The FIC Advisory Board met in the Stone House, on the NIH Campus in Bethesda Maryland, at 9:00 a.m. EDT, Dr. Peter Kilmarx, FIC Acting Director, presiding.
Present
- Peter Kilmarx, M.D., Chair, Acting Director, FIC
- Carol Dahl, Ph.D., Formerly Lemelson Foundation
- Wondwossen Gebreyes, M.D., Ohio State University
- Gregory Germino, M.D., National Institute of Diabetes and Digestive and Kidney Diseases, NIH (Ex Officio)
- Karen Goraleski, M.S.W., American Society of Tropical Medicine and Hygiene
- Chandy John, M.D., Indiana University School of Medicine
- Jennifer Kates, M.D., Kaiser Family Foundation
- Maureen Lichtveld, M.D., University of Pittsburgh School of Public Health
- Robert Murphy, M.D., Northwestern University
Also Present
- Kristen Weymouth, Executive Secretary; FIC
- Nalini Anand, J.D., M.P.H., Director, Division of International Science Policy, Director, Center For Global Health Studies, FIC
- Blythe Beecroft, M.S., Center for Global Health Studies, FIC
- Flora Katz, Ph.D., Director, Division of Training and Research, FIC
- Praveen Kumar, Ph.D., NIH Climate and Health Scholar, FIC
- Vesna Kutlesic, Ph.D., Director, OGH, OD
- Andrey Kuzmichev, Communications Director, FIC
- Kayla Laserson, Sc.D., SM, FASTMH, Director, Global Health Center, CDC
- Vivian Pinn, M.D., FIC
- Josh Rosenthal, Ph.D., Senior Scientist, Division of Epidemiology and Population Studies, FIC
- Jane Simoni, Ph.D., Director, OBSSR
- Rachel Sturke, Ph.D., M.P.H., M.I.A., Acting Deputy Director, FIC
- Nidia Trovao, Ph.D., Research Scientist, FIC
- Judith N. Wasserheit, M.D., M.P.H., University of Washington
- Celia Wolfman, Policy Analyst, FIC
Acting Director's Update and Discussion of Current and Planned FIC Activities
Dr. Peter Kilmarx called the meeting to order and gave an update on the recent activities of the FIC. This was the last meeting for Dr. Judith Wasserheit, Dr. Carol Dahl, Ms. Michelle Williams, and Ms. Karen Goraleski, as they would be stepping down as members of the Advisory Board. Dr. Jeanna Marrazzo will become the new NIAID Director at the end of September. Interviews are underway for a new permanent FIC Director, making this meeting Dr. Kilmarx's last as Acting Director. In June, Judy Coan-Stevens and Dr. Kilmarx attended the International Tropical Neurology Conference in Peru and met with Hugo Garcia and other Fogarty grantees and former trainees, along with touring IMPACTA Peru, the National University of San Marcos, and Cayetano's Alexander von Homboldt Tropical Medicine Institute. Dr. Mirko Zimic, a former Fogarty trainee, ran the Bioinformatics Laboratory at Cayetano and was working on numerous projects. Peru has 130 NIH extramural research awards and collaborations with 15 different NIH Institutes, Centers and Offices, making them a gold partner for NIH.
In June, NIH hosted the Emerging Topics in Global Health Summer Symposium, which focused on early career individuals and trainees at NIH. Topics included climate change, research equity, and health technology. Also in June, Dr. Kilmarx attended the planning meeting for the Ukraine HIV Research Training Program in Warsaw, where Dr. Kostyantyn Dumchev, Scientific Director of the Ukrainian Institute of Public Health Policy, relayed that despite the war and unrest they continued to follow displaced patients with HIV infections. There were 270 NIH extramural research awards in 25 countries from 20 ICs in the region. While in Warsaw, Dr. Kilmarx met with NIH's CDC partners. In August, Dr. Kilmarx attended the National Medical Association meeting in New Orleans to discuss training and grant opportunities that were available, as well as NIH's desire to increase diversity amongst their trainees and researchers.
