About
FIC | Advisory
Board
Meeting
Minutes
DEPARTMENT
OF HEALTH AND HUMAN SERVICES
Public Health Service
National Institutes of Health
John E. Fogarty International Center
for Advanced Study in the Health Sciences
Minutes
of the Advisory Board
Fifty-fifth Meeting |
September
16, 2003 |
|
The John E. Fogarty International Center for
Advanced Study in the Health Sciences (FIC) convened the
fifty-fifth meeting of its Advisory Board on Tuesday,
September 16, 2003, at 8:45 a.m., in Room E1-E2 of Natcher
Conference Center, National Institutes of Health (NIH),
Bethesda, Maryland. The
meeting was open to the public from 8:45 a.m. to 12:05 p.m.,
followed by the closed session, from 1:00 p.m. to adjournment
at 3:00 p.m., as provided in Sections 552b(c) (4) and 552b(c)
(6), Title 5, U.S. Code, and Section 10 (d) of Public Law
92-463, for the review, discussion, and evaluation of grant
applications and related information.
Dr. Gerald T. Keusch, Director, FIC, presided as chair.
Board Members Present:
Dr. Yvonne T. Maddox (ex
officio)
Mr. Dikembe Mutombo (appointment pending)
Dr. Sharon L. Ramey
Dr. Robert R. Redfield
Dr. Robert E. Shope
Dr. Burton H. Singer
Dr. Stephen E. Straus (ex
officio)
Dr. Catherine M. Wilfert
Board Members Absent:
Dr.
Theodore Reich
Members absent themselves
from the meeting when the Board discusses applications
from their own institutions or when a conflict of interest
might occur. The
procedure applies only to individual applications
discussed, not to en bloc actions.
Members of the Public Present:
Dr.
Chris Beyrer, Johns Hopkins University (JHU), Baltimore, MD
Dr. Liza Dawson, JHU, Baltimore, MD
Dr. Wafaie Fawzi, School of Public Health, Harvard University,
Cambridge, MA
Dr. Nirbhay Kumar, JHU, Baltimore, MD
Dr. Chris Plowe, University of Maryland, College Park, MD
Dr. Lee Riley, School of Public Health, University of
California, Berkeley, CA
Dr. Jaime Sepulveda, Director General, Instituto Nacional de
Salud Pública, Cuernavaca
Federal Employees Present:
Dr. Martin Alilio, FIC/NIH
|
Dr. Linda Kupfer,
FIC/NIH
|
Ms. Nalini Anand, FIC/NIH
|
Ms.
Judy Levin, FIC/NIH
|
Mr.
Kevin Bialy,
FIC/NIH | Ms.
Sonja Madera, FIC/NIH
|
Ms.
Danielle Bielenstein, FIC/NIH |
Dr.
Jeanne McDermott, FIC/NIH
|
Dr.
Kenneth Bridbord, FIC/NIH |
Dr.
Kathleen Michels, FIC/NIH
|
Ms.
Irene Edwards, FIC/NIH |
Ms.
Sherri L. Park, NICHD/NIH
|
Ms.
Lisa Foster, FIC/NIH | Ms.
Amanda Percival, FIC/NIH
|
Dr.
Pierce Gardner, FIC/NIH | Dr.
Aron Primack, FIC/NIH
|
Dr.
Ruth J. Hegyeli, NHLBI/NIH
| Ms.
Charlotte Quinn, FIC/NIH |
Mr.
George Herrfurth, FIC/NIH
| Ms.
Minerva Rojo, FIC/NIH |
Dr.
Karen Hofman, FIC/NIH
| Dr.
Joshua Rosenthal, FIC/NIH |
Ms.
Cherice Holloway, FIC/NIH | Ms.
Laura Rowe, FIC/NIH |
Dr.
J. Allen Holt, FIC/NIH | Dr.
Chris Schonwalder, FIC/NIH |
Dr.
Sharon Hrynkow, FIC/NIH | Dr.
Hilary Sigmon, CSR/NIH |
Mr.
Andrew Jones, FIC/NIH | Dr.
Sandy Warren, CSR/NIH |
Mr.
Maria Kaspar, FIC/NIH | Ms.
Brinah White, FIC/NIH |
Dr.
Flora Katz, FIC/NIH
| Ms.
Patricia Williams, FIC/NIH |
Dr.
Gerald T. Keusch, FIC/NIH
| Mr.
Randolph Williams, FIC/NIH |
OPEN
PORTION OF THE MEETING
I.
CALL TO ORDER
Dr.
Gerald T. Keusch called the meeting to order.
The meeting was held in the Natcher Conference Center
to accommodate a video conference with Mr. Robert Eiss, Senior
Advisor for Strategic Initiatives, FIC, from London, England
(see section VI below).
Dr.
Keusch welcomed all Board members.
He noted that FIC has nominated six individuals to fill
current openings on the Board.
