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Testimony on the Fogarty International Center's FY 1998 Budget by Dr. Philip E. Schambra
Director, John E. Fogarty International Center for Advanced Study of the Health Sciences
National Institutes of Health
Accompanied by
Ms. Stephanie J. Bursenos, Deputy Director, FIC
Mr. Richard Miller, Executive Officer, FIC
Dr. Harold Varmus, Director, NIH
Mr. Dennis P. Williams, Deputy Assistant Secretary, Budget, DHHS

U.S. Department of Health and Human Services

Before the House Appropriations Committee, Subcommittee on Labor, Health and Human Services, Education and Related Agencies
March 5, 1997

Mr. Chairman, it is my privilege to present the programs and accomplishments of the Fogarty International Center (FIC). Our namesake, John E. Fogarty, who served as Chairman of this subcommittee, is one of a continuing lineage of Congressional Representatives who have enabled NIH to become an international leader, not only in the quality of its research, but through cooperation with over 100 nations.

FIC was established to improve health through international scientific cooperation. As we look toward a new century, health concerns are increasingly global in scope. Unexpected diseases have surfaced due to altered patterns of land use, the adaptability of disease pathogens, and other factors. With the ease and frequency of international travel, disease outbreaks in foreign countries can rapidly cross U.S. borders. This includes infectious diseases such as the Ebola virus, new variants of the AIDS virus, and dengue fever. Pollutants in the atmosphere, water, and food chain pose equally insidious risks, contributing to a host of chronic diseases and developmental disorders. The persistence of population growth in resource-poor nations threatens to undermine health gains by impeding economic growth. It is estimated that in the next 25 years, nearly three billion people will be added to the world's population. Ninety-five percent of this growth will occur in developing countries, where high birth rates already force subsistence farmers onto marginal land, into crowded urban areas, or across national borders. Such global demographic changes will lead to the emergence of new infectious diseases and increased human exposure to pollutants.

Biomedical research is the foremost means of reversing these disturbing health trends through new medical technologies and prevention strategies. Through prevention research, it is conceivable that the developing world may be spared the burden of disability and death from diabetes, coronary heart disease, and hypertension that has plagued industrialized, urban societies. But these challenges cannot be met through research that is confined within our borders. What is urgently required are international partnerships that enable American scientists to train foreign colleagues and to work cooperatively in affected regions of the world. This is how the United States helped to eradicate smallpox globally, and virtually eliminate polio in this hemisphere. Ultimately, such cooperation will become the most effective armament against the new epidemics of infectious and chronic disease.

FIC builds these partnerships through research training programs, small grants, individual fellowships and institutional alliances. Technical skills and knowledge are shared with scientists worldwide in such fields as epidemiology, immunology, microbiology, endocrinology, cell and molecular biology, toxicology, biochemistry and biostatistics. Cooperative studies are supported in regions of the world that, due to disease burdens or environmental conditions, provide unique opportunities to devise methods of treatment and prevention. For example, the development of certain vaccines may depend on international field trials. These include vaccines for HIV\AIDS, respiratory infections caused by pneumococcus, and diarrheal diseases caused by shigella and cholera.

FIC's international partnerships are planned and conducted in cooperation with our sister institutes at NIH. In addition, FIC undertakes concerted efforts to bring new resources and scientific perspectives to global health through cooperation with other agencies of the Public Health Service and Federal Government. Almost sixty percent of the funds managed by FIC (including AIDS funding sanctioned by the OAR) come from other NIH or Federal components, who view FIC as a means of advancing their international goals. These intra- and interagency alliances also reduce administrative costs and streamline management requirements.

The model for FIC's global health efforts is its AIDS International Training and Research Program, established by Congress in 1988 to provide training for scientists and health professionals from developing countries where HIV is a critical health concern. Since its inception, over 1000 scientists from over 80 countries have received training in the United States and now assist the U.S. in international prevention efforts. This past year, the program documented a substantial decrease in the prevalence of HIV in the population of one foreign country as a result of a systematic prevention strategy. Our long-range objective is to create these same partnerships to meet the challenge of emerging infectious diseases, environmental health and population growth. This would demonstrate a compelling leadership role for the United States in international health. The geopolitical, as well as scientific benefits of these linkages are significant. Many FIC trainees represent the future scientific leadership of their countries.

