The FIC Advisory Board met via Video Teleconference, at 12:02 p.m. EDT, Dr. Roger Glass, Director, presiding.
Present
- Roger I. Glass, M.D., Ph.D., Director, Fogarty International Center,
Chair
- Carol Dahl, Ph.D., Lemelson Foundation
- Wondwossen Gebreyes, M.D., The Ohio State University
- Gregory Germino, M.D., National Institute of Diabetes and Digestive and Kidney Diseases
(ex-officio)
- Karen Goraleski, MSW, American Society of Tropical Medicine and Hygiene
- Chandy John, M.D., Indiana University School of Medicine
- Maureen Lichtveld, M.D., University of Pittsburgh School of Public Health
- Robert Murphy, M.D., Northwestern University
- Steffanie Strathdee, Ph.D., University of California San Diego School of Medicine
- Sten Vermund, M.D., Ph.D., Yale University School of Medicine
- Judith N. Wasserheit, M.D., MPH, Harvard T.H. Chan School of Public Health
- Michelle A. Williams, Sc.d., Harvard T.H. Chan School of Public Health
Also Present
- Nalini Anand, Fogarty International Center
- Geetha Bansal, Ph.D., Fogarty International Center
- Blythe Beecroft, M.S., Fogarty International Center
- Barbara Catelnuovo Data, M.D., Ph.D., Research Infectious Diseases Institute, Mulago Hospital
- Claudine Humure, University of Washington
- Farid Jarrous, Fogarty International Center
- Debora Charles Kajeguka, Ph.D., Kilimanjaro Christian Medical University College
- Peter Kilmarx, M.D., Deputy Director, Fogarty International Center
- Joseph Kolars, M.D., University of Michiga
- Linda Kupfer, Ph.D., Fogarty International Center
- Keith Martin, M.D., P.C., Consortium of Universities for Global Health
- Folasade Ogunsola, Lagos University Teaching Hospital
- Sarah Okumu, Kenya Medical Research Institute
- Christine Sizemore, Ph.D., Fogarty International Center
- Susan Vorkoper, M.P.H, M.S.W., Fogarty International Center
- Kristen Weymouth, FIC Advisory Board Executive Secretary, Fogarty International Center
Opening Statements
Dr. Roger Glass brought the open meeting to order at 12:02 p.m. Eastern Daylight Time and welcomed the Board Members and guests. Dr. Glass reserved the Director's Update for later in the meeting to account for time zone differences between those located domestically and the presenters located abroad.
Supplement awards to develop Institutional Policy against Sexual Harassment in FIC Grantee Institutions
Overview
Dr. Bansal presented the outcomes from a unique supplement program developed by FIC’s Division of International Training and Research (DITR) in order to build infrastructure to combat sexual harassment at the NIH and NIH-funded institutions, a critical need identified by the Institutes. Remedying this issue is important so that the best and brightest minds are not discouraged from continuing their work. Following the launch of an anti-sexual harassment website in 2018 and strengthening of NIH anti-sexual harassment infrastructure in 2019, Dr. Bansal aimed to collect data on low- and middle-income countries (LMIC) where data is scarce. After conducting outreach at the local level, Dr. Bansal discovered that many NIH-funded institutions in lower-income countries lack the critical infrastructure needed to handle sexual harassment claims properly, despite policies being in place.
DITR approached NIH's Office of AIDS Research (OAR) for some funds to help the grantees establish new measures to combat harassment. Applications were received in August of 2020 and $75,000 was awarded to ten applicants in September of 2020. The awardees were charged with building capacity at their LMIC institutions, developing policies, and engaging in training programs. Additionally, reporting and documenting processes were required to be implemented or strengthened.
Infectious Diseases Institute, Uganda
The grant provided to the Infectious Diseases Institute (IDI) in Uganda focused on evaluating the knowledge of sexual harassment procedures at the workplace, analyzing the attitudes and experiences of those in the community, and develop a comprehensive training program. Prior to the grant, the only policy in place to combat sexual harassment was a boilerplate human resources (HR) policy. Dr. Castelnuovo also aimed to evaluate the impact of sexual harassment policies training programs.
IDI sent out a baseline assessment survey to gauge the attitudes and experiences of all employees in terms of sexual harassment. Documentary analysis was also used to determine the strength of anti-harassment measures. Following this analysis, the standing HR policy was found to be insufficient for the needs of the Institute. Some staff members were interviewed personally to recount their experiences with workplace sexual harassment.
