Tropical Diseases Research in Panama:Tropical Diseases Research in Panama:Historical Perspectives and Current Historical Perspectives and Current

OpportunitiesOpportunities

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

Fogarty International CenterFogarty International Center

National Institutes of HealthNational Institutes of Health

Bethesda, Maryland, USABethesda, Maryland, USA

Workshop to Establish the Santiago Center Workshop to Establish the Santiago Center for Geographic Medicine and Emerging for Geographic Medicine and Emerging

Tropical DiseaseTropical Disease

Santiago, PanamaSantiago, Panama

6–7 December 20026–7 December 2002

40 Years of Tropical Medicine Research40 Years of Tropical Medicine Research

A History of the Gorgas Memorial Institute of A History of the Gorgas Memorial Institute of Tropical and Preventive Medicine, Inc. and Tropical and Preventive Medicine, Inc. and

the Gorgas Memorial Laboratorythe Gorgas Memorial Laboratory

Willard H. Wright, D.V.M., M.S., Ph.D.Willard H. Wright, D.V.M., M.S., Ph.D.

Washington, 1970Washington, 1970

Reese Press, Baltimore, MarylandReese Press, Baltimore, Maryland

The Gorgas Memorial Laboratory, 1928-1968 Six Epochs

1928 – 1934 (political will)1928 – 1934 (political will) Founded by Dr. Belisario Porras, President, Republic of PanamaFounded by Dr. Belisario Porras, President, Republic of Panama

- Land- Land- Building- Building- U.S. Congress support- U.S. Congress support

1934 – 1943 (scientific expertise)1934 – 1943 (scientific expertise) StaffingStaffing - Protozologist (C.M. Johnson)- Protozologist (C.M. Johnson)

- Helminthologist (A.O. Foster)- Helminthologist (A.O. Foster) - Entomologist (C.E. Rozeboom)- Entomologist (C.E. Rozeboom)

1943 – 1949 (scientific priorities)1943 – 1949 (scientific priorities) Insect repellents, insecticides Insect repellents, insecticides

- U.S. Army Corps of Engineers- U.S. Army Corps of Engineers

The Gorgas Memorial Laboratory, The Gorgas Memorial Laboratory, 1928-1968 (2)1928-1968 (2)

1949 – 1956 (public health priorities)1949 – 1956 (public health priorities) Yellow Fever (Santo Tomás, Hospital)Yellow Fever (Santo Tomás, Hospital) Yellow Fever Service of PanamaYellow Fever Service of Panama

1956 – 1960 (resource increase)1956 – 1960 (resource increase) $150,000 from U.S. Congress (tripled budget)$150,000 from U.S. Congress (tripled budget) NIAID grant, leishmanasisNIAID grant, leishmanasis

1960 – 1968 (resource increase)1960 – 1968 (resource increase) $500,000 from U.S. Congress for infrastructure$500,000 from U.S. Congress for infrastructure InsectaryInsectary Grants and giftsGrants and gifts

The Gorgas Memorial Laboratory, 1928-1968The Gorgas Memorial Laboratory, 1928-1968

Types of ResearchTypes of Research

Core activitiesCore activities

- Epidemiology- Epidemiology

- Treatment- Treatment

- Control- Control

- Laboratory work in support of field - Laboratory work in support of field activitiesactivities

The Gorgas Memorial Laboratory, 1928-1968The Gorgas Memorial Laboratory, 1928-1968Types of Research (2)Types of Research (2)

Major themesMajor themes

- Malaria- Malaria- Yellow fever- Yellow fever- Other arboviral infections- Other arboviral infections- Chagas disease- Chagas disease- Leishmaniasis- Leishmaniasis- Equine trypanasomiasis- Equine trypanasomiasis- Residual insecticides- Residual insecticides

The Gorgas Memorial Laboratory, 1928-1968The Gorgas Memorial Laboratory, 1928-1968

Types of Research (3)Types of Research (3)

- - Helminithic and protozoal Helminithic and protozoal infectionsinfections

- Diarrheal diseases- Diarrheal diseases

- Reservoir hosts- Reservoir hosts

- Immunology- Immunology

- Other: herpetology, insect genetics - Other: herpetology, insect genetics ((Drosophila)Drosophila)

