Research and Training Opportunities in Global Health

1. Research and Training Opportunities in Global Health Joel G. Breman, MD, DTPH Fogarty International Center U.S. National Institutes of Health The Academy of Sciences for the Developing World BioVisionAlexandria 2008 Conference Alexandria, Egypt April 11, 2008

2. Research Funding Perspectives • Demographic and disease trends • Thinking research needs • National Institutes of Health (NIH) • Fogarty International Center, NIH, programs

3. Research Funding Perspectives • Demographic and disease trends • Thinking research needs • National Institutes of Health (NIH) • Fogarty International Center, NIH, programs

4. Disease Control Priorities Project 2006 Publications www.dcp2.org Presented at BioVisionAlexandria, 2006

5. Disease Control Priorities Project (DCPP)Life Expectancy, 1550-2050 Source: Disease Control Priorities Project, 2006 (http://www.ncbi.nlm.nih.gov/books/bookres.fcgi/dcp2/ch1.pdf)

6. Leading causes of Disability-Adjusted Life Years in Low/Middle-income and High-Income Countries, by World Bank Region, 2001 Rank South Asia (GNI: $450) LE:63 Sub-Saharan Africa (GNI: $460) LE:46 East Asia and the Pacific (GNI: $900) LE:69 Europe and Central Asia (GNI: $1,970) LE:69 Middle East and North Africa (GNI: $2,200) LE:68 Latin America and the Caribbean (GNI: $3,580) LE:71 High–income countries (GNI: $26,500) LE:78 1 Perinatal conditions HIV/AIDS Cerebrovascular diseases Ischemic heart disease Ischemic heart disease Perinatal conditions Ischemic heart disease 2 Lower respiratory infections Malaria Perinatal conditions Cerebrovascular diseases Perinatal conditions Unipolar depressive disorders Cerebrovascular diseases 3 Ischemic heart disease Lower respiratory infections Chronic obstructive pulmonary disease Unipolar depressive disorders Traffic accidents Homicide and violence Unipolar depressive disorders 4 Diarrheal diseases Diarrheal diseases Ischemic heart disease Self-inflicted injuries Lower respiratory infections Ischemic heart disease Alzheimer's and other dementias 5 Unipolar depressive disorders Perinatal conditions Unipolar depressive disorders Chronic obstructive pulmonary disease Diarrheal diseases Cerebrovascular diseases Tracheal and lung cancer GNI = gross national income per capita (US$); LE = life expectancy at birth (average male and female). Sources: Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL, eds in Global Burden of Disease and Risk Factors, 2006 1 World Development Indicators, 2003

7. “The Bottom Billion”* • Over a billion people live on less than $1 a day • 980 million people live in “trapped countries,” 58 nations “clearly heading toward what might be described as a black hole.” • 70 percent of the bottom billion live in Africa; most of the rest in Central Asia • Average life expectancy in the bottom billion is 50 years • Around one in seven children dies before the age of 5 • Nearly three-quarters of the people in the bottom billion have recently been through, or are still in the midst of, a civil war * The Bottom Billion: Why the Poorest Countries Are Failing and What Can Be Done About It, by Paul Collier, Oxford University Press

8. Disease Control Priorities Project10 Best Buys for Health • Prevent neonatal mortality • Ensure healthier mothers and children • Promote good nutrition • Reduce cardiovascular disease deaths • Stop the AIDS pandemic

9. Disease Control Priorities Project10 Best Buys for Health (2) • Stop the spread of tuberculosis • Control malaria • Combat tobacco use • Reduce fatal and disabling injuries • Ensure equal access to high-quality care

10. Research Funding Perspectives • Demographic and disease trends • Thinking research needs • National Institutes of Health (NIH) • Fogarty International Center, NIH, programs

11. Research Needs: Disease Burden that Can or Cannot be Averted with Existing Interventions Disease Burden: Research Needs: Biomedical research to identify new and improved interventions 100% Not Avertable Increase effectiveness or reduce costs of existing interventions Avertable Already averted coverage Broader implementation of cost-effective interventions; identify obstacles to expansion of coverage

12. Research and Development Categories and Results for Implementation New basic understanding • Fundamental research • Epidemiology, risk factors, disease modeling New and improved tools • Drugs • Vaccines • Diagnostics • Devices • Vector control • Environmental modification • Behavioral, social, and economic change

13. Research and Development Categories and Results for Implementation New and improved intervention methods • Treatment algorithms and guidelines • Intervention packaging • Priority setting: costing and cost-effectiveness studies • Delivery: health systems and health services • New and improved policy instruments

14. NIH: Medical and Behavioral Research for the World “Science in pursuit of fundamental knowledge about the nature and behavior of living systems • Has research laboratories and recruits outstanding scientists • Institutes/Centers created in response to public health needs • Trainees join NIH and become leaders in US and world • 117 grantees or trainees are Nobel Laureates (as of 2005) and the application of that knowledge to extend healthy life and reduce the burdens of illness and disability.” ...

