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Research and Training Opportunities in
Global Health
Joel G. Breman, MD, DTPH
Fogarty International Center
U.S. National Institutes of Health
The Academy of Sciences for the Developing World
BioVisionAlexandria 2008 Conference
Alexandria, Egypt
April 11, 2008
Research Funding Perspectives

Demographic and disease trends

Thinking research needs

National Institutes of Health (NIH)

Fogarty International Center, NIH, programs
Research Funding Perspectives
 Demographic
and disease trends

Thinking research needs

National Institutes of Health (NIH)

Fogarty International Center, NIH, programs
Disease Control Priorities Project
2006 Publications www.dcp2.org
Presented at BioVisionAlexandria, 2006
Disease Control Priorities Project (DCPP)
Life Expectancy, 1550-2050
High Income Countries
85
Europe & Central Asia
Middle East & North Africa
75
Latin America & Caribbean
65
East Asia & Pacific
South Asia
55
Sub-Saharan Africa
45
35
19501955
19601965
19701975
19801985
19901995
20002005
Source: Disease Control Priorities Project, 2006 (http://www.ncbi.nlm.nih.gov/books/bookres.fcgi/dcp2/ch1.pdf)
Leading causes of Disability-Adjusted Life Years in Low/Middle-income
and High-Income Countries, by World Bank Region, 2001
Rank
South Asia
(GNI: $450)
LE:63
SubSaharan
Africa
(GNI: $460)
LE:46
East Asia and
the Pacific
(GNI: $900)
LE:69
Europe and
Central Asia
(GNI: $1,970)
LE:69
1
Perinatal
conditions
HIV/AIDS
Cerebrovascular
diseases
Ischemic heart
disease
2
Lower
respiratory
infections
Malaria
Perinatal
conditions
Cerebrovascular
diseases
3
Ischemic
heart
disease
Lower
respiratory
infections
Chronic
obstructive
pulmonary
disease
4
Diarrheal
diseases
Diarrheal
diseases
5
Unipolar
depressive
disorders
Perinatal
conditions
Middle East
and North
Africa
(GNI:
$2,200)
LE:68
Latin America
and the
Caribbean
(GNI: $3,580)
LE:71
High–income
countries
(GNI: $26,500)
LE:78
Ischemic
heart
disease
Perinatal
conditions
Perinatal
conditions
Ischemic heart
disease
Unipolar
depressive
disorders
Cerebrovascular
diseases
Unipolar
depressive
disorders
Traffic
accidents
Homicide and
violence
Unipolar
depressive
disorders
Ischemic heart
disease
Self-inflicted
injuries
Lower
respiratory
infections
Ischemic heart
disease
Alzheimer's and
other dementias
Unipolar
depressive
disorders
Chronic
obstructive
pulmonary
disease
Diarrheal
diseases
Cerebrovascular
diseases
Tracheal and lung
cancer
GNI = gross national income per capita (US$); LE = life expectancy at birth (average male and female).
Sources: Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL, eds in Global Burden of Disease and Risk Factors, 2006 1
World Development Indicators, 2003
“The Bottom Billion”*


Over a billion people live on less than $1 a day
980 million people live in “trapped countries,” 58 nations
“clearly heading toward what might be described as a black
hole.”
 70 percent of the bottom billion live in Africa; most of
the rest in Central Asia
 Average life expectancy in the bottom billion is 50 years
 Around one in seven children dies before the age of 5
 Nearly three-quarters of the people in the bottom billion
have recently been through, or are still in the midst of, a
civil war
* The Bottom Billion: Why the Poorest Countries Are Failing and What Can
Be Done About It, by Paul Collier, Oxford University Press
1.
Disease Control Priorities Project
10 Best Buys for Health
Prevent neonatal mortality
2.
Ensure healthier mothers and children
3.
Promote good nutrition
4.
Reduce cardiovascular disease deaths
5.
Stop the AIDS pandemic
Disease Control Priorities Project
10 Best Buys for Health (2)
6.
Stop the spread of tuberculosis
7.
Control malaria
8.
Combat tobacco use
9.
Reduce fatal and disabling injuries
10.
Ensure equal access to high-quality care
Research Funding Perspectives

