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“Science for Global Health: Fostering International Collaboration”
University of Maryland at Baltimore
James Herrington, Ph.D., M.P.H.Director
Division of International RelationsFogarty International CenterNational Institutes of Health
U.S. Department of Health and Human Services
June 5, 2007
Outline
• Global Burden of Disease• Global Health Research• NIH Structure, Function• Extramural Grant Awards• NIH Investments in Intramural Researchers • Fogarty International Center
Global Burden of Disease, Reported Mortality by Cause, 2002
World
32%
59%
9%
Africa Region
72%
21%
7%
Communicable, Maternal, Perinatal, and Nutritional Conditions Non-Communicable Diseases Injuries
Source: World Health Report, 2004; Disease Control Priorities Project, 2006
Pop. ~ 6 billion Pop. ~ 672 million
Global Burden of Disease, Reported Mortality by Cause, 2002
European Region
6%
86%
8%
Africa Region
72%
21%
7%
Communicable, Maternal, Perinatal, and Nutritional Conditions Non-Communicable Diseases Injuries
Source: World Health Report, 2004; Disease Control Priorities Project, 2006
Pop. ~ 880 million Pop. ~ 672 million
Global Burden of Disease, Reported Mortality by Cause, Communicable Diseases, Africa Region, 2002
Source: World Health Report, 2004; Disease Control Priorities Project, 2006
42%
23%
7%
14%
11%2%
1%0% HIV/AIDS
Malaria
Tuberculosis
Diarrhoeal diseases
Childhood-cluster diseases
STDs excluding HIV
Trop diseases, leprosy,dengue total
Intestinal nematodeinfections
DiphtheriaMeaslesPertussisPolioTetanus
Mal Aria (“bad air”) associated with marshes; Female Anopheles mosquito taking blood meal
Global Burden of Disease, Reported Mortality by Cause, Communicable Diseases, European Region, 2002
Source: World Health Report, 2004; Disease Control Priorities Project, 2006
28%
0%
53%
13%
5%
1% 0%0% HIV/AIDS
Malaria
Tuberculosis
Diarrhoeal diseases
Childhood-cluster diseases
STDs excluding HIV
Trop diseases, leprosy,dengue total
Intestinal nematodeinfections
DiphtheriaMeaslesPertussisPolioTetanus
Global Burden of Disease, Reported Mortality by Cause: Non-Communicable Diseases, European Region, 2002
Source: World Health Report, 2004; Disease Control Priorities Project, 2006
22%
60%
5%
5%2%3% 3% Malignant
neoplasmsCardiovasculardiseasesRespiratory diseases
Digestive diseases
Diabetes mellitus
NeuropsychiatricconditionsOther
Mal Alimentation (“bad food”) associated with economic development, longevity, sedentary society
Source: http://en.wikipedia.org/wiki/BK_StackerPhoto credit: Mychal Stanley
'''BK Stacker'''
Serving size 1 sandwich311g
Energy 1000 cal
Energy from fat 620 cal
Total fat 68g
Saturated fat 30g
Cholesterol 240mg
Sodium 1800mg
Dietary fiber 1g
Sugars 6g
Protein 62g
Source www.BK.com
Notes US % Daily Value based on 2000 calorie diet.
