U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES

National Institutes of Health

Strategic Plan

ADVANCING SCIENCE 

FOR GLOBAL HEALTH

FOGARTY

I N T E R N A T I O N A L C E N T E R
Decades before phrases like “globalization” and 

“multiculturalism” became commonplace, Rep. John 

Edward Fogarty (D-RI) advocated for international 

health research to reduce suffering and foster 

peace and prosperity throughout the world. Over 

the course of his 27 years in Congress, Fogarty 

was a champion for NIH and for the value of 

medical research. During his tenure as Chair of the 

Appropriations Subcommittee with responsibility for 

health funding, the budget for NIH grew from $37 

million in 1949 to $1.24 billion in 1967.

Over the years, Fogarty repeatedly, but 

unsuccessfully, argued for the creation of an 

international health research institute to promote 

the study of global health problems. His sudden 

death of a heart attack on January 10, 1967, 

provided the catalyst that finally brought his “Health 

for Peace” center into existence in July 1968. Since 

then, the John E. Fogarty International Center 

has assumed a prominent place in the global 

health community, funding research and building 

sustainable research capacity at home and abroad.

I visualize this center ... 

as representing the visible 

and tangible embodiment 

of this nation’s devotion 

to the use of science for 

peaceful purposes and the 

good of mankind. 

 

Rep. John Edward Fogarty

1913–1967

“

”
FOGARTY STRATEGIC PLAN 1
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VISION

The Fogarty International Center’s vision is 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.

MISSION

The Fogarty International Center is dedicated to 

advancing the mission of the National Institutes 

of Health by supporting and facilitating global 

health research conducted by U.S. and international 

investigators, building partnerships between health 

research institutions in the U.S. and abroad, and 

training the next generation of scientists to address 

global health needs.
TABLE OF CONTENTS

1. Message from the Director

2. Introduction: 

 A global imperative to improve health

3. The Fogarty Goals:

 Extend the NIH research mission globally

 GOAL 1

 Build research capacity through INDIVIDUALS, INSTITUTIONS, and 

 NETWORKS to meet future and evolving global health challenges

   GOAL 2

 Stimulate innovation in the development and implementation 

 of technologies and other locally relevant solutions to address 

 global health problems

 GOAL 3

 Support research and research training in implementation science

 GOAL 4

 Advance research on prevention and control of the dual burden 

 of communicable and non-communicable diseases and disabilities

 GOAL 5

 Build and strengthen partnerships to advance global health 

 research and research capacity

4. Conclusion

FOGARTY STRATEGIC PLAN 3

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MESSAGE FROM THE DIRECTOR

Dear Colleagues

and Friends,

These are exciting times 

for global health. Over 

the past decade, the 

world has come together 

to continue and expand 

programs in low- and 

middle-income countries 

(LMICs) to achieve the 

Millennium Development 

training outstanding young investigators, both U.S. 

and foreign, and linking them early in their careers in 

research partnerships between their institutions has 

been a winning strategy that has had a major impact 

on the research enterprise for global engagement. It 

remains at the core of our programs at Fogarty and 

forces us to take the long view—to train the next 

generation of researchers in areas of global health 

where we think the field is moving and where the 

most interesting discoveries are yet to be made. 

We’ve identified several directions that seem to 

have great growth potential and merit our attention. 

Fogarty programs to address the rising tide of chronic 

illness and non-communicable diseases (NCDs) 

must be strengthened and expanded. In many 

parts of Africa, efforts to prevent and treat HIV/

AIDS, malaria, and TB over the past decade have 

reversed the precipitous decline in life expectancy 

seen in the 1990s. In other LMICs, life expectancy has 

approached or passed 70 years. These countries now 

share the same health challenges that we are facing 

in the United States. Heart disease, cancer, diabetes, 

mental illness and other chronic diseases are the main 

causes of death and disability here at home and are 

expanding globally. We must focus our attention on 

these problems and discover new ways to prevent 

and treat them. Today, global health and local 

health are becoming one and the same and research 

anywhere can help people everywhere. 

Secondly, we believe it is critical that we find new 

ways to harness the huge upsurge of interest by 

students at all levels in issues of global health. 

In order to solve the increasingly complex global 

health problems, we must expand our efforts to spur 

innovative solutions by engaging multidisciplinary 

teams with skills not traditionally related to health, 

such as engineering, business, economics and law. 

In addition—given the emergence of NCDs as the 

next global challenge—we need to attract young 

investigators with diverse specialties including 

cardiology, oncology, neurology and mental 

4 FOGARTY STRATEGIC PLAN

Dr. Roger I. Glass

Goals and set new aspirational targets for the 

future—to consider the possibility of a generation 

without HIV/AIDS, to decrease under 5 mortality 

to 20 deaths per 1,000 by 2035, and to embrace 

the burgeoning problem of non-communicable 

diseases. These goals, while ambitious, are within 

reach because of significant research advances and 

implementation of health programs with levels 

of funding that could not have been imagined a 

decade ago. They also reflect the recognition by 

many leaders that this support to improve health is 

not only important for humanitarian reasons, but 

imperative for economic development, for political 

stability, for science and for long-term growth. 

What has Fogarty done in the past and what 

can we do in the future to continue to make our 

mark on the research and training agenda for 

global health? When I travel, I am always amazed 

and gratified by the number of outstanding 

researchers, young and old, who introduce 

themselves to me and thank me for the support 

Fogarty has provided that has helped them start 

and establish their careers in research. Grantees 

from our first extramural program 25 years ago 

built collaborations between U.S. and foreign 

investigators and institutions in HIV/AIDS 

research that have trained a cadre of outstanding 

researchers at home and abroad. These trainees of 

yesterday have become well-recognized leaders 

in the field today. This concept of investing in 
FOGARTY STRATEGIC PLAN 5

health, and other topics that in the past were not 

considered in the realm of global health. 

In our increasingly wired world, it is imperative 

that we redouble our efforts to incorporate 

information and communication technology (ICT) 

into our research and training programs. Our 

grantees and partners are producing novel teaching 

tools and electronic resources that make knowledge 

about disease and prevention freely available to all. 

E-learning is a powerful way to enable physicians 

and medical personnel at all levels to gain access 

to the ever-expanding and changing knowledge 

base that can keep them up to date throughout 

their careers. Now that more people in LMICs 

have cellphones than toilets, we see growing 

opportunities to adapt mobile applications to 

improve access to populations for research and 

provision of care. While the potential is great, it is 

important that we carefully study and evaluate the 

most effective ways to incorporate these new ICT 

tools and resources into the practice of medicine, 

public health and research. 

Implementation science was a cornerstone of our 

last Strategic Plan, and remains a high priority if we 

are to ensure that proven interventions are actually 

delivered and scaled up effectively. This challenge 

continues to require a cadre of researchers who 

are trained to generate the evidence required to 

move discoveries into practice. Increased efforts are 

now needed to catalyze partnerships and improve 

communication between the scientific community 

and program implementers and decision-makers, 

so that science informs program and policy, and 

research is responsive to program and policy needs.

Today, interest in global health is tremendous but 

funding, as always, is limited. One way to leverage 

our impact is by building partnerships with groups 

that share our interests and passion. Within NIH, 

most of Fogarty’s programs receive co-funding 

from many of the Institutes and Centers that see 

value in our training activities, our overseas networks 

and in our efforts to strengthen LMIC institutions 

to enable the conduct of meaningful research 

that is both ethically and properly administered. 

Beyond NIH, we have longstanding partnerships 

with organizations such as the National Science 

Foundation, the President’s Emergency Plan for AIDS 

Relief and the Bill and Melinda Gates Foundation, 

and see tremendous opportunities to extend these 

even further. We also have new relationships with a 

number of medical research organizations globally 

to coordinate our endeavors and, increasingly, to 

provide parallel funding for scientific projects of 

mutual interest and benefit.

In summary, Fogarty’s strategy moving forward will 

be to build on the strong and productive roots of our 

past. We will continue to emphasize training and 

research but will redirect our programs to include 

the changing burden of disease in LMICs—the NCD 

agenda. We will capitalize on the enthusiasm for 

global health on campuses around the country and 

will provide new opportunities to apply the diversity 

of skills and interests of future graduates to some of 

the most challenging health problems of our time. 

