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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.[1]  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 

[1] 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/NIHMs. Amanda Percival, FIC/NIH
Dr. Pierce Gardner, FIC/NIHDr. 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/NIHMs. Laura Rowe, FIC/NIH
Dr. J. Allen Holt, FIC/NIHDr. Chris Schonwalder, FIC/NIH
Dr. Sharon Hrynkow, FIC/NIHDr. Hilary Sigmon, CSR/NIH
Mr. Andrew Jones, FIC/NIHDr. Sandy Warren, CSR/NIH
Mr. Maria Kaspar, FIC/NIHMs. 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.[1]  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.


[2] 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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