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 Bio. Vision. Alexandria 2008 Conference Alexandria, Egypt April 11, 2008
Research Funding Perspectives l Demographic and disease trends l Thinking research needs l National Institutes of Health (NIH) l Fogarty International Center, NIH, programs
Research Funding Perspectives l Demographic and disease trends l Thinking research needs l National Institutes of Health (NIH) l Fogarty International Center, NIH, programs
Disease Control Priorities Project 2006 Publications www. dcp 2. org Presented at Bio. Vision. Alexandria, 2006
Disease Control Priorities Project (DCPP) Life Expectancy, 1550 -2050 Source: Disease Control Priorities Project, 2006 (http: //www. ncbi. nlm. nih. gov/books/bookres. fcgi/dcp 2/ch 1. 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 Sub. Saharan Africa (GNI: $460) LE: 46 East Asia and the Pacific (GNI: $900) LE: 69 Europe and Central Asia (GNI: $1, 970) LE: 69 Middle East and North Africa (GNI: $2, 200) LE: 68 Latin America and the Caribbean (GNI: $3, 580) LE: 71 High–income countries (GNI: $26, 500) LE: 78 Ischemic heart disease Perinatal conditions Ischemic heart disease Unipolar depressive disorders Cerebrovascular diseases 1 Perinatal conditions HIV/AIDS Cerebrovascular diseases Ischemic heart disease 2 Lower respiratory infections Malaria Perinatal conditions Cerebrovascular diseases 3 Ischemic heart disease Lower respiratory infections Chronic obstructive pulmonary disease Unipolar depressive disorders Traffic accidents Homicide and violence Unipolar depressive disorders 4 Diarrheal diseases Ischemic heart disease Self-inflicted injuries Lower respiratory infections Ischemic heart disease Alzheimer's and other dementias 5 Unipolar depressive disorders Perinatal conditions Unipolar depressive disorders Chronic obstructive pulmonary disease Diarrheal diseases Cerebrovascular Tracheal and lung diseases cancer GNI = gross national income per capita (US$); 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”* n n 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. ” n 70 percent of the bottom billion live in Africa; most of the rest in Central Asia n Average life expectancy in the bottom billion is 50 years n Around one in seven children dies before the age of 5 n 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 l Demographic and disease trends l Thinking research needs l National Institutes of Health (NIH) l 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 coverage Research Needs: Biomedical research to identify new and improved interventions Increase effectiveness or reduce costs of existing interventions 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. ” . . . n Has research laboratories and recruits outstanding scientists n Institutes/Centers created in response to public health needs n Trainees join NIH and become leaders in US and world n 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 for Information Technology Center for Scientific Review
U. S. Balanced National Biomedical Research Portfolio, FY 2008 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 ØGenomics, proteomics, metabolomics… ØNanoscience ØMolecular biology ØClinical trials networks http: //www. nlm. nih. gov/ International Resource § Free full-text archive § 315 journals* § 985, 000 items* § Voluntary submissions - May 2, 2005 Visit NIH Databases at: http: //www. ncbi. nlm. nih. gov/ ØImaging & biomarker advances ØInformation & communications technology “The speed of biomedical advance is accelerating – like Moore’s law “ Ray Kurzweil *As of 2/13/07
Pub. Med 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
Medline. Plus 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 (K 99/R 00) § 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 n Address health needs of developing countries with research support n Build research capacity in developing countries- individual and institutional -through research training • • Institutional partnerships • • Empowerment/mutual respect Advanced In-country research training opportunities 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 l Builds institutional capacity l Develops senior leaders Authored 25% of HIV/AIDS papers in conferences l Johns Hopkins AITRP program: Nurse training session at Sassoon General Hospital , Pune, India. Jeanne Mc. Dermott, Program Officer, FIC mcdermoj@mail. nih. gov
International Cooperative Biodiversity Groups Drug Discovery Scientific and Economic Development Bioinventory and Biodiversity Conservation
ICBG Accomplishments: Science § § 275+ novel bioactive compounds discovered § § Found new species of plants, fungi and insects 20 compounds for malaria, leishmaniasis, trypanosomiasis, tuberculosis, HIV, bacteria, cancer 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 rosenthj@mail. nih. gov katzf@mail. nih. gov
ICBG Accomplishments: Conservation § § § Initiate/strengthen 12 biodiversity reserves § New models of intellectual property rights and benefitsharing New/enhanced databases on biodiversity distribution Leveraged investments from 50 companies, foundations, universities and governments
Global Infectious Disease Research Training Program n Research training (laboratory, clinical, epidemiological or social science). n Relevant to developing countries. n 35 programs in 25 countries Barbara Sina, Program Officer, FIC sinab@mail. nih. gov Ecology of Infectious Diseases Research Program § Past 30 years, changes in biodiversity coincided with the emergence and re-emergence of infectious diseases worldwide § 8 projects, in 7 th year. Josh Rosenthal, Program Officer, FIC rosenthj@ficod. fic. nih. gov
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 n Call program officer to clarify eligibility, etc. n Get copies of successful relevant grants from colleagues to model n Write for the peer reviewers, not for yourself n 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-C 11763337. 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 1 Condition Infections/resistance 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 Priority Condition 9 Neglected diseases* *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 1 sandwich 311 g Energy 1000 cal Energy from fat 620 cal Total fat 68 g Saturated fat 30 g Cholesterol 240 mg Sodium 1800 mg Dietary fiber Sugars 6 g Protein 62 g Source www. bk. com Notes Source: http: //en. wikipedia. org/wiki/BK_Stacker Photo credit: Mychal Stanley 1 g 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. jbreman@nih. gov
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