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

16. Clinical Research Clinical Research Translational Research Translational Research Basic Research Basic Research Private Sector – $59 B NIH – $29 B U.S. Balanced National Biomedical Research Portfolio, FY2008

17. People: Countries Sending the Most Visiting Scientists to NIH Fiscal Year Average Number of Scientists=3,800/yr

18. Why now? New Frontiers in Science Accelerating Discovery http://www.nlm.nih.gov/International Resource • Free full-text archive • 315 journals* • 985,000 items* • Voluntary submissions • May 2, 2005 • Genomics, proteomics, metabolomics… • Nanoscience • Molecular biology • Clinical trials networks • Imaging & biomarker advances • Information & communications technology “The speed of biomedical advance is accelerating –like Moore’s law “ Ray Kurzweil Visit NIH Databases at: http://www.ncbi.nlm.nih.gov/ *As of 2/13/07

19. PubMed Hits — June, 2006 Germany 8.1 M U.K. 14.0 M Hits/country 8.8 M 6,068 6.0 M Portugal 1.1 M 6.5 M 869,520 2.1 M 17,079 41,048 21,485 8,597 72,558 59,023 18,695 1.1 M Jordan 82,898 3,930 268,900 293 Million Hits in June, 2006 Saudi Arabia 246,935

20. MedlinePlus Page ViewsDecember 2005

21. Research and Research Training • ~$50 million in grant awards • 2/3 research training, 1/3 research • Awards range $10,000 – • $1 million • Low/middle income countries • Research capacity development http://www.fic.nih.gov/programs/index.htm

22. Extramural Training Grants • Institutional training grant to U.S. universities/research institutions in response to a specific request for applications (RFA) • Awardees are current NIH grant recipients withdemonstrated research collaboration with foreign research institutions • Purpose – support training for research-capacity building for scientists from developing nations http://www.fic.nih.gov/programs/index.htm

23. FIC Training Capacity Building: 14 Programs • AIDS International Training and Research Program (AITRP) • International Bioethics Education and Career Development Award • International Clinical, Operational and Health Services Research Training Award for HIV/AIDS and Tuberculosis (ICOHRTA AIDS/TB) • ICOHRTA Non-communicable Diseases • ICOHRTA Malaria • Global Infectious Diseases Research Training Program Award (including TB and Malaria) (GID) • International Training and Research in Population and Health • International Training and Research in Environmental and Occupational Health • Fogarty International Collaborative Trauma and Injury Research Training (ICTIRT) http://www.fic.nih.gov/programs/index.htm

24. FIC Training Capacity Building: 14 Programs • Informatics Training for Global Health • Framework Programs for Global Health • The NIH Pathway to Independence (PI) Award (K99/R00) • Fogarty International Clinical Research Scholars Resource and Support Center (FICRS) (formally known as the FIC/Ellison Program) • International Scientist Research Development Award (IRSDA) http://www.fic.nih.gov/programs/index.htm

25. Research Grants – 8 Programs • Fogarty International Research Collaboration Award (FIRCA) • International Cooperative Biodiversity Groups (ICBG) • Ecology of Infectious Diseases (EID) • International Studies on Health and Economic Development (ISHED) • Int’l Tobacco and Health Research and Capacity Building Program • Global Research Initiative Program for New Foreign Investigators (GRIP) • Stigma and Global Health Research Program • Brain Disorders in the Developing World: Research Across the Lifespan http://www.fic.nih.gov/programs/index.htm

26. Fogarty International Center Program Characteristics • Institutional partnerships • Advanced In-country research training opportunities • Empowerment/mutual respect • Networking • Flexibility • Leverage • Systematic approach • Long-term commitment • Response to local priorities • Long-term mentoring • Mutual reinforcement of investments in training and research Fogarty International Center Major Research and Training Sites • Address health needs of developing countries with research support • Build research capacity in developing countries- individual and institutional -through research training

