FIC FY2003 President's Budget Request for NIH
Department of Health and Human Services
Gerald T. Keusch, M.D.
John E. Fogarty International Center for Advanced Study in the Health Sciences
On Fiscal Year 2003 President's Budget Request for the National Institutes of Health
May 13, 2002
Mr. Chairman and Members of the Committee, I am pleased to present the President's budget request for the Fogarty International Center for FY2003, a sum of $63,833,000, which reflects an increase of $6,480,000 over the comparable Fiscal Year 2002 appropriation.
Science for Global Health
For 34 years now, the Fogarty International Center (FIC) has built alliances for global health to advance medical research for the benefit of all. We live in an interconnected, international community and because science is an inherently international endeavor, FIC initiatives reach across borders and contribute knowledge to enhance health here at home while narrowing the gap in health status between rich and poor countries.
We face many global health challenges and threats. The World Health Organization (WHO) estimates that 1,200 people die each hour from an infectious disease. AIDS has killed more than 22 million people, leaving in its wake households without bread-winners, orphaned children, and unspeakable human suffering. In the U.S., 45,000 people become infected each year. As we battle AIDS, TB, malaria and other infectious diseases on the rise around the globe, we confront new microbial threats and drug-resistant strains of common foes. At the same time, we know that chronic diseases will become more important causes of the global burden of disease in the coming decades (WHO/World Bank Report, 1996). With aging of populations and changing demographics, due to new economic growth, heart disease, stroke, diabetes, mental illness and other chronic diseases, will all add to the increasing health burden on the global community. As we combat today's diseases challenges, we must prepare for those on the horizon. Sound science is at the foundation of our approach to addressing these global health threats.
As a nation, our interest in global health stems not only from our humanitarian concerns as we work to alleviate human suffering, but also from an enlightened self- interest. Traditionally, such interests focus on protecting our nation from imported diseases. Now we recognize the political and economic benefits as well: healthy, stable countries make strong allies and trading partners. Yet, our self-interest goes beyond these issues. Through partnerships with scientists from around the world, including those in developing countries, we are able to identify new strategies and new understandings of disease processes, including for AIDS, TB, and chronic diseases such as heart disease, that affect us all. In light of the tragic events of September 11th, these partnerships take on new meaning. As President Bush noted to the U.N. General Assembly soon after the tragedy, "My country is pledged to investing in education and combating AIDS and other infectious diseases around the world. Following September 11th, these pledges are even more important. In our struggle against ... poverty and despair, we must offer an alternative of opportunity and hope." The programs of the FIC provide both scientific opportunity and hope for generations of scientific leaders, especially those in the poorest, most marginalized parts of the world.
Narrowing the Knowledge Gap
FIC currently addresses global health challenges through twenty research and research capacity building programs as well as through its leadership of global scientific alliances. Working in over 100 countries and through more than 120 U.S. universities, medical schools and schools of public health, FIC-supported scientists are in the vanguard in advancing research and in training the next generation of scientists. The pairing of research with research training is the cornerstone of FIC's approach toward building capacity in the developing world, and it has produced over time spectacular and enduring results. A complete description of the FIC Strategic Plan is available on the Web at plan.html.
FIC's AIDS International Training and Research Program, now in its 14th year, has provided Ph.D.-level, Master's-level and advanced short course training to thousands of scientists in the developing world. Research successes supported through that program include identification of effective strategies to reduce HIV transmission from mother to child, insights into risk behavior that leads to HIV infection and related intervention strategies, and development of technologies to ensure the safety of the blood supply. Importantly, scientists who received training through the AIDS program are competitive for other NIH funds, as well as funds from other science agencies, and become the leaders in science in their home countries as new studies and clinical interventions are developed and tested.