IDI wanted all departments to be involved with the creation of the new anti-harassment policy. To accommodate this, the HR department organized two workshops to analyze the initial data findings. The staff broke down to four working groups for different sections of the policy. Within one month, they developed the new policy and an anti-sexual harassment committee was established. Thirty individuals were trained to lead four new training models: sexual harassment; consensual relationships and inappropriate behavior in the workplace; reporting, confidentiality, and disciplinary actions; and retaliation and discrimination. From July to August of 2021, all staff members were trained under the new models.
In addition to new training measures, educational literature was improved and widely disseminated. IDI developed signage that was posted in all buildings to inform staff members of anti-harassment policies and procedures. Educational videos highlighting different examples of workplace harassment were produced and posted online, along with the aforementioned training programs. All staff members that have been trained are planned to engage in a refresher training course in the future.
Dr. Castelnuovo highlighted the impact of the grant through the results of a survey conducted after the new policies were implemented. Respondents showed an increased willingness to actually report sexual harassment incidents should they arise. The survey also showed perceived workplace hostility dropping from 60 percent at the baseline assessment to 13.9 percent following the new policies. Dr. Castelnuovo acknowledged the work that is still needed to be done and reaffirmed the need for refresher trainings in the future.
Kilimanjaro Christian Medical University College, Tanzania
Dr. Debora Charles Kajeguka of the Kilimanjaro Christian Medical University College (KCMUCo) focused on sexual harassment in higher education institutions in northern Tanzania. At KCMUCo, the existing policy that outlines sexual harassment was found to be insufficient for the needs of the students and staff. The existing policy was directed only at students and not the staff. Given that sexual harassment had not been reported in years, Dr. Kajeguka suspected knowledge of the policies against sexual harassment was limited.
Two surveys were developed to test the climate at KCMUCo, one targeting students and one targeting staff. The survey concluded 87 percent of staff members and 52 percent of students experienced sexual harassment. 45 percent of female staff and 40 percent of students experienced sexual harassment in their lifetime. 53 percent of staff members and 52 percent of students knew where to go to address a sexual harassment incident. Dr. Kajeguka indicated there is no specific reporting infrastructure.
KCMUCo has developed an anti-sexual harassment manuscript, which is under review. The survey indicated an urgent need for intervention, so a committee, comprised of 50 percent females, was formed. The committee created a sexual harassment policy that was approved by the quality governing board. The committee held workshops to create awareness of the new policy. Videos and training materials were created for all new staff and students to watch, read, and take an assessment on. Certificates were issued to those who achieved 80 percent on their assessments.
Lagos University Teaching Hospital, Nigeria
Professor Folasade Ogunsola of the Lagos University Teaching Hospital (LUTH) at the University of Lagos (UNILAG) began her presentation with a prelude about a BBC sting operation that showed a lecturer harassing a student. This revealed their existing anti-harassment policy was ineffective. UNILAG entered into a partnership with Northwestern University in order to improve their harassment policies and learn better methods of enforcement. The second step to improve the culture on campus was to work with UNILAG leadership to implement policy changes from the top down.
Due to the ongoing COVID-19 pandemic, travel was restricted and virtual learning sessions were held with UNILAG and Northwestern to share experiences. Professor Ogunsola and her team worked with UNILAG stakeholders, administrators, counseling center, medical center, security units, and the sexual harassment task force through meetings and roundtable discussions. A community survey was released, and it revealed that many people were not aware that their behaviors were considered inappropriate. A new policy manual was drafted, and training began. The manual has been adopted by management but has yet to be adopted by the Senate due to a strike action.
225 students and 67 staff members have been trained on the new policies and procedure to gauge its effectiveness. Following the training, the students designed messages and materials to be used across campus. This program has been adopted by student affairs. Five meetings have been held across the university to educate more students. This has led to the development of a data repository for sexual predators known as the No Hiding Place program.
Two key obstacles to successfully implementing the new policies are the need for long-term funding and the community's tendency to blame the victim. The new training has provided some progress in educating the public as to what constitutes sexual harassment, but there is still a lot of work to be done to improve campus life. The lack of availability of clear data on serial sexual harassers has also proved to be a challenge UNILAG hopes to resolve.
Concerning sustainability, UNILAG has started training students upon entry on how harassment policies and reporting structures operate. One of the key findings was that many students were unaware of how to access resources when reporting sexual harassment or what constitutes sexual harassment. UNILAG required all staff to read and sign the new policy and worked to operationalize the No Hiding Place program.
