Research%20and%20Training%20Opportunities%20in%20Global%20Health

1
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

2
Research Funding Perspectives

• Demographic and disease trends
• Thinking research needs
• National Institutes of Health (NIH)
• Fogarty International Center, NIH, programs

3
Research Funding Perspectives

• Demographic and disease trends
• Thinking research needs
• National Institutes of Health (NIH)
• Fogarty International Center, NIH, programs

4
Disease Control Priorities Project 2006
Publications www.dcp2.org
Presented at BioVisionAlexandria, 2006
5
Disease Control Priorities Project (DCPP)Life
Expectancy, 1550-2050
Source Disease Control Priorities Project, 2006
(http//www.ncbi.nlm.nih.gov/books/bookres.fcgi/dc
p2/ch1.pdf)
6
Leading causes of Disability-Adjusted Life Years
in Low/Middle-income and High-Income Countries,
by World Bank Region, 2001

• Highincome countries
• (GNI 26,500)
• LE78

• Latin America and the Caribbean
• (GNI 3,580)
• LE71

• Middle East and North Africa
• (GNI 2,200)
• LE68

• Europe and Central Asia
• (GNI 1,970)
• LE69

• East Asia and the Pacific
• (GNI 900)
• LE69

• Sub-Saharan Africa
• (GNI 460)
• LE46

• South Asia
• (GNI 450)
• LE63

Rank
Ischemic heart disease
Perinatal conditions
Ischemic heart disease
Ischemic heart disease
Cerebrovascular diseases
HIV/AIDS
Perinatal conditions
1

• Cerebrovascular
• diseases

Unipolar depressive disorders
Perinatal conditions
Cerebrovascular diseases
Perinatal conditions
Malaria
Lower respiratory infections
2
Unipolar depressive disorders
Homicide and violence
Traffic accidents
Unipolar depressive disorders
Chronic obstructive pulmonary disease
Lower respiratory infections
Ischemic heart disease
3
Alzheimer's and other dementias
Ischemic heart disease
Lower respiratory infections
Self-inflicted injuries
Ischemic heart disease
Diarrheal diseases
Diarrheal diseases
4
Tracheal and lung cancer
Cerebrovascular diseases
Diarrheal diseases
Chronic obstructive pulmonary disease
Unipolar depressive disorders
Perinatal conditions
Unipolar depressive disorders
5
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
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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
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Disease Control Priorities Project10 Best Buys
for Health

• Prevent neonatal mortality
• Ensure healthier mothers and children
• Promote good nutrition
• Reduce cardiovascular disease deaths
• Stop the AIDS pandemic

9
Disease Control Priorities Project10 Best Buys
for Health (2)

• Stop the spread of tuberculosis
• Control malaria
• Combat tobacco use
• Reduce fatal and disabling injuries
• Ensure equal access to high-quality care

10
Research Funding Perspectives

• Demographic and disease trends
• Thinking research needs
• National Institutes of Health (NIH)
• Fogarty International Center, NIH, programs

11
Research Needs Disease Burden that Can or Cannot
be Averted with Existing Interventions
Disease Burden
Research Needs
Biomedical research to identify new and improved
interventions
100
Not Avertable
Increase effectiveness or reduce costs of
existing interventions
Avertable
Already averted
coverage
Broader implementation of cost-effective
interventions identify obstacles to expansion
of coverage
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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

13
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

14
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)

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Fogarty International Center
16
U.S. Balanced National Biomedical Research
Portfolio, FY2008
17
People Countries Sending the Most Visiting
Scientists to NIH
Fiscal Year
Average Number of Scientists3,800/yr
18
Why now? New Frontiers in Science
Accelerating Discovery
http//www.nlm.nih.gov/International Resource

• Free full-text archive
• 315 journals
• 985,000 items
• Voluntary submissions
• May 2, 2005

• Genomics, proteomics, metabolomics
• Nanoscience
• Molecular biology
• Clinical trials networks
• Imaging biomarker advances
• Information communications technology
• The speed of biomedical advance is accelerating
  like Moores law
• Ray Kurzweil