Short- and Long-Term Research TrendsShort- and Long-Term Research Trends

Short-termShort-term- - Equine trypanosomiasis, 1930-1946 (H.S. Eakins), Equine trypanosomiasis, 1930-1946 (H.S. Eakins),

retirement; horses used lessretirement; horses used less- Equine helminthiasis, 1934-1939 (A.O. Foster)Equine helminthiasis, 1934-1939 (A.O. Foster)- Cattle trypanasomiasis, 1940-1943 (war priorities)Cattle trypanasomiasis, 1940-1943 (war priorities)- Intestinal helminths, 1930 (intermittent, E.C. Faust)Intestinal helminths, 1930 (intermittent, E.C. Faust)- Tropical climatology, 1941Tropical climatology, 1941- Tuberculosis, BCG vaccination, 1949-1951 (taken - Tuberculosis, BCG vaccination, 1949-1951 (taken

over by Servicioover by Servicio Cooperativo Interamericano de Salud Cooperativo Interamericano de Salud Publica)Publica)

Long Term ProjectsLong Term Projects

Malaria, 1929 (H.C. Clark, C.M. Malaria, 1929 (H.C. Clark, C.M. Johnson)Johnson)

Chagas disease, 1931 (C.M. Johnson)Chagas disease, 1931 (C.M. Johnson) Leishmaniasis, 1944 (M. Hertig, A. Leishmaniasis, 1944 (M. Hertig, A.

Herrer)Herrer) Insect taxonomy, 1929 (D.P. Curry)Insect taxonomy, 1929 (D.P. Curry) Santa Rosa Field Station, 1931 and Santa Rosa Field Station, 1931 and

Chagres River Villages (DDT use)Chagres River Villages (DDT use)

How Research Projects ChosenHow Research Projects Chosen

-Incidence, prevalence, epidemicsIncidence, prevalence, epidemics

-Available staffAvailable staff

-Outside scientific collaborationOutside scientific collaboration

-ResourcesResources

-SerendipitySerendipity

Major AchievementsMajor AchievementsMalaria, began in 1929Malaria, began in 1929

Drug treatmentDrug treatment- - Quinine studies, 1931Quinine studies, 1931- Atebrin/plasmochin, 1935- Atebrin/plasmochin, 1935- Quinine/plasmochin, 1935- Quinine/plasmochin, 1935- DDT house spraying, 1945 (continued to 1977)- DDT house spraying, 1945 (continued to 1977)- Chloroquine/paludrine weekly, 1947- Chloroquine/paludrine weekly, 1947

Parasite rates droppedParasite rates dropped 26.5 % 26.5 % 0.7 % (CQ) 0.7 % (CQ)

34.8 % 34.8 % 1.5% (P) 1.5% (P)- Pyrimethamine/primaquine + DDT, 1960- Pyrimethamine/primaquine + DDT, 1960 (La Repressa and Mendoza villages) eliminated (La Repressa and Mendoza villages) eliminated

disease after 2 months!disease after 2 months!Maintained 2 yearsMaintained 2 yearsBut 53 cases detected from 1962 - 1964But 53 cases detected from 1962 - 1964

Primate malariaPrimate malaria- P. brasilianum, - P. brasilianum, attempt transmission to human attempt transmission to human

volunteers, 1930volunteers, 1930- Immunity and - Immunity and P. falciparumP. falciparum, 1931, 1931- Human malaria to monkeys, 1966 - Human malaria to monkeys, 1966

Aotus trivirgatusAotus trivirgatus and and P. vivaxP. vivax, 1967, 1967AotusAotus (night monkey) (night monkey)AtelesAteles (spider monkey) (spider monkey)Saquinus Saquinus (marmoset)(marmoset) CebusCebus

Transmission with Transmission with Anopheles albimanusAnopheles albimanus DDT resistance detected after 8 years of use, late 1960sDDT resistance detected after 8 years of use, late 1960s

Malaria (con’t)Malaria (con’t)

