May 2002

 IC International Representatives Meeting

May 15, 2002 

                                                   Summary

Introductions of new members:  Dr. Zakir Bengali, new representative for CSR.

Guests:  Dr. Jean-Louis Belard, Senior Scientist, USAMRC, Fort Detrick, MD; Ms. Ana Maria Puente, HRSA; Ms. Merri Weinger, Bureau for Global Health, USAID.

Dr. Hrynkow introduced the guest speaker, Dr. Dean Jamison, who joined FIC in February for a 2-year assignment to head the new Disease Control and Priorities Project (DCPP) and to participate in other FIC/NIH initiatives.  An economist by training, he developed the World Bank 1993 World Development Report.  He is a professor at UCLA, where he directs the program on global health. 

Dr. Jamison opened his presentation on the DCPP with some historical background.  Data collected over the past 40 years has shown the important impact education has on the rate of national economic growth (and on individual incomes) and the subsequent impact on the health status of the population (fertility reduction, mortality reduction, etc.).  During the period of 1975-1985, education became a central item on the agenda of macroeconomic policy in many developing countries.  In the following years, however, the dominant view was that better economic conditions led to better health, and therefore, that poverty was the main source of ill health in the world.  Although current macroeconomic policy for developing countries views poverty reduction as a major tool to improving population health rates, thinking is increasingly shifting to focus on causality in the other direction: investing in health not only generates direct benefits but it is also instrumental in increasing the rates of economic growth and poverty reduction. 

The 1993 World Development Report deals with a broad range of issues related to health finance, organization and management of health systems, and considers how modest healthcare interventions could make a large impact on the burden of disease.  The important information that underpinned the review of cost-effectiveness in the World Development Report was the Disease Control Priorities Project.  Organized by disease, it was intended to bring together an economist, a physician, a scientist, a public health epidemiologist to work on a chapter on specific diseases, like cardiovascular disease and polio, in order to develop estimates of burden as well as a sense of the cost-effectiveness of the major available interventions.  One conclusion of the report was that personal clinical services interventions were on average often as cost-effective as those categorized as public health interventions.  In addition, for the major diseases of poverty, approximately 2/3 of the intervention expenditures required to efficiently deal with these diseases would be spent on clinical services.  Further, there was no suggestion in the comparative cost-effectiveness that primary prevention was on average more cost- effective than cure or secondary prevention, however, there was a strong suggestion that most of the clinical services that seemed to be cost-effective where those provided at the 200-300 bed district-level hospital and not at an academic medical center or tertiary-type hospital.  On the economic side, the cost of achieving an additional year of healthy life through many available clinical and public health interventions seemed to be relatively small compared to any reasonable estimate of the economic benefits. 

The second phase of the DCPP, now beginning, aims to update the previous findings, including the assessment of comparative cost-effectiveness across major conditions.  Particular attention will be paid to interventions like integrated management of childhood illness. 

The unprecedented improvements in human health over the last 50 years are due mostly to the generation and utilization of new knowledge, through new vaccines, diagnostic tools, or surgical procedures.  The assumption is that new knowledge will continue to be important, and that increased emphasis should be placed on how to better disseminate and take advantage of existing and new technologies.  In the next round of the DCPP, it will be important to think about research and product development much more explicitly among the range of investment options, particularly for the international community, but also for major national governments.  Locating this effort at the Fogarty Center and at NIH reflects an important measure; the hope that this effort will be able to take advantage of the available scientific capacity, both here and abroad.

Dr. Jamison noted that the 2-3 year effort will develop chapters on multiple conditions, risk factors and interventions in consultation with scientists, policy makers, clinicians and public health officials from developing countries, and national and international agencies and foundations.  ICs will be invited to co-author and review chapters of interest to them.  The first consultations on specific disease areas have already been held, one in Annapolis on the topic of child health and nutrition and one in Lausanne (chaired by Dr. Lenfant) on cardiovascular diseases.  Dr. Jamison concluded his presentation with the announcement that he and his colleagues will contact the IC directors and international reps in the near future to identify areas of common interest and to identify contact points for specific chapters.  A near final annotated table of contents will be distributed to the international representatives in early July.