Dr. Flora Katz updated the Advisory Board on the Division of International Training and Research's (DITR) recent activities. Dr. Aspen Reese is a new AAAS fellow in DITR who will be working on the Climate Change and Health portfolio. The LAUNCH program (Global Health Program for Fellows and Scholars) held an in-person orientation for its fellows in July and will be sending 107 trainees from the class across 7 consortia to 60 LMIC research institutions in 28 countries supported by 16 ICOs. Dr. Katz announced the Lee Riley Memorial Global Health Equity lecture to be an annual session at the orientation. In August, the AFREHealth Symposium was held. AFREHealth is a pan-African organization that links academics in medicine, nursing, and public health, which grew from the Medical Education Partnership Initiative that Fogarty managed with PEPFAR support. Dr. Roger Glass received AFREHealth's leadership award. DITR hosted two network meetings since the last Board meeting, led by Geetha Bansal; one on the HIV Research Training program, and the other on HIV-associated NCDs. Future networking meeting topics included: NCD-Lifespan 9/27/23 - 9/29/23, HIVRT Trainees 10/2/23 - 10/3/23, Brain Disorders Across the Lifespan 10/17/23 - 10/19/23, mHealth 10/25/23 - 10/26/23, and Trauma and Injury Research Training with dates to be announced.
Ms. Nalini Anand and Ms. Blythe Beecroft updated the Board on the Division of International Science Policy, Planning and Evaluation's recent activities. Jenna Durham, a Health Science Policy Analyst, and Dr. Jessica Ott, a medical anthropologist and AAAS Fellow, have joined as new staff members. DISPPE's project promoting equity in global health research received 186 responses to its RFI and extracted six key thematic areas: global research partnerships, peer review, data access and ownership, priority setting, capacity, and funding limitations and structures. DISPPE had published a summary report capturing the responses and analysis and presented the report and its results to the NIH Working Group and partnering organizations. The NIH Working Group on Promoting Research Equity was comprised of eight partner ICs in addition to Fogarty and was in the process of forming five subgroups focused on: building grants application and management capacity; data sharing, management, and scientific capacity; equitable research partnerships and community engagement; funding opportunities and administration; and peer review. The Working Group at-large had identified the need to communicate existing work and IC activities related to research equity, as well as curating examples of equitable partnerships and pinpointing the characteristics that made them such. A DISPPE project looking at global implementation science decided to commission case studies with the objectives of documenting examples of rigorous implementation research in global contexts and providing a resource to help research capacity. The project has published a commentary piece as an introduction to the series in
Implementation Science Communications, as well as six published cases, with three additional cases still under review. The case studies highlighted diverse disease areas and geographic regions.
FIC Communications Director Andrey Kuzmichev provided the Board with a communications update on the FIC website, social media, projects and products. Since the last Board meeting, the FIC website had received 133,481 views, compared to 289,389 between the previous four months, the third highest of the 26 NIH Institutes. The top three FIC pages viewed were Non-NIH Funding Opportunities, the Fogarty Home page, and NGOs Working in Global Health Research. The top Google searches that brought viewers to the website were "Fogarty," "NIH Biosketch," "Implementation Science Framework," and "(Introductions to) Epidemiology pdf." Most views came from the U.S., followed by India, Nigeria and the U.K. FIC has a growing number of followers on Twitter, Facebook, and LinkedIn. Since the last Board meeting, there was an increase in the rate of follower acquisitions on all platforms with the exception of LinkedIn. Communications increased its number of posts on all platforms, and the number of impressions from those posts increased as well. Followers by country ranked the U.S. as number one, but the rest of the top countries for followers changed by platform. Two common themes among the top social media posts were topics related to alumni fellows and funding/fellowship opportunities. Projects and products that garnered more followers included Global Health Matters, the FIC's flagship newsletter and several of its articles, and the inclusion of FIC in the NIH's Oral Histories Project. The Oral Histories Project conducted interviews on the NIH's history and would be conducting interviews particularly on COVID-19, and Director Kuzmichev asked Board members to forward to him any suggestions they had on who to interview.
Dr. Nídia Trovão updated the Board on the Division of International Epidemiology and Population Studies (DIEPS) recent activities. Dr. Josh Rosenthal was awarded a Fulbright Scholarship to build the first MPH program in India on climate change and health, and will be spending the fall in Chennai, India, working with Dr. Kalpana Balakrishnan, the Dean of Research at Sri Ramachandran University. The project's goals are to develop the MPH curriculum and implement it in multiple universities throughout India. DIEPS scientists published 21 articles since January 2023, including a collaborative study with NIAID intramural that looked at how behavioral factors, such as masking, affected the spread of COVID-19 in households in Costa Rica. Other published studies include direct and indirect mortality impacts of the COVID-19 pandemic in the United States from 3/1/20 - 1/1/22; sequential viral introductions and spread of BA.1 across Pakistan provinces during the Omicron wave; and effects of LPG stove and fuel intervention on adverse maternal outcomes.