Demographic and disease trends
 Thinking
research needs

National Institutes of Health (NIH)

Fogarty International Center, NIH, programs
Research Needs: Disease Burden that Can or Cannot
be Averted with Existing Interventions
Disease Burden:
100%
Not Avertable
Already averted Avertable
Research Needs:
Biomedical research to
identify new and
improved interventions
Increase effectiveness
or reduce costs of
existing interventions
coverage
Broader implementation of
cost-effective
interventions;
identify obstacles to
expansion of coverage
Research and Development Categories and Results
for Implementation
New basic understanding
• Fundamental research
• Epidemiology, risk factors, disease modeling
New and improved tools
• Drugs
• Vaccines
• Diagnostics
• Devices
• Vector control
• Environmental modification
• Behavioral, social, and economic change
Research and Development Categories and Results
for Implementation
New and improved intervention methods
• Treatment algorithms and guidelines
• Intervention packaging
• Priority setting: costing and cost-effectiveness studies
• Delivery: health systems and health services
• New and improved policy instruments
NIH: Medical and Behavioral Research for
the World
“Science in pursuit of fundamental
knowledge about the nature and
behavior of living systems
and the application of that
knowledge to extend healthy life
and reduce the burdens of illness
and disability.”
...

Has research laboratories and recruits outstanding scientists

Institutes/Centers created in response to public health needs

Trainees join NIH and become leaders in US and world

117 grantees or trainees are Nobel Laureates (as of 2005)
National Institutes of Health
Office of the Director
National Institute
on Aging
National Institute
on Alcohol Abuse
and Alcoholism
National Institute
of Allergy and
Infectious Diseases
National Institute
of Arthritis and
Musculoskeletal
and Skin Diseases
National Cancer
Institute
National Institute
of Child Health
and Human
Development
National Institute on
Deafness and Other
Communication
Disorders
National Institute
of Dental and
Craniofacial
Research
National Institute
of Diabetes and
Digestive and
Kidney Diseases
National Institute
on Drug Abuse
National Institute
of Environmental
Health Sciences
National Eye
Institute
National Institute
of General
Medical Sciences
National Heart,
Lung, and Blood
Institute
National Human
Genome Research
Institute
National Institute
of Mental Health
National Institute
of Neurological
Disorders and
Stroke
National Institute
of Nursing Research
National Institute of
Biomedical Imaging
and Bioengineering
National Center
for Complementary
and Alternative
Medicine
Fogarty
International
Center
National Center
for Research
Resources
National Library
of Medicine
National Center on
Minority Health and
Health Disparities
Clinical Center
Center for
Information
Technology
Center for
Scientific Review
U.S. Balanced National Biomedical Research
Portfolio, FY2008
Clinical
Research
Translational
Research
Basic Research
NIH – $29 B
Clinical Research
Translational
Research
Basic
Research
Private Sector – $59 B
People: Countries Sending the Most Visiting Scientists to NIH
Fiscal Year
Average Number of
Scientists=3,800/yr
Why now?
New Frontiers in Science
Accelerating Discovery
Genomics, proteomics,
metabolomics…
Nanoscience
http://www.nlm.nih.gov/
International Resource
 Free full-text archive
 315 journals*
 985,000 items*
 Voluntary submissions
- May 2, 2005
Molecular biology
Clinical trials networks
Visit NIH Databases at:
http://www.ncbi.nlm.nih.gov/
Imaging & biomarker
advances
Information &
communications
technology
“The speed of biomedical
advance is accelerating –
like Moore’s law “
Ray Kurzweil
*As of 2/13/07
PubMed Hits — June, 2006
Germany
U.K.
Hits/country
8.1 M
14.0 M
8.8 M
6,068
6.0 M
Portugal
1.1 M
6.5 M
869,520
2.1 M
21,485
8,597
18,695
293 Million Hits in June, 2006
59,023
3,930
17,079
41,048
72,558
1.1 M Jordan
82,898
268,900 Saudi Arabia
246,935
MedlinePlus Page Views
December 2005
Research and Research
Training
• ~$50 million in grant
awards
• 2/3 research training,
1/3 research
• Awards range $10,000 –
• $1 million
• Low/middle income
countries
• Research capacity
development
http://www.fic.nih.gov/programs/index.htm
Extramural Training Grants
• Institutional training grant to U.S. universities/research institutions
in response to a specific request for applications (RFA)
• Awardees are current NIH grant recipients with demonstrated
research collaboration with foreign research institutions
• Purpose – support training for research-capacity building for
scientists from developing nations
http://www.fic.nih.gov/programs/index.htm
FIC Training Capacity Building: 14 Programs
 AIDS International Training and Research Program (AITRP)
 International Bioethics Education and Career Development Award
 International Clinical, Operational and Health Services Research
Training Award for HIV/AIDS and Tuberculosis (ICOHRTA AIDS/TB)
 ICOHRTA Non-communicable Diseases
 ICOHRTA Malaria
 Global Infectious Diseases Research Training Program Award
(including TB and Malaria) (GID)
 International Training and Research in Population and Health
 International Training and Research in Environmental and
Occupational Health
 Fogarty International Collaborative Trauma and Injury Research
Training (ICTIRT)
http://www.fic.nih.gov/programs/index.htm
FIC Training Capacity Building: 14 Programs
 Informatics Training for Global Health
 Framework Programs for Global Health
 The NIH Pathway to Independence (PI) Award (K99/R00)
 Fogarty International Clinical Research Scholars Resource and
Support Center (FICRS) (formally known as the FIC/Ellison Program)
 International Scientist Research Development Award (IRSDA)
http://www.fic.nih.gov/programs/index.htm
Research Grants – 8 Programs
• 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
http://www.fic.nih.gov/programs/index.htm
Fogarty International Center Program Characteristics
•
•
•
•
•
Systematic approach
Long-term commitment
Response to local priorities
Long-term mentoring
Mutual reinforcement of
investments in
training and research
Fogarty International Center
Major Research and
Training Sites