Five have been accepted by the Secretary, U.S.
Department of Health and Human Services (DHHS), and one is
pending. When
agreement is reached on all six, the Secretary, DHHS, will
send formal letters to the individuals inviting them to serve
on the Board.
Dr.
Keusch extended a special welcome to Dr. Burton H. Singer,
Princeton University, New Jersey, who was attending his first
Board meeting as a Board member, and he introduced Mr. Dukembe
Mutombo, Dikembe Mutombo Foundation, Atlanta, Georgia, whose
appointment is pending. He
extended a special welcome to Dr. Jaime Sepulveda, Instituto
Nacional de Salud Pública, Cuernavaca, Mexico, who serves on
FIC’s international advisory panel.
Dr.
Keusch noted that the terms of the following two Board members
will expire in 2004 before the next meeting: Dr. Theodore
Reich and Dr. Catherine M. Wilfert. He thanked each for their
excellent service and insights and presented a certificate of
appreciation to Dr. Wilfert.
FIC will mail a certificate to Dr. Reich, who was
unable to attend the meeting.
Dr.
Keusch welcomed Dr. Sandy Warren and Dr. Hillary Sigmon,
Center for Scientific Review (CSR), who administer the review
of FIC’s growing number of programs.
Dr. Keusch noted that FIC currently has 29 programs,
approximately 18 of which are new in the past 4 years.
Dr.
Keusch also welcomed several members of the public: Dr. Wafaie
Fawzi, School of Public Health, Harvard University, Cambridge,
Massachusetts; Dr. Lee Riley, School of Public Health,
University of California, Berkeley; Dr. Chris Plowe,
University of Maryland, College Park, Maryland; and Dr. Chris
Beyrer, Dr. Liza Dawson, and Dr. Nirbhay Kumar, Johns Hopkins
University, Baltimore, Maryland.
II.
CONSIDERATION OF MINUTES OF PREVIOUS MEETING
The minutes of the Advisory Board meeting of May
20, 2003, were considered and accepted unanimously.
III.
REVIEW OF REQUIREMENTS FOR CONFIDENTIALITY AND CONFLICT
OF INTEREST PROCEDURES
The
rules and regulations pertaining to conflict of interest
were maintained.
IV.
FUTURE MEETING DATES
The
following meeting dates were confirmed:
Tuesday,
February 10, 2004
Tuesday, May 18, 2004
Tuesday, September 14, 2004
Tuesday, February 8, 2005
Tuesday, May 24, 2005
Tuesday, September 13, 2005
All
subcommittees of the Board will meet on the Monday preceding
each Board meeting.
Dr.
Keusch asked the Board members to inform Ms. Irene Edwards,
Executive Secretary, of any scheduling conflicts they may have
with the future dates.
V.
REPORT OF THE DIRECTOR
Dr.
Keusch reported on personnel changes at NIH and FIC.
Reporting on the FIC, he elaborated on the budget,
mission and foci, the FIC “house,” the FIC 35th
anniversary, and programs and initiatives.
The written Report of the Director, which was mailed to
Board members, is appended to these minutes as Attachment 2, Written
Report of the Director.
Personnel
Announcements
Dr.
Keusch noted that the NIH has two new institute directors. Dr. Jeremy Berg will assume the position of Director,
National Institute of General Medical Sciences (NIGMS), in
November 2003. Dr. Judith
Greenberg has served as Acting Director of NIGMS since the
departure of Dr. Marvin Cassman in May 2002.
Dr. Story Landis became Director, National Institute of
Neurological Disorders and Stroke, on September 1, 2003.
The
directors of three institutes are changing.
Dr. Claude Lenfant, Director, National Heart, Lung, and
Blood Institute, retired on August 30, and Dr. Barbara Alving
is Acting Director. Dr. Lenfant
had also served as FIC Director from 1981-82.
Dr. Kenneth Olden will step down from his position as
Director, National Institute of Environmental Health Sciences
(NIEHS), as soon as a replacement is found.
Dr. Ellie Ehrenfeld, Director, CSR, will step down from
this position at the end of September, but will continue as
Chief, Picornavirus Replication Section, Laboratory of
Infectious Diseases, National Institute of Allergy and
Infectious Diseases (NIAID).
Dr. Brent Stanfield, CSR Deputy Director, will serve as
Acting Director, CSR.
At
FIC, Dr. Jim Lavery, Bioethicist, Division of Advanced Studies
and Policy Analysis (DASPA), left in July 2003 to become Staff
Scientist, Center for Global Health Research, and Assistant
Professor, Public Health Sciences, University of Toronto,
Canada. Dr. Liza
Dawson, a bioethicist from Johns Hopkins University, will
succeed Dr. Lavery and will join FIC in 2 weeks.
Dr.
J. Allen Holt will retire from FIC in October 2003.
Dr. Keusch and the Board applauded Dr. Holt for his
superb work.
