pneumococcal diseases, resistance to antimicrobial therapy has significant repercussions. Understanding the dynamics and risk factors related to the spread of penicillin resistance for Streptococcus pneumoniae can assist in the development of more effective regimens to treat disease and prevent spread. FIC-supported researchers from Brazil assessed risk factors for acquiring penicillin-resistant pneumococcal disease using a rapid and inexpensive technique for typing penicillin-resistant bacteria during outbreaks. Approximately 10 percent of children with pneumococcal meningitis harbored bacteria with intermediate-level resistance to penicillin. Penicillin-resistant isolates were significantly associated with children age two and under, previous antibiotic use, and co-resistance to another antibiotic. The increasing spread of penicillin-resistant strains of meningitis-causing pneumococcus suggests that more effective prevention strategies, including those involving new drug regimens, are urgently needed.

Building Capacity to Stem the Spread of AIDS

The FIC AIDS International Training and Research Program (AITRP) enables U.S. universities and other research institutions to provide HIV/AIDS-related research training to scientists and health professionals from developing nations and to forge collaborative ties with research institutions in countries impacted by the AIDS virus. These FIC training programs are an essential element of the NIH AIDS research program and are designed to increase the proficiency of scientists and health professionals to undertake biomedical and behavioral research related to HIV/AIDS. One of the priority areas addressed by the AITRP is to reduce transmission of HIV through contaminated blood and to develop skills to conduct clinical trials and prevention-related research. Transmission of HIV through unsafe blood donation has been virtually wiped out in countries with sophisticated medical systems. This mode of transmission remains a serious threat for much of the world where procedures to ensure safe donation or transfusion of blood or blood products are inadequate. The commercialization of blood and blood products, as seen in China, results in an increased risk of HIV infection through donation and unsafe blood supplies. Once HIV infection among donors was recognized as a serious problem, the Chinese government temporarily closed the commercial plasma collection centers and issued more stringent regulations. Little is known, however, about the extent of HIV infection among these plasma donors. Researchers from the Chinese Academy of Preventive Medicine who were trained through a FIC-supported program worked with their UCLA counterparts to identify and interview individuals from rural China who had donated plasma or blood prior to the introduction of screening blood donors for HIV, which began in 1995. Donors and their spouses were interviewed and tested for HIV infection. The study found that the HIV incidence among the plasma donors was 12.5 percent, and the HIV infection rate among non-donating spouses of plasma donors was 2.1 percent. Among the plasma donors, the risk of HIV infection increased with the number of donations reported. China's experience with blood and plasma donation underscores the global need for safe blood services, policies, and practice.

Russia is experiencing one of the sharpest increases in the prevalence rate of HIV infection in the world. Forty thousand HIV cases have been diagnosed in Russia, almost all in the last three years, and Russian health authorities expect that one million new cases are likely within two years (Pokrovski VV. Report of the Russian Federal Center for Prevention of AIDS. Moscow, Russia: Russian Federal Center for Prevention of AIDS; 2000). To avert a widespread epidemic, improved HIV prevention methods are vital. However, prevention is largely based on behavior change, and little is known about Russian understanding, attitudes, and risk behavior with respect to HIV infection and other sexually transmitted diseases. Research conducted by FIC-supported programs has provided essential insights into the behaviors associated with the increased transmission of HIV in Russia. Two-thirds of those studied acknowledged their behavior placed themselves at risk of contracting HIV; however, less than 25 percent reported taking any steps to reduce the risk. Risk behaviors and unsafe sexual practices prevail in the Russian populations, as a result of poor knowledge about AIDS risk, new openly gay communities, and perceived peer norms that do not support safer sex practices. Russia's economic, cultural, and social upheavals will require both customized and new interventions to control this burgeoning HIV epidemic.