We have a strong track record upon which to build, 

a number of areas where we see the potential for 

innovative research over the next few years, and 

the prospect for developing and sustaining fertile 

partnerships that will seed the next generation of 

global health researchers. 

Many thanks for your continued support!

In partnership,

 Roger I. Glass, M.D., Ph.D.

 Director, Fogarty International Center

 Associate Director for Global Health Research, NIH

Fogarty International Center
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FOGARTY STRATEGIC PLAN 7

Build research capacity through INDIVIDUALS, INSTITUTIONS, and NETWORKS

to meet future and evolving global health challenges

 Strategic Priorities

• Support training of INDIVIDUALS to build future research leaders in the U.S. and low- 

 and middle-income countries.

 • Invest in INSTITUTIONS as sustainable platforms for research in low- and middle-income countries.

 • Promote research NETWORKS.

 • Stimulate linkages among disciplines to address complex global health problems.

Stimulate innovation in the development and implementation of technologies

and other locally relevant solutions to address global health problems

 Strategic Priorities

 • Support the enhanced use of information and communication 

 technologies to facilitate and improve health research education.

 

 • Encourage innovation in the development and implementation of mobile 

 and other technologies, systems, and policies to address global health problems.

Support research and research training in implementation science

 Strategic Priorities

• Expand investment in research and research training in implementation science across programs.

 • Catalyze interaction between researchers, policymakers and program implementers to 

 promote uptake of evidence into global health policy and practice.

Advance research on prevention and control of the dual burden of 

communicable and non-communicable diseases and disabilities

 Strategic Priorities

 • Support research and research training in clinical, behavioral and population sciences.

 • Identify ways to leverage investments in communicable diseases, including HIV, to better 

 address the dual burden of disease.

Build and strengthen partnerships to advance global health research and research capacity

 Strategic Priorities

• Engage and support the NIH Institutes and Centers to advance their research agendas 

 for global health.

 • Forge partnerships at home and abroad to leverage complementary interests and strengths.

 • Convene global experts to address priority research questions and catalyze new areas of science.

GOAL 1

STRATEGIC PLAN GOALS

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GOAL 2

GOAL 3

GOAL 4

GOAL 5

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A GLOBAL IMPERATIVE 

TO IMPROVE HEALTH

 n every region of the world, the Fogarty International Center

 advances the NIH mission to seek fundamental knowledge

about the nature and behavior of living systems and the application 

of that knowledge to enhance health, lengthen life, and reduce 

illness and disability. For Fogarty, this mission translates into 

advancing science and strengthening research capacity in areas 

of the world where resources are limited and challenges to health–

the dual burden of communicable and non-communicable diseases, 

poverty, inadequate water and sanitation, limited health infrastructure, and adverse environmental exposure—are daunting. 

Fogarty investments accelerate the pace and progress of research, 

expand the scientific enterprise by building capacity at research 

institutions across the globe, and, most importantly, develop the 

knowledge and evidence needed to confront health challenges 

wherever they occur. By taking science to where the problems are, 

and by supporting research and research training in areas where 

the burden of disease is greatest, Fogarty investments will continue 

to build the health research workforce of the future while bringing 

scientific inquiry to bear on some of the world’s most complex 

health problems affecting populations both at home and abroad. 

FOGARTY STRATEGIC PLAN 9

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These are exciting times for global health, with new opportunities 

for partnership, the introduction of transformative technologies, and 

scientific priorities that are evolving to match the changing burden 

of disease. Capitalizing on these developments demands a nimble 

and multidisciplinary research workforce that can function across 

cultures and borders to solve health problems. Fogarty will continue 

to support research and research training programs that train the best 

and brightest researchers around the world and facilitate scientific 

collaboration. Fogarty will also encourage innovation in research and 

capacity building. 

Fogarty’s 2014 Strategic Plan will advance the global health research 

agenda by building on past and current Fogarty investments and 

successes in a way that responds to the changed landscape in global 

health. This vision is outlined in five main areas: building research 

capacity to meet current and future global health challenges; 

stimulating innovation in the development and evaluation of 

technologies to address global health problems; supporting research 

and research training in implementation science; advancing research 

on prevention and control of communicable and non-communicable 

diseases and disability; and building partnerships to advance global 

health research and research capacity. Fogarty investments will 

continue to advance the goals and sustain the leadership of the NIH 

and the U.S. government in biomedical research, while improving the 

health of Americans and populations across the globe.

10 FOGARTY STRATEGIC PLAN
FOGARTY STRATEGIC PLAN 11

GOAL 1

Build research capacity through 

INDIVIDUALS, INSTITUTIONS, and NETWORKS

to meet future and evolving global health challenges

Based on 25 years of experience in global health research training, 

Fogarty will continue to invest in building current and future leaders in 

global health research, strengthening the long-term capacity of research 

institutions to be sustainable platforms for cutting-edge science, and 

catalyzing meaningful collaborations between and among institutions. 

Together, these investments comprise a continuum of capacitystrengthening that is uniquely supported by 

Fogarty. 

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Strategic Priority

Support training of INDIVIDUALS to 

build future research leaders in the U.S. 

and low- and middle-income countries

The most important resources in global health 

research are people. These critical resources 

must be renewed and diversified. Addressing 

today’s complex global health challenges 

requires a critical mass of first-class scientists 

who are well versed in regional health 

problems and understand the cultural, social, 

economic, and political context that influences 

the effectiveness of interventions. 

Invest in future U.S. global health research leaders

In an effort to harness the energy and significant interest in global health 

at U.S. universities, Fogarty will continue to support the training of 

early-career scientists at research centers in LMICs, enabling them to 

understand the diverse health challenges and opportunities of working 

in low-resource and international settings and to establish partnerships 

with local researchers to tackle complex global health issues. Fogarty 

supports these hands-on, clinical research training experiences in 

low- and middle-income countries (LMICs) in close partnership with 

an increasing number of NIH Institutes and Centers. Through these 

programs, Fogarty and its NIH partners provide experiences that 
encourage young U.S. investigators to take risks and 

approach problems creatively and collaboratively 

under constraints that may not exist in high-income 

settings. These highly motivated individuals often 

build lasting professional relationships with their 

peers in LMICs and go on to conduct research that 

addresses health needs of the U.S. and LMICs.

Invest in future LMIC research leaders 

Fogarty has supported the training of thousands 

of scientists in LMICs who, with their intimate 

knowledge of the local context, are uniquely poised 

to make discoveries in global health research.

Many of these investigators have become leaders 

in academic institutions and ministries of health in 

their home countries, and are involved in national 

efforts to improve the health care of the local 

population. Fogarty grants have also catalyzed a 

cycle of sustainable research training, whereby the 

first generation of trained foreign investigators 

trains subsequent generations of scientists, leading 

to a compounded return on scientific investment.

Fogarty supports unique training programs for 

LMIC scientists that are grounded in long-standing 

partnerships between research institutions in the 

U.S. and in LMICs. These programs extend the 

international scientific reach of the U.S. institutions, 

while creating novel pathways for mutual learning 

and benefit. Past Fogarty investments have 

multiplied the number of foreign investigators 

working abroad, who serve as change agents within 

their institutions, become leaders, and participate in 

international scientific networks. Fogarty programs 

have supported long-term research training for 

over 4,500 scientists in more than 100 countries, in 

collaboration with over 230 U.S. and LMIC research 

institutions. Many trainees have gone on to conduct 

groundbreaking research with major impact. 

Fogarty will continue to support innovative training 

and research programs for LMIC scientists.

12 FOGARTY STRATEGIC PLAN

Fogarty International Clinical Research 

Scholars and Fellows Program

Over the last decade, American university campuses 

have seen a soaring interest in global health 

among students and faculty from a wide range of 

fields. Since 2004, Fogarty has met this interest 

by providing individual support to more than 500 

fellows (postdoctoral students and M.D.s) and scholars 

(current Ph.D.s and M.D. students) for hands-on, 

clinical research training experiences in low- and 

middle-income countries (LMICs). Participants have 

published more than 750 articles in peer-reviewed 

journals, presented research findings at numerous 

scientific meetings, and used their research training 

to make practical improvements and advancements in 

treating disease. Most important, many have launched 

their careers in global health. 