Perspective on the FIC
Budget
Dr.
Keusch commented that Congressman John E. Fogarty’s vision
was large when he introduced in 1958 a bill to establish a
national institute of international health research with a
budget of $50 million (the entire NIH budget in that year was
$400 million). He
noted that, if this vision had been fulfilled and had been
sustained with 45 years of significant investment, the FIC
budget would now approximate $4 billion—comparable to that
of NIAID or the National Cancer Institute (NCI). This investment could have made a great difference in the
lives of individuals living in poverty throughout the world,
as well as a major difference across the NIH.
Instead,
FIC was established as a relatively small center—which has
grown, and continues to grow, toward the large vision
initially formed by Congressman Fogarty. Dr. Keusch noted that, over the past 35 years, FIC has been
able to make a significant difference in the health of the
world’s people, through both intramural and extramural
activities, and NIH has invested significantly in global
health initiatives. He
said that, as FIC prepares to develop a strategic plan for the
next 5 years, funding is critical.
Along with sufficient ideas, staff, and collaborations
to build capacity, perform science, and implement scientific
results—to really make a difference in global health—FIC
must be funded adequately to continue to advance science and
build capacity.
Reviewing
FIC’s appropriations history, Dr. Keusch noted that FIC’s
budget increased significantly beginning in fiscal year (FY)
1988, when the AIDS International Training and Research
Program (AITRP) was established, and thereafter increased
incrementally through FY 1998.
With Congress’s action to double the NIH budget
beginning in FY 1998, FIC’s appropriations more than doubled
from FY 1998 through FY 2003.
The FIC budget for FY 2003 funding level is
approximately $62.2 million.
Dr. Keusch reported that the budget for FY 2004 is
still in conference in the Congress.
The House proposes to appropriate the same amount
requested in the President’s Budget, $64,266,000, and the
Senate is recommending a slight increase to $65,900,000.
Dr.
Keusch commented that, for FIC, a small percentage increase
(e.g., 4 percent) in an already small budget has little
effect, compared with the same percentage increase for an
institute or center (IC) that has a large budget.
He noted that the Infectious Diseases Society of
America, in testifying to Congress, recommended a doubling of
the FIC budget between FY 2003 and FY 2004.
Similar efforts by the scientific community and
professional societies extramurally and internationally would
help to increase awareness of the uniqueness of FIC’s niche
and programs and the need to bolster support for the FIC
agenda.
To
leverage its resources, FIC partners with approximately 20 ICs
to co-fund FIC programs.
Dr. Keusch expressed some concern that the IC’s
ability to continue co-funding may diminish if they have
difficulty funding their primary programs during this
post-doubling period. If
this co-funding disappeared, the amount of monies available
for FIC’s programs would decrease by approximately $24
million. Dr.
Keusch noted that this possibility is a significant concern
for FIC as it begins to plan strategically for the future.
He characterized FIC’s budget outlook as optimistic
and cautionary.
FIC’s Mission and Foci
FIC’s
mission is to promote and support scientific research and
training internationally and to reduce disparities in global
health—in short, “science for global health.”
Dr. Keusch noted that FIC developed this mission
statement from Congressman Fogarty’s remarks that “there
is widespread belief that the nations of the world can and
must share their knowledge and other resources, so that people
everywhere may have the blessing of better health and, through
health, may move forward to new levels of peaceful
productivity.”
Beginning
in 1988, FIC shifted its energies and resources from
supporting exchange visits between U.S. and foreign scientists
to supporting training and capacity building in developing
countries. This
shift was accomplished through the leadership of Dr. Philip
Schambra, former Director, FIC, and Dr. Kenneth Bridbord,
Director, Division of International Training and Research
(DITR), and with the establishment of AITRP.
Dr. Keusch noted that FIC now focuses almost completely
on issues in developing countries and that a major aim is to
promote a global culture of science.
In
the budget request for FY 2004, FIC highlights three main
areas of activity: communicable diseases, non-communicable
diseases, and development of a global culture of science
(e.g., by addressing issues of bioethics, intellectual
property, and global public goods).
Dr. Keusch noted that, in FY 2004, FIC plans to
begin development of national, and ultimately regional,
centers of excellence and support for “glue grants” to
link individuals across the research continuum.
FIC also will seek to strengthen the institutional base
in developing countries to better manage the science, set
priorities, utilize and administer funds, and foster
communication among scientists. In addition, FIC will continue to foster a cadre of U.S.
scientists who understand and are willing to engage in
important global health issues.
Dr.
Keusch said that, as guideposts, or program characteristics,
over the past 15 years, FIC has tried to be systematic in
identifying where FIC’s modest investments can best make a
difference in global health, work toward stability and
long-term commitment of funds (including decadal funding),
respond to local needs and priorities, invest in local
scientific leadership, reinforce other NIH and other public
and private investments, and establish individual and
institutional partnerships in training.