Among the outstanding leaders associated with FIC's research capacity building programs is Dr. Nelson Sewankambo, a long-standing FIC affiliate of our AIDS program, now Dean of the School of Medicine in Kampala, Uganda. Dr. Crispus Kiyonga, Minister of Health of Uganda, has received advanced training in AIDS research methodologies with FIC support to Johns Hopkins University. Both individuals had a major impact on the formulation and implementation of AIDS policies that have contributed to the decline in overall HIV infections in Uganda. Today, Dr. Kiyonga leads the United Nations Global Fund to Fight AIDS, Tuberculosis, and Malaria, a newly-established fund to address the burden of those diseases in the developing world. In addition, Dr. Phillippa Musoke, once a trainee in the AIDS program, later competed successfully for NIH funds and went on to make one of the seminal discoveries in Uganda on the use of anti-retroviral drugs to block mother to child transmission of AIDS. Looking more broadly at the impact of the AIDS program on individual career development and scientific productivity, a review of the presentations at the most recent AIDS International Conference held in Durban, South Africa, in June 2000 shows that fully 25 percent of all research papers were authored or co-authored by FIC-supported scientists from developing countries. Ultimately it is people who drive progress.
Using the same capacity building paradigm as with AIDS, FIC supports research and research training in other critical areas of global health concern, including in the fields of maternal and child health, environmental and occupational health, and tobacco and health, while building essential capacity in ethics and information technology. While training the next generation of researchers, key advances in critical areas have emerged: a U.S.-Peru team developed a low-cost diagnostic test for multi-drug resistant TB that is fast, cost-effective and can be used in resource-poor settings; a U.S.- Brazil team tracked the spread of penicillin resistance in populations; a U.S.- China team elucidated the risks associated with unsafe blood products and the spread of HIV; and a U.S.- Russia team defined intravenous drug use and sexual practices related to the burgeoning AIDS epidemic in Russia to identify effective interventions. As a companion to these research capacity building programs for developing country scientists, FIC supports a career development program for junior U.S. scientists to allow them opportunities to conduct research on global health issues in developing country institutions.
FIC's support for research also includes work that spans diverse disciplines to generate new knowledge. For example, the International Cooperative Biodiversity Groups program, launched in 1993, fosters drug development from diverse plants and microorganisms. At the same time, working through community groups and local governments, it works to conserve biodiversity and promote economic development where these source organisms are located. A number of novel lead compounds to combat a range of diseases, including AIDS, TB, malaria, leishmaniasis, bacterial infections, and cancer, are now in animal testing programs in collaboration with pharmaceutical partners. Additionally, FIC is working to strengthen the knowledge base of the linkage between health status and economic development through joint awards to economists and health scientists. Launched with other NIH partners and the World Bank, this new FIC program supports studies to promote collaborative decision making among Ministries of Development, Finance and Health in the developing world, for example studies that document the link between the nutritional status of children and adult economic productivity, providing the evidence base for appropriate interventions.
As a leader in the global health arena, FIC initiates partnerships and implements research and training with other NIH components on issues of common interest as well as with other U.S. agencies, science funding agencies abroad, international organizations, foundations and other non-governmental groups. FIC is the Secretariat for the Multilateral Initiative on Malaria (MIM), a global alliance of organizations and institutions committed to advancing malaria research and building research capacity in the developing world. FIC works closely with the National Institute of Allergy and Infectious Diseases, the National Library of Medicine, the WHO and science funding agencies in France, the United Kingdom, and other countries to advance the goals of the MIM. In addition to its support for collaborative research projects and training in malaria, the Secretariat will hold the third Pan-African and International Malaria Conference in Arusha, Tanzania in November 2002. Other examples of FIC's leadership in key global health areas include a major project to develop a new assessment of "Disease Control Priorities in Developing Countries," in partnership with the World Bank, WHO, and the Bill and Melinda Gates Foundation. This new initiative will develop data on disease burden and health care infrastructures in the developing world as a means to inform policy makers. FIC has been selected by the partners as the Secretariat for the Project. In another area, FIC is playing a leading role in advising on the development of the Global Alliance for Improving Nutrition, a public-private sector partnership to enhance global health through food fortification and other nutritional interventions.
