TALKING POINTS FOR IJJNCHEON PRESENTATION
NATIONAL COUNCIL FOR INTERNATIONAL HEALTH GOVERNING BOARD
            FERRUARY 74, 1983

I,  INTRODUCTION:

A, DESPITE THE CONSIDERARLE PURLICITY IN THE INTERNATIONAL

HEALTH COMMUNITY AROUT 'DESTRUCTION" OF THE INTERNATIONAL
HEALTH PROGRAM WITHIN THE PUBLIC HEALTH SERVICE, I AM

HERE TO TELL YOU THAT THE PROGRAM IS ALIVE AND WELL,

B, To ILLUSTRATE THAT POINT, THE FOLLOWING ARE THE AREAS 1
   PLAN TO INCLUDE IN THIS PRESENTATION:

1, THE BUDGET FOR INTERNATIONAL HEALTH IN PF(S,

2, How INTERNATIONAL HEALTH IS ORGANI7ED IN PHS,

3, OUR YULTILATERAL PROGRAM INVOLVEMENT

4, BILATERAL PROGRAMS OF THE PHS

5, ACTIVITIES THAT MAY RE OF PARTICULAR INTEREST TO

THIS GROUP --  SELECTED INTERNATIONAL ACTIVITIES OF
THE NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS
DISEASES, NIH, AND OF THE CENTERS FOR DISEASE
CONTROL,

II, THE BUDGET FOR INTERNATIONAL HEALTH IN PHS

B, PHS DOES NOT HAVE A BUDGET FOR INTERNATIONAL


HEALTH AS SUCH,  MOST OF THE PHS' INTERNATIONAL OR

INTERNATIONALLY RELATED ACTIVITIES ARE FUNDED THROUGH:

o FUNDS APPROPRIATED FOR DOMESTIC RESEARCH AND

REI ATED SALARY AND EXPENSE ITEMS, THIS HAS ALWAYS
BEEN THE CASE WITH FUNDS PROVIDED DIRECTLY FROM PHS
APPROPRIATIONS AND IT REFLECTS THE FACT THAT THE
PHS AGENCIES HAVE A LEGISLATED MANDATE TO CONDUCT
INTERNATIONAL RESEARCH AND RELATED ACTIVITIES WHICH
WILL ADVANCE THE STATUS OF THE HEALTH SCIENCES AND
THEREBY THE HEALTH OF THE AMERICAN PEOPLE,  INDEED,

FOR THE PAST SEVERAL YEARS, BETWEEN '%r,o AND 870
MILLION (DEPENDING 0~ HOW YOU DEFINE INTERNATIONAL
ACTIVITIES) HAS BEEN SPENT EACH YEAR FROM PHS
APPROPRIATIONS FOR I\!TERNATIONAL ACTIVITIES,

(NOTE:  ESTIMATES FOR FY I!%5 ARE NOT AVAILABLE
AND, FRANKLY, WE DO NOT NOW KNOW WHAT IMPACT THE
OVERALL BUDGET CUTS WILL HAVE ON OUR EXPENDITURES
FOR INTERNATIONAL HEALTH ACTIVITIES,  THE IMPACT

WILL PROBABLY BE MODEST, INASMUCH AS MOST OF THE
EXPENDITURES ARE FOR GRANTS AND CONTRACTS SUPPORTED
UNDER THE NIH RESEARCH PROGRAM,?

o ANOTHFR SIGNIFICANT SOURCF OF FUNDING IS THE AGENCY
FOR INTERNATIONAL DFVELOPMENT,  EXAMPLES HERE
INCLUDE CDC WORK IN AFRICA TO IMPROVE PROGRAMS FOR
CHILDHOOD IMMUNI7ABLE DISEASES, AND NIH ACTIVITIES
TO ESTABLISH REGIONAL CAPABILITIES FOR MAINTENANCE
OF RESEARCH LABORATORY EQUIPMENT, AT

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THE PRESENT TIME, THERE ARE AROUT TWENTY ACTIVE
INTERAGENCY AGREEMENTS RETWEEN MD AND THE PHS.
THESE RANGE FROM SMALL PARTICIPATING AGENCY SERVICE
AGREEMENTS TO PROVIDE FOR THE SERVICES OF A
PARTICULAR EXPERT TO LARGE RESOURCES SUPPORT
SERVICES AGREEMENTS WHICH PROVIDE FOR TECHNICAL

ASSISTANCE IN SUCH AREAS AS PLANNING FOR NUTRITION
INTERVENTIONS IN PRIMARY HEALTH CARE PROGRAMS,

o REIMBURSABLE PROGRAMS WITH FOREIGN GOVERNMENTS -THE
PROGRAMS WITH KUWAIT AND NIGERIA FALL INTO THIS
  CATEGORY,  i'/E GOW IN OURSECOND YEAR OF THE
                                                         4

PROGRAMS WITH THESE TWO COUNTRIES AND THE
EXPERIENCE WE ARE GAINING MAY WELL SERVE AS MODELS
FOR SIMILAR COOPERATIVE ARRANGEMENTS WITH OTHER
COUNTRIES,  INDEED, wE HAVE RECEIVED INQUIRIES FROM
AT LEAST TWO OTHER GOVERNMENTS (UNITED ARAB
EMIRATES AND SAUDI ARABIA) APOUT-T';E-;;OSS?RILITY OF

R>IF;iRIJ:SARLE PR;GR`;;MS,'

