DEPARTMENT OF HEALTH AND HUMAN SERVICES

NATIONAL INSTITUTES OF HEALTH

Fiscal Year 2006 Budget Request

Witness appearing before the

House Subcommittee on Labor-HHS-Education Appropriations

Dr. Sharon H. Hrynkow, Acting Director

Fogarty International Center

March 9, 2005

William Beldon, Deputy Assistant Secretary, Budget

Mr. Chairman and Members of the Committee:

I am pleased to present the Fiscal Year (FY) 2006 President's Budget for
the Fogarty International Center (FIC). The FY 2006 budget includes
\$67,048,000, which reflects an increase of \$416,000 over the FY 2005
enacted level of \$66,632,000 comparable for transfers proposed in the
President's request.

Many years ago, President John F. Kennedy noted that "A rising tide
lifts all the boats. And a partnership, by definition, serves both
partners, without domination or unfair advantage." These words serve to
remind us of the importance of working in partnership with those around
the world, on equal footing, and for the common good. Congressman John
E. Fogarty, for whom our Center is named, also shared this belief and
worked tirelessly to champion improved health of Americans in a
healthier world---through international health research and training
programs.

Today, the vision of Congressman Fogarty continues to inspire the Center
in building international partnerships on behalf of the National
Institutes of Health (NIH) and in supporting research and training
programs to advance the objectives of global health. FIC's unique
mission and initiatives add value, complement NIH international programs
and build scientific capacity around the world for the benefit of
Americans and the global community.

I welcome this opportunity to discuss briefly FIC's progress over the
past year as well as our proposed plans for FY 2006. Developed with the
support and guidance of the Administration and this Committee, the
Fogarty programs reflect our nation's enduring commitment to global
health as well as vibrant, and equal, international collaborations.

**GLOBAL BURDENS OF ILL HEALTH**

The health challenges we face as Americans and as members of a global
community are many. HIV/AIDS and tuberculosis continue to rise at
alarming rates. SARS, West Nile Virus, and avian flu are constant
threats to global health and economies. At the same time, as chronic
diseases such as cancer, cardiovascular disease, and mental health
disorders increase year after year, taking enormous tolls in human
suffering and economic costs, the development and deployment of more
effective preventive and treatment measures is urgent.

The Fogarty response to these challenges is to support a range of
critical research and training programs, each designed to tackle
specific health problems shared by U.S. and foreign populations. We work
in partnership with universities in the United States, low- and
middle-income nations, and our fellow Institutes at the NIH, the Centers
for Disease Control and Prevention, the World Health Organization, and
others to effect change. Fogarty supports over 20 research and training
programs in more than 100 countries, involving more than 5,000
scientists in the United States and abroad. HIV/AIDS, TB, maternal and
child health, environmental health and bioethics are just a few of the
priority program areas in which Fogarty and its partners are making an
impact.

**IMPACT OF FOGARTY PROGRAMS**

I want to share with you two examples to highlight the impact of Fogarty
programs worldwide. The first is a genealogy of sorts of one scientist's
career path and support by Fogarty. Dr. Lee Riley of the University of
California at Berkeley traces his professional roots to Dr. Warren D.
Johnson, Jr. of the Weill Medical College of Cornell University. Both
have dedicated decades of their professional careers to understanding,
preventing, and treating infectious diseases in the slums of Brazil. It
all started in 1988 when Dr. Johnson received FIC support to train AIDS
scientists in Brazil. When Dr. Riley joined the Cornell faculty in 1990,
Dr. Johnson brought him into the AIDS training effort and allowed Dr.
Riley to initiate additional training activities on tuberculosis
diagnostics and pathogenesis. When Dr. Riley moved to the University of
California at Berkeley in 1996, he competed successfully for his own
training program in Brazil through Fogarty\'s International Training and
Research in Emerging Infectious Diseases Program (ITREID). Dr. Johnson
received a similar ITREID program grant at Cornell, enabling the two to
coordinate and synergize their training activities. Dr. Riley\'s group
ultimately expanded the ITREID program to other countries in Latin
America as well as to Eastern Europe, and Dr. Riley competed
successfully for a new FIC-supported grant on Global Infectious Disease
Training and Research in Brazil.

