The Seeding of Third World Science

Last August a contingent of US AIDS researchers visited Malawi, where health officials believe 20% of the urban population is HIV-infected. The investigators wanted to know if government leaders would allow citizens to take part in an AIDS vaccination trial set to begin later this year. When meeting with the nation's top three health ministers, the visiting scientists were surprised to find that each were former Fogarty International Center (FIC) fellows trained at Johns Hopkins University. "The other investigators turned to me and said, 'Is there anyone here leading the AIDS effort that you haven't trained?'" says Chris Beyrer, a researcher from Johns Hopkins' Bloomberg School of Public Health and member of the Malawi team. "I had a good sense that we had had a big impact there. But it kind of surprised me." The presence of Fogarty scholars shouldn't have surprised Beyrer. Johns Hopkins has been a part of the Center's campaign against AIDS in developing countries since its inception 14 years ago. During that time, Fogarty has underwritten the training of more than 2,000 developing world scientists in AIDS research at US universities. Other FIC fellows study other diseases. "We are devoting the major part of our resources to research and research training in developing countries where the burden of disease is greatest and the resources are the most limited," says Gerald T. Keusch, FIC director. The Fogarty International Center is one of many industrialized country organizations that develop Third World scientists. The 24-country, 1,200-member European Molecular Biology Organization (EMBO) underwrites instruction, workshops, and lectures in molecular biology. It also offers long-term fellowships and operates a young investigator program, which encourages independent research. In May, EMBO will invite a new round of trainees. "We are giving out fellowships to researchers in developing countries to come into a member country to work," says Ellen Peerenboom, EMBO's public relations officer. The British Medical Research Council has located several labs in the Third World. The MRC also works with the Department for International Development (DFID) to sponsor a £16 million, five-year international research collaboration among institutions in South Africa, Tanzania, Uganda, Cameroon, Zambia, and the United Kingdom to develop microbicides—drugs that could protect against HIV and other sexually transmitted diseases. The Swedish government also financed 108 million SEK in cooperative developing world health research in 2000. While few question the altruistic intent of such programs, some experts say agencies should target their limited funding for more efficient results. Many Third World governments lack the financial wherewithal to support high-end scientific research that their doctors and scientists begin at universities in Europe and the United States. "Let's just say that there are better ways to use what still remains scarce resources [for] dealing with international health issues," says Charles Finch, director of international health at Moorehouse School of Medicine. "There are more cost-effective and pragmatic ways those scarce resources can be employed." For instance, programs that send scientists to Africa to help upgrade skills and infrastructure work more effectively than do sophisticated study projects in the industrialized world, Finch asserts. "The best way to do it is to go in and help those individuals who are already in the system and have some reasonable prospect of employment and who can also help develop the capacity for building infrastructure," he says. "It's not just training. That is the first step. There are infrastructure issues that need to be addressed." Fogarty's Keusch agrees that training without support doesn't address healthcare and medical issues, and says that the FIC tries to match programs with the community's needs. "The Fogarty AIDS training program is a good example," Keusch says. "The long-term training in the United States for the developing country scientist has been appropriate for local needs and local resources. And the US training institution is involved in a long-term research relationship with the host country." The vast majority of Fogarty's fellows return to their homes, where many become nationally renowned leaders in science and medicine. Cripsus Aiyonga, a former Fogarty fellow and the former Ugandan minister of health, has been tapped to head the United Nation's Global Fund for AIDS. Conception to Contraception Originally conceived by former US congressman John E. Fogarty, who believed that "just as disease knows no boundaries, so also the benefits of medical research and indeed research itself can know no boundaries," the center opened in 1968. "Initially the focus was between developed countries or in Latin America where education was particularly advanced," Keusch says.1 "In the past 20 years that perspective has changed. The heavily diseased parts of the world, which lack resources, don't get much attention. The perspective has changed from global science to add the critical issues in global health." That change in mission led to Fogarty's recognition of the threat of HIV-AIDS. In 1988 the Center created what is now its longest-standing training program. The AIDS program is only one of the many research projects on which the agency spends $46 million (US) of its $56 million fiscal 2002 budget. The remaining money will be used for