DIEPS will be holding several training workshops. The African Network for Influenza Surveillance and Epidemiology will hold two workshops 9/11/23 - 9/13/23 on influenza genomic analysis and phylogenetics and estimating influenza disease burden to establish and expand influenza vaccination. DIEPS would also hold two workshops 9/11/23 - 9/22/23 in collaboration with JHU APL and the Pasteur Institute of Tunis on the topics of responsible conduct in the genomic sciences and applied bioinformatics for genomic epidemiology. The final planned workshop will be held 9/25/23 - 9/30/23 and focuses on personnel reliability best practices for laboratories.
Dr. Kilmarx reviewed the work and goals of Congressman John E. Fogarty and informed the Board that FIC would be hosting all-hands events every two months to celebrate its 55th anniversary. Future FIC Advisory Board meetings were scheduled for February 5-6, 2024 (in-person), June 3-4, 2024 (virtual), and September 5-6, 2024 (in-person).
Dr. Gregory Germino stated that during the summer, NIH re-signed its collaboration agreement with the ICMR of India and held a kickoff meeting on August 23, 2023. Topics of interest for the collaboration included the heterogeneity of diabetes and the potential role of lifestyle choices in prevention, risk reduction, and therapy. Dr. Chandy John asked what the possible next steps were with regards to DEI. Dr. Katz responded that the five subgroups were being encouraged to reach out to engage with others in order to get more input. The steps were not yet clear, but there were specific recommendations that arose from the RFI responses. There were goals that would be easier to address in the immediate future, but the subgroups were still organizing themselves and gathering information on the best ways to do so. Dr. John stated that the report was well done, but it could use more publicity in order to maintain and build the momentum surrounding DEI.
Ms. Goraleski expressed her enthusiasm for the inclusion of the Communications Update due to the growing need for communications in an ever-changing global environment where disseminating information in just one way is no longer feasible. There are also certain audiences, such as staff and press, looking to see that FIC was conveying the types of information that are most useful. Dr. John asked if TikTok could be used for spreading information and Dr. Kilmarx explained that as part of the federal government they were not allowed to use that platform. Dr. Jennifer Kates asked if, in the documentation and case studies for global implementation science, there were examples of the policy environment affecting implementation research. Dr. Rachel Sturke responded that they had not included that but it would be an interesting extension of what has been done. The examples used were primarily academic, so a logical next step would be to investigate from a higher perspective and include broader contextual factors.
Dr. Wondwossen Gebreyes asked what work and training was being done to deal with the rising issue of antimicrobial resistance. Dr. Kilmarx stated that there were a number of activities, but they were not yet at the point of being able to meet the estimates Dr. Gebreyes was concerned about. Some work is currently being done through the Common Fund program, but capacity building was needed in the area. Dr. Katz noted that there had not been a concerted initiative, so most of the work was being done through random grants in a few programs but they were aware of its importance. Dr. Kilmarx elaborated that if they had a new bolus of resources and a NOSI, then AMR would likely fall under their global infectious disease research training program. Without more resources and funding, however, they were reluctant to announce interest in a new area. Dr. Vesna Ketlusic informed the Board that NHCID is still following the COVID-19 impacts on pregnant individuals and children. NHCID will be hosting a webinar on October 25, 2023, regarding underserved communities in the U.S. and Canada and the impacts of COVID-19, as well as methods of promoting health equity moving forward. NHCIS is also focusing on the nutrition needs of school aged children and works closely with the Gates Foundation on pregnancy outcomes, growth and nutrition, and neural development.