The spread of HIV connected with drug use is increasing dramatically worldwide. In 1999, 114 countries and territories had reported HIV transmission associated with injection drug use compared to only 52 nations in 1992 (Joint United Nations Programme on HIV/AIDS, World Health Organization. AIDS Epidemic Update. Geneva: 2001). The critical role that drug use and sexual practices of drug users play in spreading the HIV epidemic is now well established, although patterns of drug use differ by country. To effectively design HIV/AIDS preventive interventions, it is critical to understand the inter-relationship between the two modes of infection, injection drug use, and heterosexual contact within populations. In northern Vietnam, where the opening of the border with outside nations and changing economic conditions have contributed to increased drug use and commercial sex trade, there is an urgent need for improved epidemiologic information about the spread of HIV infection in order to develop more effective prevention and control strategies. Researchers from the National Institute of Hygiene and Epidemiology in Haiphong, Vietnam who were trained through a FIC-supported program at UCLA, collaborated with their UCLA counterparts to conduct studies to estimate the prevalence of HIV infection among male drug users and to better understand patterns of drug use and sexual behaviors. HIV prevalence among injection drug users was 25 percent higher than among other drug users. Sharing unsafe equipment was common among this group, and those who shared equipment injected more frequently. Unsafe sex was common among the injecting drug users as well. This study suggests that a range of prevention activities will be critical to reducing the spread of HIV infection and high-risk behaviors in drug users in Northern Vietnam. Such activities would include increasing access to condoms, expanding programs to treat drug users, and focusing efforts to provide full services for HIV testing and counseling in a safe environment. These efforts would benefit drug-using and non-drug-using populations.

Unraveling the mystery of Alzheimer's disease

Alzheimer's disease, a primary degenerative disease of the brain, is characterized by progressive decline of cognitive functions such as memory, thinking, comprehension, calculation, language, learning capacity, and judgment. Its insidious onset, usually after age 65 years, is followed by inevitable progression. As populations worldwide live longer, Alzheimer's disease will pose significant and increasing challenges for individuals, families, and communities. The appearance of an abnormal protein and its clumping into neurofibrillary tangles in selective neurons is one of the major brain pathologies of Alzheimer's disease. The more tangles, the greater the degree of dementia. Recent discoveries have shown that specific mutations in the gene coding for the "tau" protein can cause neurodegeneration and dementia in effected individuals. The mechanisms underlying the neurofibrillary degeneration and the association between the abnormal "tau" protein and its normal counterparts are under intensive study. FIC-supported scientists in the U.S. and Argentina have uncovered an important clue as to how the abnormal protein leads to degeneration of nerve cells in the brain. Fresh understanding of the molecular mechanism of neurofibrillary degeneration is the basis for the development of rational treatment of Alzheimer's disease and potentially related disorders, such as Parkinson disease.

Assessing the Effects of Oxygen Levels on Pregnancy and Neonatal Health

Over 40 years ago a difference in the rate of intrauterine growth contributing to variation in birth weight, independent of gestational age, was observed in women living at high-altitude. Since then, research has demonstrated that maternal oxygen transport variables affect fetal growth at high altitude but are not important at low altitude. A collaborative study between U.S. and Bolivian researchers was undertaken to determine how populations of high-altitude ancestry are protected from altitude-associated intrauterine growth restriction compared with persons of low-altitude ancestry. The data confirm that women who are pregnant and living at high altitude adjust to pregnancy in a fashion that is intermediate between those occurring at sea-level and those that are complicated by life-threatening hypertension. Previously, infants born to women living at high altitudes were judged premature. Examination of the gestational-age distribution, however, revealed that the infants were not premature, but that intra-uterine growth was reduced. In addition, reduction in fetal growth at high altitude is both chronic and progressive, with greater decreases in the growth trajectory later in pregnancy. Such data suggest that with greater attention to the prevention of pre-term delivery and access to better medical care, the significant disadvantages accruing to high-altitude infants in Asia and South America could be reduced.

Assessing the Effects of Environmental Change on Health

As nations expand industrial, agricultural, and natural resource development, the dynamics of environmental change, including the impact of cross-border pollution through air, water and other means seriously affect human health. In low- and middle-income countries there are rapid changes in environment, industrialization, and urbanization. In countries of the former Soviet Union, the use of nuclear energy sources has benefited populations while at the same time has introduced new health risks related to nuclear accidents. FIC-supported scientists, working closely with partners in the National Cancer Institute and the Ukrainian Institute of Endocrinology and Metabolism, have been studying the health effects of the 1985 Chernobyl nuclear accident in Ukraine. In 2000, FIC support of the data management staff at the Ukrainian Institute of Endocrinology and Metabolism permitted U.S. scientists to process a large backlog of data on incidence of thyroid cancer in children under 18 before and after the accident. These data provide insight into radiation-induced cancer in children as well as cellular and molecular mechanisms underlying the initiation and progression of cancer in the general population.