American American Trypanasomiasis (T. cruzi)Trypanasomiasis (T. cruzi) Chagas Disease, began 1931Chagas Disease, began 1931

DiagnosisDiagnosis PrevalencePrevalence ManifestationsManifestations TreatmentTreatment EpidemiologyEpidemiology HostsHosts Vectors and ecologyVectors and ecology

3.8 % positive of 1,251 tested by CF test, 19633.8 % positive of 1,251 tested by CF test, 196340,000 cases, 196640,000 cases, 1966

Surveys, 1967Surveys, 1967 NumberNumber % Pos% Pos

Blood bankBlood bank 6,2536,253 2.02.0

OutpatientsOutpatients 1,2941,294 11.411.4

SurveysSurveys 399399 12.512.5

• Studies in Santo Studies in Santo TomTomáás s HospitalHospitalArrythmias (RBBB, LBBB, A/V block)Arrythmias (RBBB, LBBB, A/V block)Ventricular and atrial enlargementVentricular and atrial enlargementVentricular aneurysmsVentricular aneurysms

• TreatmentTreatment8 aminoquinolines8 aminoquinolines

Chagas Disease (2)Chagas Disease (2)

Parasitology and EcologyParasitology and Ecology- T.cruzi- T.cruzi found in 33 animal species; dogs, rats, found in 33 animal species; dogs, rats,

positivepositive- T. rangeli- T. rangeli found to cross-react found to cross-react

Entomology and EcologyEntomology and Ecology- Rhodnius pallescens- Rhodnius pallescens efficient, but efficient, but R. prolixusR. prolixus (not (not

native) could not be infected with local isolates.native) could not be infected with local isolates.- Other triatomes identified, but - Other triatomes identified, but R. pallescensR. pallescens found found

in native houses of 3,203. 32.1% infected with in native houses of 3,203. 32.1% infected with T. T. cruzicruzi and 4.1% - 8.1% with and 4.1% - 8.1% with T. rangeliT. rangeli (non- (non-pathogenic, 1960s)pathogenic, 1960s)

Chagas Disease (3)Chagas Disease (3)

Leishmaniasis, 1944Leishmaniasis, 1944

EpidemiologyEpidemiology TreatmentTreatment Vectors and ecologyVectors and ecology FindingsFindings

- - Forest disease, disappears when forests clearedForest disease, disappears when forests cleared- - Pyrimethamine, 90% curePyrimethamine, 90% cure- - Geographic strain differencesGeographic strain differences- - Natural infection in wild caught Natural infection in wild caught Phlebotomines, Phlebotomines,

infection rate 8.1%infection rate 8.1%- - Animal model studies; tried rats, mice, hamsters, Animal model studies; tried rats, mice, hamsters,

kinkajou, olingo, porcupine, marmosetkinkajou, olingo, porcupine, marmosetSucceeded with spiny ratSucceeded with spiny rat

Helminths, 1930Helminths, 1930

Ascaris lumbricoidesAscaris lumbricoides, “common”, 80% prevalence, “common”, 80% prevalence Necator americanusNecator americanus, “common”, 80% prevalence, “common”, 80% prevalence Trichuris trichiuraTrichuris trichiura, 1.0% - 21.0%, pos., 1.0% - 21.0%, pos. Strongyloides stercoralisStrongyloides stercoralis, 20% pos. of 1,663 in Santa , 20% pos. of 1,663 in Santa

TomTomááss Hospital with 10.5% of those positive having Hospital with 10.5% of those positive having symptomssymptoms

Mansonella ozzardiMansonella ozzardi, 9.9% of 244, 9.9% of 244 Capillaria hepaticaCapillaria hepatica in 8% of 194 stools in 8% of 194 stools First report of First report of Echinococcus oligarthrusEchinococcus oligarthrus from fatal case; from fatal case;

seen in puma, jaguar, jaguarundi, agoutiseen in puma, jaguar, jaguarundi, agouti Trichinella spiralis;Trichinella spiralis; EEE, EEE, IlhéusIlhéus virus, Jap B encephelitis, virus, Jap B encephelitis,

ended fatally in animalsended fatally in animals

Rickettsial and Viral DiseasesRickettsial and Viral Diseases RickettsialRickettsial