FIC also has tried to advance in-country research
(through, for example, the Global Health Research Initiative
Program for New Foreign Investigators, or GRIP), empower
people to take responsibility in a scientific environment with
mutual respect, network programs to foster global perspectives
on common problems and scientific priorities, retain
flexibility and responsiveness to meet needs, leverage
support, and listen to others working in global health.
FIC’s
House
Dr.
Keusch reviewed FIC’s strategic, systematic approach to
science for global health. He has previously conceptualized this approach as FIC’s
house. Dr. Keusch
expanded on the progress made, and future directions, in
constructing this house, as background for discussion of
FIC’s strategic plan for the next 5 years (see section VI
below).
Dr.
Keusch noted that FIC has achieved most of the initiatives set
forth in its strategic plan for FY 2000-03.
The framework, or house, remains the same, although
specific initiatives may change.
The house rests on a platform, or mission, of four
essential strategies: to build international research
capacity, promote strategic alliances, create collaborations
(with the IC, other government agencies, multinational
organizations, and foundations), and conduct applied research.
Dr. Keusch noted that FIC’s conduct of applied
research adds value to the research activities supported by
other ICs and is the responsibility of FIC’s newest
division, the Division of International Epidemiology and
Population Studies (DIEPS), headed by Dr. Mark Miller.
The
foundation of FIC’s house contains four areas of capacity
that are critical for a national or regional center of
excellence: genetics research, bioethics, bioinformatics, and
clinical, operational, and health services research. Resting on FIC’s platform and foundation are the next two
levels of FIC’s house: communicable diseases and
environment, and non-communicable diseases.
Dr. Keusch noted that FIC continues to expand its
activities in non-communicable diseases.
In
the communicable diseases area, FIC is focusing on HIV/AIDS,
malaria, tuberculosis, and other emerging infectious diseases.
Dr. Keusch noted that, in recognition of the importance
of the environment, FIC organizes its programs at this level
into four areas: environmental and occupational health;
environment, ecology, and emerging infectious diseases;
biodefense; and health, environment, and economic development.
Dr.
Keusch commented that environment is part of every issue in
global health and that the term “environment” embraces
various concepts—pollutants, environmental change,
ecological relationships.
FIC’s program on ecology of infectious diseases,
developed through the efforts of Dr. Joshua Rosenthal,
Deputy Director, DITR, arose from an appreciation of the
importance of ecological relationships and emerging disease. Dr. Keusch anticipated that environmental concerns,
specifically related to the ecological context of health, will
be a large part of FIC’s strategic plan for the next 5
years. He noted
that FIC enjoys a close working relationship with Dr. Olden,
NIEHS, and its Advisory Council and is preparing to sign a
second agreement with NIEHS to foster international efforts in
the environmental sciences.
Dr. Christopher Schonwalder, formerly of NIEHS, has
joined FIC as Senior Environmental Health Advisor to the FIC
Director, DITR, and is FIC’s direct liaison with NIEHS.
Other
FIC initiatives include (a) the International Research
Scientist Development Award for U.S. Postdoctoral Scientists (IRSDA)
program, which now has 20 grantees, and (b) the new
Fogarty-Ellison International Clinical Research Training
Program for U.S. and Developing Country Students in the Health
Sciences. The
latter, which was announced at FIC’s 35th
anniversary symposium and is funded in collaboration with the
Ellison Medical Foundation, will support early career
opportunities for U.S. graduate students in the health
professions in mentored clinical research in developing
countries. Fifteen
laboratory sites have been selected.
Dr. Pierce Gardner, Senior Advisor for Clinical
Research and Training, FIC, and Dr. Aron Primack, Program
Officer, DITR, are the FIC leads for this program.
Dr.
Keusch reported that the only initiative in the strategic plan
for FY 2000-03 that remains undone is under- and
over-nutrition (obesity).
He noted the global importance of nutrition and said
that although FIC supports some nutrition activities in other
efforts, it has yet to develop a targeted, focused program.
In
another area of interest to FIC, Dr. Keusch highlighted a
workshop held in London in early September to pair up, or
“twin,” editors from leading British and African medical
journals in mentoring relationships that will serve to enhance
and improve the African journals.
He noted that the 1.5-day workshop, which was
cosponsored by FIC, NIEHS, and the National Library of
Medicine, was enthusiastically received and will lead to the
organization of a strategic plan to strengthen African
journals in the long term.
The challenges relate, for example, to issues of
content, peer review, and professional editorship; development
of business plans; reporting on quality clinical research and
environmental health; and parallel publishing, or inviting
African scientists to publish in British journals.