Over the past 15 years, a wide range of observations have led scientists worldwide to examine the relationships between environmental changes and infectious diseases in humans and other animals. Certain species of frogs and salamanders have proved to be an important early warning system for environmental changes that may have subsequent adverse impact on human health. Scientists at Pennsylvania State University, building on years of field observations and research supported by NIH and the National Science Foundation, have clarified the relationship of several environmental factors and a deadly pathogen of the Bufo boreas frog. They have shown that an increase in ultraviolet-B radiation exposure associated with the loss of ozone, rainfall rates, and the incidence of fungal infection of frog embryos are related. Frog deaths were more common when ultraviolet-B radiation is high and water levels low. This important work depended on international collaborative efforts to demonstrate the complex interactions of environmental change with ecological niches and the potential for subsequent emergence of new infectious diseases. It also highlights the growing pressures on global biodiversity as well as the range of potentially adverse implications of environmental degradation.

FIC Story of Discovery

Breastfeeding and HIV Transmission

Mother-to-child transmission of HIV was first reported in the 1980s and most scientific attention has been directed towards reducing this risk. The prevalence of HIV infection among pregnant women ranges from 5 percent in most Latin American countries, to more than 20 percent in Asia and in some countries in eastern and southern Africa up to 50 percent in certain populations. Rates of HIV transmission from mother to infant have varied from 15 to 45 percent, with the rates being generally higher in populations in which the majority of the women breast-feed as breast milk is a known source of HIV in lactating HIV-infected women. These findings are particularly disturbing because of the long-standing recognition that in numerous resource-poor countries, breast-feeding --- a practice promoted by maternal and child health advocates and policymakers for many years --- is crucial to child survival.

FIC trainees working through an NICHD-funded research program performed a study in collaboration with Kenyan scientists, in which women were randomly assigned to different feeding methods. The results of the study conducted from 1992 to 1998 show that babies born to breast-feeding mothers were more likely to be HIV infected at 24 months than babies born to mothers using formula. The rate of transmission through breast-feeding was estimated to be about 16 percent, with most of the infections occurring during the initial six months of breast-feeding. However, the mortality of the newborns in the two groups did not differ, a somewhat reassuring finding, as many breast-feeding advocates were concerned that formula feeding would put these children at increased risk of death from other infections and diarrhea.

Since many HIV-infected women in resource-poor countries choose to breast-feed for both economic and cultural reasons, these findings highlight the need to better understand how breast-feeding affects the mother and what can be done to reduce any adverse effects. In addition to developing interventions to reduce mother-to-child HIV transmission, attention to the needs of the HIV-infected mother after delivery are critical to increasing the survival rates among infants born to these women. Recently, the WHO issued a statement in response to the publication of this study calling for increased attention to the support and care of HIV-infected mothers, further expansion of HIV counseling and testing for women, and increased access for pregnant women to programs that prevent mother-to-child transmission of HIV.


