Mr. Chairman, it is my privilege to present the programs and accomplishments of the
Fogarty International Center (FIC). Our namesake, John E. Fogarty, who served as
Chairman of this subcommittee, is one of a continuing lineage of Congressional
Representatives who have enabled NIH to become an international leader, not only in
the quality of its research, but through cooperation with over 100 nations.
FIC was established to improve health through international scientific cooperation.
As we look toward a new century, health concerns are increasingly global in scope.
Unexpected diseases have surfaced due to altered patterns of land use, the adaptability
of disease pathogens, and other factors. With the ease and frequency of international
travel, disease outbreaks in foreign countries can rapidly cross U.S. borders. This
includes infectious diseases such as the Ebola virus, new variants of the AIDS virus,
and dengue fever. Pollutants in the atmosphere, water, and food chain pose equally
insidious risks, contributing to a host of chronic diseases and developmental
disorders. The persistence of population growth in resource-poor nations threatens to
undermine health gains by impeding economic growth. It is estimated that in the next
25 years, nearly three billion people will be added to the world's population. Ninety-five percent of this growth will occur in developing countries, where high birth rates
already force subsistence farmers onto marginal land, into crowded urban areas, or
across national borders. Such global demographic changes will lead to the emergence
of new infectious diseases and increased human exposure to pollutants.
Biomedical research is the foremost means of reversing these disturbing health trends
through new medical technologies and prevention strategies. Through prevention
research, it is conceivable that the developing world may be spared the burden of
disability and death from diabetes, coronary heart disease, and hypertension that has
plagued industrialized, urban societies. But these challenges cannot be met through
research that is confined within our borders. What is urgently required are
international partnerships that enable American scientists to train foreign colleagues
and to work cooperatively in affected regions of the world. This is how the United
States helped to eradicate smallpox globally, and virtually eliminate polio in this
hemisphere. Ultimately, such cooperation will become the most effective armament
against the new epidemics of infectious and chronic disease.
FIC builds these partnerships through research training programs, small grants,
individual fellowships and institutional alliances. Technical skills and knowledge are
shared with scientists worldwide in such fields as epidemiology, immunology,
microbiology, endocrinology, cell and molecular biology, toxicology, biochemistry
and biostatistics. Cooperative studies are supported in regions of the world that, due
to disease burdens or environmental conditions, provide unique opportunities to
devise methods of treatment and prevention. For example, the development of certain
vaccines may depend on international field trials. These include vaccines for
HIV\AIDS, respiratory infections caused by pneumococcus, and diarrheal diseases
caused by shigella and cholera.
FIC's international partnerships are planned and conducted in cooperation with our
sister institutes at NIH. In addition, FIC undertakes concerted efforts to bring new
resources and scientific perspectives to global health through cooperation with other
agencies of the Public Health Service and Federal Government. Almost sixty percent
of the funds managed by FIC (including AIDS funding sanctioned by the OAR) come
from other NIH or Federal components, who view FIC as a means of advancing their
international goals. These intra- and interagency alliances also reduce administrative
costs and streamline management requirements.
The model for FIC's global health efforts is its AIDS International Training and
Research Program, established by Congress in 1988 to provide training for scientists
and health professionals from developing countries where HIV is a critical health
concern. Since its inception, over 1000 scientists from over 80 countries have
received training in the United States and now assist the U.S. in international
prevention efforts. This past year, the program documented a substantial decrease in
the prevalence of HIV in the population of one foreign country as a result of a
systematic prevention strategy. Our long-range objective is to create these same
partnerships to meet the challenge of emerging infectious diseases, environmental
health and population growth. This would demonstrate a compelling leadership role
for the United States in international health. The geopolitical, as well as scientific
benefits of these linkages are significant. Many FIC trainees represent the future
scientific leadership of their countries.