Fogarty Trainees 1988-present
Promote pathways to research independence 

A robust global health research workforce requires that talented 

investigators from LMICs have opportunities to establish independent 

research careers. A strong career pipeline ensures that investments in 

research training can build research leaders who remain in-country 

to advance science locally and 

internationally and help train 

the next generation of scientists. 

The pipeline leading to scientific 

independence for foreign researchers 

is particularly vulnerable during the 

postdoctoral phase, where there is 

little funding for new researchers and 

the mentored research experiences 

that foster research independence can 

be difficult to obtain. To address this 

critical juncture, Fogarty will continue to support career development for 

promising LMIC scientists at foreign institutions to ensure they can launch 

a successful and independent research career. 

 Strategic Priority 

 Invest in INSTITUTIONS as sustainable platforms 

 for research in low- and middle-income countries

Fogarty also supports efforts to strengthen research capacity at the 

institutional level. Academic institutions are an integral part of the health 

system. As centers for scientific discovery, excellence in service delivery 

and training of future leaders, they 

play a unique and powerful role in 

stimulating their researchers and key 

stakeholders to address priority health 

problems. Despite the many challenges 

faced by academic institutions in 

resource-poor settings, they are highly 

capable of substantial contributions 

to the health of their communities, 

countries–and by extension, to global 

health. A sustainable base of research 

institutions in LMICs can help advance 

the development of priority 

FOGARTY STRATEGIC PLAN 13

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interventions for global health, with these institutions serving a critical 

role in generating solutions and training the research workforce of the 

future.

Fogarty strengthens institutional research capacity by investing 

in programs such as research ethics, library sciences, research 

management, and informatics. Moreover, a strong research 

environment helps to ensure that scientists remain in their home 

institutions to conduct research. This also enables institutions to 

serve as centers of excellence that can attract international scientific 

collaboration and retain staff. Research ethics capacity, for example, 

provides the impetus and skills to strengthen ethical review and 

oversight of research within an institution, helping to foster a 

culture of scientific rigor and independence. Research management 

14 FOGARTY STRATEGIC PLAN

Strengthening International Research Ethics Capacity:

Fogarty’s Bioethics Program

The protection of human subjects is essential to the conduct of sound, ethical research. 

In light of increased international collaborations and clinical trials abroad, trained 

individuals and institutional frameworks are needed to ensure that any research 

conducted is held to high ethical standards and human subjects are adequately 

protected. As the success and credibility of major national and U.S. investments in 

clinical trials and other health research studies depend on strong local ethics review 

boards and appropriate national regulations, building research ethics capacity in LMICs 

is critical.

Fogarty’s International Research Ethics Education and 

Curriculum Development Award (“Bioethics”) program supports 

the development of culturally relevant bioethics curricula for 

LMIC scientists, while also supporting training to produce 

leaders who can advise LMIC institutions on formulating and 

strengthening local bioethics guidelines, build well-informed 

review bodies capable of evaluating research proposals, and 

train others in the principles of ethical research conduct. In 

the last decade, Fogarty has enabled over 560 LMIC scientists, 

academics and health professionals to complete master’s level training in bioethics.

For example, Nigerian grantee Dr. Clement Adebamowo has provided ethics training to 

over 1,000 West African researchers, drafted the Nigerian National Code for Research 

Ethics, and established a web-based research protocol tracking system for the country. 
FOGARTY STRATEGIC PLAN 15

capacity promotes stronger financial and 

grants management capabilities within these 

institutions, enabling more accountability, 

transparency and research competitiveness. 

Finally, given the exponential increase in 

biomedical information and computerbased tools available for access and analysis, 

individuals with advanced training in 

informatics are essential to facilitate highquality and cutting-edge research. 

Building on investments in individual research 

institutions, Fogarty is now supporting 

networks, enabling institutions to leverage 

each other’s strengths. By supporting such 

interactions, Fogarty aims to facilitate 

collaboration and information sharing, 

ultimately helping to develop relationships 

between research institutions that serve as 

centers of excellence and regional resources 

for training, data management, and 

multidisciplinary research. 

Fogarty will support networks of institutions 

in several ways. First, Fogarty will continue 

to invest in the development or expansion 

of multidisciplinary centers for global health 

research. These centers or hubs serve as 

focal points for research, research training, 

and collaborative activities around specific 

global health topics. These hubs form links, 

or “spokes,” to other local institutions 

enabling the development of regional research 

collaborations that leverage unique strengths 

of respective institutions, expand research 

training opportunities, and support the science 

needed in order to inform nationally-relevant 

policy development. 

Second, Fogarty will continue to invest in 

network models such as the Medical Education 

Lasting Capacity: The Formation of a 

Regional Informatics Network

Dr. Patty Garcia’s first connection with 

Fogarty was as a trainee with the AIDS 

International Training and Research 

Program (AITRP). Dr. Garcia went on 

to receive further NIH grants, and, 

following a few years as Chief of Peru’s 

National Health Institutes, now serves 

as Professor and Dean of the School of Public Health at 

Universidad Peruana Cayetano Heredia (UPCH).

In collaboration with the University of Washington and with 

support from Fogarty’s Informatics Training for Global Health 

program, Dr. Garcia has built informatics capacity at UPCH 

over the past 14 years, and most recently created the Andean 

Global Health Informatics and Training Center as a regional 

center of excellence, initially in partnership with universities 

in Colombia and Ecuador. She has led efforts to establish 

certificate and master’s programs in informatics at UPCH, and 

organized a pan-Latin America informatics and health summit 

and a pan-Latin America Symposium on mHealth. Over the last 

25 years, UPCH has built a diverse, highly regarded research 

portfolio and currently holds over 20 NIH grants and contracts. 

Partnership Initiative (MEPI) that supports 

a large network of African medical schools 

that are recruiting and retaining wellqualified faculty, employing state-of-the-art 

teaching tools, developing regional training 

centers, and upgrading technology to enable 

distance learning and resource sharing 

among institutions. Direct funding to African 

institutions in this model encourages local 

ownership and allows each institution to 

adapt the program to suit its unique resources 

and local health needs.

Finally, some of Fogarty’s long-term 

investments have trained a critical mass 

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Strategic Priority

Promote research NETWORKS
of researchers and leaders, enabling the emergence of regional 

networks in areas such as informatics and bioethics.

 Strategic Priority 

 Stimulate linkages among disciplines to address 

 complex global health problems

Global health challenges are often embedded in relationships 

with biological, social, economic, political, and environmental 

determinants. Some of the most transformative advances in science 

and technology have come by bringing together collaborators 

from different disciplines to arrive at novel solutions. Indeed, 

collaborative research across disciplines fueled the development of 

such fields as genomics, nanobiology, bioinformatics, behavioral 

science, and systems biology and is producing cutting-edge 

advances in every field of health-related research, from cancer to 

immunology, brain disorders, blindness, and infectious disease. 

Fogarty will support research training that encourages scientists 

to think and work across disciplines, form lasting working 

relationships with colleagues in different fields, and develop new 

models for problem-solving that 

draw upon a wide range of expertise 

in disciplines as diverse as law, 

economics, business, information 

technology, and engineering. In 

doing so, Fogarty will stimulate 

innovation in interdisciplinary 

approaches to global health 

research training, incentivize new 

collaborations, and increase the 

pipeline of researchers from a variety 

of fields.

The information and communication 

technology (ICT) revolution presents 

exceptional opportunities and new 

tools for global health research and 

research education. Scientists across the world are more connected 

than ever before due to the speed and ease with which so many can 

communicate using these tools. Fogarty will expand its support 

of innovation in the use of ICT to facilitate knowledge generation, 

scientific exchange and research education.

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16 FOGARTY STRATEGIC PLAN
Fogarty’s divisions work together to support global health research 

and research training activities within the Center and across the NIH. 

DIVISION OF INTERNATIONAL TRAINING RESEARCH:

Research and research training at home and abroad

The Division of International Training and Research administers research grants, training 

grants and fellowship programs at institutions in more than 80 countries. Fogarty programs 

that build the research pipeline are anchored to peer-reviewed research grants and 

designed to be collaborative, long-term and flexible. Over a quarter of Fogarty awards 

are made directly to research institutions in low- and middle-income countries, while the 

remaining grants are made to U.S. institutions that collaborate with institutions in low- and 

middle-income countries. About one-fourth of Fogarty’s investments focus on scientific 

discovery, and three-fourths support research training.