Addressing the Growing Burden of Brain Disorders

The combined effects of improved health care (which has decreased maternal and infant mortality, malnutrition, and infectious diseases) and declines in fertility have increased life expectancy in developing countries. This has led to a new set of health problems due to the increased vulnerability of older populations to chronic disease, including neurological and psychiatric disorders. At the beginning of life, neurodevelopmental problems such as mental retardation, autism, learning disabilities, and attention deficit hyperactivity disorder are likely to be as important in developing countries as they are in the developed nations, although their prevalence is not well documented. The social and economic demands associated with cognitive disorders, cerebral palsy, epilepsy, depression, schizophrenia, and stroke --- as well as the stigma associated with these conditions --- strain entire families, diminishing productivity and quality of life. While cost-effective treatment to reduce the burden of brain disorders in the developed world is available, this is not the case in the developing world. Building on its support for the Institutes of Medicine's Report on Neurological, Psychiatric, and Developmental Disorders: Meeting the Challenges in the Developing World (2001), FIC will continue its partnership with the National Institute of Child Health and Human Development, the National Institute of Neurological Disorders and Stroke, and the National Institute of Mental Health to explore the research challenges of neurological, psychiatric, and developmental disorders in the developing world. In FY 2003, FIC will work with its partners at NIH to launch a program aimed at building research capacity in the field of brain disorders and supporting operational research to identify and implement mental health interventions that are relevant in low-resource settings.

Linking Health, Environment and Economic Development

The past 100 years have witnessed a divergence in the economic paths taken by developed and developing countries. While some developing nations have grown significantly and experienced a steady rise in their standard of living, others are only slightly better off than they were at the start of the 20th century; in some cases, disease burdens as a result of HIV/AIDS are reversing the gains achieved. Unfortunately, the most resource-poor countries continue to face depletion of human, natural, and economic assets, often together with other threats including the spread of communicable diseases, natural disasters, and economic crises. Unraveling the links among economic trends and activities, environmental conditions, and health problems can inform policy-makers' understanding about the consequences of and possible solutions to these problems. In FY 2003, building on current research programs that focus on the interaction between health and economic productivity, and the effects of environmental degradation on the ecological relationships between infectious agents their human and non-human targets, FIC will launch a new program aimed at more clearly establishing the relationships between health, environment, and economic development. In addition to an economic analysis of the public health risks imposed by increased international trade and the health risks of infrastructure development, this research may focus on the effects of urbanization in Africa and Asia, the health effects and consequences of agricultural practices, water-borne diseases, nutrition and food safety, and the economic and social costs and benefits of global environmental trends.

Preventing Brain Drain from Developing Countries

Foreign scientists who have trained and worked in U.S. universities and NIH laboratories often face challenges in establishing research careers upon returning home. NIH makes a significant investment in training biomedical and behavioral researchers from developing countries through a variety of programs. This advanced training is critical to the trainees' development as independent researchers. Facing challenges in establishing research careers upon returning home, this can be particularly difficult if scientists return to the developing world after a protracted absence while working in a well-resourced environment. The specific goal of this new initiative is to provide opportunities that promote productive re-entry of NIH-trained foreign scientists from low- and middle-income countries back into their country of origin and to allow them to sustain scientific relationships with their mentor and his/her laboratory in the U.S. The re-entry program will be open to both visiting scientists leaving the NIH campus and developing country trainees leaving U.S. academic institutions. It will also provide opportunities for returning scientists from eligible nations to compete for funds through a peer-reviewed process. Developing country scientists supported by this new funding initiative are expected to continue their pursuit of independent and productive research and education careers within their home institutions. Combating brain drain is in the long-term interests of the U.S. in terms of greater opportunities for productive global collaborations.

Stigma and Global Health

One of the pervasive problems affecting health globally is the stigma attached to certain diseases. Stigma and associated behaviors have powerful impacts on individuals, families, and communities, but may also threaten an individual's physical well being, at times their very life. Stigma may prevent individuals from obtaining diagnosis, accessing care, practicing preventative behaviors, or participating in research studies designed to find solutions to their condition. As HIV/AIDS, major depression, drug, tobacco, alcohol use, and suicide rates increase dramatically in the coming decades (Global Burden of Disease Report, 2000), the importance of addressing the stigma attributed to these and other conditions becomes all the more essential. To bring the necessary resources to bear, FIC will launch a new program with partners across NIH designed to gain a better understanding of the social and cultural determinants of stigma, both in the United States and in the developing world, and the behavioral responses resulting from stigmatization in different cultural settings. This understanding is fundamental to the identification and testing of effective behavioral interventions. The program will build on the many insights gained at the September 2001 conference, "A Stigma and Global Health: Developing a Research Agenda," sponsored by FIC and over 20 partner agencies from NIH, the U.S. Government, Non-Government Offices, and international organizations.

