Global Health: The Fogarty International Center, National Institutes of Health: Vision and Mission, Programs, and Accomplishments

Abstract

Summary The Fogarty International Center (FIC) of the U.S. National Institutes of Health has supported long-term (>6 months) basic, clinical and applied research training and research for over 3,600 future leaders in science and public health from low- and middle-income countries (LMICs); tens of thousands more persons have received short-term training. FIC started these programs in 1988 with the flagship HIV/AIDS International Training and Research Program (AITRP) in response to the global pandemic. More than 23 extramural training and research programs plus an intramural program are now operating – all in collaboration with other Institutes and Centers at NIH, U.S. government agencies, foundations, and partner institutions in LMICs and the U.S. While infectious diseases still reign mightily in Sub-Saharan African and South East Asian countries, non-communicable diseases are emerging globally, including in LMICs. Newer FIC training programs are addressing chronic, non-communicable diseases and strengthening the quality of medical schools and health care provider training, in addition to expanding expertise in infectious diseases. The model for successful training is based on long-term commitments, institutional strengthening, “twinning” of research centers, focus on local problems, and active mentoring. Trainees from Africa, Asia, and Latin America have made notable scientific contributions to global health, attained leadership positions, and received special recognition nationally and internationally. As the FIC programs are institutional-strengthening partnerships and candidates are carefully selected and mentored, close to 90% of FIC trainees return to their countries of origin. After returning home the FIC-trained leaders have continued to mentor and train thousands of individuals in their home countries.

The Collaborative Role of North American Departments of Pediatrics in Global Child Health

“…† US funding agencies are increasingly providing funding to projects with primary LMIC institutions and principal investigators and initiatives with clear partnerships between NA and LMIC institutions. 113 In addition to creating a shared research agenda, NA departments of pediatrics must address the challenge of making a clear commitment to supporting the professional development of LMIC researchers and research infrastructure as part of their partnerships. 90, 96 -98, 100 -103 Failure to attend to these factors results in inequitable partnerships that hinder successful research and the development of long-term collaborations.…”

Observational Research on NCDs in HIV-Positive Populations

“…90 However, such capacity is lacking in many settings in SSA. Although substantial investments have been made in training a labor force with the methodological expertise needed to address the challenge of NCDs, 91,92 expanded training opportunities for local investigators, both in the form of on-the-job training and through master's and PhD level courses in biostatistics, epidemiology, and information sciences, are often lacking in LMICs. Further, development of a mentored and well-supported research career path for LMIC investigators is needed to ensure that investments in graduate-level training translate into sustainable improvements in LMIC research capacity.…”

The ethics of clinical research in low- and middle-income countries

“…Beyond engaging in research responsible to diseases prevalent in the host country, wealthy country investigators can train LMIC individuals to serve as study support staff, balance staff losses to emigration or other HIC recruitment with new LMIC staff training, support host country development of research infrastructure via equipment purchases and building development, and provide monetary and other incentives for trained staff re-entry into the LMIC research infrastructure (Kupfer et al, 2004). Such measures can be the prerogative of individual study investigators, or of industry, or promoted by HIC governmental agencies such as the Fogarty International Center at the National Institutes of Health (Breman et al, 2011;Fogarty International Center, 2012). Given the complexity and fragility of any research infrastructure, and its unavoidable marriage to local economic realities, efforts to improve LMIC research infrastructure will require many years of sustained effort, and in the vast majority of cases improvements in LMIC research infrastructure will be detectable much more slowly than might be easily promoted in the 5-year federal grant renewals.…”