Address health needs of
developing countries with
research support

Build research capacity in
developing countries- individual
and institutional -through
research training
• Institutional partnerships
• Advanced In-country research
training opportunities
•
•
•
•
Empowerment/mutual respect
Networking
Flexibility
Leverage
AITRP
AIDS International Training and Research Program
First and oldest research training program at FIC and the model
for subsequent research training programs

Builds institutional capacity

Develops senior leaders
Authored 25% of HIV/AIDS
papers in conferences

Johns Hopkins AITRP program: Nurse training
session at Sassoon General Hospital , Pune, India.
Jeanne McDermott, Program Officer, FIC
[email protected]
International Cooperative Biodiversity Groups
Drug
Discovery
Scientific and
Economic
Development
Bioinventory and
Biodiversity Conservation
ICBG Accomplishments:
Science
 275+ novel bioactive compounds discovered
 20 compounds for malaria, leishmaniasis,
trypanosomiasis, tuberculosis, HIV, bacteria, cancer
 Found new species of plants, fungi and insects
 Publications in chemistry, biodiversity and policy
Madagascar
Kazakhstan
Vietnam and Laos
Tajikistan
Panama
Uzbekistan
Costa Rica
Papua New Guinea
Kyrgyzstan
Fiji
Josh Rosenthal, Program Officer, FIC
Flora Katz, Program Officer, FIC
[email protected]
[email protected]
ICBG Accomplishments:
Conservation
 Initiate/strengthen 12 biodiversity reserves
 New/enhanced databases on biodiversity distribution
 Leveraged investments from 50 companies,
foundations, universities and governments
 New models of intellectual property rights and benefitsharing
Global Infectious Disease
Research Training Program
Research training (laboratory,
clinical, epidemiological or social
science).