Kenya Medical Research Institute
Sarah Okumu of the Kenya Medical Research Institute (KEMRI) revealed that there was no governing policy related to sexual harassment or reporting mechanisms when someone was harassed in place at KEMRI. While gender and grievance committees exist at KEMRI, their existence is largely unknown to the community and they do not specifically address sexual harassment. A draft policy was proposed, but its implementation stalled in 2015. Ms. Okumu stated that KEMRI's goals for this project are to build and sustain a safe work environment and establish a reporting mechanism.
Two working groups were developed to help KEMRI meet its goals. The first working group was a task force comprised of leaders from the Institute and members of existing gender and grievance committees. The second group was an advisory committee that consisted of current and past NIH awardees and KEMRI staff from the corporate, financial, legal, and HR departments. The task force's job was to develop community assistance tools and conduct training. The advisory committee provided supervisory guidance and all activities were approved by them.
KEMRI conducted a needs assessment between April and August of 2021. This assessment consisted of a survey and key informant interviews. The key finding of the assessment was that 72 percent of the staff was unaware of how to obtain resources concerning sexual harassment in the workplace or how to report incidents. In 2021, there was a new scientific staff appointment that narrowed the gender disparity in the workplace. There has been an increase of reporting of sexual harassment. Training was conducted across KEMRI centers countrywide during July of 2022. KEMRI has partnered with other institutions such as Maseno University and the IDI in Uganda.
As part of policy implementation, KEMRI is working to establish the Gender Equality and Empowerment Office, which will serve as the foundation for sexual harassment training and reporting at KEMRI going forward. The roles and structures of the Office are clearly outlined in the policy.
Questions and Comments
Dr. Judith Wasserheit asked the presenters how they would define sexual harassment. She also inquired if there was any identification of females harassing males. Lastly, she asked Dr. Bansal if any awards were granted in Latin America and Asia.
Dr. Kajeguka defined sexual harassment as unwanted sexual advances or sexual favors. Dr. Kajeguka confirmed there were reports of sexual harassment by female perpetrators. Dr. Castelnuovo includes vulgar language, unwelcome comments, physical touch, unwanted and persistent propositions for sex, unwanted demands for sexual activities, sexual statements, stalking, spying, cyberstalking, and sexual assault as examples of sexual harassment. Dr. Castelnuovo reported instances of females harassing males and mentioned that IDI produced a video on the subject of male victims of sexual harassment. Professor Ogunsola reiterated her colleagues' definitions of sexual harassment but emphasized the element of persistence. Professor Ogunsola mentioned that males are less likely to be the victim of harassment by females, but there were reports. Ms. Okumu also reiterated her colleagues' definitions of sexual harassment and reported there were some instances of males being the victims of harassment, acknowledging the need for more education and training on the topic.
Dr. Bansal highlighted the key accomplishments from the grantees' policy implementations. Dr. Bansal explained that there were no applicants from Southeast Asia, South America, or Europe for the sexual harassment policy awards.
Dr. Wondwossen Gebreyes asked Dr. Kajeguka if there was a mechanism in place to respond to data provided. He also asked Ms. Okumu if there is targeted intervention material. Dr. Kajeguka informed Dr. Gebreyes that there is a mechanism in place and there is a chain of reporting involved. Ms. Okumu informed the Board of a reporting mechanism and a system involving an ad hoc committee to adjudicate claims.
Dr. Chandy John thanked the presenters and inquired if a toolkit can be developed from this project to use at other institutions. Dr. Bansal mentioned that four grantees were from Kenya: Maseno University, Moi University, Kenyatta National Hospital (KNH), and KEMRI. Dr. Bansal directed the question of collaboration to Ms. Okumu. Ms. Okumu informed the Board that there is ongoing collaboration among different institutions. There is also a plan to collaborate further at the KEMRI Annual Scientific and Health Conference (KASH).
Dr. Michelle Williams inquired about the long-term solutions for a sustainable anti-harassment policy. Dr. Bansal echoed Dr. Williams's concerns and stressed the need for funding to implement new programs and sustain their upkeep.
Dr. Keith Martin of the Consortium of Universities for Global health suggested sharing the materials provided by Dr. Bansal and the other panelists with the Consortium's constituent members. He offered to augment a list of positive outcomes from the policy implementations in order to create a best practices guide for institutions wishing to improve their anti-harassment policies in the future. Karen Goraleski echoed these points and suggested spreading the word via the Consortium's newsletter. She also recommended a symposium on the issue of sexual harassment in 2023.