DIVISION OF INTERNATIONAL SCIENCE POLICY, PLANNING AND EVALUATION:

Planning for future global health needs

The Division of International Science Policy, Planning and Evaluation provides strategic 

guidance to Fogarty’s director on the development, analysis and evaluation of Fogarty’s 

programs and on international science policy issues. The division tracks activities of 

international funding agencies and research trends in global health, and advises Fogarty’s 

director on legislative and partnership matters. This division also manages Fogarty’s 

Center for Global Health Studies, which serves as a hub for project-based scholarship and 

a platform for dialogue and international collaboration on emerging priorities in global 

health research and research training.

DIVISION OF INTERNATIONAL RELATIONS:

Catalyzing new research partnerships through diplomacy

The Division of International Relations facilitates new partnerships among U.S. scientists, 

institutions and counterparts abroad to advance research and training in the biomedical 

and behavioral sciences. The division works on behalf of Fogarty and the whole of NIH to 

identify opportunities for collaboration with foreign science-funding agencies, the U.S. 

Department of State, U.S. technical agencies and international organizations. It also forms 

agreements with other nations to establish research collaborations and commitments for 

home country support.

DIVISION OF EPIDEMIOLOGY AND POPULATION STUDIES:

Predicting and analyzing disease trends and outbreaks

Fogarty’s in-house scientists in the Division of Epidemiology and Population Studies 

conduct research on the epidemiology and mathematical modeling of infectious diseases. 

Primary concentrations include cross-national studies of mortality patterns with special 

emphasis on malnutrition and enteric diseases, influenza, vector-borne diseases, and 

vaccine-preventable diseases. Since 2000, these scientists have produced research used to 

guide domestic and international policy, as well as public health measures to control the 

spread of diseases.

FOGARTY STRATEGIC PLAN 17
 
FOGARTY STRATEGIC PLAN 19

Information is the most prized currency of 

our fast-paced, wired world. As bandwidth 

is expanding across Africa and elsewhere 

in the developing world, we must support 

online research collaborations, distance 

learning, science communication and 

knowledge exchange. All have the potential 

to revolutionize research and research 

training in low-resource settings. Fogarty will 

support efforts that explore how ICT can most 

effectively catalyze, facilitate and improve 

education and research training for health.

Eventually we hope to stimulate the 

development of “learning laboratories” in 

LMICs that are empowered to develop and 

evaluate different models of distance learning 

and other ICT strategies, as well as adapt open 

access platforms for the needs of research and 

research educational communities. Research 

will also be needed to identify new models 

Mark Siedner, M.D., M.P.H.

Fogarty Fellow, Uganda – 2011-2012

RESEARCH FOCUS:

Determinants of care and technological interventions

Post-training employment:

Clinical and research fellow in the Division of Infectious 

Diseases at Massachusetts General Hospital and Harvard 

Medical School

“My ability to participate in everything from research 

to clinical care in Mbarara, being mentored myself and 

mentoring others, has really set me on a trajectory to 

pursue my career goal of being an academic clinician 

focused on doing research in places like Uganda.”

for training in the use of 

ICT tools and strategies that 

can be implemented in lowresource settings, to foster the 

next generation of tech-savvy, 

multidisciplinary scientists.

Fogarty’s investments in this 

area will help ensure that the 

most recent scientific advances 

are accessible to students and 

scientists in LMICs.

Over time, this capacity will enable 

professionals in LMIC institutions to 

assess the vast resources available and 

GOAL 2

Stimulate innovation in the development and 

implementation of technologies and other 

locally relevant solutions to address global 

health problems

 Strategic Priority

 Support the enhanced use of information

 and communication technologies to facilitate 

 and improve health research education

s
what works best for their 

particular needs as they develop 

novel education tools. They 

will also have the capability 

to adapt their research and 

research training models to 

technologies as they evolve.

Students and faculty will access, 

teach and share information 

in creative and transformative 

ways, enabling new approaches 

to collaborative learning and 

problem-solving in partnership 

with colleagues in the next room 

and across continents.

 Strategic Priority

 Encourage innovation in the development and implementation 

 of mobile and other technologies, systems, and policies to address 

 global health problems

The use of mobile health technologies has expanded exponentially 

around the world. Of the 5.4 billion global mobile phone 

subscriptions, over 483 million are in low-income countries and 

2.6 billion in lower-middle-income countries, with growth rates 

well over 35 percent in most developing regions (UNDP, Mobile 

Technologies and Development, 2012). Widespread access to 

cellphones has enabled health care providers to deliver information 

and services to larger and hard-to-reach populations. Scientists 

who utilize these tools can enhance the quality of their research and 

address certain research priorities. For example, mobile technologies 

can transform epidemiological and surveillance research and the 

ways data are collected and analyzed. Mobile devices can be used 

to capture, store, analyze, manage and present data. These devices 

can also be used to help create data platforms for new diagnostics 

and low-cost and real-time tools for tracking disease progression, 

movement, behavior, adherence to therapy, and environmental 

exposures.

20 FOGARTY STRATEGIC PLAN

s
FOGARTY STRATEGIC PLAN 21

Although much attention is focused on the promise of mobile 

technologies and health (mHealth), there is relatively little evidence 

linking improved health outcomes to mHealth interventions. 

Rigorous studies are required to assess the health impact of mobile 

technologies and to determine how they can be effectively scaled 

up in diverse, low-resource settings. The field is evolving so rapidly, 

that new, innovative and robust research methodologies will also 

be helpful to swiftly evaluate mHealth interventions. Finally, 

research is needed to determine how to best integrate the use of 

mobile technologies into larger research and health care systems. In 

sum, a foundation of evidence for mHealth interventions must be 

built to maximize their impact on health. This evidence base is not 

only critical for the development and implementation of effective 

mHealth interventions in LMICs, but research on this leapfrog 

technology can also be applied to health care in the U.S.

Global Health Research and Research Training 

eCapacity Initiative (eCapacity)

In 2013 Fogarty launched the eCapacity Initiative, 

with the aim of supporting innovative research 

education programs that provide researchers at 

LMIC institutions with the knowledge and skills 

necessary to incorporate ICT into global health 

research and research training. eCapacity grants 

are designed to leverage research and education 

efforts from current or prior Fogarty grants, 

connecting established research and/or research training programs, to ICT tools 

such as electronic training resources (distance learning platforms, open education 

collaborations or library collections) and ICT research tools (mobile technologies, 

modeling, bioinformatics, geospatial information systems). Through the initiative, 

participants will develop the skills and expertise needed to successfully integrate 

ICT into their activities and keep pace with rapidly evolving technologies.
Oluwatoyin F. Fafowora

Fogarty Fellow, Nigeria – 2008-2010

RESEARCH FOCUS:

Mutant genes in juvenile-onset glaucoma 

Post-training employment:

Research fellow at UCLA’s Jules Stein Eye Institute

22 FOGARTY STRATEGIC PLAN

The development of feasible, effective, and 

affordable solutions to health problems in 

culturally diverse, low-resource settings 

would benefit from more inclusive ways 

of conducting science. This paradigm 

engages researchers and other relevant 

experts from diverse disciplines together 

to think through all aspects of a particular 

health challenge and develop more holistic 

solutions that challenge the status quo. 

This type of innovation is relevant not only 

to the development and implementation 

of new or improved technologies, but also 

to processes, systems, and policies that impact the problem being 

addressed.

To encourage innovation in research and research training, Fogarty 

will continue to support interdisciplinary solutions-based approaches 

to global health challenges.

In addition, in partnership with other NIH Institutes and Centers, 

Fogarty will support training and encourage innovation in the 

development of low-cost technologies that are designed for, or can 

be adapted to, a wide range of low-resource settings. Such “frugal 

technologies”—cost-effective technologies that are developed 

specifically for local conditions—hold significant promise for 

improving population health and quality of life in LMICs. The Jaipur 

Foot, a rubber prosthetic for people who have lost their leg and foot 

below the knee; PATH’s Uniject injection system, which allows onceonly use of needles for injectable contraceptives; and the eRanger, 

a durable rural ambulance based around a motorbike and stretcher 

sidecar, are some examples of technologies that can be used, adapted 

and scaled up in diverse cultural and economic contexts.

