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Summary of the NIH International Representatives MeetingSeptember 10, 2007
Dr. Roger Glass, NIH Associate Director for International research, and Director, Fogarty International Center, welcomed the NIH IC representatives to the Building 31, 6C, Conference Room 10. He noted that the NIH IC Directors held a retreat during the week of September 3rd and for the first time "Global Health" was included as one of the main topics at the Directors Retreat. The Global Health session was co-convened by NIAID's Dr. Anthony Fauci and Dr. Glass and included presentations by NHLBI, NIA and NCI. Dr. Glass further noted that as part of growing interest in global health across the NIH campus, FIC would be working with others at NIH to produce an NIH "White Paper" on global health research with inputs from interested ICs. He also reflected on the fact that NIH invests approximately $700 million in research in countries around the world, with about 60-70 percent of this total being in OECD countries. Dr. Glass highlighted that Dr. Zerhouni expressed interest in broadening the NIH research investment in non-OECD countries. In concluding his opening remark, Dr. Glass also informed the IC representatives that he recently returned from visiting four African countries (South Africa, Mozambique, Tanzania and Rwanda) with HHS Secretary Leavitt. The Secretary was pleased to see and learn about NIH investments, noting specifically FIC, made in training researchers in the countries visited. Dr. Glass next introduced the guest presenter, Dr. Tikki Pang, Director, WHO Research Policy and Cooperation. Dr. Pang was educated in Australia and elsewhere in biochemistry, microbiology and immunology and previously served as Professor of Biomedical Sciences at the Institute of Postgraduate Studies and Research in Kuala Lumpur, Malaysia. His efforts at WHO are to strengthen the informational, scientific and ethical foundations of health research systems so as to enable these systems to contribute effectively to health system development, particularly in developing countries. Overall Research Strategy for the World Health Organization: Dr. Pang began by highlighting a quote by Dr. Bruce Alberts, former President of the National Academy of Sciences: "Science cannot be focused solely on acquiring knowledge. It must also examine the ethical implications of the application of such knowledge in an international context in order to form legitimate public policy, and it must promote ways to ameliorate the miserable conditions in which the majority of the world's people live." He next outlined the major global health problems, including infectious diseases, antibiotic resistance, chronic diseases, and weak health systems. He emphasized that the core of the above problems are the first three of the aforementioned challenges with the fourth - weak health systems - exacerbating these problems. He noted that health research is currently dominated by wealthy countries and is not focused necessarily on the health problems facing more than 90 percent of the world's population that reside in developing countries. He noted that of the 1,393 new drugs developed between 1975-99, only 1.6 percent was for tropical diseases prevalent in developing countries. He also highlighted examples of very low percentage of research funding dedicated for health systems research by developed country research institutions. Moreover, he noted the low percentage of research cited on MEDLINE that comes from researchers from developing countries. Dr. Pang described the current situation whereby there is a very substantial increase in clinical trials being conducted in developing countries which has raised a number of questions related to ethical, legal and social concerns and cited the recent Nuffield Council Bioethics studies on this issue. He noted that there are critical and real issues in transparency and accountability arising from the greatly increased numbers of clinical trials being conducted in many developing countries around the world. Dr. Pang cited the recent reluctance of Indonesia to provide bird flu samples to the WHO because of concerns that such samples could turn up in the hands of private pharmaceutical interests that would then make vaccines to be sold by to Indonesia at a price the people of that country could not afford. Thus Indonesia and similar developing countries are skeptical about what they perceive as a lack of transparency and accountability with regard to the use of valuable genetic material from their populations and would not want to be placed in a position of not being able to afford to vaccinate their populations against pandemic flu while developed countries will be able to do so, thanks to genetic material from the developing countries. With this backdrop, Dr. Pang noted that WHO is not a "major player" in research funding and indeed only expends about $60 million per year ($120 million in the current biennium) on health research, compared with the annual $28 billion budget of the NIH. He noted that in general WHO has focused its efforts on advocacy for health research (e.g., Global Ministerial Forum on Research for Health), forward thinking assessments for research (e.g. WHO report on Genomics and World Health), developing networks to support health research, encouraging public-private partnerships for research (e.g., the Global Alliance for TB Drug Development), the International Clinical Trial Platform Registry, Capacity Building activities (especially through the Tropical Disease Research [TDR] Program), and through the International Health Regulations [IHR] and other legal instruments (e.g., the Framework Convention on Tobacco Control). Dr. Pang highlighted WHO's comparative advantages, which include offering political legitimacy for pursuing common global health goals, direct contact with health ministries around the world, neutrality and independence, experience in managing public health events and decentralized structure and in-country presence. He also highlighted WHO shortcomings related to health research, including the fact that research activities supported by WHO are fragmented and poorly coordinated and that there is a weak research culture at WHO, further burdened by a lack of an overall strategy and vision. He made reference to the Lancet article published earlier this year which revealed that various WHO health guidelines were produced without credible scientific evidence. WHO is now undertaking an effort to produce a coherent Research Strategy for the organization. It is currently a work in progress and will be an "open, inclusive, participatory and iterative" process at all levels of WHO. Its goals will be to have WHO provide global stewardship in health research through advocacy, setting norms and standards and convening partnerships and strengthening capacity. Under the strategy, WHO will conduct and support research and capacity building in focused areas of need and relative advantage. The strategy will also call for the development of a coherent system for the governance and management of WHO's research activities within a "strengthened organizational research culture." Further information on the WHO research strategy process may be found at http://www.who.int/rpc/research_strategy. During his presentation, Dr. Pang invited PAHO's Dr. Luis Gabriel Cuervo to highlight PAHO's regional activities to support research activities among its members. PAHO is currently undertaking effort to support in-country research planning especially in countries with limited resources. Dr. Pang also invited Mr. Charles Gardner, WHO advisor, to provide information on the planning process for the next Global Ministerial Forum on Research for Health that will be held in Bamako, Mali, in November 2008. Mr. Gardner noted the results from the first such Forum meeting held in 2005 in Mexico City and indicated that WHO would be seeking a broadening of Ministerial participation at the Mali meeting so as to promote a broader platform of support for health research at the country level. More information on the Mali meeting may be found at: http://bamako2008.org/. During a question and answer period following Dr. Pang's presentation, several of the IC representatives highlighted recent efforts and support for various WHO activities. For example, NCI highlighted its support for WHO/IARC activities. One of the most recent efforts deals with technologies that NIH ICs have which can be provided/identified to WHO and in turn be potentially used in developing country settings to support research and/or health systems delivery activities in those countries. Next Meeting: Tentatively set for Tuesday, November 13, 2007, at 1 p.m. in the NIH Stone House. Attendance: Archives of Past IC Reps Meetings
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