1. 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 Research Fogarty International Center National Institutes of Health E-mail: jbreman@nih.govjbreman@nih.gov Web site: www.nih.gov/ficwww.nih.gov/fic Fogarty International Center Infectious Diseases Programs and Perspectives of the Fogarty International Center, National Institutes of Health International Affairs Committee, IDSA January 29, 2001

2. The FIC Mission “To promote and support scientific research and training internationally to reduce disparities in global health.” Fogarty International Center

3. 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

6. National Institutes of Health International Research Expenditures 1994 to 1999 $- $10,000,000 $20,000,000 $30,000,000 $40,000,000 $50,000,000 $60,000,000 $70,000,000 $80,000,000 $90,000,000 $100,000,000 199419951996199719981999 Fiscal Year Amount Direct Foreign Research Grants and Contracts Foreign Components of Domestic Grants and Contracts Training Grants Visiting Program

7. Fogarty International 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 Chronic Diseases Promote FIC In-house Research Create Collaborative International Research Networks Build International Research Capacity Medical Informatics Bioethics Genetics Clinical/Operational Research HIV & Emerging Infectious Diseases Medical Informatics Environmental & Occupational Health Biodiversity Population & Demography FUTURE NEW INITIATIVES CURRENT PROGRAMS PLATFORM — MISSION FOUNDATION

8. Fogarty International Center Extramural Programs

9. Fogarty International Center Program Initiatives and Collaborating Partners Fiscal Year 2000 Funding FIC Population and Health $1.2 million NIA NICHDFIC Environmental and Occupational Health $2.0 million CDC NICHD FIC Emerging Infectious Diseases $2.8 million NIDCR NIAID FIC Biodiversity $3.6 million NHLBI USDA NIDA NSF NIMH NCI NIAID FIC AITRP $12.8 million NIDCR NIDANIMH NCI NIAID MIRT $2.7 million FIC ORMH Medical Informatics $.6 million NLM NIAID OD Tuberculosis $1.2 million NICHD NIAID FIC

10. Fogarty International Center 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

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

12. Sustainability in FIC Programs Commitment * National * Institutional * Trainee Re-entry grants for trainees Diversified program themes Contribution of resources from all partners Principles Fogarty International Center

13. Sustainability in FIC Programs Sustained linkages Leveraged resources Dual appointments for faculty Connectivity via modern IT systems Centers of excellence in home countries Mutual benefits known to all Principles (continued) Fogarty International Center

14. Research, Training and Support Needs According to Understanding of Diseases and Efficacy of Interventions Research Needs Efficacy of Control Methods High Training SomeHighModerate Research Support Needs Low

15. Research, Training and Support Needs According to Understanding of Diseases and Efficacy of Interventions Research Needs Efficacy of Control Methods High Smallpox Guinea worm Poliomyelitis H. influenzae type B Measles Tetanus Training SomeHighModerate Research Support Needs Low Dengue Malaria HIV/AIDS Tuberculosis Ebola/Marburg Influenza Cancers Alzheimer’s

16. Fogarty International Center 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 = Global Health = U.S. Self Interest

17. For More Information Fogarty International Center E-mail: jbreman@nih.govjbreman@nih.gov www.nih.gov/fic www.nih.gov