Mal Comportment (“bad behavior”) associated with economic development, longevity, mobile society
Source: Tobacco Free Initiative, World Health Organization
Mal Environment (“bad surroundings”) associated with economic stagnation/decline, low female literacy, agrarian society
Photo: G
rameen S
hikka
Global Burden of Disease, Projected Mortality by Cause: Communicable (Group I) Diseases, World, 2002-2030
Source: Mathers, C.D. and Loncar, D. in http://medicine.plosjournals.org/archive/1549-1676/3/11/pdf/10.1371_journal.pmed.0030442-L.pdf
Global Burden of Disease, Projected Mortality by Cause: Non-Communicable (Group II) Diseases, World, 2002-2030
Source: Mathers, C.D. and Loncar, D. in http://medicine.plosjournals.org/archive/1549-1676/3/11/pdf/10.1371_journal.pmed.0030442-L.pdf
Source: Mathers, C.D. and Loncar, D. in http://medicine.plosjournals.org/archive/1549-1676/3/11/pdf/10.1371_journal.pmed.0030442-L.pdf
Global Burden of Disease, Projected Mortality by Cause: Trauma and Injury (Group III), World, 2002-2030
Disease Control Priorities Project (DCPP)The 20th Century Take Off in Human Health, Life Expectancy, 1550-2050
Source: Disease Control Priorities Project, 2006 (http://www.ncbi.nlm.nih.gov/books/bookres.fcgi/dcp2/ch1.pdf)
Disease Control Priorities Project (DCPP)Levels and Changes in Life Expectancy, 1960-2002, by World Bank Region
Source: Disease Control Priorities Project. Burden of Disease in China in 2001 (http://www.dcp2.org/pubs/DCP/1/Table/1.1)
Life Expectancy at Birth
30
40
50
60
70
80
90
1960 1990 2002
Period
Age
in
Yea
rs
Low- and middle-incomecountriesEast Asia and the Pacific
China
Europe and Central Asia
Latin America and theCaribbeanMiddle East and NorthAfricaSouth Asia
India
Sub-Saharan Africa
High-income countries
World
0.7%
0.8%
1.8%
3.3%
3.9%
7.4%
7.6%
9.2%
10.9%
12.2%
Iron deficiency
Unsafe sex
Illicit drugs
Physical inactivity
Low fruit and vegetable intake
Overweight
Cholesterol
Alcohol
Blood pressure
Tobacco
Developed countries
Burden of Disease Attributable to Alcohol Among the 10 Leading Risk Factors for Disease In Developed and Developing Countries - % DALYs*
Source: World Health Organization, 2002
*disability-adjusted life years (years of potential life lost due to death plus
years of healthy life lost to disability)
Alcohol/Tobacco Blood pressure Nutrition
Alcohol/Tobacco Blood pressure Nutrition 1.7%
1.8%
1.9%
1.9%
2.1%
2.7%
3.1%
4.0%
5.0%
6.2%
Unsafe water, sanitation and hygiene
Iron deficiency
Indoor smoke from solid fuels
Low fruit and vegetable intake
Cholesterol
Overweight
Underweight
Tobacco
Blood pressure
Alcohol
Developing countries with low child and
low adult mortality
Examples of Change in China: Adult Per Capita Alcohol Consumption by Development Status: 1960-20001
0
1
2
3
4
5
6
7
1960 1965 1970 1975 1980 1985 1990 1995 2000
Developed countries
Former Soviet Union China 2
(1961-1999)
Developing countries
Lit
ers
of P
ure
Alc
ohol
Per
Per
son
15+
Yea
rs
1Adapted from Room et al. (2002). Alcohol and the Developing World: A Public Health Perspective [Summary]. Helsinki: Finnish Foundation of Alcohol Studies in collaboration with the WHO, p. 12.
2Derived from World Health Organization Health Statistical Database: Apparent Alcohol Consumption. http://www3.who.int/whosis/
Epidemiological, Demographic, and Political Transitions
• Shift from Acute to Chronic Diseases
• Aging Population
• Health Disparities
• Emerging and Re-emerging diseases
• Behavioral and Mental Health diseases
• Biodefense
4.2% ($29.2 billion) of total FY 2007 HHS budget ($698 billion) in research
Administration forChildren and Families
(ACF)
Administration forChildren and Families
(ACF)
Food and DrugAdministration
(FDA)
Food and DrugAdministration
(FDA)
Health Resourcesand Services
Administration(HRSA)
Health Resourcesand Services
Administration(HRSA)
Administration onAging(AoA)
Administration onAging(AoA)
Centers for Medicare and
Medicaid Services (CMS)
Centers for Medicare and
Medicaid Services (CMS)
Indian HealthService(IHS)
Indian HealthService(IHS)
Centers for Disease Controland Prevention
(CDC)
Centers for Disease Controland Prevention
(CDC)
Substance Abuse andMental Health Services
Administration(SAMHSA)
Substance Abuse andMental Health Services
Administration(SAMHSA)
Program SupportCenter(PSC)
Program SupportCenter(PSC)
