Fogarty FY2004 President's Budget Request for NIH
Department of Health and Human Services
Gerald T. Keusch, M.D.
Director, John E. Fogarty International Center for Advanced Study in the Health Sciences
On Fiscal Year 2004 President's Budget Request for the National Institutes of Health
April 8, 2003
Mr. Chairman and Members of the Committee, I am pleased to present the President's budget request for the Fogarty International Center for FY 2004, a sum of $64,266,000 which reflects an increase of $801,000 over the comparable Fiscal Year 2003 appropriation.
Science For Global Health
Thirty five years ago, the Fogarty International Center was established to honor the memory of Congressman John E. Fogarty of Rhode Island. The authorizing legislation, introduced by Representative Melvin Laird of Wisconsin, stated "...the committee has provided funds to plan a lasting memorial to a man who for more than a quarter of a century worked tirelessly for a healthier America in a healthier world." (Congressional Record, House, May 25, 19867, p. 14062). It is my privilege to report to you, that for the past 35 years, the Fogarty International Center has fulfilled this promise -- Mr. Fogarty and Mr. Laird would be proud of their legacy. Today Fogarty is an essential component of the DHHS and NIH response to global challenges in health, representing the nexus between science and diplomacy and promoting both at the same time. Fogarty is known and respected around the world for its critical role in promoting research and capacity building for global health.
The research and training supported by Fogarty is a window to a brighter future for the low- and middle-income countries with heavy burdens of disease. While people in these countries typically suffer from high infant, child and maternal mortality rates, amplified manyfold by the threats represented by AIDS, TB, malaria and other seemingly intractable infectious diseases, increasingly these populations are now subject to the ravages of chronic disease and premature mortality represented by cardiovascular disease, diabetes, and cancer. All of these conditions limit societal productivity, economic growth, and stability. To this end Fogarty supports research to better understand the impact of improving health on economic development, political and social stability, and active participation in the global marketplace of the 21st century. Because economic growth invariably impacts on the environment, usually in an adverse manner, Fogarty has also developed a research agenda to improve our understanding of the impacts on population's health and individual's well-being related to sustainable economic development. These programs are crucial as we identify health care interventions that can improve both health and development.
The programs of Fogarty directly address five of the eight goals outlined in the United Nations Millennium Declaration, including eradication of extreme poverty (Goal 1), reducing child mortality and improving maternal health (Goals 4 and 5), combating HIV/AIDS, TB and malaria (Goal 6), and ensuring environmental sustainability (Goal 7). These goals are daunting, but not incapacitating. As U.N. Secretary General Kofi Annan has said, "They are achievable, not by holding more world conferences, but by people in every country, coming together and taking action." This is precisely what Fogarty does every day. To maximize and leverage the impacts of Fogarty programs, the Center has collaborated extensively within the NIH, across the Department of Health and Human Services, and beyond, including other components of the Federal government, bilateral and multilateral agencies here and abroad, foundations, and international organizations such as the World Health Organization, The World Bank and the Regional Development Banks.
Strengthening the Global Culture of Research
For scientists to come together and take action requires them to share a common culture of scientific ethos and values. This can only be accomplished in an environment in which rapid communication is possible, wherein scientific knowledge is readily available to all, and where research is conducted based on partnership and equity. When American scientists work across geographic boundaries in this manner, the beneficiaries are the collaborating scientists, science in general, the United States and foreign partner countries.
Fogarty strengthens this "global culture of research" through a range of programs. The Fogarty International Bioethics Education and Career Development Award provides trainees with a strong background in ethics and an understanding of research. The cadre of thoughtful and knowledgeable people trained through this program will insure that internationally and US-accepted ethical principles are upheld in studies around the world, including in poor nations. An additional component to strengthening a global culture of science is to ensure that technological advances made in one country are accessible to the greatest extent in all countries.
Fogarty addresses the growing divide in the development and use of genetic technologies through the International Collaborative Genetics Research Training Program. Fogarty-supported training in the technology of modern genetics research is accompanied by a strong component of ethical, social, and legal considerations and focuses on the implications of performing genetics research in low- and middle-income countries.
The third pillar in support of the global culture of science is access to information, which is addressed by the International Training Program in Medical Informatics. This program enables U.S. institutions to support training in order to build the capacity of scientists in developing countries to access, utilize and construct computer-based tools to access and exchange information to advance biomedical research and public health. This program will recompete in FY 2004. As a companion to this initiative, Fogarty in collaboration with the National Library of Medicine is embarking on additional programs to support and improve the editorial content of key biomedical research and health journals in developing countries, and to improve the quality and accuracy of reporting on medical research and health by developing country journalists, whether they are working in print, radio or television.
As Fogarty works to strengthen the global culture of science through all its programs, to maximize the benefits of individual initiatives in FY 2004 Fogarty proposes to pilot innovative International Glue Grants. These grants will provide resources to link together regional and national institutions in developing countries with their several U.S. partner institutions, taking advantage of the perspective of biomedical, clinical and behavioral and social scientists in creating new ways to explore old and emerging health problems. We expect the "glue" will bring investigators together in a common framework for addressing critical issues, enabling these collaborators to work more cost-effectively and with greater productivity on critical challenges such as AIDS, maternal health, and impacts on health from environmental pollution.
