Linda E. Kupfer Acting Director, Division of International Science Policy, Planning and Evaluation

1. Global Health: The challenges… the opportunities…a plan Linda E. Kupfer Acting Director, Division of International Science Policy, Planning and Evaluation Fogarty International Center, NIH

2. The Challenges

3. Challenges: Aging has changed the research portfolio for global health in the 21st centuryLife Expectancy at Birth (1950 – 2005) Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, 2005. World Population Prospects: The 2004 Revision.

4. Deaths in Low and Middle Income Countries Gaziano TA. Circulation 2005; 112:3547-53

5. Prevalence of diabetes (age > 17) in the poorest and richest income quintiles in selected LMICs (2002) Source: WHO World Health Survey (www.who.int/healthinfo/survey/en)

6. By 2020, Cancer could kill10.3 Million People per Year (16 million new cases per year) Source: IACR, WHO

7. Dual Burden Infectious disease deaths Chronic disease deaths http://www.worldmapper.org

8. Public Health Spending http://www.worldmapper.org

9. Lack of researchers/scientists Researchers per million inhabitants, 2005 or latest available year UNESCO Institute for Statistics, 2007

10. The Opportunities

11. Public and Private Investment in Global Health

12. Gates Investment • Number and total value of new global health grants between 1998 and 2007 (and total disbursements per year) made by the Bill & Melinda Gates Foundation The Lancet, Vol. 373 May 9, 2009 1645-1653

13. USG Investment: HIV/AIDS Funding

14. New U.S. Administration on Global Health May 6, 2009 Obama Seeks a Global Health Plan Broader Than Bush’s AIDS Effort By Sheryl Gay Stolberg WASHINGTON — President Obama asked Congress on Tuesday to spend $63 billion over the next six years on a new, broader global health strategy that would reshape one of the signature foreign policy efforts of his predecessor, George W. Bush. Mr. Bush made combating global AIDS a centerpiece of his foreign agenda. The program he created — the President’s Emergency Plan for AIDS Relief or Pepfar— is regarded as one of his most significant achievements. But the plan Mr. Obama outlined Tuesday envisions a more far-reaching approach to global health that would focus not only on AIDS, but also on tropical diseases and other treatable and preventable illnesses that kill millions, many of them children, each year. “We cannot simply confront individual preventable illnesses in isolation,” the president said in a statement released by the White House that cited the swine flu outbreak as an example. “The world is interconnected, and that demands an integrated approach to global health.”

15. Global investments in health R&D Source:Global Health Forum for Health Research, 2008

16. For a Global Generation, Public Health Is a Hot Field By David Brown Friday, September 19, 2008 "It took something like HIV/AIDS … to capture our attention and make us realize that there were such inequities in the world," said Thomas Coates, head of the global health program at the University of California at Los Angeles, describing the new interest in public health. But the benefits of studying public health go considerably beyond understanding infectious disease.

17. NIH Allocation of American Recovery Reinvestment Act Comparative Effectiveness Research Extramural Scientific Equipment Extramural Repair, Improvements, & Const. Intramural Repair, Improvements, & Constr. $8.2 Extramural Scientific Research (All ICs, OD, Common Fund) $1.0 $0.3 $0.5 AHRQ – $0.4 ARRA appropriated $10 billion directly to NIH Oversight, Risk ManagementFinancial & Employment Reporting (Dollars In Billions)

18. ARRA Opportunities Fogarty Recovery Act Funding Opportunities • Focus: ICT, Implementation Science, Hubs • Challenge Grants Administrative Supplements • Fogarty Recovery Act Awards Issued Recovery Act funding will bolster global health programs on US campuses through Fogarty’s Framework Programs for Global Health.

19. The Benefits of Investment in Global Health Include • Advancing biomedical discoveries by taking research where the problems are (to high-risk communities or specific populations). • Extending security of the U.S. by the early identification of new threats from infectious disease, environmental hazards and lifestyle changes – H1N1 • Improving the economy in developing countries • Promoting health diplomacy, extending a positive, humanitarian image of America to those in greatest need. • Increasing competitiveness of U.S. biomedical science.

20. Discoveries Resulting from Collaborative International Health Research Oral rehydration therapy for Diarrhea Directly-Observed Tuberculosis Treatment HIV prevention – PMTCT, circumcision Artemisinin Combination Therapy for Malaria Viral antecedents of CA - Burkitt's lymphoma

21. National Institutes of Health Office of Director National Cancer Institute National Heart, Lung and Blood Institute National Human Genome Research Institute National Institute of Aging National Institute on Alcohol Abuse and Alcoholism National Eye Institute National Institute of Dental and Craniofacial Research National Institute on Deafness and Other Communication Disorders Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institute of Biomedical Imaging and Bioengineering National Institute of Arthritis and Musculoskeletal and Skin Diseases National Institute of Diabetes and Digestive and Kidney Diseases National Institute of Allergy and Infectious Diseases National Institute on Drug Abuse National Institute of Environmental Health Sciences National Institute of General Medical Sciences National Institute of Mental Health National Institute of Neurological Disorders and Stroke Fogarty International Center National Library of Medicine National Institute of Nursing Research National Center for Complementary and Alternative Medicine National Center on Minority Health and Health Disparities National Center For Research Resources Clinical Center Center for Information Technology Center for Scientific Review

22. Fogarty Intl Center Percent of NIH Budget

23. NIH Global Investment and Regional Distribution NIH International Report, 2004

24. Our plan

25. FIC Mission • FIC is dedicated to advancing the mission of the NIH by supporting and facilitating global health research conducted by US and international investigators, building partnerships between health research institutions in the US and abroad and training the next generation of scientists to address global health needs.

