November 2001

IC International Representatives Meeting

November 20, 2001  

                                                      Summary

In Attendance:  Dr. Lois Cohen, NIDCR; Ms. Linda Cook, NINR; Ms. Isabel Ellis, NIAAA; Dr. Ruth Hegyeli, NHLBI; Mr. Gray Handley, NICHD; Dr. Mary Frances Picciano, ODS; Dr. Juan Ramos, NIMH; Ms. Linda Reck, OAR; Dr. Jerry Robinson, NCRR; Ms. Julia Royall, NLM, Dr. Christopher Schonwalder, NIEHS; Ms. Patricia Turner, NINDS; Dr. Karl Western, NIAID.

Also participating: Ms. Eva Sereghy, NICHD; Dr. David Lozovsky and Ms. Donna Mayo, NIMH; Ms. Susan Wise, OAR; Dr. Agnes Rupp, NIMH; Dr. Anthony Dempsey, OD/OER; and FIC staff: Dr. Gerald Keusch, Dr. Sharon Hrynkow, Dr. Ken Bridbord, Mr. Eric Dakake, Mr. George Herrfurth, Dr. Karen Hofman, Dr. Allen Holt,

Mr. Aranthan Jones, Dr. Flora Katz, Ms. Judy Levin, Dr. Kathleen Michels, Dr. Aron Primack, Ms. Minnie Rojo, Dr. Luis Salicrup, Ms. Natalie Tomitch and Ms. Chris Keenan.

Dr. Hrynkow welcomed Dr. Judith Bale and Dr. Stacey Nobler, Institute of Medicine; Ms. Betsy Brown, USAID; and Dr. Jimmy Volmink, Global Health Council; and introduced the guest speakers, Dr. Richard Johnson, Johns Hopkins University, and co-chair of the IOM Committee on Nervous System Disorders in Developing Countries, and Dr. Dale Lawrence, Chief Medical Officer, Vaccine Clinical Research Branch, DAIDS, NIAID.

Dr. Johnson made a presentation on the IOM study of brain disorders in the developing world.  In his introduction, he noted the gross disparity in health between affluent and poor countries and the close relationship of socioeconomic development and health.  He noted that with the recent success related to maternal and fetal health and mortality, as well as attention on nutritional and environmental factors, there has been a decrease in some communicable diseases, while there is a concomitant increase in the burden of chronic diseases, including cardiovascular disease, diabetes, cancer and brain disorders.  Approximately 250 million people in developing countries are disabled with neurological psychiatric disorders.  The goal of the IOM study was to define the increased burden caused by neurological, psychiatric, and developmental brain disorders and to identify the areas for research, development, and capacity strengthening that would significantly reduce the burden of these disorders.  Dr. Johnson recognized FIC, NICHD, NIMH and NINDS, CDC, and the Global Forum for funding the study and noted that the Study Committee on Health Research had strong representation from Latin America, India and Africa.  The study focused on diseases that are common, potentially soluble, relatively easy and inexpensive to treat, and associated with stigma and discrimination: developmental disorders, schizophrenia, epilepsy, depression, and stroke.  

Dr. Johnson concluded his presentation with the observation that the report was put together to target organizations in developing countries and their national health and finance ministries, the national agencies for international development, multi-lateral development banks, research and medical universities, non-government organizations, foundations and professional societies, advocacy groups, pharmacological and technical industries, and patient groups.

During the discussion period, Dr. Johnson noted that only anecdotal evidence exists on cost of prevention and treatment of specific illnesses.  He added that reporting from several countries over a period of time is needed to develop scientific data.  In addition, Dr. Johnson noted that a concerted global effort will be needed, to include private organizations and foundations, federal agencies, WHO, and others, in order to create sustainable research and care capacities in the developing world.

Dr. Keusch remarked that we are in a new century and new era in thinking about the kinds of problems addressed in the report -- moving away from a single disease and a single solution to an understanding of the interrelatedness of global health problems in general.  This perspective is reflected in the programs across the whole of the NIH.  He noted that in weighing the economic cost of treating versus waiting for the impact to be seen, we have to also look at the significant loss of economic productivity, an added and major burden for developing countries.  If the impact of brain disorders on economies as well as families and individuals were better understood, it would be expected that a country’s resources would be better allocated to address them.  He referred to the recent international conference on stigma, held September 5-7 in Bethesda (see www.nih.gov/fic/news for a summary), and noted that FIC and its NIH partners are developing research programs to look at the dynamics of stigma and where the research intervention points are that would mitigate its impact.  He also mentioned the new FIC and partner ICs-sponsored program in clinical, operational, and health services research training related to mental health; this program will add to the knowledge base and pave the way for improved care in the developing world.