Insights into Disease Dynamics: Exploring Viral Epidemics in African Health
Dr. Trovão presented an update on two projects regarding measles and rabies in Africa. The first project, Evolution and Transmission Dynamics of Measles in Africa, showed the highest rates of measles were observed in Africa. Due to the COVID-19 pandemic, a global postponement of vaccination campaigns led to 117 million children becoming at risk for measles; a 400% increase in cases occurred between January and March of 2022. The study dataset was collected by Dr. Herve Kadjo's department at the Institut Pasteur de Cote d'Ivoire. This dataset consists of 336 N gene sequences from 12 African countries studied against 693 background sequences from around the globe. The study reconstructed the evolution and transmission of measles using phylodynamic modeling. Despite most of the sequences being collected from outside of Africa, the study's inferences revealed two main viral source clusters; one cluster from Africa and one cluster from elsewhere around the world. Nigeria was found to be an important viral source to other African countries. As part of the phylodynamic modeling the study was able to infer the routes of measles dissemination, with most dissemination occurring within Africa and some sporadic viral introductions between other continents in both directions. The study revealed the diversity of measles spreading in Africa, dominated by genotype B3. African sequences tended to cluster with others on the continent, indicating cross-country transmission. The sustained transmission would have important implications on informing where to enact control measures to prevent cross-country transmission. This genomic surveillance study was the first to generate sequences that gave information on the viral diversity in countries like Mauritania, Chad, Burkina Faso, and Guinea, but there were still large gaps in northern, southern and eastern Africa.
The second Project was the Impact of the Military and Political Crisis on the Central African Republic Rabies Epidemic. Since its independence in 1960 the CAR has experienced decades of violence and instability. The current civil war began when the Séléka group captured many towns in 2012 and seized the capital of Bangui in 2013, continuing since that time. Due to conflicts throughout the country, the population density has shifted towards western and central regions, including the capital. Despite the rabies vaccine and the vaccination program established in the CAR in 1980, disease management remains centralized with rural and outskirt areas having limited access to vaccines. In Africa, dogs appeared to be the main reservoirs of rabies, but humans contributed to the movement of animals when colonization and mass migration events occurred both in rural and urban settings. The political crises in the CAR have led to the permeability of borders and mass migrations, bringing with them the animals that are reservoirs for rabies. The Institut Pasteur de Bangui was the only reference laboratory in the country designated by the Ministry of Health to collect and diagnose suspected rabies samples. Between 2011 and 2017, the Institut Pasteur de Bangui collected 247 brain and saliva samples, mostly from animals but also some humans. The study observed a high positivity rate of ~76% compared to the 2021 positivity rate in the U.S. of 2.7%. Of the 247 samples, 188 tested positive and due to limited sequencing resources 65 samples from across the districts of Bangui were used for further analysis. Sanger sequencing of those 65 samples yielded 24 complete nucleoprotein gene sequences. The 24 RABV sequences formed 2 different genotypes with cases of both distributed throughout the country, most being genotype 2.
The study then applied a time-scaled Bayesian Phylodynamics approach, reconstructed a tree of the 24 nucleoprotein sequences, and generated a genomic background dataset of more than 1000 RABV sequences obtained globally. The most recent common ancestor of CAR viruses in dogs was estimated to have existed between the late 19th century and the early 20th century and was the first introduction of Rabies into the CAR. By conducting phylogeographic modeling the study revealed 2 independent introductions of RABV in the CAR that matched genotypes 1 and 2. The study sequenced 4 genomes from smaller outbreaks that clustered closely with other viruses from Cameroon, Chad, Gambia, Liberia, and Nigeria. The largest outbreak included the remaining 20 cases of RABV infection sequenced in the study; additionally, there were 15 previously generated RABV sequences which were basal and closely related to the 20 cases the study had sequenced. Focusing on the study's 20 cases of RABV, it was reconstructed to have emerged in dogs between 2011 and 2014 which coincided with the advances of the Séléka. While spatial distribution suggests dogs as the predominant host for RABV spread, the study identified for the first time, RABV circulation in cats likely constituted a dog spillover event occurring in the late 1990s.
The study doubled the number of RABV sequences available for the CAR. This revealed a decline in circulation of genotype 1 in urban settings, suggesting a possible disappearance of it in cosmopolitan areas. There was an observed amplification of genotype 2 in the city of Bangui, likely due to internal population displacement towards the capital caused by military unrest. The study linked viral introductions with periods of military and political instability; however, it was difficult to determine the degree to which these factors contributed to the dissemination of RABV due to limited genomic surveillance in the region. The study helped conclude that in the context of permeable borders that allow the free movement of humans and animals, the strengthening of veterinary services, control measures, and establishing a well monitored vaccination program that targets high prevalence areas would likely help curb viral exchange among countries and limit the introduction and expansion of new rabies diversity in the CAR.
Dr. Kutlesic asked if the study looked at stray populations and if the Ministries had any programs for controlling them. Dr. Trovão stated that the stray population had risen with the unrest but did not know if the Ministries had any plans to deal with that rise. Dr. Germino asked how the phylodynamic modeling results of both studies would help inform public health, to which Dr. Trovão responded that knowing where certain genotypes are focused allows for better targeted preventative steps to be taken in the future as well as helping predict ways in which the viruses might mutate.