Her Fogarty fellowship 

experience led to a change 

in career path from clinical 

work to research. “I’m in 

research now and I like 

it. I want to work to find 

new knowledge, to make a 

difference.”
FOGARTY STRATEGIC PLAN 23

Innovation in Training, Strategies and Technologies for Global Health: 

FRAME Signature and FRAME Innovation 

Today’s complex public health challenges will benefit from the 

engagement of investigators from a wide variety of fields working 

together to find novel solutions. To date, few universities prepare 

students and faculty to respond to global health challenges through 

broad, interdisciplinary research. Two Fogarty programs−Framework 

Programs for Global Health (FRAME) Signature Innovation Initiative and 

FRAME Innovation−have supported multidisciplinary approaches in 

global health research training. 

The Signature one-year pilot program supported the creation 

of infrastructure, resources, and opportunities for postdoctoral 

investigators in U.S. universities to carry out multidisciplinary team 

research in global health. For example, researchers from engineering, 

Manisha Nair

Fogarty Scholar, India – 2009-2010

RESEARCH FOCUS:

Rate of coronary artery disease in South Asians

Post-training position:

Ph.D. student in Public Health

at the University of Oxford

“This experience 

completely changed the 

direction of my career...

without going through 

such a learning experience 

I would not have had the 

confidence and knowledge 

in research that I have now 

to design any research 

project or epidemiological 

study.”

public health, and medicine applied point-of-care telemedicine units built with highly innovative lens-less, $2 microscopes 

attached to a cellphone to enable diagnosis of such infectious diseases as malaria and HIV in remote settings with no access 

to clinics. Another group worked collaboratively with a university in South Africa to develop an agent-based model to monitor 

the effects of interventions to improve water quality and reduce diarrheal disease in a poor rural province, drawing together 

participants from more than eight different schools within the partner universities. Other groups worked on innovations to 

disrupt the airborne transmission of TB, understand the relationship between women’s empowerment and improved family 

health, increase retention in clinical trials, and explore drug resistance.

Building on FRAME Signature and Innovation awards, Fogarty is supporting U.S. and LMIC institutions to develop 

interdisciplinary, postdoctoral five-year research training programs in global health, directed at innovation in health products, 

processes, and policies. U.S. and LMIC teams identify critical health needs, and then do the research to develop and test 

concepts and solutions. At the outset, these projects will consider effectiveness, affordability, accessibility, ease of use or 

delivery, and scalability. This practical focus will increase the potential for translation of research findings into concrete and 

realizable health benefits.
24 FOGARTY STRATEGIC PLAN
FOGARTY STRATEGIC PLAN 25

 GOAL 3 

 Support research and research training in 

 implementation science

 Strategic Priority

 Expand investment in research and research training 

 in implementation science across programs

 

In the previous Strategic Plan, Fogarty highlighted research to ensure 

that proven health interventions can be effectively implemented 

and brought to scale. The gap between the promise of scientifically 

proven health innovations and their successful implementation 

in the real world persists in a wide variety of contexts, from 

prevention of mother-to-child transmission of HIV, to introduction 

of effective tobacco control strategies, to interventions to prevent 

adverse environmental exposures. Implementation science and 

researchers who are trained in related disciplines therefore remain 

a critical priority if the results of investments in research are to be 

fully realized. This research plays an important role in identifying 

barriers to, and enablers of, effective global health programming 

and policymaking, and 

leverages that knowledge 

to develop evidence-based 

innovations in effective 

delivery approaches. 

Given enduring gaps in 

translation of evidence 

into policy and programs, 

Fogarty will continue 

to support research and 

research training in 

implementation science 

across its programs, 

including in areas related 

to global tobacco control 

research, brain disorders, and HIV/AIDS. Fogarty will also continue 

to work with other NIH Institutes and Centers that are supporting 

research in this area, to help ensure that broader NIH efforts integrate 

a global perspective and provide a pathway for lessons learned 

abroad to be applied to public health challenges in the U.S.

s
26 FOGARTY STRATEGIC PLAN

Nigeria — High fatality rates and 

ineffectiveness of treatment of 

African women with breast cancer, 

compared with Caucasian women 

in the United States, was linked to 

three genes.

In addition to several other factors such as access to care, genes play a 

key role in the poor prognosis of breast cancer and the lower success 

rates of treatment of the disease in African American women. Knowledge 

of genetic markers can facilitate personalization of treatment. 

Breast 

Cancer

Worldwide Discoveries Anywhere Can Help People Everywhere

DISEASE DISCOVERY IMPLICATIONS FOR GLOBAL HEALTH & THE AMERICAN PUBLIC

Taiwan — A 20-year study followed 

children vaccinated against Hepatitis 

B and found reduced rates of liver 

cancer. 

Hepatitis B is a direct cause of cancer and vaccination in infancy can 

prevent liver cancer later in life.

Hepatitis B

South Africa—Scientists studied the 

optimal time to begin antiretroviral 

drug therapy (ART) for those infected 

with tuberculosis (TB). They found 

that ART drugs are safe and effective 

when given during TB treatment.

This discovery addressed widespread concerns about HIV and TB drug 

interactions. The World Health Organization and the government of 

South Africa changed their treatment guidelines to initiate ART in TB/HIV 

patients.

Tuberculosis

Uganda — Use of one of three 

chemotherapy drugs—CTX, MTX, 

or VCR—cured or achieved partial 

response in infected patients. 

Building on this initial use of chemotherapy to treat patients with 

Burkitt lymphoma, simpler chemotherapy regimens have been 

implemented in sub-Saharan Africa. Scientists have gone on to conduct 

studies that led to today’s combination chemotherapy regimes with a 

better understanding of dose-response relationships.

Burkitt

lymphoma 

Uganda — Two randomized trials 

demonstrated that male circumcision 

reduced the risk of male HIV 

infection by about 60%.

Haiti — Cellphones were distributed 

to HIV-positive patients in rural Haiti 

with no access to land line phones, 

in order to communicate with them 

regarding treatment and adherence.

Circumcision is recommended worldwide as an HIV prevention strategy 

and programs to circumcise both adult men and infants are now ongoing.

HIV

Mobile technologies proved effective in promoting increased treatment 

and adherence to therapy. This program has been replicated in rural 

Virginia.

Worldwide — Annual information is 

collected on flu incidence, flu strains 

and predisposing conditions to 

prepare new vaccines for global and 

domestic use. 

Next generation flu vaccines given in the United States and around the 

world are produced in response to the international flu data collected. 

Influenza
 Strategic Priority

 Catalyze interaction between researchers, policymakers and 

 program implementers to promote uptake of evidence into 

 global health policy and practice

s

Support of implementation research alone will have limited 

impact unless it is accompanied by efforts that facilitate utilization 

of scientific evidence by health program implementers and 

policymakers. Knowledge translation and optimal uptake of 

evidence-based interventions requires deliberate and strategic 

efforts to facilitate collaboration, communication, and relationshipbuilding between the scientific community and implementers 

and decision-makers. Therefore, building on its investments 

in implementation science research and training, Fogarty will 

explore new strategies to catalyze effective interactions between 

researchers and program implementers and policymakers in 

an effort to maximize public health outcomes and the return on 

research investments. Enhanced communication and collaboration 

between these communities can help to facilitate better translation 

of evidence into health policies and programs, while simultaneously 

helping to ensure that research is country-driven and responsive to 

the local context.

FOGARTY STRATEGIC PLAN 27
28 FOGARTY STRATEGIC PLAN
FOGARTY STRATEGIC PLAN 29

GOAL 4

Advance research on prevention and control of the 

dual burden of communicable and non-communicable 

diseases and disabilities

Dr. Margaret Chan, Director General of the World Health 

Organization, noted that the global epidemic of chronic, 

non-communicable diseases (NCDs) is a “slow-motion 

catastrophe.” Although most NCDs develop gradually, 

the risk factors that underlie NCDs are spreading rapidly 

in all world regions. According to the Global Burden 

of Disease Study 2010, 34.5 million or 65.5 percent of 

total deaths at all ages were due to chronic diseases. 