During the past Fiscal Year, FIC launched the International Research and Training
Program on New and Emerging Infectious Diseases. The purpose is to support
cooperative research and training in regions of the world that are the potential origin
of new epidemics, employing new molecular and analytic tools in their study. New
knowledge is needed to develop a global research surveillance system capable of
detecting and containing future epidemics. The program represents a partnership with
the National Institute of Allergy and Infectious Diseases and The Centers for Disease
Control and Prevention (CDC) in support of a Presidential Decision Directive and
recommendations of the President's National Science and Technology Council. The
useful role of this program already has been demonstrated in the case of the deadly
Ebola virus. In early 1996, a scientist from Gabon received research training on this
infectious agent at Yale University. Upon return to Gabon, he traced the origin of an
Ebola-infected patient to a lumber camp. Because of his special training, he was able
to perform the required laboratory studies in collaboration with CDC. As a
consequence, Gabon was able to confirm the Ebola outbreak, take appropriate
treatment and prevention measures, and undertake a research program to identify the
natural history of the virus.
This new program builds on current research conducted under the Fogarty
International Research Collaborative Award (FIRCA), a small supplemental grant
to NIH-supported investigators to increase scientific cooperation in this hemisphere
and with the new democracies of Eastern Europe and the former Soviet Union. Since
its initiation by Congress in the wake of the fall of communism, the FIRCA has
supported 64 projects with the former Soviet Union and 45 projects with Latin
America in scientific areas of mutual priority. Under the FIRCA, scientists at the
Academy of Medical Sciences in Moscow are collaborating with the New England
Medical Center to determine the extent of Lyme disease in Russia and the precise
identification of the specific microbe isolated from Russian patients. Such
information is needed as work progresses on the development of a vaccine that can be
used worldwide. Collaborative research between scientists at the University of
Oklahoma and the Russian Academy of Sciences in St. Petersburg are identifying the
distinguishing genetic characteristics of Group A streptococci, commonly known as
"flesh eating" bacteria. Because microbes are so readily transmitted across
international borders, the Russian streptococci might be imported and cause disease in
the United States. If this were to occur, knowledge about Russian streptococci would
be key to diagnostic and treatment strategies.
The International Training and Research Program in Population and Health,
now in its second year, supports research to improve reproductive and neonatal health
care and demographic capabilities. The goal is to create a broad range of safe,
reversible and acceptable contraceptive methods and to decrease maternal mortality
and morbidity from infections, nutritional deficiencies, toxemia, high blood pressure
and other conditions. The program was launched in partnership with the National
Institute of Child Health and Human Development. The International Training
and Research Program in Environmental and Occupational Health, also in its
second year, enables the U.S. to work cooperatively with regions of the world with
high levels of contaminants in the environment and workplace. With the application
of new scientific methods, the effects of environmental agents on human health will
be examined and interventions devised to reduce health risks. It is notable that the
American public was alerted to the carcinogenic properties of agents such as dioxin
through international studies. This program was launched in cooperation with the
National Institute of Environmental Health Sciences and CDC's National Institute for
Occupational Safety and Health.
The health consequences of environmental degradation also include the potential loss
of valuable medicinal products derived from nature. For centuries, plants have been
the source of medicines such as digitalis for heart disease and quinine for malaria.
Yet only a small fraction of the world's biological wealth has been studied for
potential therapeutic benefit. The International Cooperative Biodiversity Groups
Program, supported and administered by FIC, is designed to discover new drugs
from the earth's biological diversity. In addition, strategies are pursued to preserve
natural ecosystems and promote economic growth through drug discovery and
development. This pioneering program has influenced resource management policies
in several participating countries, and has served as a case-study in international
treaty discussions. In its first two years, over 3,000 species of plants and insects have
been examined for their potential therapeutic properties. Bioactive samples are now
being tested as candidate drugs against certain cancers and viral diseases, malaria and
degenerative neurological disorders. The program is supported by several NIH
components, the National Science Foundation, the U.S. Agency for International
Development, and U.S. industries. It demonstrates the potential of pooling expertise
and resources across the public and private sectors.
Mr. Chairman, the political basis for public investment in biomedical research
emerged from our nation's critical needs during World War II. Today, the pursuit of
health through research again is integral to our nation's security. Scientific solutions
to global health threats require a coordinated global response. Dr. John Evans, a
Canadian who served as chairman of the independent Commission on Health
Research for Development, aptly remarks "that with increased awareness of global
interdependence in health, self-interest should reinforce humanitarian concerns" in
our efforts to improve global health. With the support of Congress, FIC will continue
to advance this important mission through international cooperation.
Thank you Mr. Chairman. Our FY 1998 budget request is $16,755,000. I will be
pleased to answer any questions.