Q fever, first report in Panama, 1946Q fever, first report in Panama, 1946 Murine typhus, first report, 1947Murine typhus, first report, 1947 RMSF, first report, 1951RMSF, first report, 1951

VirusesViruses Mosquito vectors of yellow fever, first description in Panama and Central Mosquito vectors of yellow fever, first description in Panama and Central

America, 1949America, 1949 Vector ecology and transmission studies, 1949Vector ecology and transmission studies, 1949 SLE, first recovery and identification of human patients, 1957SLE, first recovery and identification of human patients, 1957 Ilhéus Ilhéus virus, first isolation, 1958virus, first isolation, 1958 Changuinola, first isolation, 1960Changuinola, first isolation, 1960 New arboviruses discovered, Madrid, Ossa, Patois, Zegla, 1961New arboviruses discovered, Madrid, Ossa, Patois, Zegla, 1961 Wyeomia subgroup, first isolated from human, 1963Wyeomia subgroup, first isolated from human, 1963 Bussuquara, first isolation from human, 1964Bussuquara, first isolation from human, 1964 Ilhéus Ilhéus virus, first case of encephalitis, 1964virus, first case of encephalitis, 1964 SLE found SLE found DeinoceritesDeinocerites (crab-hole mosquitoes) as host, 1964 (crab-hole mosquitoes) as host, 1964 Vesicular Stomatitis Virus, isolation from humans, sentinel monkeys, 1968Vesicular Stomatitis Virus, isolation from humans, sentinel monkeys, 1968

EntomologyEntomology- Dermatobia hominis- Dermatobia hominis (human botfly), lifecycle in (human botfly), lifecycle in

man, 1929man, 1929- An. albimanus- An. albimanus, first laboratory colony in , first laboratory colony in

Central America, 1935Central America, 1935- DDT for - DDT for PhlebotominePhlebotomine control, 1944 control, 1944- DDT for - DDT for SimuliumSimulium control, 1945 control, 1945- DDT for - DDT for CulicoidesCulicoides sandflies, 1945 sandflies, 1945- Trombiculidae- Trombiculidae (chigger mites), habits and (chigger mites), habits and

ecology, 1945ecology, 1945- Inventory of ticks and biting insects, 1966- Inventory of ticks and biting insects, 1966

MiscellaneousMiscellaneous- Inventory of poisonous snakes and incidence - Inventory of poisonous snakes and incidence

of snake bites, 1930-1954of snake bites, 1930-1954

Papers Published by the Gorgas Memorial Papers Published by the Gorgas Memorial Laboratory, 1930-1969Laboratory, 1930-1969

PapersPapers MeanMean

1930-19341930-1934 6969 1414

1935-19391935-1939 114114 2323

1940-1944*1940-1944* 5858 1212

1945-1949*1945-1949* 6161 1212

1950-19541950-1954 6969 1414

1954-19591954-1959 5353 1111

1960-19641960-1964 7777 1515

1965-19691965-1969 130130 2626

1930-19691930-1969 630630 1616

* 1943-1945 = 12 papers* 1943-1945 = 12 papers

Major Topics in Publications by the Gorgas Major Topics in Publications by the Gorgas Memorial Laboratory, 1930-1969Memorial Laboratory, 1930-1969

Malaria, 60 papersMalaria, 60 papers Birds, 54Birds, 54 CulicidaeCulicidae, 51, 51 PhlebotomusPhlebotomus, 49, 49 TabanidaeTabanidae, 47, 47 Animals, wild, 40Animals, wild, 40 Monkey diseases, 36Monkey diseases, 36

AnophelesAnopheles, 35, 35 Laboratory infection, 35Laboratory infection, 35 Yellow fever, 26Yellow fever, 26 Laboratory techniques, 23Laboratory techniques, 23

Middle America Research Unit, National Middle America Research Unit, National Institute of Allergy and Infectious Diseases, Institute of Allergy and Infectious Diseases,