Nearly 80 percent of chronic disease deaths now occur in 

LMICs, with close to one-third of these deaths affecting 

people under the age of 60. As we face a dual epidemic 

of NCDs and infectious diseases in many LMIC regions, 

NCD prevention research and collaboration between the 

infectious disease and NCD scientific communities will 

be critical to reversing these trends and improving health.

Gapminder Life Expectancy Chart

Source: Gapminder Foundation, 2006
Training the Next Generation of Scientists 

in Chronic, Non-communicable Diseases

During a Fogarty International 

Clinical Research Fellowship 

in Kenya in 2009-2010, Dr. 

Gerald Bloomfield observed 

an epidemic of diabetes, 

heart failure and high blood 

pressure. He responded by 

creating a series of lectures 

that enhanced the capacity 

of local medical students, residents and technicians. As 

an Assistant Professor in the Department of Medicine 

(Cardiology) and the Duke Global Health Institute, Dr. 

Bloomfield currently researches the epidemiology of heart 

failure and cardiovascular risk factors in sub-Saharan Africa. 

A K01 award from Fogarty now supports Dr. Bloomfield’s 

research in cardiology and pulmonology. He also works 

closely with the National Heart, Lung and Blood Institute’s 

Cardiovascular and Pulmonary Disease Center of Excellence 

at Moi University where he spends six months a year 

studying heart failure epidemiology, the cardiovascular 

effects of indoor air pollution and cardiovascular risk 

factors among HIV-positive patients. By demonstrating 

the true burden of chronic, non-communicable disease 

through epidemiology, Dr. Bloomfield hopes to use research 

evidence to influence policy change in LMICs. 

 Strategic Priority

 Support research and research training 

 in clinical, behavioral and population sciences

Fogarty is uniquely poised to catalyze 

prevention research and support research 

training to understand the determinants, risk 

factors, disease prevention strategies, and 

potential interventions for a wide range of 

NCDs. Common risk factors have resulted in 

an escalating burden of metabolic disorders, 

with epidemics of under- and over-nutrition, 

diabetes, and obesity. The ecosystem in which 

risk factors—such as aging, rapid urbanization, 

lifestyle changes, early life exposures, nutrition, 

genetic predispositions, and access to care— 

interact is complex. How this contributes to 

these epidemics is critical to the development 

of interventions that can prevent NCDs from 

escalating, and provide therapies for treatment. 

Fogarty will stimulate research and support 

training in this space, encouraging new 

approaches to problem-solving and research 

that addresses multiple disease burdens 

simultaneously.

Confronting the global NCD crisis will require 

a highly skilled and nimble research workforce 

that is poised to examine a wide range of risk 

factors and their interactions. The development 

of effective and locally appropriate interventions 

will require that these scientists be trained to 

think and work across multiple disciplines and 

across diverse international settings in response 

to local needs and research priorities. Given 

the burden of NCDs in the U.S. and other highincome countries as well as LMICs, this research 

is ripe for knowledge exchange, collaboration 

and team science. Fogarty is well-positioned to 

invigorate this workforce both in the U.S. and 

s

30 FOGARTY STRATEGIC PLAN
Krista Pfaendler, M.D.

Fogarty Scholar, Zambia

2006-2007

RESEARCH FOCUS:

Cervical cancer screening in Zambia

Post-training employment:

Resident in obstetrics and gynecology

The program cemented 

her decision to apply for 

obstetrics and gynecology 

residency, sparked interest 

in gynecologic oncology, and 

created relationships that 

allow continued research 

and collaboration during her 

residency.

abroad, and in doing so, engage other partners to 

support training of the next generation of scientific 

leaders in global NCDs.

 Strategic Priority

 Identify ways to leverage investments in communicable 

 diseases, including HIV, to better address the dual 

 burden of disease

Fogarty’s long-standing investments in research and 

training on HIV/AIDS and other communicable diseases 

provide a platform to address other global challenges. 

Fogarty will support an approach that leverages the 

human capital and research platforms built to address 

HIV/AIDS and other infectious diseases to now tackle the 

rising burden of NCDs and address the interrelationships 

between infectious diseases and NCDs. For example, as 

access to antiretroviral therapy has increased significantly 

and HIV-infected individuals are living longer, a new 

research agenda has emerged around HIV and NCD 

co-morbidities. This includes epidemiological studies 

regarding the incidence and prevalence of co-morbidities, 

the potential effects of antiretroviral therapy (ART) 

on pathogenesis, cost-effective ways to integrate HIV 

and NCD services that improve health outcomes, and 

prevention of NCDs in the HIV-positive population. 

Other examples of relevant research areas include chronic 

infectious diseases with NCD sequelae, infectious origins 

of NCDs, disease management strategies that impact 

multiple conditions, and the development of mobile 

and other technologies that integrate health data across 

conditions to improve patient care.

Over the next several years, Fogarty will support efforts 

to build on existing cohorts, data collection and analytic 

capabilities, laboratory capacity and human research capacity to move the prevention science agenda forward 

and respond to evolving public health challenges.

s

FOGARTY STRATEGIC PLAN 31
32 FOGARTY STRATEGIC PLAN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1990

1 Lower respiratory infections

2 Diarrheal diseases

3 Preterm birth complications

4 Ischemic heart disease

5 Stroke

6 Chronic obstructive 

7 Malaria

8 Tuberculosis

9 Protein-energy malnutrition

10 Neonatal encephalopathy

11 Lower back pain

12 Road injury

13 Congenital anomalies

14 Iron-deficiency anemia

15 Major depressive disorder

16 Measles

17 Neonatal sepsis 

18 Meningitis

19 Self-harm

20 Drowning

1 Ischemic heart disease

2 Lower respiratory infections

3 Stroke

4 Diarrheal diseases

5 HIV/AIDS

6 Lower back pain

7 Malaria

8 Preterm birth complications

9 Chronic obstructive 

10 Road injury

11 Major depressive disorder

12 Neonatal encephalopathy

13 Tuberculosis

14 Diabetes

15 Iron-deficiency anemia

16 Neonatal sepsis 

17 Congenital anomalies

18 Self-harm

19 Falls

20 Protein-energy malnutrition

2010

Communicable, maternal, neonatal, and nutritional disorders

Non-communicable diseases Injuries

Global Burden of Disease Study 2010:

Change in disability-adjusted life years, by cause, rank

pulmonary disease

pulmonary disease
AIDS International Training & Research Program (AITRP)

Contributing to an AIDS-Free Generation

 

 

Salim Abdool Karim

Director CAPRISA, South 

Africa & President of the 

South African Medical 

Research Council

AITRP PI

1997-2004

Dr. Abdool Karim has played a major role in 

Columbia University’s 20-year AITRP program, 

which has trained and mentored numerous 

South African researchers. The program is 

linked to significant scientific advances, 

including effective management strategies for 

patients co-infected with HIV and TB and the 

use of microbicides as a tool for preventing 

HIV infection in women.

Zunyou Wu

Director, National Center for 

AIDS/STD Control & Prevention, 

Chinese CDC, China

AITRP Trainee 2000

ICOHRTA AIDS/TB PI 

2002-Present

Dr. Wu conducted a series of projects that led 

to the development of national guidelines 

for HIV prevention among sex workers and 

the national condom promotion program. He 

also developed the methadone maintenance 

program for injecting drug users, which has 

now expanded to most provinces in China. 

Ruth Nduati

Faculty of Medicine, College 

of Health Sciences, University 

of Nairobi

AITRP Trainee

1991-1994

Dr. Ruth Nduati is internationally recognized 

for her research involving mother-to-child HIV 

transmission. She received her master’s through 

AITRP, writing her thesis on the correlates of HIV-1

in breastmilk. Dr. Nduati provides technical 

expertise to the Kenyan Ministry of Health and 

WHO, and is currently working on increasing the 

retention rate of faculty at the University of Nairobi 

in collaboration with the MEPI program.

Treatment as Prevention

A multi-country study demonstrated that patients who took antiretroviral drugs soon after diagnosis were 96 percent less likely to infect 

their HIV-negative heterosexual partner than if they waited until the virus climbed to a specific concentration in their blood. As a result, 

the WHO updated its guidelines on when to begin antiretroviral therapy. The finding was named Breakthrough of the Year by Science

magazine in 2012.