The presentation was followed by a question and answer period. 

In response to a question on the audience for the report, Dr. Jamison explained that the primary intent of the first report was to help decision makers at central levels in bureaucracies identify ways of moving resources into interventions that had high health gain per dollar spent and away from low gain interventions; the updated report will seek to reach the leadership of the control community around a particular disease, i.e., the immunization area, tuberculosis, or malaria.  It is also expected to reach the national development policy community as a means to demonstrate the high potential returns to investments in health for development and for poverty reduction. 

One of the questions raised was about an independent assessment of the cost- effectiveness methods recommended in the conclusions of the first report.  Dr. Jamison affirmed that there were critical commentaries on the methods used in the first report, but there were no real objective assessments on utility.  He noted, however, that project packages implemented in Indonesia and Tanzania provided some feedback on the effectiveness of their recommendations.  In his response to the question about methods of economic analysis, he indicated that consideration will be given to the World Bank’s concern that DCPP focused only on health outcomes; this time economic outcomes more broadly will also be assessed. 

Announcements:

Dr. Hrynkow gave a brief overview of the activities planned around the 35^th Anniversary of FIC in May 2003. 

Ms. Rojo thanked the ICs reps for their response to a request from the Secretary’s office concerning the posting of HHS staff overseas.  In a NIH-wide survey, ICs have been asked to report staff that is currently assigned overseas and to propose future staffing needs for consideration by HHS.  Questions were raised regarding the inclusion of hired foreign nationals, as well as contractors.  Dr. Moore, OGHA, agreed to provide additional details on the request.

Dr. Hegyeli announced that NHLBI, in collaboration with ORWH and the Lorenzini Foundation in Italy, will publish a comprehensive report on women’s health and menopause that will cover, among other issues, cardiovascular disease, osteoporosis, Alzheimer’s disease, and the controversial HRT.  The report should be available in the next few months. 

Dr. Hrynkow concluded the meeting with an invitation to the July 9 meeting when OER will lead the discussions on IPR issues as related to foreign grants. 

Attendance:

Dr. Sharon Hrynkow, Chairperson of the IC International Representatives Committee and FIC Deputy Director; Dr. Gerald Keusch, FIC Director; Ms. Minnie Rojo, Director, Division of International Relations, FIC; Ms. Chris Keenan, Executive Secretary, FIC; Ms. Peggy Murray, NIAAA; Ms. Eva Sereghy, NICHD; Mr. John Whitaker, NEI;

Dr. John Norvell, NIGMS; Dr. Ruth Hegyely and Ms. Helen Wegman, NHLBI;

Ms. Patricia Turner, NINDS; Ms. Linda Cook, NINR; Ms. Julia Royal, NLM; Dr. Juan Ramos, NIMH; Mr. Baldwin Wong, NIDCD; Dr. Karl Western NIAID; Dr. Federico Welsch, NCI; Dr. Lois Cohen, NIDCR; Ms. Sharon Pope, NIDDK; Dr. Heather Miller, OER; and Dr. Paul Gaist, OAR; Dr. Melinda Moore, OGHA; Mr. Glen Drew and Ms.Tina Johnson, OHRP; Ms. Mollie Sourwine, NIBIB; Dr. Donna Mayo and Dr. David Lozovsky, NIMH; Ms. Dale Weiss, NIDA; and FIC staff Ms. Nalini Anand, Mr. Kevin Bialy, Dr. Ken Bridbord, Mr. Bruce Butrum, Ms. Jennifer Cabe, Dr. Pierce Gardner,

Mr. George Herrfurth, Dr. Allen Holt, Dr. Linda Kupfer, Mr. Michael McDowell, Mr. Mark Pineda, Dr. Aron Primack, Dr. Luis Salicrup, Ms. Jill Salmon, Dr. Barbara Sina, and Ms. Natalie Tomitch.