Canal Zone (1958-1972)*Canal Zone (1958-1972)*Focus on arthropod virologyFocus on arthropod virology Discovery of Machupo virus (Bolivian hemorrhagic Discovery of Machupo virus (Bolivian hemorrhagic

fever)fever)- Uncovered biology and ecology of virus, and rodent - Uncovered biology and ecology of virus, and rodent

reservoir leading to building arenavirus familyreservoir leading to building arenavirus family Venezuelan Equine Encephalitis virus, discovery of Venezuelan Equine Encephalitis virus, discovery of

antigenic and equine virulence variants; live virus antigenic and equine virulence variants; live virus vaccine (TC-83) for lab workersvaccine (TC-83) for lab workers

Vesicular stomatitus virus; first clear demonstration Vesicular stomatitus virus; first clear demonstration of transovarial transmission of an arbovirusof transovarial transmission of an arbovirus

* Provided by Karl M. Johnson, MD, Director, MARU, 1964-1972* Provided by Karl M. Johnson, MD, Director, MARU, 1964-1972

““Every advantage in the past is Every advantage in the past is judged in the light of the future judged in the light of the future

issue”issue”

DemosthenesDemosthenes

Recent National Institutes of Health and Recent National Institutes of Health and Government of Panama CollaborationsGovernment of Panama Collaborations

National Cancer Institute, 1993-2001National Cancer Institute, 1993-2001- - Human retroviruses: epidemiological survey at Human retroviruses: epidemiological survey at

HospitalHospitalSanto Santo TomTomáás ands and Research Triangle Park Research Triangle Park InstituteInstitute

-- Establishment of cancer information center at Establishment of cancer information center at Instituto de Nacionale de Oncologie, ManaguaInstituto de Nacionale de Oncologie, Managua

National Institute on Drug Abuse, 1997-1999National Institute on Drug Abuse, 1997-1999- - Drug involvement among Latin Americans, Drug involvement among Latin Americans,

Departamento de Farmacodependencias and Departamento de Farmacodependencias and Johns Hopkins UniversityJohns Hopkins University

Recent National Institutes of Health and Recent National Institutes of Health and Government of Panama Collaborations (2)Government of Panama Collaborations (2)

National Institute on Deafness and Other National Institute on Deafness and Other Communicable Disorders, 1997-2002Communicable Disorders, 1997-2002-- Neural basis of complex-sound processingNeural basis of complex-sound processing-- National de Recursos Naturales Renovables National de Recursos Naturales Renovables

and Washington Universityand Washington University Pan American FellowshipPan American Fellowship

-- PAHO/WHO partners with NIHPAHO/WHO partners with NIH-- One year postdoctoral training in the NIH One year postdoctoral training in the NIH

intramural laboratoriesintramural laboratories-- Focus on Caribbean, Central America and Focus on Caribbean, Central America and

Andean countriesAndean countries-- Regional public health issues are priorityRegional public health issues are priority

Recent National Institutes of Health and Recent National Institutes of Health and Government of Panama Collaborations (3)Government of Panama Collaborations (3)

Fogarty International CenterFogarty International Center-- International Cooperative Biodiversity Group, 1995-1998:International Cooperative Biodiversity Group, 1995-1998:

Bioprospecting to discover new drugs for malaria and other Bioprospecting to discover new drugs for malaria and other infectious diseases. infectious diseases. Smithsonian Tropical Research Smithsonian Tropical Research Institute, University of Panama, Gorgas Memorial Institute Institute, University of Panama, Gorgas Memorial Institute for Health Researchfor Health Research, G.W. Hansen’s Disease Center , G.W. Hansen’s Disease Center (Louisiana), Walter Reed Army Institute of Research, (Louisiana), Walter Reed Army Institute of Research, Nature Nature Foundation of PanamaFoundation of Panama, Novartis, , Novartis, Conservation InternationalConservation International

-- Fogarty International Research Collaborative AwardsFogarty International Research Collaborative AwardsBioprospecting in the Panamanian rainforest, 1995-1998Bioprospecting in the Panamanian rainforest, 1995-1998Fundacion Para La Conservacion de Los RecursosFundacion Para La Conservacion de Los Recursos and the and the University of UtahUniversity of Utah