0 REIMBURSEMFNTS FROM THE WORLD HFAITH ORGANIZATION
FOR PHS STAFF WHO WORK IN VARIOUS WHO PROGRAMS,
ALSO, WHO PROVIDES FINANCIAL SUPPORT To SEVERAL
COMPONENTS OF THE PHS, ESPECIALLY CDC AND NIH,
WHICH SERVE AS WHO INTERNATIONAL COLLABORATING
CENTERS (E,G, IN THE AREAS OF INFLUENZA AND OTHER
  RESPIRATORY DISEASES, HEPATITIS, OTHER VIRAL
DISEASES, IMMUNOLOGY, LEPROSY, TO NAME A FEW),

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o OTHER SPECIAL F~JNDING ARRANGEMENTS  - THE JOINT
FUNDS WITH ,POLANF AND YUGOSLAVIA ARE EXAMPLES,
SIMILARLY, WE HOPE TO PARTICIPATE IN THE NEW S II T
FUND THAT IS BEING ESTABLISHED WITH SPAIN UNDEQ THE
TREATY OF FRIENDSHIP AND COOPERATION;

B, THE ONLY SPECIFICALLY INTERNATIONAL LINE ITEMS IN THE

BUDGET OF THE PHS AT THIS TIME ARE:

1,

THE SPECIAL FOREIGN CURRENCY APPROPRIATION, WHICH
Is ADMINISTERED BY THE OFFICE OF INTERNATIONAL
HEALTH ON BEHALF OF THE ENTIRE PHS, (FYI - THE
CURRENT EXCESS CURRENCY COUNTRIES ARE INDIA,
PAKISTAN, GUINEA AND POLAND, You SHOULD BE AWARE
THAT WHILE POLAND JUST WENT BACK ON THE EXCESS

CURRENCY LIST, WE ARE NOT NOW BEING PERMITTED TO
USE THE MONEY FOR DIPLOMATIC REASONS,  ALSO, THERE
HAVE BEEN INDICATIONS THAT TAIWAN MAY BECOME AN

EXCESS CURRENCY COUNTRY,)

3, THE BUDGET FOR THE FOGARTY INTERNATIONAL CENTER OF THE
NATIONAL INSTITUTES OF HEALTH IS THE SECOND

INTERNATIONAL LINE ITEM IN THE SUDGET,

3, THE ONLY INTERNATIONAL HEALTH LINE ITEM THAT HAS BEEN
ELIMINATED FROM THE PHS RUDGET IS THE OFFICE OF
INTERNATIONAL HEALTH, OASH, YET, THE OIH CONTINUES TO
  EXIST AS A LEANER YET VERY ACTIVE OFFICE.

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III,

WITHIN THE OFFICE OF THE ASSISTANT SECRETARY FOR
HEALTH, THE REDUCTION IN THE OFFICE OF INTERNATIONAL
HEALTH HAS APPARENTLY GIVEN RISE TO A RELIEF, IN SOME
CASES, THAT PHS HAS REDUCED ITS COMMITMENT TO
INTERNATIONAL HEALTH,  THAT SIMPLY IS NOT CORRECT,
THE PHS HAS A NUMBER OF IMPORTANT LEADERS, STARTING
WITH DR. BRANDT AND INCLUDING BILL FOFGF, BUD MAYER~
JIM WYNGAARDFN, ART HAYES, AND BOR GRAHAM WHO ARE

STRONGLY COMMITTED TO INTERNATIONAL HEALTH
COOPERATION,

How IS INTERNATIONAL HEALTH ORGANIZED WITHIN THE PHS?

A, THE OFFICE OF INTERNATIONAL HEALTH, OASH, CARRIES OUT
  SOME VERY IMPORTANT FUNCTIONS WITHIN THE OFFICE OF THE
  ASSISTANT SECRETARY FOR HEALTH, THESE INCLUDE:

o THE OFFICIAL LIAISON FUNCTI~ ON BEHALF OF THE PURLIC
HEALTH SERVICE, FOR THE U.S. GOVERNMENT WITH THE WORLD
HEALTH ORGANIZATT~~LAND THE PAN AMERICAN HEALTH
ORGANIZATION,  INDEED, THE OFFICE OF INTERNATIONAL
HEALTH WAS ESTABLISHED IN 1945 TO DEAL WITH THE
GROWING INTERNATIONAL HEALTH INVOLVEMENT OF THE u,S,
GOVERNMENT, BUT PARTICULARLY FOR DRAFTING "CHARTERS
AND POSIITON PAPERS" FOR THE PROPOSED UNITED NATIONS
  INTERNATIONAL HEALTH ORGANIZATION -- WHAT IS NOW THE
h!HO -- AND FOR COOPERATION WITH SUCH AGENCIES AS THE
PAN AMERICAN SANITARY BUREAU,