Director’s Update and Discussion of Current and Planned FIC Activities
Dr. Roger Glass began his update by welcoming guests to the meeting and recognizing Dr. Anthony Fauci's departure from the National Institute of Allergy and Infectious Disease (NIAID). He highlighted Dr. Fauci's accomplishments and contributions to the Fogarty International Center, including his remarks to the House Appropriations Committee on the vital role Fogarty’s research and training programs have on public health worldwide.
Dr. Glass recognized Dr. Monica Bertagnolli as the new Director of the National Cancer Institute (NCI). Dr. Bertagnolli is the first woman to lead the NCI. Dr. Glass commended Dr. Satish Gopal, Director of NCI’s Center for Global Health, for his work on bringing bright minds to NCI through the Center. Dr. Glass highlighted the work of former Fogarty fellow Dr. Laura Lewandowsky, who now works with the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), and her work on sickle cell disease in Sub-Saharan Africa.
Dr. Glass highlighted Dr. Rob Murphy's new podcast on global health. Dr. Joel Breman was commended for his work trying to control the spread of the 2022 monkeypox outbreak. Dr. Vivian Pinn was recognized for her work on biomedical and minority issues.
Dr. Glass along with Dr. Francis Collins and the Coalition for African Research and Innovation (CARI) traveled to Senegal to stimulate more investment in global health research. Drs. Glass and Collins met with Amadou Sall and Souleymane Mboup, both former NIH grantees, to establish a connection to increase the supply of vaccines. Marie-Angelique Sene is working to increase the yield of virocells, which are needed to produce many essential vaccines. Dr. Glass visited a yellow fever vaccine production plant, a promising sign for domestic vaccine production.
Dr. Glass visited the Institute for Health Research, Epidemiological Surveillance, and Training and shared images of their laboratory. Dr. John Nkengasong was confirmed by the Senate to lead PEPFAR.
In July, FIC, led by Unja Hayes, held the orientation for 112 trainees from the Launching Future Leaders in Global Health (LAUNCH) Research Training Program (formerly known as the fellows and scholars program). The 20th anniversary of the program will be celebrated in April alongside the CUGH annual meeting and there will be an alumni event at NIH and a booklet of stories collected from alumni to show the variety of ongoing projects.
Dr. Glass highlighted the work of Dr. Ghada el-Hajj Fuleihan of American University - Beirut (AUB), a Harvard alumna researching bone growth and osteoporosis. She set up the Scholars in Health Research program at AUB, a summer course for researchers interested in non-communicable diseases. Dr. Fuleihan is joined by Dr. Fadlo Khuri in her instruction of the course.
AfreHealth hosted its 5th Anniversary Symposium in Zimbabwe. This marked FIC staff’s first international travel since the outbreak of the COVID-19 pandemic. Drs. Roger Glass, Peter Kilmarx and UnJa Hayes represented FIC at the event. On this trip, the FIC representatives made several site visits. Dr. Glass acknowledged the passing of the University of Zimbabwe's Clinical Research Center's Dr. James Hakim.
Dr. Glass turned the floor over to Dr. Kilmarx to address some of the report. The CUGH hosted a working group on decolonizing global health that was chaired by Drs. Michele Barry and Agnes Binagwaho. The group did a literature review, including one paper on decolonizing global health by lead author Madelon Finkel. The consensus of the working group was that there was a need for a more universal definition of decolonization. A survey revealed that the role of funding is critical when addressing the power imbalance between the United States and LMICs.
The African Postdoctoral Training Initiative (APTI) is now taking applications for the 3rd cohort. APTI brings postdoctoral students from Africa to the United States for two years to work in NIH intramural labs before returning to their home countries with salary and research support. This program is in collaboration with the Bill & Melinda Gates Foundation and the African Academy of Sciences.
The American Society of Tropical Medicine and Hygiene (ASTMH) annual meeting will be held in Seattle, Washington, from October 30 to November 3, 2022. Karen Goraleski and Dr. Kilmarx will be co-moderating a panel.
Dr. Glass acknowledged the retirements of Kathy Michels and Linda Kupfer. He highlighted their many achievements and thanked them for their long careers and contributions to FIC.
The next Board meeting will be in-person on February 6 and 7, 2023.
