Building Sustainable Global Health Science Partnerships

1. Building Sustainable Global Health Science Partnerships May 8, 2009 Michael P. Johnson, M.D., M.P.H Deputy Director Fogarty International Center

2. Canadian Researcher and Genetic Carrier

3. Prevalent Canadian Genetic Condition

4. IOM Reports on Global Health 1997 2008

5. Global Health Leadership and Commitment

7. Rise in HIV/AIDS Funding - USG

8. U.S. Public Opinion About Global Health (GH) National Global Health Survey, Research America, Nov 2008

9. U.S. Public Opinion About Global Health (GH) National Global Health Survey, Research America, Nov 2008

10. 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.

11. Sunday, February 10, 2008 Global Classrooms U.S. Universities Rush to Set Up Outposts Abroad Carnegie Mellon University campus in Doha, Qatar

12. CSIS COMMISSIONON SMART POWERA smarter, more secure America CSIS CENTER FOR STRATEGIC & INTERNATIONAL STUDIES CoChairs: Richard L. Armitage Joseph S. Nye, Jr.

13. Disparity in health workers, scientists, and health worker training institutions Consistent correlation between density of health workers and probability of survival Africa has 24% of disease burden, 3% of health workers, 1% of health expenditure Academic model should integrate clinical care, teaching, research, public health, management

14. Researchers/Scientists Worldwide Researchers per million inhabitants, 2005 or latest available year UNESCO Institute for Statistics, 2007

15. Technical Assistance/Consultants Glad I am here so that you can get it right Technical assistance may: • overpriced • inappropriate • distort local systems • diminish local capacity

16. Healthcare workforce pyramid Academic health professionals Doctors Others Nurses Community health workers The “tip of the pyramid” are the fewest in number, yet play key role in training at other levels of the pyramid

17. Synergy of research, training, service delivery Service Delivery Research Training

18. 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 Intl 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

19. NIH Global Investment and Regional Distribution NIH International Report, 2008

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

21. Degrees awarded by Fogarty-funded training programs

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

23. 6 PhD degrees (2 still in training) 30 Masters degrees JHU (18), Alabama (3), Makerere (5) Regional (4) 15 Bachelors degrees, Makerere 65 Diplomas, Certificate 13 Post doc / Sabbatical Rakai Health Science Program Fogarty Trainees

24. Productivity of Long-Term Partnerships

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

26. Fogarty 40th Anniversary DinnerOctober 15, 2008 Foundation for NIH • Awards to Congressman Payne and Senator Lugar • Participation of many sponsors • Many eminent and experienced speakers • Hosted by Italian Embassy in Washington, D.C.

27. Funding (NIH/Other) FIC Human and Institutional Capacity building Collaborative Long Term Relationships

28. Characteristics of Success Research, service delivery and training are synergistic Locally-controlled training that builds upon existing research/program support Early investments in U.S. and foreign scientists yields “compound interest” High rate of return to home country following U.S. training when there is local institutional capacity (colleagues, career) “Second-generation” training occurs, i.e. foreign scientists return home contribute to the training of the next cohort U.S.-supported global health training produces lasting collaborations, brings foreign scientists into global community

29. Health Professional Training Institutions By Region Source: Mercer H, Dal Poz MR. Global health professional training capacity (background paper for The world health report 2006; http://www.who.int/hrh/documents/en/)

30. Capacity in Research Management FIC Grants Management Specialist Elizabeth Cleveland, Program Officer Jeanne McDermott, and Executive Officer Tim Tosten at a network meeting of East African research administrators in Tanzania Charles Miuri of Duke, who works with FIC’ International AIDS Training and Research Program in Tanzania, speaking at FIC • Advance contributions of research administration to the research enterprise • Improve communication between individuals and institutions to enhance collaboration and dissemination of best practice • Increase the number of research administrators and establish Offices of Research Administration • Provide a model to other regions in Africa and elsewhere

31. 80 70 60 50 40 30 1990 1960 About 1930 Life Expectancy (Years) About 1900 0 5,000 10,000 15,000 20,000 25,000 Income Per Capita (1991 International Dollars) World Development Report 1993 p. 34. Changes in Life Expectancy

32. Life expectancy – China, 1960-2000 • Life expectancy in China rose from 39 years in 1960 to 71 years in 2000 • ~ 8 years per decade for 4 decades • The most rapid prolongation of life in history • The consequences on health are enormous

33. Tropical Medicine  Geographic Medicine  International Health  Global Health Infectious diseases - AIDS, TB, malaria, diarrhea, respiratory infections, other childhood infections and maternal health - the unfinished agenda Newly emerging global epidemics of chronic disease due to prolongation of life expectancy - heart disease, stroke, cancer, mental illness, Coming agenda, largely man-made; environmental hazards, obesity, traffic accidents, climate change, addictions, smoking

34. Discoveries Resulting from Collaborative International Health Research • Oral rehydration therapy • Directly-Observed Tuberculosis Treatment • HIV prevention – PMTCT, circumcision • Artemisinin Combination Therapy • Huntington’s gene discovery • Viral antecedents of CA - Burkitts lymphoma • Chemotherapy for Cancer • Polypill for CVD

35. Identification of Huntington’s Disease Gene World's largest family with Huntington's disease, 18,000 individuals Helped map other disease genes for Alzheimer's disease, kidney cancer, two kinds of neurofibromatosis, Amyotrophic Lateral Sclerosis (ALS), dwarfism

36. Aggressive breast cancer in African Americans? Poor access to health care, environment, or genetic profile? Breast tumors without receptors for estrogen, progesterone, and HER2, “Triple Negatives”, are more aggressive African women >70% African-American 39% Causcasians 16% Olufunmilayo Olopade (UIC) Science , 314:592-4, 2007

37. 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

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

39. Trends in HIV Prevention Investments and Related Publications Total Investment (2002-2007) - $130 Million * - Publications on male circumcision and herpes suppression Source: HIV Resource Tracking, 2008

40. Interventions to Prevent HIV Infection Estimated Worldwide Access 8% IDU harm reduction 9% Condom access 9% MSM behavior change 10-12% HIV testing for adults 11% Prevention of mother-to-child transmission < 20% CSW behavior change PEPFAR HIV Prevention Technical Working Group, 2008

41. Partnerships to Enhance Capacity Pfizer Global Health Fellows • Work with NGOs • Provide technical training/support • Receive direct experience of work in global health setting • Multiple partners; USAID, PAHO, IAVI, Earth Institute, AMREF

42. Fogarty International Center – 2008 - 2012 • Train next generation of U.S. & foreign global health researchers • Build institutional capacity for health science research • Continue infectious disease, yet expand chronic diseases portfolio • Support implementation science – “know-do gap”, scale-up • Foster institutional partnerships

43. Fogarty Intl Center Percent of NIH Budget

44. NIH (and other) Co-Funding of FIC Awards FY 2007 Source: IMPACII

45. IOM Report on Global Health Preliminary Report Policy and Governance • Pillar of US foreign policy • WH interagency committee • High-level WH post Financial Commitment • Double funding • Balance funding • Respond to NCD challenges Enhance Investment • Support country plans, systems • Rigorous evaluation • Research and research capacity • Support WHO

46. 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.”