The results and impact of these 17 yearlong partnerships have been
enormous. In terms of people and publications, thirty Brazilian
investigators have been trained in the United States, 29 of whom are
still active researchers in Brazil; 28 articles have been published in
top scientific journals; 12 Ph.D. and 3 Masters degrees in public health
have been conferred; and, a large number of allied health professionals,
many of whom are or were residents of slums, have received
project-related training. Just one of the trainees who has returned to
Brazil, Dr. Albert Ko, has trained over 50 local staff---both laboratory
and field---over the last eight years, and he has now received his own
FIC training award. Other trainees are applying for and are receiving
funds from NIH and other research agencies.

Critically, the wealth of knowledge generated has been enormous. New
understandings have emerged of the causes and treatments of
leptospirosis, a disease that impacts primarily young people. Patterns
of the spread of tuberculosis in crowded situations have been uncovered,
and prevention strategies deployed. Training of health scientists from
Brazil through the FIC AIDS training programs led to a major research
grant from the National Institute of Allergy and Infectious Diseases for
the study of the pathogenesis of leishmaniasis in Brazil and for a
subsequent Fogarty award in infectious disease training. Training
through the FIC AIDS training programs has helped Brazil evaluate the
effectiveness of antiretroviral therapy programs that have served as a
model and inspiration to other developing countries. The partnerships
have generated millions of dollars of additional support from Brazil,
Spain, Mexico, and other nations to sustain the research and training
activities. And, the relationships and partnerships that have been built
over time are the ones that will allow future studies to move ahead
expeditiously.

The second example is from a research project involving a 1996 pilot
program in Orizaba, Mexico working to evaluate the impact of Directly
Observed Therapy (Short-Course) (DOTS) in populations with
drug-resistant tuberculosis. DOTS is the WHO recommended TB treatment
regimen whereby TB patients are monitored daily to ensure that
medications are taken properly. In this region, 21% of the new cases
were resistant to at least one anti-tuberculosis drug and 3% were
multi-drug resistant (MDR) over a five-year period. The data collected
demonstrated that DOTS could rapidly reduce transmission and the
incidence of both drug-susceptible and drug-resistant tuberculosis. The
case rates of multi-drug resistant tuberculosis were also reduced;
however, the fatality rate was highest (12%) for patients infected with
resistant strains. In a developing country with a moderate rate of
drug-resistant tuberculosis, DOTS can rapidly reduce the transmission of
both susceptible and resistant organisms. Additional studies are now
under way to expand on these initial findings.

**FY 2006 INITIATIVES**

FIC will continue to support the NIH Roadmap for Medical Research in the
21^st^ Century. Working with partners across NIH and universities around
the world, FIC will foster interdisciplinary programs in clinical
research training, identify novel technologies to combat global health
threats, and expand efforts to bring experts from multiple disciplines
together to advance NIH Roadmap goals. In keeping with the Roadmap, FIC
will work in FY 2006 to bring new partners into the global health
enterprise. FIC will support the Framework Programs for Global Health to
link multiple schools within the same university (or coupled
universities) around the topic of global health, bringing business,
journalism, social science, engineering, medicine, law, public health
and other disciplines into the global health arena in the university
setting. A second goal will be to energize the next generation of global
health leaders through development of undergraduate and graduate
curricula on global health. This effort will propel global health
efforts forward in new ways in the United States and abroad.

FIC will enhance its two main programs to address HIV/AIDS and related
TB challenges. Fogarty's AIDS International Research and Training
Program builds capacity in resource poor nations to tackle the AIDS
problem through science and evidence-based policies. Working through 25
U.S. universities, educational programs support post-doctoral, doctoral,
Masters level work, and training for allied health professionals,
including nurses, to advance research on vaccine development and
microbicide development, to identify groups at high-risk for exposure
and to help support the development of interventions that make sense at
the local and community levels. Nearly 2,000 developing country
researchers from over 100 countries have been trained in the United
States, many at senior levels, and more than 50,000 through in-country
workshops and courses. More than 80% of those trained in the United
States through this program returned home to pursue research and health
efforts locally. And, recognizing the need for clinical and health
systems researchers for AIDS and TB, FIC launched a unique International
Clinical, Operational and Health Services Research Training Award
program to meet these needs. Today, under this program, experts in
Uganda, Haiti, Russia, and China are working with U.S. partners to
advance AIDS prevention and treatment strategies through targeted
training efforts and to monitor the effectiveness of AIDS drug delivery
paradigms. These programs support the goals of the President\'s
Emergency Plan for AIDS Relief and the Global Fund and will lead to
useful insights about effective drug delivery approaches in resource
poor nations.