Circumcision

A study in Uganda’s Rakai district confirmed that male circumcision reduces HIV incidence. This discovery prompted the WHO to 

recommend circumcision as a way to help curb HIV infection in high-risk populations.

Tuberculosis Co-infection

A house-to-house study in rural Kenya used cough monitors to determine the prevalence of HIV and TB coexistence and the severity of 

multidrug resistance in rural Kenya. The technique has now been replicated in other countries. 

Discordant Couples

A large survey in Uganda revealed that HIV prevalence had leveled off, so researchers investigated the predominant way HIV was being 

transmitted. They found that transmission was no longer via casual relationships but rather occurred in established relationships. Their 

findings led to changes in prevention strategies in Uganda and other countries.

Antiretroviral Adherence

With the advent of antiretroviral drugs, some questioned whether patients in low-resource, low-education settings could follow the 

regimen of multiple drugs to be taken at precise times each day. AITRP trainees in Port-au-Prince, Haiti, helped conduct a study showing 

that patients in such settings were able to adhere to the drug regimen as effectively as patients in New York City.

Scientific advances that include contributions from former AITRP trainees

FOGARTY STRATEGIC PLAN 33
 

Improving Understanding of Environmental 

and Occupational Health Hazards Worldwide

In low- and middle-income countries 

(LMICs), exposures to environmental 

and occupational hazards such as 

contaminated air, water, soil, and food 

contribute to nearly a quarter of all 

deaths and illnesses. In order to build 

LMIC capacity to study the links between 

environmental and occupational risk 

factors and disease, Fogarty’s International 

Training and Research In Environmental 

and Occupational Health (ITREOH) program 

funded 22 U.S. institutions and over 75 

LMIC institutions to train LMIC scientists, 

clinicians, epidemiologists, toxicologists, 

engineers, industrial hygienists, chemists, 

and allied health workers in 40 countries 

in both general environmental health 

and occupational health. This program 

produced 460 publications, approximately 

300 of which are in PubMed.

Among other important exposures, 

ITREOH projects contributed to scientific 

understanding of the link between 

cognitive function and toxin (arsenic and 

manganese) exposures in childhood. 

In Mexico, researchers found that arsenic 

exposure and chronic malnutrition 

combined to negatively affect verbal ability 

and long-term memory. In both Brazil 

and Bangladesh manganese exposure 

was linked to negative outcome−in Brazil 

to lower verbal and IQ abilities, and in 

Bangladesh to problematic classroom 

behavior. These findings are important for 

future efforts to protect children’s health.

Building on these investments, the ITREOH 

program has evolved into the Global 

Environmental and Occupational Health 

(GEOHealth) Hub Program, launched in 

partnership with the National Institute of 

Environmental Health Sciences (NIEHS) 

and the CDC’s National Institute for 

Occupational Safety and Health (NIOSH). 

GEOHealth will support a network of 

collaborative research training hubs 

in LMICs that will, in close partnership 

with U.S. academic institutions, focus on 

collaborative research, data management, 

training, curriculum development and 

policy support regarding high-priority

environmental and occupational 

health research in their regions. 

The hubs will build a critical mass 

of well-trained scientists in LMICs 

with support and recognition from 

national governments, and provide 

world-class platforms for collaborative 

population-based environmental 

health research of global relevance. 

Using the core sciences of environmental monitoring, exposure science, 

epidemiology, genetics, biostatistics, 

information and communications 

technology, and data management, 

the GEOHealth hubs will become 

21st century knowledge synthesis 

networks in the developing world.

34 FOGARTY STRATEGIC PLAN
 

GOAL 5

Build and strengthen partnerships to advance 

global health research and research capacity

Fogarty investments in global health research and capacity building 

have always been based upon creative and sustainable partnerships. 

Long-term collaborations between scientists in LMICs and the U.S. 

have formed the backbone of Fogarty’s programmatic investments. 

Beyond research institutions, the world of global health now includes 

a wide range of stakeholders, presenting exciting new opportunities 

for innovative partnerships. NIH Institutes and Centers, other U.S. 

government agencies, other nations, foundations, and industry all 

bring unique assets to our common endeavor of improving health 

around the world. Partnerships both within and outside the NIH can 

marshal respective strengths and resources to increase returns on 

investment and achieve greater global public health gains. 

Strategic partnerships will continue to be at the core of how Fogarty

fulfills its mission. The Center will work closely with its partners 

to promote greater scientific collaboration, build bridges between 

scientists, institutions and countries, and capitalize on the rising tide 

of interest in advancing global health.

FOGARTY STRATEGIC PLAN 35
 
FOGARTY STRATEGIC PLAN 37

 Strategic Priority

 Engage and support the NIH Institutes and Centers 

 to advance their research agendas for global health

Since its establishment, Fogarty has served as a focal point for 

global health at the NIH by informing, initiating, and managing 

global health activities in collaboration with other NIH Institutes 

and Centers. The last several years have seen greater engagement 

in global health research and capacity building across the NIH. 

This trend presents exciting opportunities to catalyze new activities 

that address emerging global health priorities and to forge new 

scientific relationships and agreements with other countries. 

Fogarty research training programs also provide platforms for other 

Institutes and Centers to invest in the next generation of U.S. and 

foreign researchers in targeted areas of research interest. Fogarty 

will also work with NIH partners to design research and research 

training programs that cut across multiple NIH Institute and Center 

Brain Disorders in the Developing World: Research Across the Lifespan (BRAIN) 

Despite the significant burden of 

disease they represent, nervous system 

disorders and conditions have been 

largely absent from the global health 

agenda. In LMICs, these disorders are 

predicted to have an increasing impact, 

so research on the etiology, prevention 

and treatment of individual conditions 

and disorders is needed, along with 

implementation research on how to 

Dr. Gretchen Birbeck has conducted critical research on epilepsy 

in Africa, where it is the most common chronic neurologic 

disorder. However the stigma associated with epilepsy prevents 

many from seeking affordable care. As a Fellow, Dr. Birbeck 

conducted quantitative and qualitative studies in Zambia, aimed 

at understanding all facets of the epilepsy burden and developing 

interventions that can reduce the stigma as well as the morbidity 

and mortality from epilepsy. She currently leads an R01 grant 

that builds on her previous research to develop, implement, 

and evaluate interventions that will reduce seizure-related 

morbidity and mortality while addressing epilepsy stigma and 

promoting the socioeconomic status of those living with epilepsy. 

As an associate professor at Michigan State University (MSU), 

the Director of MSU’s International Neurologic & Psychiatric 

Epidemiology Program, honorary lecturer at both the University 

of Zambia and the University of KwaZulu Natal, and the Director 

of Chikankata Health Services in Zambia, Dr. Birbeck is pioneering 

efforts to increase understanding of and local capacity to address 

epilepsy in resource-poor environments.

best deliver affordable and effective care for conditions such 

as epilepsy. Fogarty’s BRAIN program supports cutting-edge 

research in LMICs on nervous system development, function, 

and impairment throughout life−research that could lead to 

new diagnostics, prevention, and treatment strategies. 

Reducing the Stigma of Epilepsy

Former Fogarty Fellow and current Fogarty and National 

Institute of Neurological Disorders and Stroke (NINDS) grantee 

s
mandates. Strong inter-Institute and Center collaboration 

strengthens the impact of Fogarty investments and harnesses 

the unique scientific expertise that resides in other parts of the 

NIH. Fogarty’s deep regional expertise will continue to serve as 

a unique resource for NIH, and for individual foreign scientists, 

institutions, and countries seeking effective mechanisms to 

enable collaboration.Through these relationships, Fogarty is able 

to advance global health research and research training goals 

shared by NIH partners.

 Strategic Priority

 Forge partnerships at home and abroad 

 to leverage complementary interests and strengths

Today’s diverse landscape of public and private entities engaged 

in global health presents exciting opportunities to strengthen and 

build new partnerships that further the global health research 

agenda. Fogarty will continue to work closely with existing and 

new partners to address mutual interests and harness respective 

38 FOGARTY STRATEGIC PLAN

The Interactions of Malnutrition & Enteric Infections: 

Consequences for Child Health and Development (MAL-ED)

In LMICs, an estimated one in every five children is malnourished. Poor nutrition is linked to 

over half of child deaths around the globe, with malnutrition increasingly shown to be a critical 

cause of cognitive and physical defects, low birth weight, and death. Alongside the morbidity 

and mortality linked to poor nutrition and malnourishment, children in LMICs are exposed to an 

enormous burden of enteric infectious diseases that contribute to malnourishment, decrease gut 

integrity, and weaken immune systems.

