HHS-India Fact Sheet: Activities in India

Working Together With India to Increase Scientific Knowledge and Use Best Public Health Practices; Promote Research Collaborations in Maternal, Infant, Reproductive, Environmental and Occupational Health, HIV/AIDS, mental health and other priorities; Develop and Evaluate Vaccines,  Drugs, Medical Devices, and Public Health interventions; Training the next generation of scientific and health leadership; Supporting research infrastructure; Ensuring Safety and Quality of Food, Drugs, and Medical Devices; and, Control, Prevent, and Eliminate Diseases

Introduction: Over the past few decades, the U.S. Department of Health and Human Services (HHS) Office in India has provided support for over $200 million of cooperative biomedical and behavioral and social science research and public health projects implemented by HHS’ technical agencies, focused in high-priority areas such as HIV/AIDS, smallpox, polio, tuberculosis, malaria, influenza, and maternal and child health, and capacity building.

The benefits from HHS collaborations with India are visible today in many parts of the country, in the form of thousands of Indian scientists trained in the United States, dozens of collaborative programs, and numerous personal and institutional relationships.

This past year, HHS committed nearly $30 million to U.S.-India collaborations, through the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), and the Food and Drug Administration (FDA).

By working together we are: 1) developing new scientific knowledge; 2) creating new technology for the development of vaccines, drugs, diagnostic tools, and medical devices; 3) collaborating on the safety and efficacy of drugs, devices and food; 4) working together to control, prevent, and eliminate diseases; and, 5) training the next generation of Indian and U.S. scientists to effectively address the global health challenges of tomorrow.

The benefits from these collaborations flow back to both the American and Indian people, and through the good will generated on both sides, to Indo-American relations in general.

HHS/National Institutes of Health (NIH): Between 1998 and 2003, HHS/NIH nearly quadrupled the number of research projects to which it provided funding in India, from 17 to 67.  Today, that number has nearly tripled again to 190 projects.  NIH builds research capacity and collaborative opportunities through investigator-initiated research grants, support for a Non-Human Primate Research Center in Mumbai, an International Center for Excellence in Research in Chennai, targeted workshops, long-term research training in mutually identified priority areas, and post-doctoral research training in NIH’s intramural laboratories for over 300 Indian scientists per year.

HHS/Centers for Disease Control and Prevention (CDC): With staff posted in Delhi, Chennai and Hyderabad, HHS/CDC is partnering with Indian institutions in a wide variety of bilateral and multilateral programs.  HHS/CDC is one of the largest supporters of polio-eradication efforts in India.  Under President Bush’s Emergency Plan for AIDS Relief (PEPFAR), HHS/CDC supports the Indian Government’s efforts to control the country’s HIV epidemic.  HHS/CDC also provides technical and funding support for disease surveillance and the laboratory detection of seasonal and avian influenza, which also builds capacity for pandemic preparedness.  HHS/CDC provides substantial technical support for India’s national efforts to prevent and treat tuberculosis, and gives technical support for tobacco control and lymphatic filariasis elimination.

HHS/Food and Drug Administration (FDA): Regulatory staff from HHS/FDA routinely conducts inspections of Indian pharmaceutical facilities to ensure products exported to the United States meet stringent safety and efficacy standards, which helps to avoid costly recalls for Indian exporters.  FDA is posting staff in Delhi and Mumbai to: 1) expedite inspections by FDA inspectors of FDA-regulated products from India that are being exported to the U.S.; 2) share comprehensive knowledge of current requirements, programs and activities related to FDA-regulated products with Indian industries that export to the U.S.; 3) foster collaboration on efforts to enhance understanding of the safety, efficacy, and quality of FDA-regulated products produced in India for export to the U.S. and exported from the U.S. to India; and 4) when requested by the Indian regulators to do so, work jointly with Indian regulatory authorities on regulatory and technical problems (i.e. workshops, inspections, and laboratory analysis, etc.) and cooperate on mutual needs to ensure product safety and quality.