Agency for ToxicSubstances andDisease Registry
(ATSDR)
Agency for ToxicSubstances andDisease Registry
(ATSDR)
Agency for Health Care Policy
and Research(AHCPR)
Agency for Health Care Policy
and Research(AHCPR)
National Institutesof Health
(NIH)
National Institutesof Health
(NIH)
Michael Leavitt Secretary of Health and
Human Services
Michael Leavitt Secretary of Health and
Human Services
= Institutes and Centers that award grants
Elias Zerhouni, M.D.Director, NIH
Elias Zerhouni, M.D.Director, NIH
National Instituteon Alcohol Abuseand Alcoholism
National Instituteon Alcohol Abuseand Alcoholism
National Instituteof Arthritis andMusculoskeletal
and Skin Diseases
National Instituteof Arthritis andMusculoskeletal
and Skin Diseases
National CancerInstitute
National CancerInstitute
National Instituteof Diabetes andDigestive and
Kidney Diseases
National Instituteof Diabetes andDigestive and
Kidney Diseases
National Instituteof Dental andCraniofacial
Research
National Instituteof Dental andCraniofacial
Research
National Instituteon Drug Abuse
National Instituteon Drug Abuse
National Instituteof Environmental Health Sciences
National Instituteof Environmental Health Sciences
National Instituteon Aging
National Instituteon Aging
National Instituteof Child Health
and HumanDevelopment
National Instituteof Child Health
and HumanDevelopment
National Institute onDeafness and Other
CommunicationDisorders
National Institute onDeafness and Other
CommunicationDisorders
National EyeInstitute
National EyeInstitute
National HumanGenome Research
Institute
National HumanGenome Research
Institute
National Heart,Lung, and Blood
Institute
National Heart,Lung, and Blood
Institute
National Instituteof Mental Health
National Instituteof Mental Health
National Instituteof NeurologicalDisorders and
Stroke
National Instituteof NeurologicalDisorders and
Stroke
National Instituteof General
Medical Sciences
National Instituteof General
Medical Sciences
National Instituteof Nursing Research
National Instituteof Nursing Research
National Libraryof Medicine
National Libraryof Medicine
Center for InformationTechnology
Center for InformationTechnology
Center for Scientific Review
Center for Scientific Review
National Centerfor Complementary
and AlternativeMedicine
National Centerfor Complementary
and AlternativeMedicine
National Instituteof Allergy and
Infectious Diseases
National Instituteof Allergy and
Infectious Diseases
National Centerfor ResearchResources
National Centerfor ResearchResources
Clinical CenterClinical Center
National Center on Minority Health andHealth Disparities
National Center on Minority Health andHealth Disparities
National Institute of Biomedical Imagingand Bioengineering
National Institute of Biomedical Imagingand Bioengineering
FogartyInternational
Center
FogartyInternational
Center
Mission
Address global health challenges through innovative and collaborative research and training programs
Support and advance the NIH mission through international partnerships
“Science for Global Health”
FY 2007 Appropriation $67 million
National Institutes of Health Main CampusBethesda, Maryland, U.S.A.
NIH Mission
Uncover New Knowledge That Leads To Better Health For Everyone By:
Supporting peer-reviewed scientific research at universities, medical schools, hospitals, and research institutions throughout United States and overseas
Conducting research in its own laboratories
Training research investigators
Developing and disseminating credible health information based on scientific discovery
Contemporary NIH
NIH creates research laboratories and recruits outstanding scientists from universities and abroad
Institutes and Centers are created in response to public health needs, most with intramural programs
Many young trainees join NIH and go on to become leaders in science across the US and around the world
117 grantees or trainees are Nobel Laureates (as of 2005)
Appropriated NIH Budget, FY07, $29.2 Billion
SpendingSpendingOutside NIHOutside NIH
$24.2 B$24.2 B
SpendingSpending
at NIHat NIH
$4.9 B$4.9 B
% Amount Expenditure
10% $2.9B 6000 Intramural Scientists & Research Personnel
3.8% $1.1B Research Mgt & Support
3.2% $1.0B NLM, OD, etc.
83% of the total NIH budget supports about 212,000 Extramural Scientists and Research Personnel at 2,800 Institutions Nationwide.