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o OVERALL HEALTH POLICY DEVELOPMENT WITHIN THE DHHS, AND
  OVERSIGHT AND COORDINATION OF THE INTERNATIONAL HEALTH
ACTIVITIES OF THE FIVE PHS AGENCIES -- NIH, HRSA, FDA,
ADMAHA, CDC -- AND OF THE VARIOUS PROGRAMMATIC
COMPONENTS OF THE OFFICE OF THE ASSISTANT SECRETARY
FOR HEALTH !E,G, NCHSL

o OFFICIAL REPRESENTATION TO FOREIGN GOVERNMENTS ON PHS

BILATERAL HEALTH PROGRAM MATTERS,

o STAFF SUPPORT TO THE SECRETARY AND ASH ON

INTERNATIONAL HEALTH MATTERS,

B, THERE ARE INTERNATIONAL PROGRAM OFFICES WITHIN EACH OF

THE PHS AGENCIES,  THFSE RANGE FROM RATHEP SMALL OFFICES

PLAYING A POLICY, COORDINATION AND REPRESENTATION ROLE
FOR THEIR AGENCY (E,G, ADMAHA) TO OPGANIZATIONS, SUCH AS
THE FOGARTY INTERNATIONAL CENTER AT NIH, WHICH CONDUCT A

VARIETY OF PROGRAMS, SUCH AS STUDIES OF INTERNATIONAL
HEALTH RESEARCH POLICY ISSUES, SPONSORSHIP OF
INTERNATIONAL CONFERENCES, AND PROVISION OF INTERNATIONAL
FELLOWSHIPS,

D

I  WITHIN THE PHS, IT IS THE AGENCIES WHICH ARE KEY TO

PLANNING AND IMPLEMENTATION OF INTERNATIONAL
ACTIVITIES,  ALL OF THE PHS INTERNATIONAL ACTIVITIES
REFLECT THE DOMESTIC RESPONSIRILITIES AND CAPARILITIES OF
THE AGENCIES,  INDEED, THE PRFVAILING VIEW WITHIN THF

DEPARTMENT IS THAT INTERNATIONAL COOPERATION IS CRITICAL
TO THE FULFILLMENT OF OUR MISSION,  'hlITHOUT SUCH
COOPERATION, OUR PROGRAM OF BIOMEDICAL RESEARCH
WOULD NOT RE WHAT IT IS TODAY: WE WOULD RF FACED WITH FAR

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MORE DIFFICULT PROBLEMS IN THF FOOD AND DRUG CONSUMER
PROTFCTION AREA: WE WOULD BF AT A GREAT DISADVANTAGE AS
WE ATTEMPT TO CARRY OUT OUR RESPONSIBILITIES FOR
PROTECTING THE li,S, POPULATION FROM COMMUNICABLE
DISEASFS, ETC.

IV, MULTILATERAL PROGRAM ACTIVITIES

A, THE UNITED STATES IS ONE OF 158 MEMBERS OF WHO AND WE

PARTICIPATE IN ACTIVITIES AND DECISIONS OF THE
ORGANI7ATION THROUGHOUT THE YEAR IN FULFILLMENT OF THE
HEALTH RESPONSIBILITES AND OBLIGATIONS AS A MEMBER
GOVERNMENT,  MANY OF THESE DECISIONS ARE EFFECTED AT THE
SESSIONS OF ?HO's GOVERNING BODIES, THE ?ORLD HEALTH
ASSEMBLY AND EXECUTIVE BOARD, AND AT THE PAHO DIRECTING
COUNCIL, PAN AMERICAN SANITARY CONFERENCE, EXECUTIVE
COMMITTEE,

B, lrJ~ DEVELOP, IN COOPERATION WITH THE DEPARTMENT OF STATE,
  POLICY REGARDING HEALTH ISSlJES WHICH COME BEFORE THE
  GOVERNING BODIES OF THE OTHER UN AGENCIES, INCLUDING (IN
ADDITION TO WHO) UNICEF, UNDP, THE NARCOTIC COMMISSION,
  THE UN FUND FOR DRUG ABUSE CONTROL, THE UN ECONOMIC AND
SOCIAL COUNCIL, THE UN FUNP FOR POPULATION ACTIVITIES,
  THE UN ENVIRONMENT PROGRAM, THE UN FOOD AND AGRICULTIJRE
  ORGANIZATION, AND THE UN EDUCATIONAL SCIENTIFIC AND
  CULTURAL ORGANZATION,

c, IMPORTANT MULTILATERAL ISSUES WHICH WE HAVE DEALT WITH IN
  RECENT MONTHS OR ARE DEALING WITH AT THIS TIME INCLUDE:

I., THE RECOMMENDATORY CODE FOR MARKETING OF INFANT

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FORMULA,  CURRENTLY, A PHS TASK FORCE IS REVIEWING

SCIENTIFIC EVIDENCE CONCERNING THE RFLATIONSHIP
BETWEEN INFANT FEEDING AND INFANT HEALTH AS WELL,

3, INTERNATIONAL DRUG SCHEDULING - THIS JS A RECURRING

ISSIJE REGARDING THE INTERNATIONAL SCHEDULING OF ABUSE-
POTENTIAL DRUGS, INCLUDING, FOR EXAMPLE,
BENZODIA~EPHINE DRUGS,

3, HEALTH FOR ALL RY THE YEAR 7000 - As A MEMBER

GOVERNMENT, WE HAVE A RESPONSIBILITY TO DEVELOP A
NATIONAL STRATEGY FOR HFA AND TO REPORT PERIODICALLY
ON PROGRESS TOWARD ITS ACHIEVFMENT,  WE ARE CURRENTLY
WORKING ON THE REPORT ON THE MONITORING OF OUR
NATIONAL STRATEGY, TO BE SUBMITTED TO !iHO IN MARCH

4, EFFORTS TO PROMOTE EFFECTIVE DIALOGUE BETWEEN WHO AND
u,S, INDUSTRY ON PHARMACEUTICAL MATTERS AND
PARTICULARLY ON WHO's ACTION PROGRAM ON ESSENTIAL
DRUGS,