During the past Fiscal Year, FIC launched the International Research and Training Program on New and Emerging Infectious Diseases. The purpose is to support cooperative research and training in regions of the world that are the potential origin of new epidemics, employing new molecular and analytic tools in their study. New knowledge is needed to develop a global research surveillance system capable of detecting and containing future epidemics. The program represents a partnership with the National Institute of Allergy and Infectious Diseases and The Centers for Disease Control and Prevention (CDC) in support of a Presidential Decision Directive and recommendations of the President's National Science and Technology Council. The useful role of this program already has been demonstrated in the case of the deadly Ebola virus. In early 1996, a scientist from Gabon received research training on this infectious agent at Yale University. Upon return to Gabon, he traced the origin of an Ebola-infected patient to a lumber camp. Because of his special training, he was able to perform the required laboratory studies in collaboration with CDC. As a consequence, Gabon was able to confirm the Ebola outbreak, take appropriate treatment and prevention measures, and undertake a research program to identify the natural history of the virus.

This new program builds on current research conducted under the Fogarty International Research Collaborative Award (FIRCA), a small supplemental grant to NIH-supported investigators to increase scientific cooperation in this hemisphere and with the new democracies of Eastern Europe and the former Soviet Union. Since its initiation by Congress in the wake of the fall of communism, the FIRCA has supported 64 projects with the former Soviet Union and 45 projects with Latin America in scientific areas of mutual priority. Under the FIRCA, scientists at the Academy of Medical Sciences in Moscow are collaborating with the New England Medical Center to determine the extent of Lyme disease in Russia and the precise identification of the specific microbe isolated from Russian patients. Such information is needed as work progresses on the development of a vaccine that can be used worldwide. Collaborative research between scientists at the University of Oklahoma and the Russian Academy of Sciences in St. Petersburg are identifying the distinguishing genetic characteristics of Group A streptococci, commonly known as "flesh eating" bacteria. Because microbes are so readily transmitted across international borders, the Russian streptococci might be imported and cause disease in the United States. If this were to occur, knowledge about Russian streptococci would be key to diagnostic and treatment strategies.

The International Training and Research Program in Population and Health, now in its second year, supports research to improve reproductive and neonatal health care and demographic capabilities. The goal is to create a broad range of safe, reversible and acceptable contraceptive methods and to decrease maternal mortality and morbidity from infections, nutritional deficiencies, toxemia, high blood pressure and other conditions. The program was launched in partnership with the National Institute of Child Health and Human Development. The International Training and Research Program in Environmental and Occupational Health, also in its second year, enables the U.S. to work cooperatively with regions of the world with high levels of contaminants in the environment and workplace. With the application of new scientific methods, the effects of environmental agents on human health will be examined and interventions devised to reduce health risks. It is notable that the American public was alerted to the carcinogenic properties of agents such as dioxin through international studies. This program was launched in cooperation with the National Institute of Environmental Health Sciences and CDC's National Institute for Occupational Safety and Health.

The health consequences of environmental degradation also include the potential loss of valuable medicinal products derived from nature. For centuries, plants have been the source of medicines such as digitalis for heart disease and quinine for malaria. Yet only a small fraction of the world's biological wealth has been studied for potential therapeutic benefit. The International Cooperative Biodiversity Groups Program, supported and administered by FIC, is designed to discover new drugs from the earth's biological diversity. In addition, strategies are pursued to preserve natural ecosystems and promote economic growth through drug discovery and development. This pioneering program has influenced resource management policies in several participating countries, and has served as a case-study in international treaty discussions. In its first two years, over 3,000 species of plants and insects have been examined for their potential therapeutic properties. Bioactive samples are now being tested as candidate drugs against certain cancers and viral diseases, malaria and degenerative neurological disorders. The program is supported by several NIH components, the National Science Foundation, the U.S. Agency for International Development, and U.S. industries. It demonstrates the potential of pooling expertise and resources across the public and private sectors.

Mr. Chairman, the political basis for public investment in biomedical research emerged from our nation's critical needs during World War II. Today, the pursuit of health through research again is integral to our nation's security. Scientific solutions to global health threats require a coordinated global response. Dr. John Evans, a Canadian who served as chairman of the independent Commission on Health Research for Development, aptly remarks "that with increased awareness of global interdependence in health, self-interest should reinforce humanitarian concerns" in our efforts to improve global health. With the support of Congress, FIC will continue to advance this important mission through international cooperation.

Thank you Mr. Chairman. Our FY 1998 budget request is $16,755,000. I will be pleased to answer any questions.

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