Dr. Keusch noted that FIC will support this
experimental effort because of the opportunity to make an
enormous impact in improving the quality
of science and health with a reasonable investment. Similar efforts could be envisaged for Latin America and
South Asia. The
FIC leads for this activity are Dr. Karen Hofman, Director,
DASPA, and Ms. Emmy Cauthen, Program Analyst, DASPA.
FIC
35th Anniversary
Dr.
Keusch reported that FIC will be publishing a summary of the
talks presented at the 35th anniversary
symposium, “Global Health: A Challenge to Scientists,”
held May 20-21, 2003. FIC
anticipates that the publication will be a companion document
for Fogarty at 35, a history of FIC.
It will further substantiate why research is important
to improving health globally and address the question of why
so little global interest and expenditures are devoted to
research and the building of research capacity.
FIC
Programs and Initiatives
Dr.
Keusch highlighted several meetings and projects.
For additional details on these activities and other
programs and initiatives, see the written Report of the
Director (Attachment 2).
WHO Health Research
Systems Analysis Initiative.
Dr. Keusch noted that the World Health Organization
(WHO) has initiated an analysis of national health research
systems, which will culminate in a 2004 World Health Report on
research systems. The
WHO has asked NIH to participate in a pilot study of developed
countries which includes Australia, New Zealand, and the
United States. As
a first step, FIC, working closely with the NIH Director, is
conducting an analysis of the U.S. health research
infrastructure. At a meeting in Geneva, Switzerland, on September 9-10, the
FIC framework for analysis was adopted as a working model by
the other countries participating in the pilot.
Mr. Eiss is the FIC lead for the NIH.
Alliance
with the Royal Institute of International Affairs.
Dr. Keusch reported that FIC has developed a strategic
alliance with the Royal Institute of International Affairs,
the U.K. counterpart to the U.S.’s Council on Foreign
Relations, to foster interaction between political science and
health issues in the developing world.
Mr. Eiss is currently in London, England, to represent
FIC at an Institute meeting entitled “Is the Past History of
the Drug Industry Relevant to the Future?”
Dr. Keusch noted that this alliance opens a new
avenue of activity for FIC and will serve as a gateway to
establishing alliances with similar counterpart organizations
across Europe. Such
linkages are important for leveraging NIH’s resources to
address global health issues and global public goods.
Disease Control
Priorities Project (DCPP). Dr. Keusch
noted that the DCPP project is progressing well and that
developing countries are providing enormous input.
The FIC serves as the secretariat for the DCPP, a joint
effort of the NIH, WHO, and World Bank.
Dr. Joel Breman, Senior Advisor, DIEPS, is managing the
FIC effort, working closely with Dr. Dean Jamison, DCPP Senior
Editor.
Trauma
and Injury Consultation.
At NIH, in July 2003, FIC organized and cosponsored, in
collaboration with several other ICs, a consultation on
research gaps and needs in trauma and injury in the developing
world. Dr. Keusch
noted that a huge epidemic of mortality and lifelong morbidity
is associated with physical and psychological trauma and
injury in developing countries.
FIC is actively pursuing this program area and hopes to
include it in its plans for FY 2004 and 2005.
A followup meeting with NIH colleagues is being held
later in September.
NIH
Workshop on Using Research to Report on Public Health and
Medicine in Latin America. In October 2003, FIC, NCI, and NIEHS will cosponsor this
exploratory workshop of medical and health journalists from
Latin America and the United States to discuss how to improve
the quality of reporting on science and health in developing
countries. This
workshop will serve to guide future meetings with journalists
from other regions, including Southeast Asia and Sub-Saharan
Africa, as well as Russia and the newly independent states (NIS).
VI.
FIC STRATEGIC PLANNING
Dr.
Pierce Gardner introduced the session as the beginning of a
strategic planning exercise that would focus on the future
vision of FIC and its role in global health.
Mr. Eiss, via video conference from London, presented a
proposed process for strategic planning. He noted that FIC would like the Board to be engaged in all
aspects of the planning, including serving as a steering
committee for establishing ad hoc consultation groups and
expert panels.
Mr.
Eiss noted that, for FIC, strategic planning presents a unique
set of challenges and demands.
FIC is the sole Federal component authorized and
appropriated to focus on global health science. Because its budget level is not commensurate with this broad
mission, FIC has historically tried to encourage or catalyze
resources from other ICs and external agencies to support this
mission. FIC
programs focus on human capital and trans-disciplinary
research, and they have cross-cutting relevance for the other
ICs. Mr. Eiss
noted that FIC has been successful in accomplishing the
program priorities outlined in its previous plan, for FY
2000-03, largely due to Dr. Keusch’s vision and the doubling
of the NIH budget. Some
of the programs launched since FY 2000 are in clinical,
operational, and health services research and training;
cognitive sciences; genetics; stigma; tobacco-related
diseases; ecology and infectious diseases; child and maternal
health; economic linkages with health; bioethics and medical
informatics; and re-entry grants for visiting fellows.
Mr.