Responding to Trauma and Injury

Every day around the world, almost 16,000 people die from injuries and many more survive with permanent disabilities (World Health Organization. Injury: A Leading Cause of the Global Burden of Disease. Geneva, Switzerland: WHO; 1999). Injuries occur in all regions and countries of the world, and affect people in all age and income groups, although the magnitude and source of injury varies considerably by age, sex, income and region of the world. In low- and middle-income countries in the Western Pacific the leading injury-related causes of death are road traffic injuries, drowning, and suicide, while in Africa they are war, interpersonal violence, and traffic injuries. In the Americas, the leading injury-related cause of death among people aged 15 to 44 years in the higher-income countries is traffic injuries, while in the low- and middle-income countries of the Americas it is interpersonal violence. Most traffic injuries, fire-related injuries, falls, drowning, and poisonings are classified as unintentional while homicides, suicides, and war are classified as intentional. Public health officials now recognize injuries to be preventable and researchable. During FY 2003, FIC will partner with the National Institute of General Medical Sciences and other interested NIH institutes to develop and expand research and provide multidisciplinary research training for postdoctoral scientists from the developing world. These research efforts will focus on improving understanding of the body's systemic responses to major injury; fostering more rapid application of this knowledge to wound-healing following trauma and burns; developing innovative low cost/low maintenance prosthetic devices; and integrating mental and physical rehabilitation for victims of trauma. The first step will be to convene a conference to identify gaps in training and research and to seek ways to integrate basic treatment with public health interventions to assess risk and develop appropriate and promising interventions for prevention and treatment of trauma.


The Fiscal Year 2003 budget request for the FIC is $63,883,000, including AIDS, an increase of $7,430,000 and 11 percent over the FY 2002 level. This amount assumes a comparable transfer of funds from the National Cancer Institute in FY 2003.

A five-year history of FTEs and Funding Levels for FIC are shown in the graphs below. Note that Fiscal Years 2000 and 1999 are not comparable for the Managerial Flexibility Act of 2001 legislative proposal.

Column Chart: FTEs by Fiscal Year

Column Chart: Funding Levels by Fiscal Year

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 2003 request provides average cost increases for competing RPGs equal to the Biomedical Research and Development Price Index (BRDPI), estimated at 4.0 percent. Because of the natural cycle of several grant programs, and because FIC is establishing two new programs in FY 2003, the average cost will be higher this fiscal year than the BRDPI. Noncompeting RPGs will be funded at committed levels which include increases of 3 percent on average for recurring direct costs.

The Fiscal Year 2003 request includes funding for 168 other research grants. Research Management and Support receives an increase of 9 percent over FY 2002.

The FIC plays a critical role in ensuring that the United States meets current global health challenges and prepares for future challenges. The increase requested in the Research Management and Support Mechanism will provide the FIC essential resources to enhance its scientific leadership to meet these challenges. Funding for Bioterrorism activities has increased by $55,000 from $445,000 in FY 02 to $500,000 in FY 03.

The mechanism distribution by dollars and percent change are displayed below:

Bar Chart: FY 2003 Estimate Percent Change from FY 2002 Mechanism

Pie Chart: FY 2003 Budget Mechanism


1. FTEs by Fiscal Year

  • 1999 - 59 FTEs
  • 2000 - 64 FTEs
  • 2001 - 71 FTEs
  • 2002 - 79 FTEs
  • 2003 - 79 FTEs

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2. Funding Levels by Fiscal Year

(Dollars in Millions)

  • 1999 - $35.2
  • 2000 - $43.3
  • 2001 - $50.9
  • 2002 - $57.4
  • 2003 - $63.8

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3. FY 2003 Estimate Percent Change from FY 2002 Mechanism

  • Research Project Grants - 12.0%
  • Other Research - 12.0%
  • R&D Contracts - 0.0%
  • Res. Mgmt. & Support - 8.8%

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4. FY 2003 Busget Mechanism

(Dollars in Millions)

  • Research Project Grants - 24%
  • Other Research - 56%
  • R&D Contracts - 0%
  • Res. Mgmt. & Support - 20%

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