Visit NIH Databases at http//www.ncbi.nlm.nih.go
v/
As of 2/13/07
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PubMed Hits June, 2006
Germany 8.1 M
U.K. 14.0 M
Hits/country
8.8 M
6,068
6.0 M
Portugal 1.1 M
6.5 M
869,520
2.1 M
17,079
41,048
21,485
8,597
72,558
59,023
18,695
1.1 M
Jordan 82,898
3,930
268,900
293 Million Hits in June, 2006
Saudi Arabia 246,935
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MedlinePlus Page ViewsDecember 2005
21

• 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
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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
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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
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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
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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)
• Intl 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
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Fogarty International Center Program
Characteristics

• Institutional partnerships
• Advanced In-country research training
  opportunities
• Empowerment/mutual respect
• Networking
• Flexibility
• Leverage

• 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

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AIDS International Training and Research Program
AITRP

• 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 mcdermoj_at_mail.nih.gov
28
International Cooperative Biodiversity Groups
Scientific and Economic Development
Drug Discovery
Bioinventory and Biodiversity Conservation
29
ICBG AccomplishmentsScience

• 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

• Kazakhstan
• Tajikistan
• Uzbekistan
• Papua New Guinea
• Fiji

Madagascar Vietnam and Laos Panama Costa
Rica Kyrgyzstan
Flora Katz, Program Officer, FIC katzf_at_mail.nih.go
v
Josh Rosenthal, Program Officer,
FIC rosenthj_at_mail.nih.gov
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ICBG AccomplishmentsConservation

• 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
  benefit-sharing

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ICBG Accomplishments Research Capacity and
Policy Development

• gt4000 people trained in drug discovery and
  biodiversity sciences (350 long term, 112 MS and
  PhDs, 65 foreign, 35 U.S.)
• Increased laboratory, museum and field research
  capacity in 21 countries
• Informed national policies on genetic resources
  in at least 12 countries and at the United
  Nations Convention on Biodiversity

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Global Infectious Disease
Ecology of Infectious Diseases
Research Training Program
Research Program

• Research training (laboratory, clinical,
  epidemiological or social science).
• Relevant to developing countries.
• 35 programs in 25 countries

• Past 30 years, changes in biodiversity coincided
  with the emergence and re-emergence of infectious
  diseases worldwide
• 8 projects, in 7th year.

Josh Rosenthal, Program Officer,
FIC rosenthj_at_ficod.fic.nih.gov
Barbara Sina, Program Officer, FIC
sinab_at_mail.nih.gov
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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 Americas involvement in global health
• Provide scientific leadership in global health

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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
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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-N
ote-Card-C11763337.jpeg
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Advocates for Global Health
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Fogarty Ellison Scholars, 2006
24 pairs of trainees going to 16 medical
centers in the developing world
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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
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Pharmaceutical Research Priority Areas, WHO
(2004)
Priority Condition
1 Infections/resistance
2 Pandemic influenza
3 Cardiovascular diseases
4 Diabetes (1 and 2)
5 Cancer
6 Acute stroke
7 HIV/AIDS
8 Tuberculosis
Priority Condition
9 Neglected diseases
10 Malaria
11 Alzheimers
12 Osteoarthritis
13 COPD
14 Alcohol disorders
15 Depression
16 Postpartum hemorrhage
trypanasomiasis, Buruli ulcer, leishmaniasis,
Chagas disease
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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

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Mal Alimentation (bad food) associated with
Economic Development, Longevity, Sedentary
Society
'''BK Stacker''' '''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.
Source http//en.wikipedia.org/wiki/BK_Stacker Ph
oto credit Mychal Stanley
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GLOBAL EXAMPLES OF EMERGING AND RE-EMERGING
INFECTIOUS DISEASES (A.S. FAUCI)
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GLOBAL EXAMPLES OF ENDURING ENVIRONMENTAL
DISASTERS
44
GLOBAL EXAMPLES OF PEDIATRIC AND ADULT CANCERS
45
GLOBAL EXAMPLES OF GENETIC DISEASES AND DISORDERS
46
National Institutes of Health Main
CampusBethesda, Maryland, U.S.A.
jbreman_at_nih.gov