Meeting Unmet Global Health Needs: 2003 Initiatives
Translating AIDS and TB advances from bench to bedside in the developing world: As the global community continues to work to address the paired pandemics of AIDS and TB, donations of anti-AIDS drugs, increased funding from foundations and other circumstances make it possible to consider more aggressive care for those already infected while working to prevent new infections. As countries in the developing world gear up to test new treatment protocols, the need for enhanced clinical research skills and support becomes more and more important. Building on the foundation that FIC and its partners have established over many years, FIC has spearheaded the development of a new program to expand training in AIDS and TB to include clinical, operational and health services research. This program, developed closely with NIH partners as well as with other U.S. agencies and non-governmental groups, will build the capacity in poor countries so that research advances made at the bench may be rapidly translated into the delivery of health care for those who are in greatest need.
Combating Brain Drain from Developing Countries: As we work to address global health challenges, ensuring that scientists from the developing world who train in the U.S. have opportunities to conduct research on their return home is increasingly critical. To foster their productive "re-entry," FIC and partners at NIH will expand the pilot effort to provide competitive awards to junior scientists from the developing world who have "graduated" from FIC training programs in U.S. universities or who have received training in the NIH intramural laboratories in Bethesda. This program encourages continuity of the scientist-to-scientist collaboration, builds capacity in global health areas in the developing world, and encourages junior scientists from the developing world to return home because they can establish independent research careers, and builds relationships between our nations.
Addressing the Growing Burden of Brain Disorders: Mental illness and brain disorders will contribute increasingly to the global burden of disease in the coming decades (Institute of Medicine Report on Neurological, Psychiatric and Developmental Disorders, 2001). In addition to the human suffering associated with these conditions, they contribute to significant losses in economic productivity. FIC will work with partners across NIH to address the challenges of neurological, psychiatric, and developmental disorders in the developing world. In FY 2003, FIC will launch a program to build research capacity in the field of brain disorders while supporting operational research to identify and implement interventions that are relevant, feasible and affordable in low-resource settings. It is expected that the benefits of this program will be realized not only in the developing world but also in the U.S., for populations that share genetic and cultural similarities with those in resource-poor settings abroad.
The Linkages between Health, Environment, and Economic Development: Understanding the linkages between sustainable development, environmental change and health is a great challenge to those who set national health policy, especially in resource-limited nations. Building on current FIC research programs that address the impact of improving health on economic productivity on the one hand, and research to understand the impact of environmental degradation on the other, FIC will launch a new program to more fully understand the relationships between health, environment, and economic development. This research program will focus on the effects of urbanization in low-resource countries, the health effects and consequences of agricultural practices, water-borne diseases, nutrition and food safety, and the economic, social and health costs and benefits of globalization.
Stigma and Global Health: One of the pervasive problems affecting health globally is the stigma attached to certain diseases and its powerful impact on individuals, families and communities. Stigma inhibits individuals from obtaining diagnostic services or care, and from participating in research studies designed to find solutions to their condition, and results in ostracism, physical harm or even death. As the prevalence of stigmatizing conditions, including AIDS, mental illness, drug use and others, increases in the coming decades, the impact of stigma will also increase. Building on the out-comes of the FIC-led "International Conference on Stigma: Setting a Research Agenda" held in September 2001, FIC and partners across NIH will launch a new research and training program to enhance our 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.
Trauma and Injury -- New Challenges: Every day the global toll from trauma and injury from all causes is almost 16,000 deaths, and far greater numbers incur permanent disability (WHO Report; 1999). In the coming decades, road traffic accidents, injuries and trauma will contribute increasingly to the global burden of disease. FIC and NIH partners are working to address this challenge through the development of a multi-disciplinary program to link basic research on trauma, burns, wound-healing, post-traumatic stress disorders and other conditions with training for scientists from the developing world. One objective is to develop low-cost effective interventions that would be applicable in the developing world as well as within the developed world.
Meeting Unmet Global Health Needs: 2003 Initiatives
As we enter the 21st century, the health challenges facing the U.S. and the global community will continue to converge. With strong scientific partnerships across national borders, we are positioned to tackle shared health problems and to develop shared solutions. The programs of the FIC are critical to building these partnerships and to advancing medical research for the benefit of all the world's people.
The NIH budget request includes the performance information required by the Government Performance and Results Act (GPRA) of 1993. Prominent in the performance data is NIH's second annual performance report, which compared our FY 2001 results to the goals in our FY 2001 performance plan.