$818 million (~2.8%) of NIH budget is international research and research training awards
Balanced National Biomedical Research Portfolio
NIH - $29 B
Clinical Research
Basic Research
Translational Research
Private Sector - $59B
Clinical Research
Basic Research
Translational Research
NIH – Extramural and Other Grant Awards, by Type
• Research Grant Programs (8 types)• New Investigators Program (2 types)• Multiple Principal Investigators (NEW in Feb 2007)• Research Supplemental Programs (1 type)• Ruth L. Kirschstein
National Research Service Awards (NRSA) (8 types)• Research Ethics and Training Grant Programs (2 types)• NIH Career Development (K) Awards (15 types)• Small Business Awards (1 type)• Other Programs (8 types)
Source: http://grants2.nih.gov/grants/funding/funding_program.htm
NIH – Extramural Awards, by Type
Small Grant (R03)
Research Project Grant (R01)
Independent Scientist Award (K02)
Approx. Stage of ResearchTraining and Development
NIH Pathway to Independence (PI) Award (K99/R00)Mentored Research Scientist Development Award (K01)Mentored Clinical Scientist Development Award (K08)Mentored Patient-Oriented RCDA (K23)Mentored Quantitative RCDA (K25)
Exploratory/Development Grant (R21)
NIH Research Training and Career Development Timetable
Predoctoral Individual NRSA (F31)Predoctoral Individual MD/PhD NRSA
(F30)
Postdoctoral Institutional Training Grant (T32)
Postdoctoral Individual NRSA (F32)
Senior Scientist Award (K05)
Mechanism of Support
GRADUATE/MEDICALSTUDENT
POSTDOCTORAL
EARLY
MIDDLE
SENIOR
CA
RE
ER
Predoctoral Institutional Training Grant (T32)
Midcareer Investigator Award in Patient-Oriented Research (K24)
NIH Extramural Grant Awards, Competitive and Non-Competitive, New and Continuations, FY 2006
46,797 research grants awarded ($20.2 billion)
36,814 research project grants ($14.8 billion)
73% of NIH extramural awards go to institutions of higher education
More than 75,000 grant applications received (all mechanisms)
NIH Intramural Program, Visiting Fellows and Guest Researchers, by E.U. Member/Candidate Countries, 2005
Germany, 170, 18%
Italy, 161, 17%
France, 146, 15%
United Kingdom, 131, 14%
Spain, 76, 8%Poland, 60, 6%
The Netherlands, 46, 5%
Turkey, 32, 3%
Sweden, 29, 3%
Ireland, 23, 2%
Austria, 21, 2%
Czech Republic, 20, 2%
Bulgaria, 14, 1%Denmark, 12, 1%Belgium, 9, 1%
Finland, 5, 1%
Portugal, 5, 1%
Lithuania, 3, 0%
Croatia, 2, 0%
Estonia, 1, 0%
N=966 x average stipend cost $50,000/yr = $48.3 million
Rhode Island CongressmanJohn Edward Fogarty
Congressman Melvin Laird(R-WI) 1967
The Committee “… has provided funds to plan a lasting memorial to a man who, for more than a quarter of a century, worked tirelessly for a healthy America, in a healthier world.”