Dr. Dale Lawrence made a presentation on the impact of the September 11 event on the shipment of biological specimens.  He noted at the start that, as we become more increasingly a global economy and global research community, the exchange of specimens from one part of the world to the other is expected to occur seamlessly.  NIAID’s collective networks are scattered as far as China to the tip of Africa to the tip of South America to Europe.

Dr. Lawrence recalled that in 1995, the International Transport Association introduced more stringent safety regulations in response to several incidents and particularly with the publicity given Ebola and some other viruses.  The concern was to assure the utmost security during transport by air, ground and sea.  This led to regulations that containers bearing microbes, whether they be common varieties shipped every day to grocery stores or highly contagious and fatal pathogens, would resist damage under the most extreme conditions.  In case of leakage, the handlers were required to have immediate access to information, through paperwork separate from the container, on whom to contact at any time of the day or night and instructions for how to respond.  In addition to being able to take extreme punishment, the containers also needed to sustain the proper environment the specimen required.  Faced with the challenge to move large quantities of lab materials, Dr. Lawrence and colleagues at NIH, in cooperation with the CDC and the U.S. Army Logistics Support Activity, developed a new container that fulfilled the prescribed criteria.  He described the complexity of designing a container for transporting specimens packed in dry ice or liquid nitrogen to ensure safety and for compliance with airline regulations. 

Dr. Lawrence briefly described his office’s continued efforts to facilitate the importation process of specimens.  It requires involvement on several levels: providing formal training to personnel at field sites; working with field sites and companies to assure requirements for correct packaging and forms are met; familiarizing airlines with the various methods of packaging to establish a relationship of trust; working with airline cargo offices to facilitate release of shipments that are being questioned; alerting U.S. Public Health Service Quarantine Stations, at ports of entry into the USA, of all incoming shipments so they can notify U.S. Customs, USDA, and FDA for clearances. 

He remarked that the process of shipping specimens abroad requires different considerations.  The export of items with commercial, hazardous or potentially bioterrorist implications requires permission from the Department of Commerce and other agencies.  Also, the shipping of specimens that appear on a government list of highly hazardous agents require specific permits from CDC and is restricted to shipment from a lab that is duly certified to a lab with the same certification. 

Dr. Lawrence remarked that the September 11 event has not affected importation of the NIAID Division of AIDS clinical samples to a great extent, with exception of a few minor incidents.

Responding to a comment regarding the refusal of most airlines to ship live monkeys, Dr. Lawrence noted that even though his experience has not been primarily in the area of live animal shipments, in the past he has been able to resolve many complicated issues with airport and airline personnel by establishing relationships of trust with many of the cargo chiefs and through reassurances to the airlines that all concerns will be addressed.  Contact, through the USPHS Quarantine Stations to the Customs offices, describing shipments in advance has been helpful in facilitating the clearance process. 

Dr. Lawrence mentioned that when the redesign of a particular model of a large dry ice unit is completed in a few weeks, he will ask FIC to inform the ICs; the purchase price will be much lower if NIH, CDC, and the U.S. Army are able to estimate their collective needs and place pre-production orders.

Dr. Hrynkow made a few announcements.  First, she reminded ICs to pay close attention to the deadlines for submitting their Notifications of International Travel (NIT) for their travelers, noting that embassies and certain missions, such as the U.S. Mission in Geneva, are scrutinizing requests closely and, if insufficient notification is given, are denying travelers country clearance.  FIC turns the NIT around as soon as possible and informs the Department of the travel.  She also announced that Mr. Gray Handley, NICHD, has been selected to serve as the first DHHS health attaché to South Africa.  This is the fourth of the overseas offices that coordinate the work of the Department and the Public Health Service.  The office will be located at the Embassy in Pretoria and Mr. Handley will be responsible for the countries in the region of southern Africa.  Mr. Handley noted that he is looking forward to working with all of NIH, CDC, FDA and other agencies in the Department.  He expects to depart for Pretoria in February.

Updated May 2003