27. AITRP AIDS International Training and Research Program • Builds institutional capacity • Develops senior leaders • Authored 25% of HIV/AIDS papers in conferences First and oldest research training program at FIC and the model for subsequent research training programs Johns Hopkins AITRP program: Nurse training session at Sassoon General Hospital , Pune, India. Jeanne McDermott, Program Officer, FIC mcdermoj@mail.nih.gov

28. International Cooperative Biodiversity Groups Scientific and Economic Development Drug Discovery Bioinventory and Biodiversity Conservation

29. ICBG Accomplishments:Science • 275+ novel bioactive compounds discovered • 20 compounds for malaria, leishmaniasis, trypanosomiasis, tuberculosis, HIV, bacteria, cancer • Found new species of plants, fungi and insects • Publications in chemistry, biodiversity and policy Kazakhstan Tajikistan Uzbekistan Papua New Guinea Fiji Madagascar Vietnam and Laos Panama Costa Rica Kyrgyzstan Flora Katz, Program Officer, FIC katzf@mail.nih.gov Josh Rosenthal, Program Officer, FIC rosenthj@mail.nih.gov

30. ICBG Accomplishments:Conservation • Initiate/strengthen 12 biodiversity reserves • New/enhanced databases on biodiversity distribution • Leveraged investments from 50 companies, foundations, universities and governments • New models of intellectual property rights and benefit-sharing

31. Ecology of Infectious Diseases Global Infectious Disease Research Training Program Research Program • Past 30 years, changes in biodiversity coincided with the emergence and re-emergence of infectious diseases worldwide • 8 projects, in 7th year. • Research training (laboratory, clinical, epidemiological or social science). • Relevant to developing countries. • 35 programs in 25 countries Josh Rosenthal, Program Officer, FIC rosenthj@ficod.fic.nih.gov Barbara Sina, Program Officer, FIC sinab@mail.nih.gov

32. Fogarty International Center Goals • Train the next generation of medical researchers, both US and foreign, in global health • Build/strengthen centers of research excellence abroad through collaborations and partnerships • Strengthen relations through health diplomacy • Reduce health disparities and inequalities • Increase America’s involvement in global health • Provide scientific leadership in global health

33. Linking within a grant: Fogarty Collaborative Small Grants (FIRCAs) Science for Peace 2 FIRCAs: The Genetics of Hearing Loss Mary-Claire King- University of Washington -Seattle Moien Kanaan – Bethlehem Univ., Palestine Karen Avraham- Tel Aviv Univ., Israel

34. General Tips on Grantsmanship • Read the solicitation very carefully • Call program officer to clarify eligibility, etc. • Get copies of successful relevant grants from colleagues to model • Write for the peer reviewers, not for yourself The greatest risk in science is to stop taking risks! E. Zerhouni, 2007 Director, NIH http://artfiles.art.com/images/-/Null/Cliff-Jump-Note-Card-C11763337.jpeg

35. Advocates for Global Health

36. Fogarty Ellison Scholars, 2006 24 “pairs” of trainees going to 16 medical centers in the developing world

37. Global Burden of Disease (DALYS)

38. Pharmaceutical Research: Priority Areas, WHO (2004) *trypanasomiasis, Buruli ulcer, leishmaniasis, Chagas disease

39. Epidemiological, Demographic, and Political Transitions • Shift from acute to chronic diseases • Aging populations • Health disparities • Emerging and re-emerging diseases • Behavioral and psychological diseases • Biodefense

40. Mal Alimentation(“bad food”) associated with Economic Development, Longevity, Sedentary Society Source: http://en.wikipedia.org/wiki/BK_Stacker Photo credit: Mychal Stanley

41. GLOBAL EXAMPLES OF EMERGING AND RE-EMERGING INFECTIOUS DISEASES (A.S. FAUCI)

42. GLOBAL EXAMPLES OF ENDURING ENVIRONMENTAL DISASTERS

43. GLOBAL EXAMPLES OF PEDIATRIC AND ADULT CANCERS

44. GLOBAL EXAMPLES OF GENETIC DISEASES AND DISORDERS

45. National Institutes of Health Main CampusBethesda, Maryland, U.S.A. jbreman@nih.gov