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This NIH program is crucial to global health — and its future is in danger

Arthur Reingold, professor and head of epidemiology | March 29, 2017

Co-authored with Madhukar Pai, MD, a Canada Research Chair in Epidemiology and Global Health at McGill University in Montreal.

A little-noticed cut in President Trump’s proposed “budget blueprint to make American great again” would eliminate the Fogarty International Center, which is part of the National Institutes of Health. That would be a big mistake for the United States and the rest of the world.

The center, named after John E. Fogarty, a Republican representative from Rhode Island and longtime advocate for international health research, was created in 1968. Since then it has initiated and sustained research around the globe aimed at fighting polio, tuberculosis, AIDS and other infectious diseases, as well as focusing on global environmental health, bioethics, noncommunicable diseases and more. Through more than 400 research and training projects, the center has trained well over 5,000 scientists worldwide and involved more than 100 American universities. This is an incredible global footprint, by any metric.

doctorsWe have a strong allegiance to, and memories of, the Fogarty. One of us (Arthur Reingold) was a program director for the center. The other (Madhukar Pai) was a Fogarty-funded international scholar. We have seen its impact on entire countries, on individuals and on us.

Here’s one example of the center’s work to improve global health. In response to the growing HIV/AIDS pandemic in 1998, which was disproportionately affecting the world’s poorest countries, the Fogarty Center started the AIDS International Training and Research Program. It aimed to address the devastatingly inadequate research capacity of the developing countries that were worst hit by this rapidly growing epidemic, along with tuberculosis and other opportunistic infections.

Through a competitive process, the NIH initially awarded six grants to U.S. academic centers to work closely with academic and public health partners in the worst-affected countries. Their mission was to provide highly focused research training and build research capacity in those countries. Today there are dozens of such programs. They benefit academic institutions, researchers, foreign and domestic trainees, and patients in many countries. The AIDS International Training and Research Program has provided significant research training to more than 2,000 individuals from more than 100 countries.

The training provided by these programs has supported many of the pivotal studies of HIV/AIDS prevention, control, and treatment strategies that have since become the cornerstone of highly successful interventions that have helped stem the tide of the global pandemics of HIV/AIDS, tuberculosis, and related conditions. Fogarty-funded research provided the underpinning to the highly successful US President’s Emergency Plan for AIDS Relief (PEPFAR) program initiated by President George W. Bush.

The result has been the prevention of countless HIV infections and HIV/AIDS-related deaths in dozens of countries around the world, as well as the training of thousands of health researchers and the strengthening of scores of foreign and US academic institutions.

Based on this model, the Fogarty International Center initiated equally successful collaborative research training initiatives focused on emerging infectious diseases, environmental and occupational illnesses, reproductive health, and noncommunicable diseases, among others.

I (Arthur Reingold) had the extraordinary good fortune to have served as the director of a Fogarty-funded program at the University of California, Berkeley. It worked in close partnership with the University of California, San Francisco; the health departments of the state of California and the city and county of San Francisco; and numerous foreign academic institutions.

For almost 30 years, our program trained hundreds of gifted physicians, nurses, pharmacists, dentists, and biomedical researchers from countries as diverse as Brazil, Peru, China, India, Vietnam, Thailand, Uganda, Zimbabwe, Ivory Coast, Kenya, the Democratic Republic of Congo and Sudan. More than 95 percent of those who came to the U.S. for training returned home afterward and either continued to work in the same region or worked for international health organizations such as the World Health Organization, UNICEF, or the U.S. Centers for Disease Control and Prevention.

Trainees from the Berkeley program have gone on to become directors of the national HIV/AIDS programs in their respective countries; senior officials at the Joint United Nations Program on HIV/AIDS (UNAIDS) and the Pan American Health Organization; influential researchers at the CDC; the inaugural director of the newly created Africa CDC; and numerous deans and professors at leading academic institutions around the world.

