NIH Is Advised To Expand Its International Activities

Sidebar: Advisory Panel's Recommendations to NIH But budget concerns may force the agency's heralded Fogarty Center to stand pat A comparatively small proposed budget increase for the center that coordinates international programs of the National Institutes of Health may prevent any significant expansion of its global efforts in the near future. A report submitted last fall by an external advisory panel recommended "a strengthening of international activities" at NIH (see list of recommendations on page 3). The report also advised that the John C. Fogarty International Center (FIC) remain the focal point for NIH's international programs and "embark on additional activities" in collaboration with NIH's institutes, centers, and divisions (ICDs) "to advance science and promote global health." But the fiscal year 1998 budget submitted by President Clinton in early February would raise FIC's funding by only $600,000-from this year's estimated $26.6 million to next year's proposed $27.2 million. THINK GLOBALLY: The Fogarty International Center is housed on NIH’s Bethesda, Md., campus. FIC director Philip E. Schambra is optimistic that, regardless of grim budget figures, NIH's international commitment can and should expand. "There's a feeling across the government that we have tightened our belts, as related to international activities, as far as we dare go and continue to play a leading role in the world," he says. "The president has called for us to recognize our responsibilities as global leaders. This is not just in the diplomatic and military spheres, but in the science and technology sphere as well." NIH's international efforts include extramural awards for foreign scientists, which allow them to conduct training and collaborative research at United States institutions and to serve as NIH scholars-in-residence; intramural fellowships and appointments that fund American scientists studying and conducting research abroad; and collaboration agreements signed with research agencies of other countries. Created in 1968, the Fogarty Center coordinates these global activities largely through training and research programs and stimulates international research supported by the ICDs. 'BANG FOR THE BUCK': Barry Bloom contends NIH could not run without Fogarty fellows. The eight-member external advisory panel, commissioned by NIH director Harold Varmus last year to examine NIH's commitment to international health, was cochaired by Barry Bloom, a professor of microbiology and immunology at New York's Albert Einstein College of Medicine, and Joshua Lederberg, the Raymond and Beverly Sackler Foundation Scholar at Rockefeller University in New York. The panel met twice and last September released its report, which praised FIC and called for significant growth in NIH's international efforts. "We want the Fogarty to exist as a visible, permanent, identifiable link between the NIH and all kinds of international research, and we want the best possible person to lead it," cochairman Bloom tells The Scientist. "With limited resources, the present leadership of the Fogarty International Center has effectively supported the international health activities of the NIH," panel members wrote. The report added that in such areas as AIDS, emerging diseases, population and health, environmental and occupational health, and biodiversity, "the FIC offers a voice capable of articulating concepts and technical ramifications that have gained the respect of both scientists and policymakers inside and outside of the NIH." After reviewing the agency's international activities, the panel issued 10 recommendations "to enhance and strengthen" those activities. Among them are that FIC remain "a free-standing organization within the NIH," and that an associate director for international research be appointed, serving in the office of the NIH director, to oversee both the Fogarty and an "expanded leadership role in international health research." In addition, the panel "strongly" endorsed "an international role for all NIH components" and called for FIC to "continue to respond to new opportunities and challenges as they arise." However, the panel seemed to anticipate budgetary concerns, recommending that NIH "examine its [international] programs closely for potential savings that could be achieved, for example, by eliminating some programs, enhancing the efficiency of operations, and reallocating existing funds." It advised that only "modest new resources be developed to support" international health research initiatives of FIC and NIH's ICDs. And, citing greater ease in international travel and communication, the panel recommended review of the Scholars-in-Residence (SIR), Senior International Fellowship (SIF), and International Research Fellowship (IRF) programs with an eye toward reducing them "significantly" and re- allocating their resources here within FIC. "The explosion of electronic communication and the increasing ease of long-distance travel have facilitated international collaboration," says the report. FIC boosters were happy with the assessment. "One usually expects these types of reports to be full of hard-hitting criticisms and recommendations of wholly new ways of carrying out responsibilities," Schambra remarks. "The fact that we got, by and large, a general endorsement of our programs and our plans as laid out in our long-range report was a pleasant surprise." Schambra cannot say what the next definite step for the report will be. He states that he and Varmus currently are discussing which recommendations should be implemented, and that the subject will be "a top agenda item" over the next six months. 