Emerging Global Leaders Award (K43)
Program Concept
Dr. Christine Jessup presented the concept for renewal of the Emerging Global Leaders program to the Board. The K43 was the only NIH career development award for LMIC investigators based at LMIC institutions. The program aimed to ensure a career pathway for promising LMIC scientists, strengthen the intellectual capacity for global health research, and foster long-term international research collaborations. The current funding opportunities would expire after the coming 2023 deadline, and the renewal being proposed would have no significant changes to the program. The program aimed to support protected time for individuals to engage in mentored research and career development activities. It provided salary support, research support, intensive research career development experience under dual US and LMIC mentorship, and research could be in any area covered by the NIH in LMIC context. The program was for junior faculty at LMIC institutions to reach research independence. To qualify, they had to be junior faculty or research scientists with an appointment at such an institution, be established at the institution for more than a year, and not have achieved research independence. Awards were administered by FIC with partner co-funding for projects aligned with partner interests.
Program Analysis
Ms. Celia Wolfman Katz presented a review of the FIC K43 program for FY'16-'22 to the Board. There were 352 applications from 232 applicants. Of those, 77 were funded, with 34 having co-funding from 11 different ICs; 275 were unfunded, totaling $27.2 million in funding. For the 352 applications, the average success rate over the seven years was 22%. In the seven years, 88 applicants who were unsuccessful in their first applications resubmitted 2-5 times with an average resubmittal acceptance rate of 38%. The total amount of co-funding over the seven-year period equaled $7,211,534 or 27%. In descending order, the ICs that contributed most were NCI, NIMH, OD (comprised of OAR, ORWH, OBSSR, and OSP), NINDS, NIEHS, NHLBI, NIDCR, and NIA. The application topic that was most successful in receiving funding was research related to HIV/AIDS with a 45% success rate. The portfolio of the awardees was broken down based on gender, predominantly female; primary degree, more than half having a Ph.D.; whether they had former FIC training or education, 39% did; and geographic distribution, 81% in Sub-Saharan Africa, 10% in South Asia, 7% in Latin America, and 1% each in East Asia and Europe. The distribution within Africa had 62 grants spread across 34 institutions in 12 African countries. Outcomes of the K43 awards showed that 26 K43 awardees had applied to 52 NIH grants, with 14 of the awardees having been awarded 16 NIH grants; both applications and awards were primarily for research with a few for training. As of June 2023, K43 awardees had produced 650 publications, had an average of eight citations per year, and using the NIH metric for relative citation ratio, the publications had a RCR of 4.05, meaning they were four times more cited per year than the median NIH paper.
Dr. Germino asked how the co-funding worked in terms of breakdown and Ms. Wolfman Katz replied that it generally varied between 50 to 100% co-funded, but that was negotiated with each individual award. Dr. Murphy asked what other metrics they might look at to determine outcomes, suggesting promotions, leadership positions, programs run by awardees, non-NIH grants, surveys of awardees, and special assignments. Dr. Kates suggested exit interviews. Dr. Kutlesic added that measuring service within the awardees' communities would be an interesting outcome metric to have. Ms. Goraleski noted that engagement with political leaders and policymakers would be another important area to look into, as the goal of the program was designed to create global leaders and they should not just be leaders in the lab but actually helping to effectuate change in policy.
Diversity, Equity and Inclusion (DEI) in FIC Training Grants: Supplements 2023
Dr. Flora Katz presented an overview of the new DEI initiative to the Board. In FY'23, the FIC appropriations included $5 million for addressing health disparities (HD) defined by the NIH as preventable differences in health status and outcomes that adversely affect certain populations. U.S disparity populations could include racial and ethnic minorities, persons of low socioeconomic status, underserved rural residents, and sexual and gender minorities, among others. LMIC HD populations could differ depending on the country. U.S. researchers who identified with disparity populations showed special interest in HD research, and FIC considered increasing diversity of the scientific workforce a related category. This could include building research capacity at educational institutions that educated and served HD populations. There were precedents for strengthening the workforce in LMICs. In 2013, the NIH and the South Africa MRC came to a bilateral agreement between to develop the U.S.-South Africa Program for Collaborative Biomedical Research. This program established two awards, one of which initially did not have a Historically Disadvantaged Institution (HDI), but when it came up for renewal had a HDI as a full partner. There was also a 2020 request for supplements to FIC HIV training programs to include training opportunities for HDIs and under-represented minorities in South Africa. There were a number of reasons for including DEI in the context of LMICs. Scientifically, there is research showing that diverse teams working together outperform homogenous teams, both in creativity and productivity. DEI also remedies issues in global health equity by increasing the number of underserved people who receive health training.