-- Studies of Studies of Toxoplasma bradyzoiteToxoplasma bradyzoite (1999-2002) (1999-2002) Gorgas Memorial Institute for Health ResearchGorgas Memorial Institute for Health Research and Stanford and Stanford UniversityUniversity

Mission:Mission:

To promote and support

research and training internationally

to reduce disparities in global health

Fogarty International CenterFogarty International CenterScience for Global HealthScience for Global Health

FogartyFogartyInternational CenterInternational Center

Environment and Ecology

Strategic Alliances

Tobacco Prevention & Control

Maternal & Child Health

Health & Economic

Development

International Research Scientist

Career Development

Responsible Medical Reporting

Research-Policy Interfaces Nutrition

Other ChronicDiseases

Promote FIC In-house Research

Create Collaborative International Research Networks

Build International Research Capacity

Medical Informatics

BioethicsGenetics Clinical/Operational Research

HIV & Emerging Infectious Diseases

Medical Informatics

Environmental & Occupational Health BiodiversityPopulation &

Demography

FUTUREFUTURE

NEW INITIATIVESNEW INITIATIVES

CURRENT PROGRAMSCURRENT PROGRAMS

PLATFORM PLATFORM —— MISSION MISSION

FOUNDATIONFOUNDATION

Extramural Training Grants Extramural Training Grants —— 12 Programs 12 Programs

Research Grants Research Grants —— 5 Programs 5 Programs

International Training Grants for U.S. citizensInternational Training Grants for U.S. citizens* Minority International Research Training Grant (MIRT)* Minority International Research Training Grant (MIRT)* Scientist Development fellowship (post-doc)* Scientist Development fellowship (post-doc)* Foreign-funded fellowship (Japan)* Foreign-funded fellowship (Japan)

Fogarty International CenterFogarty International CenterDivision of International Training and ResearchDivision of International Training and Research

HIV/AIDSHIV/AIDS Building Capacity in Support of ICIDR sitesBuilding Capacity in Support of ICIDR sites Emerging Infectious DiseasesEmerging Infectious Diseases Environmental and Occupational HealthEnvironmental and Occupational Health FIC-NLM Medical InformaticsFIC-NLM Medical Informatics Maternal and Child HealthMaternal and Child Health Population and HealthPopulation and Health TuberculosisTuberculosis Research BioethicsResearch Bioethics MalariaMalaria Clinical, Operational, and Health Services ResearchClinical, Operational, and Health Services Research Tobacco and Health ResearchTobacco and Health Research

Fogarty International CenterFogarty International CenterTraining Grants for Developing CountriesTraining Grants for Developing Countries

• Masters and Doctoral Degrees Masters and Doctoral Degrees * Tuition, Stipends, Travel, Related Expenses* Tuition, Stipends, Travel, Related Expenses

• Post-doctoral FellowshipsPost-doctoral Fellowships* Tuition, Stipends, Travel, Related Expenses* Tuition, Stipends, Travel, Related Expenses

• Short Courses (in U.S. or In-country)Short Courses (in U.S. or In-country)* Tuition, Travel, Per diem* Tuition, Travel, Per diem

• Training-related In-country research grants, Re-entry Training-related In-country research grants, Re-entry grantsgrants

• Limited salary, Administrative support for U.S. universityLimited salary, Administrative support for U.S. university

Fogarty International CenterFogarty International CenterSupport Available Through Training GrantsSupport Available Through Training Grants

• Ecology of Infectious DiseasesEcology of Infectious Diseases

• Fogarty International Research Collaboration Award Fogarty International Research Collaboration Award (FIRCA)(FIRCA)

• HIV-AIDS and Related Illnesses Collaboration Award HIV-AIDS and Related Illnesses Collaboration Award (AIDS-FIRCA)(AIDS-FIRCA)

• International Cooperative Biodiversity Groups (ICBG)International Cooperative Biodiversity Groups (ICBG)

• International Studies on Health and Economic International Studies on Health and Economic DevelopmentDevelopment