Support for the movement of junior researchers across borders is the fourth pillar of the broader effort to strengthen the global culture of research and science. Fogarty will continue to invest in the Global Health Research Initiative Program (GRIP), which provides resources for developing country scientists who trained in the U.S. to obtain, on a peer-reviewed merit-based system, funding to conduct research upon their return home and remain linked in collaborative research with their U.S. mentors. As a corollary to this program, Fogarty is also investing in career pathways in international research for young American investigators through the Fogarty International Research Scientist Development Award (IRSDA). The IRSDA supports junior U.S. scientists as they conduct research in the developing world on issues of global import, then provides additional opportunities and a "safety net" on their return home. In addition, in FY 2004, will bring the first crop of students of medicine, public health and allied medical sciences into a new program to provide a year of mentored clinical research training in a developing country collaborative research program. The rationale for this new program is to expose students as early as possible in their professional careers to research needs and prospects in the developing world as a means to encourage them to select global health challenges as long-term career pursuits. A partnership with the Ellison Medical Foundation, the Association of American Medical Colleges, the Association of Schools of Public Health and Fogarty, the program will pair a U.S. student with one from the host country to train and participate in clinical research under the guidance of expert mentors from the U.S. and the foreign country who already work together on clinical research studies.
A previously neglected area is that of gender and global health research. Not only may risk factors, disease progression, and response to treatment vary by gender, but societal responses based on gender may exclude women from accessing health care or may imbue them with stigma that adds significantly to the burden of disease. Fogarty is initiating two new programs to address these issues. First, the Stigma and Global Health research program, expected to be funded in FY 2003, will support studies to better understand the exclusion of stigmatized populations from the benefits of medical care and participation in medical research. Importantly, it will identify interventions to address the major needs. Second, Fogarty, the NIH Office of Research on Women's Health, the Canadian Institutes of Health Research, and Harvard and Yale Universities are working with experts around the world to develop a framework for the inclusion of gender issues across the range of global research and training programs the Center and other science funding
agencies support. Included in this initiative is an effort to enhance career development for women scientists from the developing world.
Continuing to Invest in Communicable Disease Research
Fogarty currently supports a broad program of research and training in AIDS, tuberculosis, malaria and other emerging infectious diseases. In FY 2004 the Center will pursue these major global health problems in three ways, first through its continuing focus on AIDS, the greatest epidemic threat of our time, and second, through support of a comprehensive program, the Global Infectious Disease Training and Research Program (GLIDTR), to focus on infectious diseases that are predominately endemic in or impact primarily upon people living in tropical countries. Under the AIDS programs, a major new initiative will be fully launched with the awarding of the first set of comprehensive grants under the International Clinical, Operational and Health Services Research and Training Award for AIDS and TB (ICOHRTA-AIDS/TB). This program has as its major goal the promotion of excellent clinical research in support of care of AIDS patients, along with the necessary operational and health services research to move new knowledge into practice as soon as possible. The GLIDTR is augmented by Fogarty/NIH enlarging investments in the Ecology and Infectious Diseases research program, a major collaboration between Fogarty and the National Science Foundation. This innovative program is oriented towards identifying predictive models for emergence of infectious diseases so that preventive strategies can be implemented before a new global calamity is unleashed on the world. Finally, Fogarty's Division of International Epidemiology and Populations Studies is conducting and coordinating research involving mathematical modeling of epidemic disease, whether due to events in nature or caused by humans, in an effort to better identify key questions and intervention points. Working closely with NIAID, NIGMS, and the Office of Public Health Emergency Preparedness at DHHS, Fogarty is coordinating work with leading academic mathematical modeling groups in the U.S. and abroad.
Expanding Investments in Non-Communicable Diseases
With the aging of populations worldwide, including in poor nations, along with changing lifestyle patterns and migration into cities, there is a growing recognition that the global burden of disease will increasingly include non-communicable diseases. Fogarty's current programs in this broad field address the burden of mental illness, the broad range of brain disorders across the life cycle, and the major epidemic of tobacco use and the inevitable epidemic of chronic pulmonary, cardiovascular disease and cancer that will follow. To complement this set of critical issues, Fogarty intends to explore ways to address the huge and growing burden of morbidity and mortality due to trauma and injury, whether intentional or un-intentional, such as road-traffic accidents. Areas of interest include training and research activities designed to better understand the body's systemic responses to major injury, fostering more rapid application of this knowledge to wound healing following trauma and burns, development of innovative low-cost and low-maintenance prosthetic devices, integration of mental and physical rehabilitation into primary care for victims of trauma, and to develop and test effective cost-effective interventions.
A complete description of the Fogarty Strategic Plan is available on the World Wide Web.
Today, Fogarty, together with the Institutes and Centers at the NIH, is exerting leadership in global health research in important new ways, addressing critical global health problems while investing in the training of U.S. and foreign researchers who can, together, identify the solutions for tomorrow. As expressed by John E. Fogarty before his death in 1967, "The alternative is that the United States will reduce its leadership role in furthering humanitarian programs, and may become more of a responder than a leader."