In the summer of 2023, FIC issued two notices of special interest (NOSI). The first was phase 2 of the U.S.-South Africa Program for Collaborative Biomedical Research, Administrative Supplement Opportunity for South African International Research Training Grants. The second was a NOSI for administrative supplements to FIC's training grants to promote DEI, which received 25 applications during its five-week application window and approved 14 awards. The applications represented a wide range of countries and NIH programs. Overall, 28.6% of NIH's training grants were direct foreign awards and 29.2% of the 25 applications received were from direct foreign awards, showing an almost direct representation of the NIH's pool. Groups identified in awarded supplements included: indigenous minorities of South America, disadvantaged rural and Syrian refugee communities in Jordan, trainees from rural communities in Kenya, Muslim women faculty in Thailand, women from backgrounds of extreme poverty, pastoral communities in Kenya, religious minorities in India, LGBTQI+ trainees from HDIs in South Africa, new training partner institutions in Central America serving rural and indigenous populations, ethnic minorities in the Peruvian Amazon, US URM under-grads integrated into LMIC training programs on malnutrition and TB in Tanzania, and female junior faculty in MENA. There were also several complementary efforts on DEI within NIH, including a NIH-wide FOA for diversity supplements.
Dr. Germino asked whether DITR was planning to build DEI into NOFOs as a requirement or a review criteria and Dr. Katz replied that they hadn't thought about that, but based on the responses received in the applications DITR was going to incorporate different criteria in their recruitment methods for the remaining 4 years of their training program. The Board further discussed the importance of the DEI supplement and making sure it was sustainable and ensuring DEI became a priority for LMICs.
Introduction to Dr. Jane Simoni, Director of the Office of Behavioral and Social Sciences Research (OBSSR)
Dr. Jane Simoni, the new Director of OBSSR, introduced herself to the Board. Dr. Simoni had an academic career of over 30 years as a Clinical Psychologist and came from the University of Washington. After the COVID-19 pandemic, Dr. Simoni saw a lack of attention being paid to mental health and social sciences, leading her to leave the academic sphere to join the policy side of behavioral and social sciences research. Dr. Simoni noted that it was an incredible moment for behavioral health with opportunities to broaden OBSSR's influence. Dr. Simoni discussed several ongoing topics within the U.S. including the opioid epidemic, mental health crises among youth, and psychological distress from current events. Dr. Simoni stated that it was the structural and social determinants of health that were the most important in having an impact on behavioral health. In regard to global health Dr. Simoni discussed the artificial boundaries created between countries in the field of behavioral health that needed to be overcome in order to work together for the good of all. DEI and its importance to LMICs was another issue that needed addressed and Dr. Simoni gave anecdotes of how issues were treated differently in other countries, as well as the fact that the focus on STEM in those countries resulted in a dearth of social scientists. Dr. Simoni expressed an interest in the development and use of technology in health as a way of addressing disparities globally. She discussed developing OBSSR's pipeline to be able to aid communities around the world by sending people with firsthand experience and relevant knowledge to those communities and populations. Dr. Simoni also
Dr. Josh Rosenthal commented on the fact that taking U.S. models of community engagement and trying to implement them in other countries often did not work. Dr. Simoni agreed that they should often look different based on location but at a higher level many of them had the same core tenets. This required talking with every level within the health structures in place, as well as the community and religious leaders to learn what would work there. Dr. John asked about OBSSR's work in public communications and mediating misinformation on vaccines, and what Dr. Simoni's plan was for OBSSR to more successful at it. Dr. Simoni discussed that pediatricians had contributed a lot to methods of communicating proper information on vaccines and NIH had a center dedicated to studying methods of information dissemination to the public. OBSSR also had a compound initiative to study health information that had been paused by the Director, and Dr. Simoni elaborated that the issues in communication during the COVID-19 pandemic were a main factor in her decision to join OBSSR and it was an area she wanted to dedicate much study towards. Dr. Carol Dahl asked if OBSSR could provide resources in community engagement models abroad where local scientists felt overconfident in their models and did not know the methods that would be needed to implement the changes they suggested. Dr. Simoni replied that that was a main function of OBSSR and in her experience, it was when a researcher hit a wall in implementation that they asked for the assistance of behavioral health to understand the social aspects preventing their work from being implemented.
