Fogarty International Center Science for Global Health

1. Research Capacity Building Programs of the Fogarty International Center, NIHInternational Affairs CommitteeInfectious Diseases Society of AmericaSan Juan, Puerto RicoJune 21, 2002 Joel G. Breman, M.D., D.T.P.H.Senior Scientific AdvisorFogarty International Center

2. Fogarty International CenterScience for Global Health MissionTo promote and support research and research training internationally to reduce disparities in global health

3. Fiscal Year 2000 Training = $103 million (34%) Research = $203 million (66%) NIH International Research Expenditures Fiscal Years 1994 to 2000 Dollars

4. Tropical Medicine Total Malaria TB Diarrheal Diseases Dengue Chagas Disease Pathogen sequencing (FY 01-02) Multilateral Initiative on Malaria Overall $195,548,00 57,833,000 56,039,000 54,578,000 7,060,000 10,119,000 60,000,000 900,000 $255,400,000 NIH Overall Expenditures on Tropical Infectious Diseases

5. Fogarty International CenterFunding for Infectious Diseases & Other Programs Fiscal Year 2000: $35 million Other Programs:FIRCABiodiversityInformaticsEnviron & OccMCHCareer DevBioethicsOthers AIDS: 38% 44% Emerging Inf Dis: 5% Bioterrorism: 1% Ecology Inf Dis: 4% Malaria: 2% ABC/ICIDR: 3% TB: 3%

6. Fogarty International CenterPrograms and Collaborating Partners Fiscal Year 2000 Funding NIA FIC CDC FIC CDC FIC NCCAM FIC Population and Health $1.8 million Environmental and Occupational Health $2.0 million Emerging Infectious Diseases $2.7 million Research Bioethics $1.4 million NIEHS NIDCR NIAID NIAMS NHLBI NICHD NCMHD NCI NIAID NIAID NCI FIC NIAID FIC NIAAA FIC NIDCR Biodiversity $3.9 million Ecology of Infectious Diseases $1.5 million AIDS InternationalTraining and Research $15.1 million NIDA NIDA NSF OAR NICHD NCMHD NINR NHLBI USDA NIEHS NSF NHLBI NIMH NIMH HRSA FIC NICHD FIC USAID FIC NCMHD NLM FIC Maternal and Child Health $1.3 million Tuberculosis $1.5 million Medical Informatics $1.4 million MIRT $5.5 million NIAID NIAID

7. Fogarty International CenterScience for Global Health Major Training and Research Sites

8. Fogarty International CenterScience for Global Health Research Training Mechanisms • Long-term training* pre- and post-doctoral training in U.S. institutions (duration: minimum 9 months) • Short-term training* focused workshops and technology transfer (duration: several days to several weeks) • Research performed preferentially in-country

9. Fogarty International CenterScience for Global Health Program Objectives • Train leaders in science and public health • Establish centers of excellence in home countries • Promote long-term collaborations between U.S. and foreign institutions • Facilitate outstanding scientific research focused on problems of developing countries • Facilitate trainees assuming positions of responsibility, authority, and influence

10. Fogarty International CenterScience for Global Health AITRP Accomplishments, Fiscal Years 1988-1998 FY88-93 FY94-98 Total • Long-term trainingepidemiology and post-doctoral traineescountries • In-country activities • courses • trainees • countries 654 59 264 16,624 30 1,02784 451 29,804 inc 1,681 98 715 46,428 65

11. Fogarty International CenterScience for Global Health AITRP-Supported Achievements (examples) • China: Identified plasma donors at risk for HIV • Kenya: Uncircumcised males at risk for HIV 1 and genital ulcers • Uganda: Nevirapine injection to HIV-positive pregnant woman and neonates associated with 48% decrease in perinatal transmission • Uganda and Haiti: Prophylaxis with INH and rifampin reduced TB and AIDS in HIV-positive persons

12. Fogarty International CenterScience for Global Health AITRP-Supported Achievements (examples) 2 • Vietnam: Subtype E (not Thai B) identified as main subtype among injection drug users and commercial sex workers • Georgia: Develop National AIDS Prevention Program and National Blood Safety Program