Ecology of Infectious Diseases
Research Program
 Past 30 years, changes in

Relevant to developing countries.
biodiversity coincided with the
emergence and re-emergence of
infectious diseases worldwide

35 programs in 25 countries
 8 projects, in 7th year.
Barbara Sina, Program Officer, FIC
[email protected]
Josh Rosenthal, Program Officer, FIC
[email protected]
Fogarty International Center Goals

Train the next generation of medical researchers,
both US and foreign, in global health

Build/strengthen centers of research excellence
abroad through collaborations and partnerships

Strengthen relations through health diplomacy

Reduce health disparities and inequalities

Increase America’s involvement in global health

Provide scientific leadership in global health
Linking within a
grant: Fogarty
Collaborative Small
Grants (FIRCAs)
Science for Peace
2 FIRCAs: The Genetics of Hearing Loss
Mary-Claire King- University of Washington -Seattle
Moien Kanaan – Bethlehem Univ., Palestine
Karen Avraham- Tel Aviv Univ., Israel
General Tips on Grantsmanship




Read the solicitation very carefully
Call program officer to clarify eligibility, etc.
Get copies of successful relevant grants from
colleagues to model
Write for the peer reviewers, not for yourself
The greatest risk in science
is to stop taking risks!
E. Zerhouni, 2007
Director, NIH
http://artfiles.art.com/images/-/Null/Cliff-Jump-Note-Card-C11763337.jpeg
Advocates for Global Health
Fogarty Ellison Scholars, 2006
24 “pairs” of trainees going to 16 medical centers in the developing world
Global Burden of Disease (DALYS)
1990
2020
Lower Respiratory Infection
1
Ischaemic heart disease
Diarrhoeal Disease
2
Depression
Perinatal
3
Road Traffic Accidents
Depression
4
Cerebrovascular
Ischaemic Heart Disease
5
COPD
Cerebrovascular
6
Lower Respiratory Infection
Tuberculosis
7
Tuberculosis
Measles
8
War
Road Traffic Accidents
9
Diarrhoeal Disease
Congenital Diseases
10
HIV
Malaria
11
Perinatal Disease
COPD
12
Violence
Falls
13
Congenital
Iron-deficiency anemia
14
Self-inflicted injury
Protein calorie malnutrition
15
Bronchial and Lung Cancer
Pharmaceutical Research: Priority Areas, WHO (2004)
Priority
Condition
Priority Condition
1
Infections/resistance
9
Neglected diseases*
2
Pandemic influenza
10
Malaria
3
Cardiovascular diseases
11
Alzheimer’s
4
Diabetes (1 and 2)
12
Osteoarthritis
5
Cancer
13
COPD
6
Acute stroke
14
Alcohol disorders
7
HIV/AIDS
15
Depression
8
Tuberculosis
16
Postpartum hemorrhage
*trypanasomiasis, Buruli ulcer, leishmaniasis, Chagas disease
Epidemiological, Demographic, and Political Transitions
• Shift from acute to chronic diseases
• Aging populations
• Health disparities
• Emerging and re-emerging diseases
• Behavioral and psychological diseases
• Biodefense
Mal Alimentation (“bad food”) associated with
Economic Development, Longevity, Sedentary Society
'''BK Stacker'''
Serving size
Source: http://en.wikipedia.org/wiki/BK_Stacker
Photo credit: Mychal Stanley
1 sandwich
311g
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.
GLOBAL EXAMPLES OF EMERGING AND REEMERGING INFECTIOUS DISEASES (A.S. FAUCI)
GLOBAL EXAMPLES OF ENDURING
ENVIRONMENTAL DISASTERS
GLOBAL EXAMPLES OF PEDIATRIC AND
ADULT CANCERS
GLOBAL EXAMPLES OF GENETIC DISEASES
AND DISORDERS
National Institutes of Health Main Campus
Bethesda, Maryland, U.S.A.
[email protected]