Climate Change and Health (CCH)
Dr. Josh Rosenthal updated the Board on the NIH-wide Climate Change and Health Initiative. A strategic framework had been developed by the working group, comprised of 170 members from 21 ICOs, which focused on health effects research, health equity, training and capacity building, and intervention science. The working group tended to focus on extreme weather events because they were tangible, measurable, and impacts could be identified more easily. The NIH had funded a new Research Coordinating Center at Boston University in collaboration with Harvard to support the initiative and develop a community practice. The community practice would aim to be transdisciplinary and to integrate NIH's funded researchers, development officials, and implementers. It was a domestic focused alliance for community engagement that funded a few projects to work carefully with communities to determine the locations, solutions, and ultimately address priorities particularly in HD communities. The initiative was preparing to fund its first four Exploratory Centers at institutions that won the P20 competitions that were run during the summer of 2023, their names and locations would be announced at a later date, with the goal being to develop them into full CCH Centers. To expand upon NIH's own definition of climate change it held an internal competition and had one cohort of eight scholars come to the NIH who had experience in the area to assist in the development of related activities. The second round of scholars was being interviewed and the final announcement would occur that Fall.
Dr. Maureen Lichtveld provided a presentation to the Board discussing opportunities and challenges associated with CCH research and training in LMICs, a case study of community-based participatory research (CBPR) in CCH inequities, and the benefits of FIC investment in research training. LMICs were disproportionally affected by CCH but there were opportunities for development based on LMICs having a general consensus on the topic, the lack of misinformation on the topic amongst them, their commitment to balancing environmental protection and economic development, their eager commitment to regional collaborations, and their recognition of the importance of collaborations between different regions to build research training. The challenge factors LMICs faced were a lack of research and training infrastructure, a dearth of country-wide action plans, siloed approaches to action on CCH, limited chances to demonstrate competency, and less competitive research and training capacities. The priorities for LMICs regarding CCH were infectious diseases, extreme heat, food and water security, and poor air quality.
Dr. Lichtveld noted the priorities for CCH actions in the Caribbean as an example; the PAHO Caribbean Action Plan on Health and Climate Change prioritized empowerment, evidence, implementation, and resources. These priorities resulted in a call to action for transdisciplinary research and implementation science. CBPR in LMICs required co-creation as a community-academic partnership, the collection and analysis of non-traditional data such as community capitals, built-in flexibility, co-implementation, and co-management. The case study presented revolved around the blood levels of lead, mercury, and selenium in the population of Suriname as stress factors in health. Dr. Lichtveld discussed the work of Dr. Meghan Matlack on developing a climate literacy scale to access knowledge, attitudes, and behaviors towards climate change and infectious disease dynamics within the CCREOH cohort.
Dr. Praveen Kumar presented some of his research to the Board on interventions addressing climate and its impacts on health and well-being and exploring the utility of system science approaches in climate and environmental justice and in cognate research areas. Transdisciplinary research was crucial in determining the consequences of climate change on health and which climate drivers worked through different exposure pathways resulting in certain health outcomes. Dr. Kumar briefly discussed two studies; "Impact of Climate Catastrophe on Expectant and Lactating Mothers and Infants in Flood Hit areas of Sindh and Baluchistan provinces of Pakistan" and "Effect of transition to clean brick kiln technologies on the social and economic well-being of vulnerable low-income brick workers in Dhaka, Bangladesh" and which areas of the NIH's CCH strategic framework they worked with. The Bangladesh study focused on climate change adaptation, which meant taking actions to prepare for and adjust to both the current impacts of climate change and the projected ones. For human systems, adaptation sought to moderate or avoid harm or exploit beneficial opportunities. Some examples of climate adaptation strategies included land use change, developing green infrastructure, reforestation, and flood protection, among others.