Eiss noted that, for the proposed planning cycle, FIC would
like to engage the external community explicitly.
This desire is driven by the current evolutionary
moment in global health science—that is, the persistent and
changing patterns of disease combined with the infusion of new
resources into global health sciences.
Mr. Eiss commented that the global health landscape is
expanding, with initiation of substantial, new international
efforts supported by nongovernmental organizations (NGOs) and
public–private partnerships; broader appreciation for the
linkage between health and economics and the economic returns
on improving health; establishment of Millennium Development
Goals and health targets by multilateral organizations; a
growing nexus between global health and national security,
biodefense, and diplomacy; and increased funding of global
health activities by U.S. agencies.
Two
of the many challenges in this environment are the absorptive
capacity of the scientific infrastructures in low-income
countries and the allocation of intellectual property rights.
Moreover, globalization (i.e., global trade and
urbanization) and integrated global markets will have effects
on health and health-related research and development
(R&D). For example, they are likely to foster dissemination of
health technology, create north–south pharmaceutical
partnerships, intensify the brain drain, expand market-based
systems of health care, shift cultural patterns and practices,
and expand the global risk of transmissible disease.
The implications of these effects are already being
felt, for example, in demands for access to drugs and exposure
to new health risks.
Mr.
Eiss noted that FIC’s broad objectives for planning would be
to (a) be highly strategic, coordinated, and disciplined in
catalyzing research against major disease burdens; (b)
establish a plan that will have utility beyond FIC; (c) form
operational alliances with R&D agencies where interests
intersect; and (d) augment the growing FIC constituency.
FIC’s operational tenets would be similar to those in
the previous plan and would emphasize programs that reduce
global health disparities, complement or catalyze other ICs’
international efforts, support interdisciplinary approaches
not adequately addressed in the NIH global portfolio, and
anticipate trans-NIH policy considerations related to global
health and serve as an analytical base for these discussions.
Mr.
Eiss referred to the recent scientific plan completed by the
National Human Genome Research Institute (NHGRI) as a
potential model for the planning process envisaged by FIC.
Rather than focusing its planning on operational
aspects, the NHGRI reviewed the broad field of human genomic
sciences to conceptualize a vision and define the competencies
and priorities of the institute.
NHGRI developed its vision statement based on extensive
consultation with members of the scientific community,
industry, the public, and academia.
Mr. Eiss noted that the published NHGRI plan has had
broad utility beyond the institute and is the most requested
reprint in the history of Nature.
The process provided a robust conceptual foundation and
established a broad constituency for NHGRI.
Mr.
Eiss asked the Board to consider the feasibility of this
approach for FIC—that is, to look more broadly at global
health and science from different disciplinary perspectives in
order to develop a vision statement for FIC.
The Board could use the analytical document to assess
FIC programs and determine the practical implications of this
vision for FIC. The plan could help to augment FIC’s constituency and could
serve as a reference source for both biomedical science and
development agencies interested in the health sciences.
Mr.
Eiss presented a “strawman” list of strategic questions
that FIC proposes to address in consultation with others.
These concerned the implications for global health and
the potential role of FIC as related to gene and environmental
interactions, development and testing of priority vaccines
(e.g., for HIV/AIDS), microbial surveillance and drug
resistance, prevention science in low- and middle-income
nations, operational and health services research to develop
infrastructures for delivering antiretrovirals and other
antimicrobials, engaging industrial R&D to develop
products for developing nations, delivering global public
goods (e.g., intellectual property agreements, data sharing),
information technologies, scientific synergy and
trans-disciplinary training, translational impediments to the
use of research findings, strengthening the “demand” for
research, research on behavioral change and risk management,
applicability of R&D models from other fields (e.g.,
agriculture), and a system for measuring scientific
performance and assuring accountability.
Mr.
Eiss reviewed the timeline for the 8-month strategic planning
process that FIC envisages.
The process would begin within FIC and move
progressively outward to gain input from other NIH and Public
Health Service (PHS) components, the extramural scientific
community, and beyond. During
September–November 2003, FIC proposes to (a) discuss
planning frameworks with the Board; (b) establish an external
strategic advisory panel under the auspices of the Board; (c)
organize an internal review of the status of FIC programs and
needs and opportunities, to be conducted in a retreat or
series of retreats with program staff; (d) develop internally,
or commission, a synthetic analysis or “environmental
scan” to assess developments that would be informative to
FIC’s planning; (e) pursue a series of internal planning
consultations with the Director, NIH, and NIH and PHS
components, to determine and develop intersecting interests;
and (f) solicit the perspectives of FIC grantees on FIC’s
forward planning.
During
December–March, FIC would convene external planning
consultations with the scientific community.
This effort would include FIC’s December 12, 2003,
satellite session of
the workshop on The Role of the U.S. University in Promoting
Global Health Research, to gain the policy perspectives of
leaders in academia, industry, and foundations.