Select Fogarty Staff Activities
Global Health Reciprocal Innovation Project
The Global Health Reciprocal Innovation (GHRI) project seeks to find methods of implementing domestic health interventions that were developed in LMICs. The GHRI project began in 2019 with the formation of a trans-NIH working group. The first task of the working group was to identify case examples of GHRI research through federal register requests for information, NIH colleague recommendations of grantees, working with the NIH library, and working with fellows from Kenya and Rwanda to conduct a recently completed scoping review of global health reciprocal innovation research.
There are currently about 20 GHRI case examples. WelTel in Kenya became PrEPmate in Chicago, Illinois. Ciclovia in Colombia became OpenStreets in San Francisco, California. The Friendship Bench in Zimbabwe was adapted to become the Friendship Bench in New York, New York.
The next step will be to analyze the collected data and hold a virtual workshop on October 24 through 26, 2022. Participants and presenters will be researchers and funders with an interest in GHRI research. FIC Advisory Board members Chandy John and Jenn Kates will be moderating. The workshop aims to articulate the opportunities and benefits of GHRI work, discuss the science used in GHRI projects, explore policy issues and barriers to GHRI, and formulate plans to move the field forward.
Partnership with CUGH
FIC is working with CUGH to update their capacity-building database. The database was first launched in 2018 and has been redesigned and revamped under the leadership of Keith Martin, Andrew Dykens, and Dalal Najjar. The new database will be released on September 21, 2022, and will enable individuals and institutions to offer training, mentorships, and partnership opportunities. There will also be a separate track for training opportunities and needs, as the demand for new scientists is critical for this field.
Efforts in Food and Nutrition Research
The interest in nutrition and food security has been on the rise both in the United States and abroad. At the end of 2021, the federal government announced an $11 billion investment to end global malnutrition by building resilient health systems and sustainable food systems to overcome setbacks caused by the COVID-19 pandemic, climate change, and conflict. The ultimate goal is to prevent more children from falling into malnutrition.
This month, the White House is holding the second conference on ending hunger, improving nutrition, improving physical activity, and reducing diet-related diseases and disparities. This is the first such conference since the Nixon administration. This year's conference will combine the public and private sector to collaborate on a best course of action.
This past summer, a notice of special interest (NOSI) on stimulating research to understand and address hunger, food insecurity, and nutrition insecurity, was issued by 16 ICOs and highlights 23 funding opportunities. The NOSI encourages research on the efficacy of interventions that address nutrition insecurity and the mechanisms of food insecurity on a number of health conditions.
FIC is working with partners across the NIH and other federal agencies on a global food insecurity webinar series. The series will be chaired by Dr. Rafael Perez-Escamilia. The series will be held biweekly starting in November. Each webinar will feature a subject matter expert and a question-and-answer session. The webinars will be recorded for future publication.
Progress in Health Equity in Research
There is an active NIH-wide working group on promoting equity in global health research. The group released a request for information (RFI) that was open from May 20 to August 1, 2022 and received 186 responses and is currently in the process of analyzing these responses. Ms. Beecroft thanked the Board for their assistance in promoting the working group's information.
Questions
Dr. Sten Vermund asked how FIC might bridge the gap between social entrepreneur enterprises and Fogarty. Dr. Carol Dahl cited the need for academic institutions to help guide potential entrepreneurs in the right direction. Drs. Dahl and Murphy cited examples of programs that are working towards this goal.
Special Presentation
Claudine Humure is a student at the University of Washington studying prosthetics and orthotics. Ms. Humure has been living with an amputation since 2005 when she lost her leg due to osteosarcoma. Her experiences both in Rwanda and the United States have inspired her to bring the medical technology used at American hospitals to amputees in Rwanda. She has worked to improve the lives of those living with amputations from improving the quality of prosthetics sockets to working with Boston Marathon bombing victims. In Rwanda, care for amputees is substandard and those living with amputations are often forced onto the streets. Ms. Humure was inspired to study prosthetics in the United States and bring a center to Rwanda that provides the same quality of care.
Closing Remarks and Adjournment
Dr. Glass asked the Board Members to give their best recommendations to improve the quality of work done at FIC. Dr. Dahl recommended more discussions into bioengineering in global health. Dr. Maureen Lichtveld recommended highlighting more global fellows and focusing on climate change issues. Dr. Wondwossen Gebreyes recommended more focus on the human-animal interface in terms of diseases like Ebola and COVID-19 as well as training in an integrated manner.
Dr. Glass thanked the Board Members and Fogarty staff for their guidance and work and brought the meeting to a close at 3:11 p.m. Eastern Daylight Time.