HHS agencies maintain the following bilateral agreements with counterpart agencies in the Government of India:

1. Vaccine Action Program (NIH-NIAID): To develop vaccines against high-priority diseases, such as HIV/AIDS, TB, malaria, and rotavirus with India’s Department of Biotechnology.
2. Contraceptive and Reproductive-Health Research Program (NIH-NICHD): To promote the development of contraceptives and research into reproductive health with India’s Department of Biotechnology.
3. Emerging and Re-Emerging Infectious Disease and Disease Surveillance Program (CDC-COGH): To strengthen India's outbreak response and disease surveillance, including seasonal and avian influenza.
4. Collaboration on the Prevention of Sexually Transmitted Diseases and HIV/AIDS (NIH-OAR): To advance epidemiological, prevention, and operational research on HIV/AIDS and other sexually transmitted diseases with the Indian Council of Medical Research.
5. Maternal and Child Health and Human Development Research Program (NIH-NICHD): To promote research in low birth weight, micronutrients, reproductive-tract infections, and other mutually identified maternal and child health research priorities with the Indian Council of Medical Research.
6. Environmental and Occupational Health Program (CDC-NCIPC): To promote research, training, and workshops in environmental and occupational health, including injury control and bomb blast trauma care management.
7. Expansion of Cooperation in Vision Research (NIH-NEI): To promote collaborative research on ocular diseases, including the prevention of blindness cases with India’s Department of Biotechnology.
8. Low-Cost, Diagnostic, and Therapeutic Medical Technologies Research Collaboration (NIH-NIBIB): To promote collaboration with India’s Department of Biotechnology on the development and use of low-cost medical technologies and devices for health care in resource-limited settings.
9. Translational Research Collaboration (NIH): To promote collaboration in the area of translational research between NIH and India’s Department of Biotechnology (DBT).
10. Mental Health, Neurology, and Addictive Disorders (NIH-NIMH, NIH-NINDS, NIH-NIDA): New collaboration with India’s Department of Biotechnology to promote collaboration on translational and clinical research for new therapies and drugs, genetic testing and mapping of brain diseases, stem cell biology research, public repositories, advanced brain-imaging technologies, training, and other priorities.
11. Training the Next Generation of Research Scientists (NIH): To promote the repatriation of Indian scientists after their NIH-sponsored training has been completed, this new collaboration with India’s Department of Biotechnology will support long-term career paths, scientific mentorship, and the pursuit of independent research careers.

In addition to the above-listed agreements, HHS agencies are collaborating with India on HIV/AIDS, malaria, TB, polio elimination, establishment of schools of public health, preparedness for avian influenza, severe disease outbreak response capabilities, graduate-level and postdoctoral research training, and short-term capacity-building efforts.  Details of HHS programs in India are provided below:

1. HHS support for capacity building through scientific workshops: HHS and its agencies (NIH, FDA, and CDC) conduct workshops on topic of mutual interest, such as clinical research and trials, HIV/AIDS, avian influenza, low-cost health technologies, ocular diseases, maternal, child, and reproductive health, medical education, enteric parasite diagnosis, emerging and re-emerging infectious diseases, lymphedema management for lymphatic filariasis, cancer, and injury control and bomb blast trauma care management in collaboration with government and academic institutions.  The purpose of these workshops is to establish collaborations on topics of interest in high-priority areas in infectious diseases, chronic diseases, and environmental and occupational health.

    

2. HHS support to Establish Schools of Public Health in India: HHS initially facilitated the development of the concept, and worked closely with the Indian Ministry of Health and Family Welfare on the establishment of the Public-Health Foundation of India.  HHS continues to provide technical and has provided funding to PHFI for initiating collaborative workshops in the area of public health and disease elimination.

    

3. HHS Support for Rotavirus Vaccine Development: Scientists from HHS/NIH and CDC are working together with Indian scientists on the development and testing of rotavirus vaccines.  These investigators are conducting a clinical trial in India of two live oral rotavirus candidate vaccines (strains 116E and I321) to determine their ability to prevent rotavirus diarrhea in Indian children.

    

4. HHS/CDC’s Global AIDS Program: HHS/CDC works with USAID, DOD and DOL under the President’s Emergency Plan for AIDS Relief (PEPFAR) to support the Government of India’s response to HIV/AIDS.  Major program activities are in the high-burden southern states of Tamil Nadu, Andhra Pradesh, Karnataka and Maharashtra.