During January–February, FIC would convene scientific
planning meetings with experts in different fields (e.g.,
infections and immunity, cognitive sciences, informatics).
During April–May, FIC would prepare an initial draft
of the plan, finalize the plan in consultation with the Board
and others, present the plan to the Board, publicly “roll
out” the plan in a press release and journal commentary, and
consult on implementation of the plan with IC directors,
Congress, and professional societies.
Mr.
Eiss invited the Board’s discussion of the proposed
strategic planning process.
VII. DISCUSSION
Dr.
Gardner moderated the discussion.
The Board addressed the planning process, the breadth
and scale of the plan, FIC’s orientation for the future,
additional questions to consider in the consultations,
measures of FIC’s accomplishments, the importance of
building bridges, and the unique role of FIC in global health.
The Planning Process.
The Board agreed that FIC should embark on a strategic
planning process. Members
commented that the proposed process seems well conceived and
should result in a good strategic plan.
Breadth and Scale of
the Plan.
The Board agreed that a document which sets forth a
vision for global health science is needed.
This document would rest on an environmental scan of
the status of global health and an assessment of FIC’s role
in global health. The
Board expressed concern about the breadth and boundaries of
the scan (e.g., would it include all global health research?
all needs for capacity building in developing countries?) and
the feasibility of accomplishing the effort within the
timeline proposed. The
Board suggested that the development of FIC’s vision will be
more complicated and complex than the planning effort
undertaken by NHGRI. Members
cautioned FIC to try to be focused in its planning and not
overly ambitious.
FIC’s Orientation for
the Future.
Dr. Keusch commented that FIC is at “a watershed”
and that the planning exercise will be an opportunity to
strategically rethink FIC’s role and activities. He noted that, when preparing the strategic plan for FY
2000-03, FIC considered the global disease burdens and gaps in
research and research information to determine whether FIC
could address these alone or in partnership with other ICs.
The grouping of FIC programs into communicable
diseases, non-communicable diseases, and the global culture of
science reflects these considerations.
As
FIC moves forward, a major consideration is whether FIC should
continue to focus on disease-specific areas or orient its
activities in an entirely different way.
For example, FIC could refocus its efforts to promote
interaction between the biomedical and the social and
behavioral sciences in addressing the processes of translating
research information into practice, improving the organization
of health care systems, and modifying people’s behaviors
with regard to their health and health care systems.
The Board highlighted the importance of
interdisciplinary training and research, citing as an example
the complexity of research conducted in urban in-migration
populations (e.g., the favelas in Brazil).
Topics for
Consideration.
The Board suggested that FIC give more thought to the
questions that will be posed in consultation, in relation to
the desired breadth and scale of the plan.
Additional topics for discussion and consideration
during the planning process could include the following: (a)
ways to leverage the NIH Roadmap Initiative (e.g., development
of interdisciplinary research teams) to FIC’s benefit; (b)
the relative emphasis that FIC should place on funding basic
research or translation of research findings to clinical
practice and, further, to society; (c) the need for systematic
evaluation of the impact of policy on health indicators; and
(d) the distinguishing features of FIC’s mission and role
compared with those of the Centers for Disease Control and
Prevention (CDC), WHO, the U.S. Agency for International
Development (USAID), and other organizations addressing global
health issues.
Review of
Accomplishments.
The Board noted that FIC has accomplished much in
recent years and has distributed its modest portfolio across a
number of areas. Members
suggested that, when defining new areas of research for the
future, FIC should retain programs that have been very
effective and that complement, but not duplicate, those of
other ICs. The
Board encouraged staff to undertake a thoughtful review of
FIC’s accomplishments (specifically in training foreign
scientists) and to consider how FIC can expand these
accomplishments in the future.
The Board suggested that FIC identify specific programs
that have fostered sustainable capacity building by
ascertaining the number of foreign scientists and individuals
trained and the effectiveness of this training.
Staff noted that FIC has launched two efforts for
tracking trainees. First,
with funds provided by the NIH Office of Evaluation, FIC is
developing a system for tracking trainees and expects to test
a pilot of this system in approximately 6 months.
Second, FIC is studying the feasibility of evaluating
the outcomes of its premier training program, AITRP, and has
initiated an outcome evaluation of the Fogarty International
Research Collaboration Award (FIRCA) program.
Building Bridges.
The Board focused on the importance of building
bridges—across the sciences, between research and practice,
across political boundaries, with other organizations, and
across U.S. agencies. The
Board noted that building bridges between the biomedical and
the social and behavioral sciences is an enormous challenge
that deserves considerably more emphasis.
The members also noted that building bridges between
research and practice is not straightforward and that
involving both researchers and practitioners in projects is
the most expeditious way to have an impact on health.
They cited two examples of successful projects in
Tanzania that were supported by the governments of Switzerland
and Tanzania and the Swiss Tropical Institute and involved
researchers and health practitioners working together to
implement disease control.