IV, BILATERAI PROGRAMS

A,

THE PHS HAS AGRFEMENTS OR PROGRAMS WITH THIRTY FIVE

COUNTRIES,  THE AGREEMENTS RANGE FROM AGENCY-TO-AGENCY
LEVEL ,4ww4ENTs (LG. FDA AGREEMENTS WITH COUNTERPART
ORGANIZATION IN A FOREIGN GOVERNMENT oN INSPECTION
STANDARDS FOR LOW ACID CANNED FOODS OFFFRED FOR EXPORT TO
THE UNITED STATES) TO GOVERNMENT-TO-GOVERNMENT HEALTH
AGREEMENTS WHICH IDENTIFY PRIORITIES FOR COOPFRATION AND
PROVIDE FOR A JOINT STRUCTURE FOR OVERSIGHT OF THE
BILATERAL PROGRAM,  ADDITIONALLY, THE PHS COOPERATES WITH

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SEVERAL COUNTRIES UNDER THE TERMS OF UMBRELLA SCIENCE AND
TEHCNOLOGY AGREEMENTS OR CULTURAL AGREEMENTS ENTERED INTO
BY THE DEPARTMENT OF STATE.

B, WE CURRENTLY HAVE FORMALIZED BILATERAL HEALTH PROGRAMS
   WITH THE FOLLOWING COUNTRIES:

EGYPT
PEOPLE'S REPUBLIC OF CHINA
FEDERAL REPUBLIC OF GERMANY
FINLAND
FRANCE
HUNGARY
INDIA
ISRAEL
ITALY
JAPAN
KUWAIT
NIGERIA
POLAND
YUGOSLAVIA

C, HIGHLIGHTS OF SOME OF THE PRINCIPAL BILATERAL PROGRAMS

ARE THE FOLLOWING:

I.. EGYPT

o THE PROGRAM IS ACTUALLY MORE THAN TWENTY YEARS OLD,

HAVING BEEN INITIATED IN I%7 AS PART OF OUR
SCIENTIFIC ACTIVITIES OVERSEAS (SPECIAL FOREIGN
CURRENCY) PROGRAM,  IT IS NOTEWORTHY THAT, EVEN
DURING TIMES WHEN DIPLOMATIC RELATIONS RETWEEN THE

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   U,S, AND EGYPT WERE SUSPENDED IN THE EARLY 197Os,
    THE PROGRAM OF HEALTH COOPERATION CONTINUED TO

     FUNCTION,

o THE U,S,-EGYPT HEALTH AGREEMENT WAS SIGNED IN 1975
   AND RENEWED IN I%?!,

o THE PROGRAM IS OVERSEEN RY A U,S,-EGYPT JOINT
   WORKING GROUP ON HEALTH COOPERATION,  MEMBERS OF
   THE JOINT WORKING GROUP ON THE U,S, SIDE ARE THE
   ASSISTANT SECRETARY FOR HEALTH, THE DIRECTOR,
   OFFICE OF INTERNATIONAL HEALTH, THE U,S, AMBASSADOR
   TO EGYPT, THE DIRECTOR OF THE AID MISSION IN CAIRO,
   AND THE COMMANDING OFFICER OF NAMRU 3,

o THIS HAS REEN A HIGHLY SUCCESSFUL PROGRAM,
     INCLUDING MANY PROJECTS OF MUTUAL INTEREST AND

     BENEFIT --  SCHISTOSOMIASIS, ARTHROPOD BORNE
    DISEASES, PREVENTION OF BLINDNESS, HEPATITIS
    RESEARCH, ETC,

o FUNDING IS NOW A CRITICAL PROBLEM,


7, INDIA

o PROGRAM INITIATED IN EARLY !%Os UNDER THE PHS
   SPECIAL FOREIGN CURRENCY PROGRAM, ALTHOUGH

   THE PHS PROVIDED TECHNICAL ASSISTANCE TO INDIA
   DURING THE 1950s AS WELL,


o THE PROGRAM ENCOMPASSES THE FULL RANGE OF INTERESTS
   OF THE PHS AGENCIES, RUT THERE IS SPECIAL EMPHASIS



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ON INFECTIOUS AND PARASITIC DISEASES, REPRODUCTIVE
PHYSIOLOGY AND PREVENTION OF BLINDNESS,

0 WE DO NOT HAVE A HEALTH AGREEMENT WITH INDIA, BUT
FUNCTION UNDER THE TERMS OF AN LJMBRELLA S 8 T
AGREEMENT,  A HEALTH AND MEDICAL SCIENCES YORKING

GROUP MEETS DURING THE APPROXIMATELY ANNUAL
MEETINGS OF THE U,S,-INDO S 8 T SURCOMMISSION,

0 A RECENT DEVELOPMENT WAS THE ESTABLISHMENT OF A
"BLUE RIBBON" PANEL OF OUTSTANDING SCIENTISTS TO

DEVELOP PLANS TO EXPAND COOPERATION IN SEVERAL
AREAS -- BIOMASS FOR ENERGY, SELECTED HEALTH AREAS
(IMMUNOLOGY, PREVENTION OF BLINDNESS, AND CONTROL
OF LEPROSY), AND FOOD PRODUCTION,  PHS IS
COOPERATING IN THE INITIATIVE, INCLUDING
PARTICIPATION ON THE "BLUE RIBBON" PANEL, DR,
RICHARD KRAUSE IS A MEMBER OF THAT PANEL, THEIR
REPORT IS EXPECTED TO BE GIVEN TO THE PRESIDENT JN
MARCH,