    

   The U.S. Government and over 30 multinational agencies and donors assisted the Government of India in developing its third National AIDS Control Plan (NACP III).  HHS/CDC has dedicated resources to the President’s Emergency Plan, including a headquarters office in the U.S. Embassy in New Delhi and field offices in Chennai and Hyderabad.  HHS/CDC provides critical technical assistance and policy guidance in the areas of capacity building, strategic information, and laboratory systems strengthening to the National Control AIDS Organization (NACO) and its State subsidiaries, and has developed implementation models at State and District levels through multiple partners.  The total PEPFAR budget for all USG in India in fiscal year 2008 was $30 million, of which $7 million came through HHS.

    

5. HHS/CDC Polio-Eradication Program: HHS/CDC is strongly committed to assisting India in its program to eradicate polio.  HHS/CDC is one of the biggest supporters of the World Health Organization’s polio team in India, and provides substantial funding for the purchase of oral polio vaccine, in addition to critical technical and managerial support.  HHS committed $8.4 and $2.6 million to polio-eradication efforts in India in 2007 and 2008, respectively.

    

6. HHS/CDC Collaboration on Highly-Pathogenic Avian Influenza and Pandemic-Influenza Preparedness: HHS/CDC is providing technical and funding support to the Indian Council of Medical Research, Department of Health Research, Indian Ministry of Health and Family Welfare to expand seasonal and avian influenza surveillance capacity, seasonal influenza disease burden estimation, seasonal influenza vaccine usage laboratory training and collection of influenza specimens for global monitoring of virus strains.  HHS/CDC provided $4.76 million for various influenza related activities for FY-08 in India.

    

7. HHS/CDC support for the Field Epidemiology Training Program (FETP): HHS/CDC is supporting two FETPs in India, one in Delhi and one in Chennai, by providing technical consultations and providing a full time Resident Advisor (RA).  The FETP in Chennai, based in the National Institute for Epidemiology, is now independent and appears to be a sustainable program.  The FETP in Delhi graduated its first class in 2008.  Two key priorities for this FETP are to further develop the curriculum and to increase the field experience portion of the training.

    

8. HHS/CDC support for Integrated Disease Surveillance Project (IDSP): HHS/CDC is providing technical support to the National Institute of Communicable Disease for the implementation of the Integrated Disease Surveillance Project.  Technical support is provided in the area of IT for health systems, laboratory-based surveillance, seasonal and avian influenza, training, capacity building and surveillance, and strategic vision.

    

9. HHS/CDC support for malaria program: HHS/CDC is providing technical support for disease burden, vaccine-related research, molecular tools for characterizing drug resistant parasites and diagnosis, and severe malarial anemia, placental malaria, and cerebral malaria studies in Jabalpur, India.  These studies are done in collaboration with the National Institute of Malaria Research, New Delhi and Regional Medical Research Center, Jabalpur, India.

    

10. HHS/CDC lymphatic filariasis (LF) collaboration project: HHS/CDC is providing technical support for a USAID-funded project assessing the impact of a large-scale lymphedema management program in Orissa, India and providing technical assistance to the state’s LF elimination program.

     

11. HHS/CDC support for identification and response to severe disease outbreaks in India: HHS/CDC collaborates with the National Institutes of Virology and the National Institute of Communicable Diseases to assist in identification and response to severe disease outbreaks in India.  Activities include provision of diagnostic protocols and reagents, testing of biologic specimens at the CDC and training of Indian scientists in outbreak investigation techniques in various CDC laboratories.  Training includes CDC assisting with development of appropriate high containment laboratories and SOPs to assure appropriate biosafety and biosecurity when working with known and emerging high hazard pathogens.  This project has already had significant impact on investigation of large viral encephalitis outbreaks in India.

     

12. HHS/CDC support for enteric parasite project: HHS/CDC is providing technical and limited funding support for collaborative projects on molecular diagnostics studies of enteric parasites in Kolkata.  This project is being undertaken in collaboration with the National Institute for Cholera and Enteric Diseases, Indian Council of Medical Research.