As a third emphasis area, FIC will expand in FY 2006 its pilot program
to support NIH Alumni Associations abroad. These Associations will serve
an important role to junior scientists as they return home through
support of networking activities in which to share information and
expertise, and other activities. At the same time, they will allow U.S.
scientists to maintain collaborative ties. Building on efforts in
Brazil, Mexico, South Africa, India and China, FIC will expand this
effort to include Central and Eastern Europe, Russia and Thailand.

As a fourth emphasis area in 2006, FIC will expand efforts in the
neurosciences. With the exception of sub-Saharan Africa, brain disorders
are the leading contributor to the years lived with disability in all
regions of the world. More than 150 million people suffer from
depression at any point in time and nearly one million commit suicide
each year. Worldwide, about 25 million people suffer from schizophrenia
and 38 million from epilepsy. FIC, in partnership with the National
Institute of Neurological Disorders and Stroke and other NIH Institutes,
will continue its efforts to develop new knowledge and technologies to
enhance the understanding of brain disorders in resource poor settings
around the world. Much of the research funded by this program could have
implications for how certain brain disorders are studied, diagnosed, and
treated in the United States.

#### 

#### CONCLUSION

The global health challenges we face are many, but the international
partnerships supported by Fogarty and its partners are a bedrock upon
which scientific progress will be made to the benefit of the American
people and the global community.

Thank you, Mr. Chairman. I would be pleased to answer any questions that
the Committee may have.

Department of Health and Human Services

National Institutes of Health, Fogarty International Center

Sharon Hemond Hrynkow, Ph.D.

Sharon Hrynkow is the Acting Director of the Fogarty International
Center (FIC) at NIH. FIC, the international component of the NIH,
addresses global health challenges through innovative and collaborative
research and training programs, and supports and advances the NIH
mission through international partnerships. FIC tackles infectious
disease threats, including HIV/AIDS; adverse health impacts of
environmental pollution; maternal and child health concerns; and the
growing burden of brain disorders and mental illness among other global
health challenges. In addition to providing leadership for all of the
Center's activities, during her tenure as Acting Director Dr. Hrynkow
has focused on combating "brain drain" through innovative approaches, on
bringing new partners into the global health arena, including schools of
business, law, journalism and communications; and on energizing the next
generation of global health professionals in the U.S. and developing
countries through curriculum development programs.

Dr. Hrynkow, a native of Rhode Island, received her Bachelor's degree
from Rhode Island College. She earned a Ph.D. in Neuroscience at the
University of Connecticut Health Center where her studies focused on
factors involved in the development of neuronal connectivity in the
developing inner ear. Her post-doctoral work, conducted at the
University of Oslo, examined patterns of neuronal migration and
differentiation of brain regions involved in hearing and balance. Dr.
Hrynkow was selected for an AAAS Science, Engineering and Diplomacy
Fellowship at the U.S. Department of State, and then for a position as
the first civil service Health/Science Officer within the State
Department's Bureau of Oceans and International Environmental and
Scientific Affairs. She worked with State Department leadership,
interagency partners, NGOs, and business leaders to produce the first
"U.S. International Strategy on HIV/AIDS."

Dr. Hrynkow joined Fogarty in 1995. She has held a range of positions
including Assistant Director for International Relations, Director of
the Division of International Relations, and Special Assistant to the
Deputy Director. She was appointed as Deputy Director of the Center in
2000 and has served as Acting Director of the Center since January 2004.

Dr. Hrynkow represents NIH on the Advisory Committee for Health Research
to the Director General of the World Health Organization, and serves on
the Committee on Science, Engineering and Public Policy of the American
Association for the Advancement of Science, among other
responsibilities. She is a member of numerous professional organizations
and has published in *Neuroscience, Brain Research,* and other journals
in her field as well as publications on scientific capacity building in
poor countries. She is a regular speaker on career path issues to groups
of young scientists and on health issues as related to foreign policy
concerns. She was elected to the Council of Foreign Relations in 1996.

Number range CHAPTERDepartment of Health and Human Services

Office of Budget

William R. Beldon

Mr. Beldon is currently serving as Deputy Assistant Secretary, Budget in
the Department of Health and Human Services. He has been a Division
Director in the Budget Office for sixteen years, most recently as
Director of the Division of Discretionary Programs. Mr. Beldon started
in federal service as an auditor in the Health, Education and Welfare
Financial Management Intern program. Over the course of more than 30
years in the Budget Office, Mr. Beldon has held Program Analyst, Branch
Chief and Division Director positions. Mr. Beldon received a Bachelor's
Degree in History and Political Science from Marshall University and
attended the University of Pittsburgh where he studied Public
Administration. He resides in Fort Washington, Maryland.