While there was limited research in the area, existing literature had found that behavior changes, awareness and capacity building was the most common type of adaptation in LMICs, followed by green infrastructure, technological advancements, and physical infrastructure improvements. The most common health outcome indicator as a result of adaptation was food security, but there was a very limited number of indicators on mental health and no adaptations were reported for maternal and child health. There was also an issue of under-representation of LMIC researchers and practitioners; even though there were many studies conducted on LMICs, most of the authors came from high income countries. More opportunities were needed to increase their participation. Also, there was a narrow scope of considered adaptation strategies, health outcomes and research approaches. The NIH CCH Initiative and the FIC were inviting submissions for case studies focused on climate adaptation in LMICs. Applicants' proposals would be reviewed by a steering committee of global experts and 8-12 proposals would be selected to develop into full case studies for publication. The applications were due October 16, 2023.
Ms. Goraleski asked how the results showing that LMICs were disproportionately affected by climate change would be promoted to the public beyond being published in academic journals. Dr. Lichtveld explained that the work being done in Suriname was all community driven, and in the Caribbean all the Ministers of Health had committed to make climate change their first priority, so the research results and developments were being shared with all of the policy makers as well as the communities. Dr. John asked where LMICs and researchers should be looking to get information on climate change, as they were all focused on health sciences not climate. Dr. Rosenthal explained that they were working to build partnerships with NGOs, governments, agencies to bring their communities together and begin discussions on the issue. Dr. Kutlesic asked if the WHO was working on CCH and Dr. Rosenthal responded that the WHO had an Active Climate Unit in its Center for Environmental Health.
Dr. Kayla Laserson, Director, Global Health Center (GHC), Centers for Disease Control and Prevention
Dr. Kayla Laserson updated the Board on changes within the CDC Global Health Center. The CDC created and deployed regional offices; the Central America/Caribbean office based in Panama, the South America office based in Brazil, the Middle East/North Africa office based in Oman, the Eastern Europe/Central Asia office based in Georgia, the Southeast Asia office based in Vietnam, and the East Asia and Pacific office based in Japan. These were in addition to 65 country offices around the globe. Post-COVID, the CDC did a self-analysis to determine areas for improvement. For the GHC, four goals were set: to optimize implementation and have greater visibility of GHC work; to have consistent, efficient and robust operational support to regions and countries; to have enhanced collaboration across HQ, regions, countries, CIOs, and partners; to streamline processes for greater coordination of responses to public health emergencies. The CDC's global strategic priorities were to strengthen global health security, increase health impacts, and build resilient public health systems. The CDC had a large role in PEPFAR impact indicators. The CDC also provided field epidemiology training programs, partnered with more than 40 countries to create new or strengthen existing NPHIs, and had a global rapid response team. The CDC was working on global immunization programs as well, combating polio, rubella and measles.
GHC was building out a global health strategy that was more measurable, objective, and coordinated on Respiratory Disease Readiness (RDR). The objective was to use RDR as a use case to exemplify CDC’s role and value globally and to optimize an area of work through enhanced cross-CIO collaboration as the first step in developing an agency-wide global strategy. The goal of the framework was to protect Americans and populations around the world by reducing morbidity and mortality from respiratory disease globally through program implementation and capacity and systems building. Dr. Gebreyes asked what the overall forecast was for global security regarding its commitment and investments. Dr. Laserson stated that part of the reason for building out the global strategy and identifying and filling gaps within it was to be sure that whatever limited funds they had were directed to the places where they were most needed to ensure a threshold of health security across the globe.
Dr. Kuzmichev asked if there was a difference between how the CDC GHC communicated globally and nationally. Dr. Laserson responded that they had officers in their regional offices dedicated to working on communications, and CDC as a whole was focused on improving its communications following COVID. Dr. Lichtveld asked how Dr. Laserson envisioned the future of partnerships between teaching institutions and different external organizations. Dr. Laserson noted that partnerships were extremely important, but they weren't a large part of what the CDC had done in the past and she would like to see them doing more in the future. Dr. Kutlesic asked to what extent GHC had health research and priorities for pregnant women, children, and individuals with disabilities. Dr. Laserson explained that there was a lot of discussion in GHC and the CDC about health equity, and globally the definition of DEI varied and who was considered vulnerable differed. Dr. Kilmarx asked in situations where the CDC was the lead of an outbreak response, where there was a role for NIH to help with conducting research. Dr. Laserson replied that research was key in those situations, and there were roles for NIH to fill.
Closing Remarks
Dr. Kilmarx thanked the Board members and Fogarty staff for their time and input into the meeting and thanked the presenters for their time. Dr. Kilmarx gave a special thanks to Dr. Dahl, Ms. Goraleski, Dr. Wasserheit and Dr. Williams, for whom it was there last meeting. There being no further business, the meeting was adjourned at 2:59 p.m.