Joel G. Breman, M.D., D.T.P.H

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Infectious Diseases Programs

and Perspectives of theFogarty International
Center, National Institutes of Health

• Joel G. Breman, M.D., D.T.P.H
• Program Director, International Training and
  Research Program in Emerging
  Infectious Diseases
• Deputy Director, Division of International
  Training and ResearchFogarty International
  Center
• National Institutes of HealthE-mail
  jbreman_at_nih.gov
• Web site www.nih.gov/fic

International Affairs Committee, IDSAJanuary 29,
2001
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The FIC Mission

• To promote and support scientific research and
  training internationally to reduce disparities in
  global health.

Fogarty InternationalCenter
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Causes of Death Differ with State of Development

• In the high-income countries, chronic
  non-communicable diseases are the major cause
  of death
• In the low-income countries, infectious diseases
  account for ¾ of the mortality in the under
  5-year-old group and up to half the mortality in
  adults
• As countries develop, there is a shift from
  communicable to non-communicable
  disease burdens

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National Institutes of HealthInternational
Research Expenditures 1994 to 1999
Direct Foreign Research Grants
100,000,000
90,000,000
and Contracts
80,000,000
Foreign Components of
70,000,000
60,000,000
Domestic Grants and Contracts
Amount
50,000,000
40,000,000
Training Grants
30,000,000
20,000,000
Visiting Program
10,000,000
-
1994
1995
1996
1997
1998
1999
Fiscal Year
7
FUTURE
NEW INITIATIVES
CURRENT PROGRAMS
FOUNDATION
PLATFORM MISSION
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Fogarty International Center Extramural Programs
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Fogarty International Center Program Initiatives
and Collaborating Partners Fiscal Year 2000
Funding
FIC
OD
FIC
Emerging Infectious Diseases 2.8 million
Environmental and Occupational Health 2.0
million
NIDCR
NIAID
CDC
NICHD
NCI
FIC
NIAID
AITRP 12.8 million
NIDA
NIMH
NIDCR
FIC
Medical Informatics .6 million
MIRT 2.7 million
NLM
NIAID
FIC
ORMH
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FIC Research Training Mechanisms

• Long-term training pre- and post-doctoral
  training in U.S. institutions (duration
  minimum 9 months)
• Short-term training focused workshops and
  technology transfer (duration several days to
  several weeks)
• Research performed preferentially
  in-country

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Where We Are Now Countries in FIC Infectious
Diseases Programs, 2000
Hungary
Lithuania
Russia
Latvia
Kazakhstan
Armenia
Czech Republic
Poland
Georgia
China
Ethiopia
Mali
Pakistan
Mexico
Haiti
Belize
India
Philippines
Guatemala
Kenya
Nicaragua
Ghana
New Guinea
Indonesia
Ecuador
Venezuela
Peru
Malawi
Brazil
Bolivia
Chile
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Sustainability in FIC Programs
Principles

• Commitment National Institutional
  Trainee
• Re-entry grants for trainees
• Diversified program themes
• Contribution of resources from all partners

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Sustainability in FIC Programs
Principles (continued)

• Sustained linkages
• Leveraged resources
• Dual appointments for faculty
• Connectivity via modern IT systems
• Centers of excellence in home countries
• Mutual benefits known to all

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Research, Training and Support Needs According
to Understanding of Diseases and Efficacy of
Interventions
High
High
Training
Efficacy of Control Methods
Research Needs
Low
Low
Some
High
Moderate
Research Support Needs
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Research, Training and Support Needs According
to Understanding of Diseases and Efficacy of
Interventions
High
High
Training
Efficacy of Control Methods
DengueMalaria HIV/AIDSTuberculosisEbola/Marburg
InfluenzaCancersAlzheimers
SmallpoxGuinea wormPoliomyelitisH. influenzae
type BMeaslesTetanus
Research Needs
Low
Low
Some
High
Moderate
Research Support Needs
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Global Health U.S. Self Interest

• The U.S. population is a mosaic of minority
  populations of origin in other countries (often
  with high disease burden). It is sometimes more
  feasible to identify risk factors in countries of
  origin
• Reducing disease transmission in endemic areas
  will reduce likelihood that U.S. travelers will
  acquire illness
• Global eradication of smallpox, polio, and
  potentially measles has benefits to the U.S.
  elimination of diseases and savings
  on vaccines

Fogarty InternationalCenter
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For More Information
E-mail jbreman_at_nih.gov
www.nih.gov/fic
www.nih.gov