     

13. HHS/CDC support for EPI: HHS/CDC has actively supported the Ministry of Health and Family Welfare in strengthening India's Expanded Program on Immunization (EPI) through technical support, collaborative studies, and training.  In collaboration with the MoHFW, WHO, and UNICEF, CDC provided technical support for a training course in epidemiology for 50 state EPI staff and conducted EPI program evaluations in Bihar and Assam.  HHS committed over $1.1 million to support measles control and efforts to support EPI in India in FY08.

     

14. HHS/CDC Tuberculosis control program: HHS/CDC is strongly committed to assisting India in its efforts to control tuberculosis.  HHS/CDC has supported the World Health Organization's tuberculosis team and the national TB control program for nearly 10 years.  HHS/CDC officers have been responsible for guiding expansion of the national TB control program, and providing critical technical support for responding to the dual emerging threats of HIV-associated TB and multi-drug resistant TB (MDR TB).

     

15. HHS/NIH extramural research grants and contracts: In the past decade, Indian investigators have been increasingly successful in competing for NIH funds through the highly competitive NIH dual level peer-review process.  In Fiscal Year 2008 alone, the NIH intended to fund 49 awards involving scientists in India, estimated at well over $13 million in FY’08 to Indian scientists.  NIH extramural funding to Indian scientists include a wide variety of priorities for the NIH, including research related to HIV/AIDS, tuberculosis, cancers, maternal and child health, cardiac disease, diabetes, population aging, mental health, environmental health, and other chronic and infectious diseases.  NIH’s extramural research funding to India involves several of India’s most well-renowned medical researchers and research institutions, in the public, private, and academic sectors.  These Indian government research organizations, universities, non-profit organizations, and private research facilities, and other NIH-funded sites are located throughout India.

     

16. HHS/NIH Extramural Research Training: HHS/NIH is partnering with Indian institutions on training of the next generation of Indian and U.S. scientists, through several extramural research training grants.  Research training grants from the NIH’s Fogarty International Center (FIC) are designed to enhance research capacity in India, with an emphasis on institutional partnerships and networking.  In India, NIH/FIC is supporting several targeted long-term training programs, involving over a dozen Indian institutions.  These NIH/FIC programs have trained hundreds of Indian scientists, many at the masters or doctoral levels.  NIH/FIC research training efforts currently focus on Bioethics, HIV/AIDS, infectious diseases, environmental and occupational health, clinical research, and reproductive health.  In addition, several other NIH Institutes support postdoctoral-level research training efforts through extramural research grants awarded to U.S. and Indian academic institutions.

     

17. HHS/NIH Intramural Research Training: NIH expenditures for postdoctoral trainees from India are estimated at well over $15 million per year.  NIH’s Intramural research programs provide an opportunity for Indian scientists to enhance their research skills in the resource-rich NIH environment, which consists of more than 1200 NIH laboratories devoted exclusively to biomedical research.  There are over 300 Indian postdoctoral scientists receiving fully-funded training experiences within approximately 20 different NIH Institutes and Centers, at any given time.  These Indian scientists pursue both basic and clinical research, free from the demands of obtaining grants and teaching.  For the past several years, the overall number of visiting researchers from India is in the top five countries, when compared to the overall number of visiting foreign researchers from any other single country worldwide.

     

18. HHS/NIH International Center for Excellence in Research (ICER):  HHS/NIH established an ICER site at the Tuberculosis Research Center, a component of the Indian Council of Medical Research, Department of Health Research, Indian Ministry of Health and Family Welfare located in Chennai, building on a lengthy history of collaboration with this institution.  The aim of the NIAID ICER program is to develop sustained research programs in areas of high infectious-disease burden.

     

19. HHS/NIH Research Infrastructure Support: HHS/NIH is providing funding for equipment, and substantial technical assistance, for a new state-of-the–art, non-human primate breeding facility under construction near Mumbai.  Once completed, this breeding facility will be an invaluable resource for HHS/NIH research priorities working in collaboration with the Indian Council of Medical Research.

Last revised: May 01, 2009