Mission
Address global health challenges through innovative and collaborative research and training programs
Support and advance the NIH mission through international partnerships
“Science for Global Health”
FY 2007 Appropriation $67 million
FIC Organizational Structure
• Dr. Glass was named Associate Director for International Research, NIH and Director of Fogarty International Center by NIH Director Elias A. Zerhouni, M.D., on March 31, 2006.• Harvard College in 1967• Fulbright Fellowship, University of Buenos, 1967• M.D. from Harvard Medical School • M.P.H. from the Harvard School of Public Health, 1972• Medical officer assigned to the Environmental Hazards Branch Text CDC in 1977 • Ph.D. from the University of Goteborg, Sweden in 1983 and joined NIH Laboratory of Infectious Diseases to work on the molecular biology of rotavirus •1986 returned to the CDC to become Chief of the Viral Gastroenteritis Unit at the National Center for Infectious Diseases
Roger Glass, M.D., Ph.D.Director, Fogarty International Center
Research and Research Training
• ~$50 million in grant awards
• 1/3 Research, 2/3 Research Training
• Awards range $10,000 - $1 million
• Low and Middle Income Countries
• Research Capacity Development and Equity
Extramural Training Grants – 14 Programs
Extramural Research Grants – 8 Programs
International Training Grants for U.S. citizens
- Scientist Development Fellowship (Post-doc)
- Fogarty/Ellison Fellowship (Pre-doc/Pre-med)
Fogarty International Collaborative Trauma and Injury Research Training
International Clinical, Operational, and Health Services Research Training Awards for HIV/AIDS and Tuberculosis
International Maternal and Child Health Research Training
Fogarty-Ellison International Clinical Research Training
Informatics Training for Global Health
International Collaborative Genetics Research Training
International Clinical, Operational, and Health Services Research Training Awards
International Clinical, Operational, and Health Services Research Training Awards for Malaria
Global Infectious Diseases Research Training
International Research Ethics Education and Career Development
International Centers for Excellence in Research Clinical Research and Management Training
International Training Program in Environmental and Occupational Health
Global Research Training in Population Health
AIDS International Training and Research
Framework Programs for Global Health
International Research Scientist Development Awards
Flexible
Long-term commitment
Built on research collaborations
Re-entry support
Response to local needs
Empowerment
Networking
Research Training Program Characteristics
Fogarty International Research Collaboration Award (FIRCA)
International Cooperative Biodiversity Groups (ICBG)
Ecology of Infectious Diseases (EID)
International Studies on Health and Economic Development (ISHED)
Int’l Tobacco and Health Research and Capacity Building Program
Global Research Initiative Program for New Foreign Investigators (GRIP)
Stigma and Global Health Research Program
Brain Disorders in the Developing World: Research Across the Lifespan
Research Grants – 8 Programs
Extramural Training Grants
Generally institutional training grant to U.S. universities and non-profit research institutions in response to a specific request for applications (RFA)
Awardees are generally current NIH grant recipients with demonstrated research collaboration with foreign research institutions
Purpose – support training for research-capacity building for scientists from developing nations
Framework Programs for Global Health
Provides support to educational institutions to develop trans-institutional programs in Global Health
Develops new multidisciplinary curricula in broad range of global health research areas
Develops administrative framework for a Global Health research program
Brings new investigators and students into the Global Health field
Applicants from U.S. or eligible low- and middle-income countries; multiple institutions may work together on a single project
Fogarty International Clinical Research Scholars Program (Pre-doc/Pre-med)Provides mentored clinical research training opportunities for 3rd year U.S. medical and other health profession graduate students in NIH-funded research centers in developing countries; 25-30 per year.
Fellowship stipends approximately $18,000-$20,000 per year (adjusted to cost of living expenses at the foreign site) with an additional $6,000 per year for travel, insurance, and educational materials.
Builds clinical research capacity in developing countries by pairing a peer trainee from the developing country with a U.S. trainee.
Collaboration with Association of American Medical Colleges, Association of Schools of Public Health, National Institute of Allergy and Infectious Diseases, the National Institute of Dental and Craniofacial Research, and the National Institute on Drug Abuse,
http://www.aamc.org/students/medstudents/overseasfellowship/start.htm
Fellowship SitesBangladesh
Botswana
Brazil
China
Haiti
India, Chennai
India, Vellore
Kenya
Mali
Peru, Lima, Johns Hopkins University
Peru, Lima, University of Washington
Russia
South Africa, Durban
South Africa, Pretoria
Tanzania
Thailand
Uganda
Zambia
Trainee Activities
3-week orientation program at NIH (July)
Clinical research at designated site (10 months)
FIC/NIH clinical research training via distance learning and contact with FIC staff
Summary report of activities and research accomplishments at the end of the training year
After completion of the research year, the fellow presents results at the annual NIH meeting (March)
Alumni remain connected via continuing relationship with mentors and collaborators and through an FIC alumni tracking/program evaluation system
NIH Alumni AssociationsBrazil – University of California, Berkeley
Central and Eastern Europe – University of Iowa
China – University of California, Los Angeles
India – Brown University
Malawi – University of Illinois at Chicago
Mexico – Emory University
Russia – Yale University
South Africa – Columbia University
Thailand – University of California, Los Angeles
Uganda – Case Western Reserve University