Dr. Keusch suggested that FIC could benefit from a
discussion with the Institute about its programmatic vision
and accomplishments.
Dr.
Keusch noted that FIC’s aim to promote broader-based,
multidisciplinary centers of excellence nationally and
regionally will depend on building bridges politically across
national boundaries. FIC’s
first step in this direction is its support of glue grants to
link together FIC and other NIH-sponsored programs within
foreign cities or countries.
The Board commented on the complexity of world politics
and noted that the increasing polarization between countries
could have negative consequences on health globally.
Dr.
Keusch noted the importance of building bridges with
organizations (e.g., NGOs, foundations) that provide services
and mobilize communities.
The Board emphasized the need to build bridges across
new U.S. initiatives in health, especially those related to
HIV/AIDS. Members
commented that FIC has a tremendous buildup of international
goodwill in the prevention and control of HIV/AIDS and that
CDC and USAID need FIC’s expertise in this area.
The Board noted that the new U.S. initiatives in
HIV/AIDS offer FIC special opportunities for leveraging its
expertise and resources.
In particular, FIC can bridge the gap between what the
new U.S. initiatives can do and what countries need.
The Board suggested that FIC has an important role to
play in brokering such large U.S. programs in countries where
FIC has supported most of the training of scientists and
health professionals.
Uniqueness of FIC.
The Board noted that “FIC is ahead of the curve” on
global health. Uniquely,
FIC emphasizes that “good science makes good policy” and
has focused on creating the capacity to address global issues
in an evidence-based way and develop policies that are
relevant. The
Board emphasized that FIC should enhance its marketing of this
uniqueness and create a presence that transcends being
embedded in the NIH budget and begin to develop a portfolio of
funding that crosses U.S. agencies, including the Department
of Defense. The
Board encouraged FIC grantees (e.g., AITRP directors) to
better articulate FIC’s activities and importance to funders.
Dr.
Keusch noted the need for FIC to continue to cultivate
linkages with the extramural community and to promote
evidence-based policies. He cited two examples of FIC’s role in fostering foster
evidence-based policy. In
partnership with the Institute of Medicine (IOM), the
Rockefeller Foundation, the Infectious Diseases Society of
America, and the Global Fund for AIDS, Tuberculosis, and
Malaria, FIC is funding a consultation that will bring
together scientists and practitioners from developing and
developed countries to address controversial aspects of
providing antiretroviral drugs for HIV/AIDS in developing
countries. In
addition, FIC is engaged in another similar effort with an IOM
panel that is addressing the public health aspects of using
DDT.
In
closing, Dr. Keusch noted that staff will address the
Board’s comments, engage the new Board members in this
discussion, and follow up with the Board on next steps.
Mr. Eiss indicated that FIC will further discuss with
the Board the appropriate scale for the plan.
The Board suggested that FIC could present the plan at
the second summit of health ministers worldwide, in Mexico, in
November 2004.
VIII.
CLOSED PORTION OF THE MEETING
This portion of the meeting
was closed to the public in accordance with the
determination that it was concerned with matters exempt from
mandatory disclosure under Sections 552b(c)(4) and
552b(c)(6), Title 5, U.S. Code and Section 10(d) of the
Federal Advisory Committee Act, as amended (5 U.S.C.
Appendix 2).
There
was a discussion of procedures and policies regarding voting
and confidentiality of application materials, committee
discussions, and recommendations.
Members absented themselves from the meeting during
discussion of and voting on applications from their own
institutions or other applications in which there was a
potential conflict of interest, real or apparent.
Members were asked to sign a statement to this
effect.
IX. REVIEW OF APPLICATIONS
Dr.
Sharon Hrynkow chaired the remainder of the meeting during
which the Research Awards Subcommittee reported on its
activities. A
total of 153 scored competing applications were reviewed by
the FIC Advisory Board at the September 16 meeting.
The applications were in the following programs:
| 38
applications for the Fogarty International Research Collaboration Award (FIRCA)
program, out of a total of 62 applications, to be funded in FY 2004; |
| 5
applications for the HIV-AIDS and Related Illnesses Collaboration Award
(AIDS-FIRCA) program, out of a total of 8 applications, to be funded in FY
2004; |
| 28
applications for the AIDS International Training and Research Program (AITRP),
out of a total of 37 applications, for $6,842,684; |
| 82
applications for the Brain Disorders in the Developing World: Research
Across the Lifespan program, out of a total of 132 applications, for
$1,134,557. |
The Board concurred with the initial review group
recommendations for the 153 applications.
Applications that were
noncompetitive or unscored or were not recommended for
further consideration by initial review groups were not
considered by the Council.
X. ADJOURNMENT
There
being no further business, the meeting was adjourned at 3:00 p.m. on September
16,
2003.
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