3. PEOPLE'S REPUBLIC OF CHINA

0 THE HEALTH PROTOCOL WITH THE PRC WAS SIGNED IN
1979,

o AGREED AREAS OF COOPERATION ARE:
- INFECTIOUS AND PARASITIC DISEASES
- CANCER
- CARDIOVASCULAR DISEASES
- PUBLIC HEALTH AND HEALTH SERVICES RESEARCH, CHILD

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HEALTH AND NUTRITION, AND ENVIRONMENTAL AND
OCCUPATIONAL HEALTH
- MEDICAL INFORMATION SCIENCE
- IMMUNOLOGY

- MEDICAL GENETICS
- MENTAL HEALTH

- FOODS AND DRUGS, INCLUDING PHARMACOLOGY
- REPRODUCTIVE PHYSIOLOGY AND FAMILY PLANNING.

o THE LAST JOINT HEALTH COMMITTEE MEETING WAS HELD IN
BETHESDA IN NOVEMBER l%?,

o AN EXAMPLE OF WORK WITH THE PRC WAS THE JOINT STUDY
OF PUBLIC HEALTH PROGRESS IN SHANGHAI CO~JNTY.  THE

RESULTS OF THAT STUDY AND OF A FOLLOW-UP SYMPOSIUM
WERE PUBLISHED AS A SPECIAL SUPPLEMENT TO THE
SEPTEMBER 1987 ISSUE OF THE AMERICAN PURLIC HEALTH
ASSOCIATION JOURNAL,

4, ISRAEL

o ALTHOUGH   THE PROGRAM OF HEALTH COOPERATION WITH
ISRAEL IS MORE THAN TWENTY YEARS OLD, A FORMAL
HEALTH AGREEMENT WAS NOT SIGNED UNTIL lq8r).

o THE PRINCIPAL EMPHASIS IS CURRENTLY

IN POLICY RELATED STUDIES AND CONSULTATIONS -- E.G.
REGIONALIZATION OF HEALTH SERVICES, THE LINKAGE
BETWEEN EPIDEMIOLOGY AND HEALTH POLICY, AND FOOD
AND DRUG CONSUMER PROTECTION ISSUES,

5, KUWAIT

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o AGREEMENT PROVIDING FOR ~EIMRURSABLE TECHNICAL
ASSISTANCE IN HEALTH FIELD SIGNED IN MAY 1981,

o SUBAGREEMENTS FOR COOPERATION IN FIVF AREAS SIGNED
  IN I%??:

- EMERGENCY MEDICAL SERVICES

- HYPERTENSION CONTROL

- REDUCTION OF INFANT MORBIDITY AND MORTALITY

- HEALTH MANPOWER DEVELOPMENT AND UTILIZATION

- VITAL AND HEALTH STATISTICS

5, NIGERIA

o HEALTH AGREEMENT SIGNED IN 1981 WITH FEDERAL
MINISTRY OF HELATH OF NIGERIA,

o AGREED AREAS ok COOPERATION INCLUDE:

- HEALTH PROFESSIONS DEVELOPMENT


- HEALTH STATISTICS

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- FOODS AND DRUGS

- COMMUNICARLE DISEASES CONTROL

o THE SECOND MEETING OF THE U,S,-\!IGERIA JOINT TASK
FORCE ON HEALTH COOPERATION WAS HELD THIS WEEK IN
LAGOS AND WE ARE AWAITING A REPORT ON THAT

MEETING,  IT IS NOT KNOWN WHETHER CURRENT ECONOMIC
DIFFICULTIES IN NIGERIA WILL HAVE AN IMPACT ON THIS

PROGRAM,

5, USSR

o THE PROGRAM WITH THE USSR HAS BEEN ACTIVE SINCE THE
LATE l%@s, ALTHOUGH THE AGREEMENT FOR COOPERATION
IN J~EDICAL SCIENCE AND PUBLIC HEALTH WAS NOT SIGNED

UNTIL 197?,  A SECOND AGREEMENT ON ARTIFICIAL HEART
R R D WAS SIGNED IN lF374, DESPITE THE DIPOMATIC
DIFFICULTIES IN RECENT YEARS, ROTH AGREEMENTS WERE
RENEWED IN EARLY !%?,

o AGREED AREAS OF COOPERATION ARE:

- CANCER

- CARDIOVASCULAR DISEASE

- ARTIFICIAL HEART

- ENVIRONMENTAL HEALTH
- ARTHRITIS

- INFLUENZA, /!CIJTE RESPIRATORY DISEASE AND VIRAL

HEPATITIS

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- MENTAL HEALTH
- EYE DISEASES
- BIOMEDICAL COMMUNICATIONS
- INDIVIDUAL SCIENTIST EXCHANGE

o DESPITE THE GENERAL SLOWDOWN IN S & T COOPERATION
BETWEEN THE U.S. AND THE SOVIET UNION, THIS PROGRAM

HAS REMAINED QUITE ACTIVE (AT ABOUT 90? OF THE PRE-
AFGHANISTAN LEVEL).

o RECENT BENEFITS TO THE U,S, HAVE INCLUDED:

- JOINT CLINICAL TRIALS OF THE Q-SWITCHED LASER FOR

THE TREATMENT OF GLAUCOMA,  WITH THE ADVICE AND
ASSISTANCE OF THE SOVIETS, A LASER HAS BEEN
CONSTRUCTED IN THE UNITED STATES AND IS BEING

USED IN THESE STUDIES,

- USEFUL EXCHANGES OF PERSONNEL, INFORMATION AND

VIRUS STRAINS FOR JOINT STUDIES OF INFLUENZA AND

ACUTE RESPIRATORY DISEASFS ARE CONTINUING,
INFORMATION ON A SOVIET FLU EPIDEMIC SEVERAL
YEARS AGO ENABLED THE CDC TO MAKE AN ASSESSMENT
OF THE DISEASE'S POSSIBLE EPIDEMIC IMPACT IN THE
UNITED STATES,

V, OTHER AREAS OF INTFREST TO THF NCIH (SELECTED NIAID AND CDC
  PROGRAM ACTIVITIES)

A, As PART OF ITS INTERNATIONAL ACTIVITIES, THE PHS IS
   ENGAGED IN OR SUPPORTING IMPORTANT RESEARCH ON DISEASES
   THAT ARE PREVALENT IN DEVELOPING COUNTRIES,  INCLUDED ARE

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   p++r   STUDIES SUPPORTED BY THE NATIONAL INSTITUTE OF ALLERGY

         /:
p w+,7 ,F:h ;&    AND INFECTIOUS DISEASES, NIH: THE CENTERS FOR DISEASE
&$2' t    CONTORL; AND THE NATIONAL HANSEN'S DISEASE CENTER OF THE
d P  &NJ      HEALTH RESOURCES AND SERVICES ADMINISTRATION,
PE;'"
r/"l       B,  NIAID

1, NIAID CONTINUES TO ASSIGN SPECIAL PRIORITY IN ITS
TROPICAL MEDICINE PROGRAM TO FILARIASIS,

LEISHMANIASIS, LEPROSY, MALARIA, SCHISTOSOMIASIS AND
TRYPANOSOMIASIS, THE SIX DISEASES TARGETED FOR
INTENSIVE RESEARCH RY THE WHO/UNDP SPECIAL PROGRAM ON
RESEARCH AND TRAINING ON TROPICAL DISEASE, THE FY

I!%:! COMMITMENT TO THE SIX DISEASES IN THE NIAID
TROPICAL DISEASE PROGRAM WAS APPROXIMATELY $17
MILLION,

2, THE NIAID PROGRAM ALSO INCLUDES OTHER INFECTIOUS

DISEASES IN WHICH INTERNATIONAL COLLABORATION IS
ESSENTIAL TO COMPLEMENT THE DOMESTIC RESEARCH
EFFORT,  THESE ACTIVITIES INCLUDE WORK IN THE GENERAL

CATEGORIES OF PARASITOLOGY; TROPICAL BACTERIOLOGY,
MYCOLOGY AND VIROLOGY; RICKETTSIOSES; AND VECTOR
PATHOGENS,

3, HIGHLIGHTS OF RECENT NIAID SUPPORT OF TROPICAL DISEASE

AND INTERNATIONAL RESEARCH, INCLUDE THE FOLLOWING:

o a ARIASIS - RECENT RESEARCH HAS FOCUSED ON THE

DEVELOPMENT OF ANIMAL MODELS, JN VITRO CULTIVATION,
IMPROVED METHODS OF DIAGNOSIS, AND IMMUNOLOGIC

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RESPONSES TO FILARIAL INFECTION,  SIGNIFICANT

DEVELOPMENTS INCLUDE THE AXENIC IN VITRO CULTURE AT
THE UNIVERSITY OF NOTRE DAME OF THIRD STAGE LARVA OF
DIPETALONEM~ VIAEAE FROM TICKS, THIS TECHNIQUE SHOULD

INCREASE THE PRODUCTION OF ANTIGENS FOR DIAGNOSTIC OR
IMMUNIZATION PURPOSES AND THE POTENTIAL TO SCREEN
CHEMOTHERAPEUTIC AGENTS,

o TROPICAL VIROLOGY

- SEVERAL NIAID AWARDEES ARE USING RECOMBINANT DNA

TECHNOLOGY TO DETERMINE WHICH GENE SEGMENTS OF VIRUSES
CODE FOR VIRULANCE,

- IN JUNE l.980, THE HUMAN DIPLOID RABIES VACCINE

ORIGINALLY DEVELOPED WITH NIAID SUPPORT AT THE WISTAR
INSTITUTE WAS LICENSED FOR GENERAL USE IN THE IJSA,
CURRENT STUDIES THERE INCLUDE: (1) THE USE OF
MONOCLONAL ANTIBODIES TO INVESTIGATE THE WORLD-WIDE
DISTRIBUTION OF RABIES VIRUS STRAINS: AND (7)
COLLABORATIVE ANALYSES OF STREET (WILD-TYPE) RABIES
STRAINS FROM ANIMALS WHICH DIED IN SPITE OF
PROPHYLACTIC VACCINATION AND OF HUMANS WHO DEVELOPED
DISEASE DESPITE POST-EXPOSURE VACCINE TREATMENT.
PRELIMINARY RESULTS INDICATE THAT NATURAL ANTIGENIC