• Proposed Global Health Research Initiative Program Proposed Global Health Research Initiative Program (GRIP) for New Foreign Investigators(GRIP) for New Foreign Investigators

• International Tobacco and Health Research and Capacity International Tobacco and Health Research and Capacity Building ProgramBuilding Program

Fogarty International CenterFogarty International CenterResearch Grants Research Grants — 7 Programs— 7 Programs

A systematic approachA systematic approach

Stability and Long-term Stability and Long-term CommitmentCommitment

Response to Local Response to Local Needs and PrioritiesNeeds and Priorities

Mutual Reinforcement Mutual Reinforcement of Investments in of Investments in Training and ResearchTraining and Research

Individual and Institutional Individual and Institutional PartnershipsPartnerships

Long-term mentoringLong-term mentoring

Advanced In-country Advanced In-country Research (re-entry grants)Research (re-entry grants)

Empowerment and mutual Empowerment and mutual respectrespect

NetworkingNetworking

FlexibilityFlexibility

LeverageLeverage

Fogarty International CenterFogarty International CenterProgram CharacteristicsProgram Characteristics

• Generally institutional training grant to U.S. Generally institutional training grant to U.S. universities and non-profit research institutions universities and non-profit research institutions in response to a specific request for in response to a specific request for applications (RFA)applications (RFA)

• Awardees are generally current NIH grant Awardees are generally current NIH grant recipients with demonstrated research recipients with demonstrated research collaboration with foreign research institutionscollaboration with foreign research institutions

• Purpose Purpose —— support training for research- support training for research-capacity building for scientists from developing capacity building for scientists from developing nationsnations

Fogarty International CenterFogarty International CenterExtramural Training GrantsExtramural Training Grants

Sustainability in FIC Sustainability in FIC ProgramsPrograms

CommitmentCommitment * National * National * Institutional * Institutional * Trainee * Trainee Re-entry grants for traineesRe-entry grants for trainees Diversified program themesDiversified program themes Contribution of resources from all partnersContribution of resources from all partners

PrinciplesPrinciples

Fogarty InternationalCenter

Sustainability in FIC Sustainability in FIC ProgramsPrograms

Sustained linkagesSustained linkages Leveraged resourcesLeveraged resources Dual appointments for facultyDual appointments for faculty Connectivity via modern IT systemsConnectivity via modern IT systems Centers of excellence in home countriesCenters of excellence in home countries Mutual benefits known to allMutual benefits known to all

Principles Principles (continued)(continued)

Fogarty InternationalCenter

Fogarty International CenterFogarty International Center

On the HorizonOn the Horizon

Brain Disorders in the Developing WorldBrain Disorders in the Developing World Trauma and InjuryTrauma and Injury

Health, Environment, and Economic Health, Environment, and Economic DevelopmentDevelopment

Navigating Navigating Your WayYour Way

FIC Website: FIC Website: http://www.nih.gov/fic

Priorities: Emerging infectious diseases, HIV/AIDS, malaria, tuberculosis, arboviral diseases, population, environment, tobacco-related illness, mental health, economics, ecology, genetics, ethics, stigma…

Fogarty International CenterFogarty International CenterScience for Global HealthScience for Global Health

Priority areas are driven by disease burden and scientific opportunity.

Priorities are set through background work, consultations internally and externally (especially Third World), international conferences, coalition formation, national and international organizations.

Research, Training and Support Needs Research, Training and Support Needs According to Understanding of Diseases According to Understanding of Diseases

andand Efficacy of InterventionsEfficacy of Interventions

Research Needs

Efficacy of

Control Methods

High HighTraining

Some HighModerateResearch Support Needs

Low Low

Research, Training and Support Needs Research, Training and Support Needs According to Understanding of Diseases According to Understanding of Diseases

andand Efficacy of InterventionsEfficacy of Interventions

Research Needs

Efficacy of

Control Methods

High High

SmallpoxGuinea wormPoliomyelitisH. influenzae type BMeaslesTetanus

Training

Some HighModerateResearch Support Needs

Low Low

DengueMalaria

HIV/AIDSTuberculosisEbola/Marbur

g InfluenzaCancers

Alzheimer’s