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
85 High Income Countries
Europe & Central Asia
75 Middle East & North Africa
Latin America & Caribbean
65 East Asia & Pacific
South Asia
55 Sub-Saharan Africa
45
35
1950- 1960- 1970- 1980- 1990- 2000-
1955 1965 1975 1985 1995 2005
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 Sub-Saharan East Asia and Europe and Middle East Latin America High–income
(GNI: $450) Africa the Pacific Central Asia and North and the countries
LE:63 (GNI: $460) (GNI: $900) (GNI: $1,970) Africa Caribbean (GNI: $26,500)
LE:46 LE:69 LE:69 (GNI: (GNI: $3,580) LE:78
$2,200) LE:71
LE:68
1 Perinatal HIV/AIDS Cerebrovascular Ischemic heart Ischemic Perinatal Ischemic heart
conditions diseases disease heart disease conditions disease
2 Lower Malaria Perinatal Cerebrovascular Perinatal Unipolar Cerebrovascular
respiratory conditions diseases conditions depressive diseases
infections disorders
3 Ischemic heart Lower Chronic Unipolar Traffic Homicide and Unipolar depressive
disease respiratory obstructive depressive accidents violence disorders
infections pulmonary disorders
disease
4 Diarrheal Diarrheal Ischemic heart Self-inflicted Lower Ischemic heart Alzheimer's and
diseases diseases disease injuries respiratory disease other dementias
infections
5 Unipolar Perinatal Unipolar Chronic Diarrheal Cerebrovascular Tracheal and lung
depressive conditions depressive obstructive diseases diseases cancer
disorders disorders pulmonary
disease
GNI = gross national income per capita (US$); 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
Disease Control Priorities Project
10 Best Buys for Health
1. 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: Research Needs:
Biomedical research to
identify new and
100 Not Avertable
improved interventions
%
Increase effectiveness
Already averted Avertable 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)
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U.S. Balanced National Biomedical Research
Portfolio, FY2008
Clinical Clinical Research
Research
Translational Translational
Research Research
Basic
Research
Basic Research
NIH – $29 B Private Sector – $59 B
People: Countries Sending the Most Visiting Scientists to NIH
Fiscal Year Average Number of Scientists=3,800/yr
Why now? http://www.nlm.nih.gov/
New Frontiers in Science International Resource
Accelerating Discovery Free full-text archive
315 journals*
Genomics, proteomics, 985,000 items*
metabolomics… Voluntary submissions
Nanoscience - May 2, 2005
Molecular biology
Visit NIH Databases at:
Clinical trials networks 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
U.K. Germany
Hits/country
14.0 M 8.1 M
8.8 M
6,068
Portugal
6.0 M
1.1 M
6.5 M 869,520
2.1 M
17,079
21,485 41,048
8,597
72,558
18,695 59,023 1.1 M Jordan
82,898
293 Million Hits in June, 2006 3,930 268,900 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 • Institutional partnerships
• Advanced In-country research
• Long-term commitment training opportunities
• Response to local priorities
• Empowerment/mutual respect
• Networking
• Long-term mentoring • Flexibility
• Mutual reinforcement of • Leverage
investments in
Fogarty International Center
training and research
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
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
Scientific and
Drug Economic
Discovery 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 benefit-
sharing
Ecology of Infectious
Global Infectious Disease
Research Training Program
Diseases
Research Program
Research training (laboratory, Past 30 years, changes in
clinical, epidemiological or social
biodiversity coincided with the
science).
emergence and re-emergence of
Relevant to developing countries. infectious diseases worldwide
35 programs in 25 countries 8 projects, in 7th year.
Barbara Sina, Program Officer, FIC Josh Rosenthal, Program Officer, FIC
[email protected] [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 Science for Peace
grant: Fogarty
Collaborative Small
Grants (FIRCAs)
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
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 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
Source: http://en.wikipedia.org/wiki/BK_Stacker based on 2000
Photo credit: Mychal Stanley calorie diet.
GLOBAL EXAMPLES OF EMERGING AND RE-
EMERGING 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]
