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Decolonizing and democratizing global health are difficult, but vital goals

July / August 2020 | Volume 19, Number 4

Opinion by Fogarty Director Dr Roger I Glass

A renewed effort to decolonize and democratize global health has recently been gathering steam, especially among college students, who are questioning the fairness of the existing framework and are calling for a shift in leadership and broader knowledge sharing. What does this mean for the research community?

At Fogarty, we believe health equity and open access to knowledge are at the very heart of our mission - to build scientific capacity in low- and middle-income countries (LMICs) to help develop equitable research partnerships, ensure studies are locally relevant and that participating communities benefit from the knowledge gained. Informing all our activities is the Fogarty vision of “a world in which the frontiers of health research extend across the globe and advances in science are implemented to reduce the burden of disease, promote health, and extend longevity for all people.”

It is obvious to us that the historical approach of taking solutions developed in high-income countries (HIC) and trying to make them fit in LMICs is not an effective approach or respectful of the local circumstances, cultural practices or available resources. Ideally, local scientists with an understanding of the local context and resources will develop and study the effectiveness of interventions tailormade for the setting.

In the 1980s, when Fogarty began its first research training program to build capacity in LMICs, in most cases trainees traveled to a HIC for their studies. Since then, the Center has supported significant training for more than 6,000 scientists worldwide. As a cadre of highly knowledgeable faculty developed in numerous LMICs, a transition began toward creation of local advanced degree programs in disciplines such as infectious diseases, epidemiology and public health. There are now 91 LMIC institutions that award degrees with Fogarty support, including more than 1,338 master’s degrees and 452 Ph.Ds.

This is significant because, not only is it more economical so allows more students to be trained, LMIC curricula are far more relevant to the local disease priorities and available resources than in programs developed for HIC consumption. Our goal is to empower LMIC scientists so they can enter into equitable partnerships where they set the research agenda, based on national priorities, and direct studies that will produce data so that policymakers can make evidence-based decisions. We believe these equitable research partnerships should be reflected in the authorship of the resulting publications. We were encouraged to discover promising trends in a study done with the NIH Library of Fogarty-supported publications. In 2002, about 12% of Fogarty-supported publications had LMIC senior (last) authors and approximately 85% had U.S. senior authors. By 2019, LMIC senior authorship had increased to about 44%. In addition, LMIC first authorship surpassed U.S. authorship in 2014 and continues to climb.

This shift has also been reflected in our grantmaking. In 2015, 18% of our grants went to LMIC institutions. By 2019, that had risen to 31%. The NIH policy decision in 2006 to allow multiple Principal Investigators on grants has allowed more equitable recognition of research partnerships. Since 1988, Fogarty has awarded grants to 408 LMIC PIs, or about 20% overall.

In recent conferences and other venues, some have called for the decolonization of the mind and democratization of information. They propose shifting the paradigm in global health education away from Eurocentric thought to a more inclusive approach. We hope we have made a contribution to that effort, through our Medical Education Partnership Initiative (MEPI), which was an African-led effort to strengthen and expand medical curricula across the continent. MEPI also supported improved internet connectivity, provided tablet computers to medical students and enabled access to up-to-date electronic medical texts and journal articles. Fogarty’s own Center for Global Health Studies has commissioned and funded numerous open-access journal supplements on topics of interest to the global health community. Through the Human Heredity and Health in Africa program, NIH and Wellcome Trust have supported genomic training and established a biorepository, so African data and samples will remain in Africa, where they can be studied by African scientists.

Building equitable partnerships in global health and pushing for wider access to knowledge so that people everywhere benefit from discoveries will require sustained effort and are on ongoing process that is central to our mission. We measure progress made over decades and understand that this is a marathon and not a sprint. At Fogarty, we are in it for the long haul.

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