VARIANTS OF RABIES VIRUS, PROBARLY OF BAT ORIGIN,
EXIST IN MANY AREAS, THUS, TRADITIONAL RABIES

VACCINES CONFERRED LITTLE OR NO PROTECTION,

0  VECTOR PATHOGFNS

RESEARCH PROJECTS INVOLVING VECTORS OF PUBLIC HEALTH

IMPORTANCE CUT ACROSS VIROLOGY, PARASITOLOGY AND


RICKETTSIAL DISEASES,

INTRAMURAL AND OVERSEAS PROJECTS (INCLUDING WORK IN
EGYPT) CONCENTRATED ON THE INSECT VECTORS OF HUMAN

DISEASES, PARTICULARLY TICK-BORNE DISEASES,  THIS
EXPERTISE WITHIN NIH IS CONCENTRATED IN THE EPIDEMIOLOGY
BRANCH OF THE ROCKY MOUNTAIN ~ARORATORIES,

SEVERAL STUDIES HAVE FOCUSED ON INNOVATIVE APPROACHES TO

VECTOR CONTROL,  A STUDY AT OHIO STATE !JNVIERSITY, FOR
EXAMPLE, IS INVESTIGATING STRATEGIES TO DISRUPT PREGNANCY
IN THE TSETSE FLY VECTORS OF AFRICAN SLEEPING SICKNESS

WHICH ONLY LAY ONE EGG AFTER EACH MATING,

0  DIARRHEAL DISEASES

IN FY 1981, NIAID ESTARLISHED A NEW ENTERIC DISEASE STUDY
CENTER WITH JOHNS HOPKINS AT THE WHITERIVER APACHE INDIAN
RESERVATION IN ARIZONA,  THE CENTER IS STUDYING THE

EPIDEMIOLOGY OF DIARRHEA AND THF EFFECT OF POTABLE WATER

SUPPLIES ON ENTERIC ILLNESS,

0  VACCINE DEVELOPMENT

NIAID IS ALSO CONCERNED WITH VACCINE DEVELOPMENT, SOME

OF THE MORE PROMISING WORK IS BEING PONE ON VACCINES FOR
HEPATITIS B, MENINGOCOCCAL MENINGITIS, HEMOPHILUS
MENINGITIS, CHICKENPOX AND TYPHOID FEVER,

0   INTERNATIONAL COLLABORATION IN INFECTIOUS DISEASF
  RESFARCH

THE ICIDR (INSIDERS PRONOUNCE THIS AS "EYE CYDER")

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PROGRAM INVOLVES AWARDS TO U,S, INSTITUTIONS TO ENARLE

THEM TO HAVE A LINKAGE OF RESEARCH WITH INSTITUTIONS

OVERSEAS.  CURRENT AWARDEES INCLUDE:

o HARVARD SCHOOL OF PUBLIC HEALTH WHICH IS COLLARORATING
WITH THE FEDERAL UNIVERSITY OF BAHIA, BRAZIL ON
SCHISTOSOMIASIS AND CHAGAS' DISEASE,

o UNIVERSITY OF ILLINOIS WHICH IS COLLABORATING WITH THE
CHIANG MAI UNIVERSITY IN THAILAND ON IMMUNORIOLOGY AND

  EPIDEMIOLOGY OF LEPROSY.

o MICHIGAN STATE UNIVERSITY WHICH IS WORKING WITH THE
CENTRAL LABORATORY OF THE MINISTRY OF HEALTH IN SUDAN

ON SCHISTOSOMIASIS, ONCHOCERCIASIS AND MALARIA,

C, CENTFRS FOR DISFASE CONTROL

1. EACH YEAP CDc COOPERATES WITH AS MANY- AS Ior)
  COUNTRIES, THROUGH VARIOUS MECHANISMS, INCLUDING*

0 INVESTIGATION OF THE OUTPREAK OF DISEASE

o ASSISTANCE IN DISEASE SURVEILLANCE ACTIVITIES AND

CONDUCTING HEALTH SURVEYS IN REFUGEE CAMPS

o CONDUCTING RESEARCH,

o PARTICIPATING IN OR CONDIJCTNG COURSES AND WORKSHOPS

ON SUCH TOPICS AS LABORATORY MANAGEMENT,
HEMATOLOGY, IMMUNOLOGY, EPIDEMIOLOGY, FAMILY
PLANNING, IMMUNIZATION, OCCUPATIONAL HEALTH, AND
DIARRHEAL, PARASITIC AND VENEREAL DISEASES,

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o COLLABORATING C!N OPERATION eRoJEcTs WITH AID AND
WHO,

7, IMPORTANT LABORATORY ASSISTANCE AND SUPPORT IS
  PROVIDED THROUGH:

o PROVISION OF REFERENCE AGENTS (E,G. ARROVIRUS) TO

OTHER COUNTRIES FOR USE IN SURVEILLANCE OF
DISEASES, DIAGNOSTIC PEAGENTS, SETS OF CONTROL
STRAINS, ETC,

o ESTABLISHMENT OF GUIDELINES AND STANDARDS FOR THE

EVALUATION AND PRODUCTION OF REFERENCE PREPARATIONS
AND TESTS,

3, CDC FACILITIES SFRVF AS 37 DIFFFRENT WHO COLLABORATING
OR NATIONAL CFNTFRS,  THESE INCLUDE COLLABORATING
CENTERS FOR REFERENCE AND RESEARCH ON ARROVIRUSES
INFLUENZA, MYCORACTFRIUM LFPRAE, RABIES, RESPIRATORY
VIRUS DISEASES, AND VIRAL HEPATITIS,