13. International Clinical, Operational, and Health Services Research Training Award for AIDS/Tuberculosis (ICOHRTA - AIDS/TB)

14. and ICOHRTA - AIDS/TB Emphasizes integration of therapy and care with prevention efforts Builds capacity to support the integration of clinical, operational, and health services research

15. ICOHRTA - AIDS/TB Fosters Major NIH International AIDS Research Efforts: • Prevention Trials Network • Vaccine Trials Network • Comprehensive International Program of Research on AIDS (CIPRA) • Popular Opinion Leaders • International Centers for Excellence in Research • Partnerships for HIV/AIDS Research in Africa

16. ICOHRTA - AIDS/TB Fosters Major USG and Other International AIDS Research Efforts: • Elizabeth Glaser Pediatric AIDS Foundation • Academic Alliance for AIDS Care and Prevention in Africa • Global AIDS, TB, and Malaria Fund • UNICEF, UNAIDS, and WHO AIDS and TB Programs • CDC Global AIDS Program • USAID Rapid Response (LIFE) Initiative • Bill & Melinda Gates Foundation • amFAR

17. Hungary Lithuania Russia Latvia Armenia Kazakhstan Czech Republic Poland Georgia China Haiti Ethiopia Mali Pakistan Mexico Belize India Philippines Guatemala Kenya Nicaragua Ghana Ecuador New Guinea Venezuela Indonesia Peru Malawi Brazil Bolivia Paraguay Chile Fogarty International CenterCountries in Emerging Infectious Diseases Program, 2001

18. ITREID Collaborations • U.S. principal investigators: 13 • Countries: 36 • Americas: 12 • Eastern Europe: 10 • Asia: 8 • Africa: 6

19. ITREID Accomplishments *2001, partial data: new countries are Bangladesh, Estonia, Rwanda, and Sri Lanka

20. ITREID Accomplishmentscontinued Scientific Output and Awards, FY 2000 • Science progress • Presentations, 104 • Publications, 109 (submitted, accepted, published) • Awards • FIRCA award received by trainee from Czech Republic to work on C. parvum (NY State Dept of Health) • Best poster European Society of Virology, molecular epidemiology of hepatitis C in Czechoslovakia (UC Berkeley)

21. ITREID Pathogen Foci Bacterial Diseases • Bartonella bacilliformis • Corynebacterium diphtheriae • Leptospira • Mycobacterium tuberculosis, M. avium • Streptococcus pneumoniae • STDs (chlamydia, gonococci)

22. ITREID Pathogen Foci Parasitic Diseases • Entamoeba histolytica • Leishmania • Plasmodium falciparum, P. vivax • Schistosoma hematobium • Trypanasomes

23. ITREID Pathogen Foci Viral and Rickettsial Diseases • Dengue • “Diarrhea” and El Niño • Human papilloma virus • Rickettsia prowazakii and R. felis

24. Fogarty International CenterScience for Global Health Principles for Capacity Building and Sustainability • Long-term commitment * National * Institutional * Trainee • Re-entry grants for trainees • Diversified program themes • Mentoring and networking • Dual appointments for faculty

25. Global Health Research Initiative Program (GRIP) Purpose: Combat “brain drain” – re-entry grants Support the best science and the best scientists to work on global health challenges Eligibility: Young scientists from resource-poor nations completing NIH-supported training in U.S. after returning home (NIH, academic centers, D43 programs) Support Level: $50,000/year for up to 5 years for salary and research costs

26. Future and Focus of FIC Research Training Programs • In-country research, re-entry awards • Organization of scientific workshops by trainees • Promotion and tracking of trainees’ careers • Special attention to: • Bioethics • Good clinical practice involving human subjects

27. Fogarty International CenterScience for Global Health Principles for Capacity Building and Sustainability • Long-term commitment * National * Institutional * Trainee • Re-entry grants for trainees • Diversified program themes • Mentoring and networking • Dual appointments for faculty

28. Fogarty International CenterScience for Global Health Principles for Capacity Building and Sustainability (2) • South-to-South collaboration • Sustained linkages • Contribution of resources from all partners • Leverage resources for added support • Connectivity via modern IT systems • Centers of excellence in home countries • Mutual benefits known to all

29. FIC Website: http://www.nih.gov/fic