26. Fogarty International Center – 2008 - 2012 Mobilize the scientific community to address the shifting burden of disease and disability Bridge the training gap in implementation research Develop human capital to meet global health challenges Foster a sustainable research environment in low- and middle-income countries Building strategic alliances and partnerships in global health research and training

27. Goal 1: Mobilize the scientific community to address the shifting burden of disease and disability 800 Million Undernourished One Billion Overweight

28. Fogarty’s investment by major disease category

29. Fogarty programs focusing on Non-Communicable disease • NEW! Millennium Promise Awards: Non-communicable Chronic disease research training program • International Clinical, Operational, and Health Services Research and Training Awards (ICOHRTA Chronic) • International Tobacco and Health Research and Capacity Building Program (TOBAC) • Fogarty Clinical Research Training Scholars Program

30. Goal 2: Bridge the training gap in implementation research Bridging Know-do gap Know-do gap

31. Variable Implementation of Insecticide-Treated Nets (Children < 5) Source: WHO Statistical Information System

32. Science of Implementation and Dissemination Jim Yong Kim, MD, PhD gave keynote talk on Implementation and Global Health to over400 attendees Consideration of research methodology in implementation and dissemination science Many sessions addressing training and curriculum development in Implementation Science

33. Pedro Chequer, Director, National STD/AIDS Program, MOH, Brazil Jean Pape, Director, GHESKIO, Haiti Salim Abdool Karim, Director, CAPRISA S. Africa Philippa Musoke, Chair of Pediatrics, Makarere University, Uganda Glenda Gray, Co-founder/Co-Director, Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, South Africa David Serwadda, Director, Institute of Public Health, Makarere University, Uganda Marcos Espinal, Stop TB Partnership Secretariat, World Health Organization Ruth Nduati, Faculty of Medicine, College of Health Sciences, University of Nairobi Patricia Garcia, Chief, National Institute of Health, Peru Zunyou Wu, Director, National Center for AIDS/STD Control & Prevention, Chinese CDC, China Goal 3: Develop human capital to meet global healthchallenges AITRP (Aids Intn’l Training & Research Program (1988-…) Investing in Leaders

34. Fogarty-Supported Training and Research • 1/3 $ Research, 2/3 $ Training • ~ $55 million/yr • ~400 active grants

35. Degrees awarded by Fogarty-funded training programs Source: CareerTrac

36. Fogarty funded trainees’ degree by world bank region, 1988-2009 Other non-degree training includes certificate, diploma, sabbaticals

37. Fogarty Scholars“early childhood education” 25 “pairs” of trainees going to 16 medical centers in the developing world

38. Important Characteristics of Training Programs Local training and research should build upon developing country needs

39. Trainee Return Home High rate of return to home country following training (85% -100% )

40. Collaboration’s lasting role Approx. 90% of FIC collaborators (FIRCA Program) continue their collaboration. About 30% of the grantees continue to co-publish Source: FIRCA Evaluation

41. Second generation training “Second-generation” training occurs, i.e. foreign scientists return home contribute to the training of the next cohort (FIRCA Evaluation)

42. Don’t just drop in Glad I am here so that you can get it right Parachute assistance may be: • inappropriate • distort local systems • insufficient to build local capacity “Give a man a fish, you feed him for a day. Teach a man to fish, you feed him for a lifetime.”

43. Goal 4:Foster sustainable research environment in low- and middle-income countries Research hubs in low- and middle-income countries (Framework Program) Bolster the development of expertise and use of ICT in support of research and research training programs (ARRA) Alumni networks (CareerTrac)

44. CASE STUDY: UNIVERSIDAD PERUANA CAYETANO HEREDIA AIDS Clin Res Train Clin Res Train Environ Health Inf Disease AIDS Informatics Framework Small grants (FIRCA) Research? Ecol Inf Diseases Biodiversity GRIP Minority Postdocs U. Alab. Birm. (15 y) Med Students U. Washington (16 y) Johns Hopkins (21 y) NMRCD* (23 y) FIC Grants TrainingResearchU.S. FellowshipsGlue grants * NMRCD = US Naval Medical Research Center Detachment

45. AIDS Clin Res Train Clin Res Train Environ Health Inf Disease AIDS Informatics Framework Small grants (FIRCA) Research? Ecol Inf Diseases Biodiversity GRIP Minority Postdocs U. Alab. Birm. (15 y) Med Students U. Washington (16 y) Johns Hopkins (21 y) NMRCD* (23 y) CASE STUDY: UNIVERSIDAD PERUANA CAYETANO HEREDIA NIMHNIGMS NIH Grants NCINHLBI NIAID * NMRCD = US Naval Medical Research Center Detachment

46. Goal 5:Build strategic alliances and partnerships in global health research and training

47. New Partners for Global Health Universities, Medical Research Groups PrivateSector U.S. GovernmentAgencies WHOWorld BankUnicef Foundationse.g. Gates, Wellcome, etc FIC Scientific Societies e.g. FASEB NGOs NIAID, NICHD, NIMH, NIDCR, NCCAM

48. NIH (and other) Co-Funding of FIC Awards FY 2008 Goal 5: Foster partnerships

49. IOM Reports on Global Health 1997 2009

50. IOM Report Recommendations • Scale up existing interventions • Generate and share scientific knowledge • Invest in people, institutions and capacity building • Increase U.S. financial commitment to global health $15 Billion by 2012 ($2 Billion for research) • Engage in respectful partnerships