The Fogarty Center also benefitted U.S. scientists and institutions. It taught numerous American trainees from across the spectrum of biomedical research how to plan, carry out, and analyze the results of important global health research projects, and to do so in collaboration with foreign investigators. Many of them have become part of the next generation of global health researchers at leading US academic institutions, and have put their training to vitally important use as responders to outbreaks of Ebola, SARS, influenza, Zika and other infectious diseases that have threatened the populations of numerous countries.

As an aspiring epidemiology trainee from India, I (Madhukar Pai) was fortunate to receive a fellowship from the AIDS International Training and Research Program in 2000 that let me pursue a doctoral degree at UC Berkeley School of Public Health and a postdoctoral fellowship at UC Berkeley and UCSF. That opportunity was the single biggest break I ever had in my career. It gave me the chance to learn from some of the best researchers in the world, collaborate with fellow trainees from several countries, conduct meaningful research in India (which I am still doing), publish several studies, and help build research capacity in India, South Africa and other countries.

Today, I am a full professor at McGill University, holding a Canada Research Chair. I direct Global Health Programs at McGill and act as an associate director of the McGill’s International TB Center. I also have the privilege of acting as an advisor to several leading nonprofit agencies, including the Bill & Melinda Gates Foundation, the WHO, and several organizations focused on tuberculosis. The amazing opportunities I had as a Fogarty trainee now allow me to pay it forward by training the next generation of global health leaders.

Ours are just two stories of many that highlight the importance of the Fogarty International Center in improving health research, and public health, around the world. We believe that the center is a national treasure, as well as an invaluable and irreplaceable global health resource. It is a splendid example of how the generosity of the American people can produce outstanding researchers and scholars and build valuable research capacity for countries to deal with major threats to health.

Eliminating the center will not make America great again. On the contrary, it will greatly diminish the tremendous contributions to global health made by America and significantly undermine the global health field. We urge the Congress to recognize this fact and do everything possible to protect the Fogarty Center and the NIH.

Arthur L. Reingold, MD, is professor and division head of the Department of Epidemiology and Distinguished Chair Emeritus in Global Public Health and Infectious Diseases at the University of California, Berkeley. Madhukar Pai, MD, is a Canada Research Chair in Epidemiology and Global Health at McGill University in Montreal.

Crossposted from STAT 

Comments to “This NIH program is crucial to global health — and its future is in danger

  1. Totally agree here with you Dave. Trump is clever and his programs and policies are against humanity. No nation becomes successful without the unity of its local people and he tried to follow the policy of divide and rule.

  2. Recent developments, such as the Ebola and Zika outbreaks, to which we can add, major environmental issues of the moment, are clear evidences, if needed, of the relevance of programs of this kind, based on the Fogarty programs’ ability to easily generate, research cooperation, dissemination of research capacity and rapid responses to all of the aforementioned calamities. Through this program, my country (Cote d’Ivoire) has been able, to secure a consistent pool of public health experts at various strategic levels and in a variety of programmatic domains (HIV, polio, surveillance, etc.), within the MoH, United Nation system agencies (UNICEF – UNAIDS, WHO , UNFPA) and CDC. As an alumni of the this program (class of 2014), I can still testify the deep and definitive change, this program has generated on me and how grateful, I will be for the rest of my live to the American people for this useful generosity. I call it useful generosity because of the smartness and the efficiency of the investment i.e. providing supports to weak and resources – limited countries on health issues while at the same time, guaranteeing the US interests (good reputation and preventing US citizen from major global health threats). I sincerely hope the decision-makers (congressmen) will pay attention to this nice and touching paper of Art and Madhukar.

  3. Trump is such a polished, experienced liar that it is difficult to ascertain whether he really means what he says and proposes versus what he routinely tosses out in his “Art of the Deal” negotiating strategy to threaten his adversaries so that later he can then appear to yield quid pro quo.
    All his proposed cuts in humanities programs, NIH programs, etc may simply be ploys he is invoking in exchange for the huge budget increases he wants for his special favorites programs.
    But keep in mind that the Democrats lost HUGE across the country in gubernatorial races, state assembly races, and the Congress…. losers are often unpopular (“nobody loves you when you’re down” as they sing in a thousand country songs)….and losers usually can’t be choosers … sucks being a loser.

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