'WORTHWHILE': International programs can benefit the United States and other countries, notes R.T. Ravenholt. Researchers from both the U.S. and abroad extol the virtues of international collaboration in science. R.T. Ravenholt, the president of Population Health Imperatives of Seattle, spent 1961 to 1963 in Paris as a European epidemiology consultant for the U.S. Public Health Service investigating outbreaks of smallpox, polio, and typhoid. "I did not immediately impact the case rates, but it did broaden my perspectives, and probably contributed to my undertaking the direction of [the U.S. Agency for International Development's] global population/family planning program some years later-a thankless task at its beginning in 1965," he recalls. Kai Simons, the head of cell biology at the European Molecular Biology Laboratory, based in Heidelberg, Germany, decries what he sees as a decrease in the number of American researchers working and studying in Europe. He hopes that FIC is able to expand because, he explains, "science is international. The more people and more ability we have in the basic research field, the more we will promote new ideas and cross-fertilization." Some researchers believe that expanding NIH's global activities will help to bolster American leadership in the international arena. Bloom, for example, believes NIH's international programs are not only humanitarian, but also a way for the U.S. to get "the most bang for the buck." He says that training foreign scientists from European and developing countries "has to be a way of establishing United States leadership in the world. The NIH could not run without the Fogarty fellows. While they're here, they're learning and also working for the scientists at the NIH." Avidan Neumann, an assistant professor of biology at Bar Ilan University in Israel, was in the U.S. as a Fogarty International Research Fellow from 1992 to 1994. He agrees with Bloom. "The U.S. is such a major player in the science world, not only because of American researchers but also because it's a center for people from all around the world to come and train there. Much of the research is done by those foreign trainees who come to train in the U.S. Many of them stay in the U.S. It's important for the U.S. and for science in general." As a Fogarty fellow, Neumann applied mathematical models of immunology and virology to lupus and HIV. He says Fogarty grants are essential to being able to come to the United States and collaborate with researchers. "Sometimes you can get support from other places as well. I could have if I wanted. But many times you don't have it." 'CLASSIC': John Donelson cites work in Huntington’s as an example of the benefits of global collaboration. HOPEFUL: Philip E. Schambra is not deterred by grim budget forecasts. In addition, people need to be aware that some research can best be done abroad yet still have critical implications in the U.S., according to John E. Donelson, a distinguished professor of biochemistry and a Howard Hughes Medical Institute investigator at the University of Iowa's School of Medicine. "The classic example of that is Huntington's disease," offers Donelson, who traveled to Kenya as a Fogarty Senior International Fellow in 1980 and just rotated off FIC's advisory board. "Two large, extended families were found many years ago in Venezuela that really provided much of the impetus of Huntington's disease research that was conducted in [the U.S.], ultimately leading a couple of years ago to identification of the gene responsible for Huntington's disease." However, there are some voices that call for vast reductions in the number of foreign scientists studying in the U.S. Gene Nelson is a Ph.D. biophysicist currently unemployed in science and a volunteer editor of the Network of Emerging Scientists, an Internet forum (http://pegasus.uthct.edu/nes/nes.html). He argues that a "glut" of science Ph.D.'s depresses wages for American scientists and decreases the likelihood that U.S. students will want to pursue careers in the sciences. "I am opposed to expansion of programs that would bring in more foreign scientists at a time of an extreme glut," he says. Whether the overall enthusiasm for greater international involvement will translate to greater funding of FIC is another matter. Rodney W. Nichols, president and chief executive officer of the New York Academy of Sciences (NYAS), observes: "There's not very much money in this effort compared to the overall NIH budget." FIC officials speak carefully, with Schambra praising the advisory panel's call for modest new resources to be made available as "an entirely appropriate, conservative, and reasonable recommendation." The external advisory panel that reviewed international efforts of the National Institutes of Health made 10 recommendations "to enhance and strengthen" these activities. They are as follows: "The panel strongly endorses an international role for all NIH components, consistent with the mission of each component, and a strengthening of international activities at the NIH." "To meet the challenges in international health, the panel advocates retention of the FIC [Fogarty International Center] as a free-standing