staffing, conferences, and networking meetings around the world. The meetings and networking sessions help scientists from developing countries stay abreast of the latest developments while cementing relationships to form an infrastructure of cooperation and collaboration around the globe, according to Fogarty fellows and staff. "We can be a family and you don't lose contact with your family," says Juan Enrique Schwarze, a Chilean working in a lab at the Center for Reproduction and Women's Health at the University of Pennsylvania. "These are contacts that you never lose." Courtesy of Judy WoodFogarty Fellows Pedro Ferrand (left) and Rosanna Sapiro (center) work alongside of Jerome F. Strauss III (right) in his University of Pennsylvania laboratory. Schwarze is one of 10 Fogarty investigators at Penn working under Jerome F. Strauss III in a seven-year affiliation in contraception, reproductive health, and mother-and-child health. The FIC fellows at Penn, most of them from Latin America, are paired with a mentor. "We bring physicians and scientists here for two to three year periods of training and they work under the guidance of a faculty member," Strauss says. "We have had some fairly senior people here in respect to their training. They are not gaining financially from their experience here." Garnering Human Capital What they don't make monetarily the fellows make up for in new skill acquisition, according to Strauss. Some participate in the $50,000 per year Global Health Research Program, a competitive exercise that helps young, foreign scientists learn how to apply and get National Institutes of Health and other funds. Fogarty started the program after surveying 600 developing-world junior scientists on the NIH campus who reported a lack of experience in raising money for scientific work. "We have had a tremendously favorable response to this initiative," Keusch says. Strauss says his staff does everything possible to assist its scientists once they return to their home countries, from reviewing scientific papers to going over grant proposals. In general, he says, Penn's former fellows do very well finding money. "The fact that they have been in the United States and had advanced training gives them a distinct advantage," Strauss says. "All of our folks have been successful in getting studies published and getting industry funding." Fogarty trainees are the best and the brightest their countries offer. Being chosen by Fogarty requires a letter of recommendation from someone in a leadership role at the person's institution. The letter must say the institute leaders will collaborate with their US counterparts. "It's another level of assurance that the investment made in training is going to be a long-term investment for the institution," Strauss says. "Clearly our goal is to seed institutions that have the capability to conduct high quality science with a willingness to invest." Strauss is already seeing some payoff. Former fellows from the Penn program have produced at least three important studies on reproductive issues. "It was all done by scientists after they returned home," Strauss says. "These folks will become the elite scientists in reproductive biology and medicine in their region." To help returning scientist get started, Fogarty gives each a reentry grant of $15,000 to $25,000. The money is generally used to establish a research program and buy laboratory equipment. "They get seed money to get their research going," Beyrer says. "It's very hard to find equipment in developing countries." Seeding Science's Future But the scientists, not the money, are the real seeds planted by FIC in the world's poorer nations. The first crop has already started to bloom. Beyrer says he can see it in places like Thailand, where Johns Hopkins and Fogarty have worked with scientists for 14 years. "We're on to the second generation training where the Thais are training the people in Laos and we're funding it through Fogarty," he says. "Instead of coming to Hopkins they are getting trained in Thailand." Fogarty continues tilling the soil. To encourage true collaborative research, the Center uses computer technology to collect and analyze clinical research data and tries to shorten the period between discovery and application of clinical research. The FIC also trains scientists and physicians in ethical conduct, taking into account different cultural perspectives. Finally, Fogarty wants to use the breakthroughs in genetics and genomic research to develop new drugs. Keusch says he would like to see Fogarty's work in developing research capital evolve into the creation of regional, multidisciplinary centers of excellence for science. "I would like to see a healthy movement back and forth of science at all levels so that the sharing and the insights are bi-directional," he says. "Two way flow means we succeeded in encouraging human capacity as well as supported it." Bob Calandra (rotoca@aol.com) is a freelance writer in Philadelphia. 1. T. Durso, "NIH is advised to expand its international activities," The Scientist 11[5]:1, March 3, 1997. Sowing Science Seeds Most industrialized countries operate programs to train developing world scientists, for example: www.nih.gov/fic/ www.mrc.ac.uk/index/public_interest/public-press_office/public-press_releases_2000/public-mrc-06-00.htm www.dfid.gov.uk/ www.sida.se/Sida/articles/9100-9199/9182/HDD2001.4.pdf

The Seeding of Third World Science

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