4, COOPFRATION WITH AID:

o CDC's FAMILY PLANNING EVALUATION STAFF PROVIDES

SUPPORT TO AID TO IMPROVE THE MANAGEMENT AND
EVALUATION OF CAPABILITIES OF FAMILY PLANNING AND
MATERNAL-CHILD HEALTH PROGRAMS IN LESS DEVELOPED

COUNTRIES,  ACTIVITIES INCLUDE EVALUATIONS OF

CONTRACEPTIVE DISTRIRUTION SYSTEMS, INCLUDING
COMMUNITY BASED PROGRAMS: CONTRACEPTIVE PREVALENCE
SURVEYS: EVALUATION OF THE COMPLETENESS AND QUALITY
OF FAMILY PLANNING DATA SYSTEMS, ETC,

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o SEVERAL CDC OFFICERS ARE NOW ASSIGNED OVERSEAS TO
  ASSIST IN THE DEVELOPMENT OF DISEASE SURVEILLANCE
IN ?O COUNTRIES IN WEST AND CENTRAL AFRICA AND IN

INDONESIA TO REDUCE MORBIDITY AND MORTALITY OF
DISEASES PREVENTARLE BY IMMUNI7ATION,  COUNTRIES
INVOLVED INCLUDE INDONESIA, ZAIRE, CONGO, IVORY
COAST, CAMEROON, AND THE ~JAMRIA,

5, EPIDEMIC INTELLIGENCE SERVICE

COOPERATING POTH BILATERALLY AND THROUGH WHO, CDC IS

ASSISTING OTHER COUNTRIES IN THE DEVELOPMENT OF
TRAINING PROGRAMS FOR AND EPIDEMIC INTELLIGENCE
SERVICE TYPE TRAINING PROGRAM, OF PARTICULAR NOTE IS
THE PROJECT NOW GOING IN THAILAND, UNDER WHO AUSPICES,
TO ESTABLISH SUCH A PROGRAM FOR THAT REGION,

5, RESEARCH

CDC IS CONDUCTING A BROAD PANGE OF RESEARCH ON
PROBLEMS OF INTERNATIONAL IMPORTANCE, INCLUDING:

0 m-- A COLLABORATIVE STUDY WITH MEXICO HAS

INCREASED OUR ABILITY TO PREDICT AREAS OF HIGHER
RISK DENGUE TRANSMISSION IN THE SOUTHEASTERN UA
AND IN PUERTO RICO,

o MALARIA - CDC's PARASITIC DISEASE DIVISION SERVES

AS A REFERENCE LAROARATORY FOR WELL CHARACTERIZED
STRAINS OF PLASMODIUM FAICIPARUM USED IN

LABORATORIES WORLDWIDE,

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o HEMORRHAGIC FEVER VIRUSES - FIELD WORK IN SIERRA
LEONE OF LASSA FEVER EPIDEMIOLOGY, TREATMENT, AND
  CONTROL, HAS CONTRIBUTED TO OUR UNDERSTANDING OF
  THIS DISEASE,  RESULTS OF THE LASSA FEVER TREATMENT

PROGRAM TO DATE INDICATE THE TREATMENT OF PATIENTS
WITH RIRAVIRIN AND IMMUNE PLASMA MAY SAVE LIVES,
PROGRESS HAS PEEN MADE IN STUDIES ON DIAGNOSTIC

AIDS AND SUP-IJNIT VACCINE WORK,

o POLIOMYELITIS - IN CONJUNCTION WITH b/HO, CDC HAS

BEEN ACTIVE IN ADDRESSING POLIO VIRUS PRORLEMS OF
THE DEVELOPING WORLD, INCLUDING THE RESPECTIVE
ROLES OF LIVE AND KILLED VACCINES IN PREVENTION AND
CONTROL AND THE ADVISABILTTY OF ROUTINE INDIVIDUAL
VACCINE ADMINISTRATION VERSUS MASS CAMPAIGN
ACTIVITY,

o TREPONEMATOSFS - A DIRECT FLUORFSCENT ANTIBODY

TECHNIQUE HAS BEEN EVALUATED FOR USE IN DIAGNOSIS
OF YAWS,

7 DRACUNCULIASIS INITIATIVF

THE YEARS 1981-90 HAVE BEEN DESIGNATED AS THE
INTERNATIONAL BOATER SUPPLY AND SANITATION DECADE.
CONTROL OF DRACUNCULIASIS HAS BEEN ESTABLISHED AS ONE
OF THE GOALS OF THE SPONSORING ORGANI7ATIONS, CDC HAS
UNDERTAKEN A SPECIAL INITIATIVE, IN COOPERTION WITH
THE WORLD BANK, UNDP, AND THE NAS BOARD ON SCIENCE AND
TECHNOLOGY FOR DEVELOPMENT, TO ADDRESS THIS PROBLEM.

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8. TRAINING

CDC HAS AN IMPORTANT TRAINING PROGRAM DIRECTED TOWARD
DOMESTIC AND INTERNATIONAL NEEDS.  IN 1983, OVER 700
INTERNATIONAL HEALTH WORKERS FROM OVER lo@ COUNTRIES
CAME TO CDC TO ATTEND SPECIAL SEMINARS, CONFERENCES,
AND COURSES OR TO RECEIVE INDIVIDUAL INSTRUCTION,

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