organization within the NIH." "The panel recommends that the FIC have three principal functions: to promote and facilitate the international activities carried out by the NIH; to support international research and conduct research training programs that complement and expand the international mission of the NIH; and to provide leadership on the identification of emerging global health concerns and possible NIH responses." "The panel recommends that leadership for the direction and implementation of NIH's international activities would best be assured by reinstituting the previous NIH tradition of appointing an Associate Director for International Research (ADIR) who would also serve as Director, FIC." "The panel commends the FIC on the evolution of its programmatic activities in response to changing priorities and developments in global health and science. The panel recommends that the FIC continue to respond to new opportunities and challenges as they arise." "The panel endorses FIC's AIDS International Training and Research Program (AITRP); Fogarty International Research Collaboration Award (FIRCA); Minority International Research Training (MIRT) Program; and new international research and training programs in population, the environment, and emerging diseases. The FIC should continue to foster the development of a competent scientific infrastructure in developing countries and the training of U.S. scientists in international health research." "The panel recommends that the Scholars-in-Residence (SIR), Senior International Fellowship (SIR), and International Research Fellowship (IRF) programs be reviewed carefully in relation to the rapid changes that have taken place in the way scientists now can communicate and collaborate around the globe. Consideration should be given to reducing these programs significantly and reassigning the bulk of their resources to other FIC initiatives." "The panel recommends that a critical review of FIC's functional units (divisions, offices, branches, etc.) be undertaken in the near future to determine the most efficient use of its resources to support the FIC mission." "The panel recommends that the FIC take a more active role in interacting with the National Library of Medicine in identifying and exploiting contemporary methods of communication to facilitate international health and science." "The panel recommends that modest new resources be developed to support FIC and ICD [institutes, centers, and divisions] international health research initiatives." For more information, write to the Public Affairs Office, Fogarty International Center, National Institutes of Health, Building 31, Room B2C08, 31 Center Dr., MSC 2220, Bethesda, Md. 20895-2220 Tel: (301) 496-2075. Fax: (301) 594-1211. E-mail: ficinfo@nih.gov World Wide Web: http://www.nih.gov/fic/ Advocates for greater international involvement by NIH say the way to overcome potential budget shortfalls is to recruit taxpayer support. "One does need to make the case to the American people, to government, to companies, about the need for greater [international] cooperation," comments Nichols. "That's one of the things I expect the Fogarty Center and Varmus and others to be doing." Bloom cites public-opinion surveys that reveal that while Americans believe too much money is spent on foreign aid, they vastly overestimate that amount. By couching NIH's efforts in humanitarian terms, as opposed to "foreign aid," advocates likely could persuade people to support "a wider use of NIH funds for international collaboration," he speculates. For their part, Fogarty grantees stress the need to publicize their projects as much as possible. They say that once taxpayers learn of the kind of work supported by FIC, they will be much more willing to contribute to international research programs. ENTHUSIASTIC: Barbara Timmermann’s lecture audiences support her Fogarty work. For instance, Barbara Timmermann, a professor of pharmacology and toxicology at the University of Arizona, is in the midst of a five-year grant from FIC's International Cooperative Biodiversity Groups program. She travels to Latin America to study bioactive agents in plants, hoping to conserve natural resources and discover new drugs. Timmermann feels it is important to "just let the people know through popular channels like TV, popular press, articles in Time magazine and Newsweek, that sort of thing. What we do is very important. The only way people will know is through popular media." Timmermann, who lectures extensively on her studies to the general public, reports that her audience is uniformly positive when she describes her international research. "People get very excited. I never get a negative comment. People say, 'This is the way to go. This is the way we should do things.'" Ravenholt, the Seattle epidemiologist, concludes: "If FIC is under excellent leadership, if the fellows are very well chosen, and if each comes to the FIC with a core discipline and interest that can be furthered while in [the U.S.], then the support of this activity would be very worthwhile-both for the countries of origin and for the United States." To that end, observers like Nichols applaud Schambra's leadership, and fellows such as Neumann and Timmermann are unstinting in their praise of FIC's programs. Perhaps all that remains is to convince the taxpaying public.

NIH Is Advised To Expand Its International Activities

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