With support from the Bill and Melinda Gates Foundation and in partnership with the Foundation 

for NIH, Fogarty manages the Global Network for the Study of Malnutrition and Enteric Disease 

(MAL–ED) program–a five–year, multisite project that investigates the linkages between malnutrition and intestinal 

infections, and their effects on children in LMICs. From MAL–ED sites in Brazil, Peru, South Africa, Tanzania, India, 

Pakistan, Bangladesh and Nepal, MAL–ED investigators evaluate the etiology, risk factors, and interactions of enteric 

infections and malnutrition for child health, with the goal of identifying better and more cost-effective interventions 

that will reduce preventable child death and illness worldwide. Genome-wide studies are also being conducted to 

identify candidate human genes associated with under-nutrition and growth impairment. 

s
strengths in support of critical global health research and research 

training priorities. 

Several other U.S. government agencies have expanded their 

engagement in global health in recent years, and Fogarty is poised 

to capitalize on those investments to confront evolving global 

health challenges. Partnerships with other U.S. government 

agencies have resulted in ground-breaking models for capacity

building and have supported high-impact global health research. 

The Office of the Global AIDS Coordinator (OGAC) remains a key 

Fogarty partner. The network of research institutions supported 

by the Medical Education Partnership Initiative—a landmark 

partnership between OGAC, the Health Resources and Services 

Administration and NIH—will continue to be an innovative 

platform for strengthening clinical research capacity in subSaharan Africa.

With the U.S. Department of State, Fogarty supports research at 

Karakoram International University in Pakistan focused on water, 

sanitation, health and hygiene interventions in northern Pakistan, 

which is intended to inform policy and program decision making 

about long-term disease-control investments. The U.S. Department 

of Agriculture and the Department of Homeland Security 

also remain strong collaborators, and Fogarty will continue to 
TRANSFORMING MEDICAL EDUCATION IN AFRICA: 

THE MEDICAL EDUCATION PARTNERSHIP INITIATIVE (MEPI) 

MEPI is an innovative cross-U.S. government initiative funded 

primarily by the Office of the Global AIDS Coordinator (OGAC), 

and jointly administered by the Health Resources and Services 

Administration (HRSA) and Fogarty, in collaboration with 18 NIH 

Institutes and Centers and other USG entities. 

MEPI is transforming medical education and research training for 

medical students in 12 African countries through direct support 

to African institutions to develop or expand and enhance models 

of medical education. The 13 universities in the MEPI network 

and over 40 partners are recruiting and retaining well-qualified 

faculty, employing state-of-the-art teaching tools, developing 

regional training centers and upgrading technology to enable 

distance learning and resource sharing among institutions. 

To complement these programmatic awards, NIH Institutes are 

funding linked awards that support critical research training 

needs. In Uganda, for example, the National Heart, Lung and 

Blood Institute is supporting a program at Makerere University 

College of Health Sciences and Mbarara University of Science 

and Technology to train medical students in cardiovascular 

disease (CVD) risk assessment and primary care. The program 

offers master’s degree programs for residents and short-term 

fellowships and Ph.D. training for young faculty interested 

in developing clinical and research careers in CVD. In Kenya, 

a MEPI linked award is supporting the establishment of a 

Collaborative Center of Excellence in Maternal, Newborn, & 

Child Health at the University of Nairobi. This center will build 

multidisciplinary implementation science research capacity 

that will enhance the ability to link research to practice in the 

critical areas of maternal, newborn and child health. 

MEPI is increasing the quality, quantity, and retention of 

medical faculty and physicians with research skills, and 

building the relationships with the public sector partners 

that promote sustainable research capacity. MEPI-supported 

universities in sub-Saharan Africa are emerging as regional 

training centers where partner institutions across the continent 

pool areas of expertise, share teaching tools, and ensure that 

all students receive the highest-quality instruction from the 

best qualified faculty and researchers. By encouraging local 

ownership and allowing each country to adapt the program to 

suit its unique resources and health needs, MEPI is making a 

sustainable difference.

“MEPI is fostering indigenous capacity to strengthen health systems in a sustainable 

manner . . . If we are to make a truly lasting difference in our health and development 

programs, we must support this kind of work.” 

 — Ambassador Eric Goosby, Former U.S. Global AIDS Coordinator

40 FOGARTY STRATEGIC PLAN
FOGARTY STRATEGIC PLAN 41

MEPI funding has helped Africa’s medical schools move 

from hard copies of textbooks, which are expensive and 

quickly out-of-date, to tablets that provide access to the 

latest information.

BEFORE AFTER
42 FOGARTY STRATEGIC PLAN

work with the U.S. Agency for International 

Development and the Centers for Disease Control 

and Prevention to identify common areas of 

interest and ways in which to leverage respective 

and unique strengths to address common global 

health goals. 

Many emerging economies especially Brazil, 

Russia, India, China and South Africa (BRICS), 

see the value of investing in research. Their major research 

institutions are now attracting scientists from around the world. 

These investments have contributed to global health training, 

building research infrastructure, ensuring access to treatment, 

and developing new interventions. This increased 

commitment and capacity presents opportunities to 

develop new models of research partnerships that 

advance scientific discoveries–models in which countries 

are investing their own resources, working together, and 

sharing expertise to stimulate innovation. 

Fogarty has played a significant role in facilitating new 

agreements between NIH Institutes and the Indian 

government related to diabetes, neuroscience and the 

development of low-cost technologies. In each case, 

the respective partners are sharing knowledge and 

leveraging resources to achieve common goals.
FOGARTY STRATEGIC PLAN 43

Other governments, foundations, 

the World Bank, scientific 

professional societies and industry 

all bring unique expertise and 

resources to the global health 

agenda. Fogarty will continue 

to explore opportunities for new 

partnerships that can increase the 

impact of respective investments, 

incentivize innovation, support 

training, and provide research 

infrastructure for tomorrow’s

global health research workforce.

Partnerships with 

Emerging Economies

Over the last few years, the emerging 

economies of Brazil, Russia, India China 

and South Africa (BRICS) have built highly 

capable biomedical enterprises. NIH 

and the BRICS countries have begun to 

establish new and innovative partnerships, 

funding individual teams of experts who 

work together and share expertise to speed discovery. The NIH is partnering with Brazil’s 

Council for Technological Development (CNPq) to train 75,000 Brazilians in science and 

technology over the next four years. CNPq will fund half of the stipends for all intramural 

postdocs, with about 80 postdocs coming to the NIH campus for research training and 

collaboration. In India, Fogarty is facilitating nine partnerships between Indian institutions 

and organizations and different NIH ICs, in specific areas of mutual interest, such as 

development of low-cost medical technologies. And in China, under the new U.S.-China 

Program for Biomedical Research Cooperation, each country will support its own scientific 

teams to conduct over 30 joint research projects, such as comparative population studies, 

to help us better understand how to prevent disease and investigations of traditional 

medicines that target cancer. 
 Strategic Priority 

 Convene global experts to address priority research 

 questions and catalyze new areas of science

Fogarty is always looking ahead to emerging challenges and new 

research opportunities, and will continue to bring the best scientific 

minds from the NIH and around the world together to identify 

significant trends, evidence gaps, and research priorities in key areas. 

In this role, Fogarty draws attention to emerging research agendas and 

unmet needs, stimulating new scientific activity. Through bringing 

diverse stakeholders together—including scientists, other U.S. and 

foreign government agencies, non-governmental organizations, and 

the private sector—Fogarty provides a platform for international 

scientific dialogue and fosters an environment that encourages 

new partnerships and collaboration. By including the perspectives 

of scientists and other relevant stakeholders from LMICs, Fogarty 

provides a unique forum for NIH and LMIC scientific leaders to 

inform each other’s activities and to collaboratively chart out scientific 

directions regarding global health issues, ranging from global tobacco 

control, to the health impacts of urbanization, to the prevention of 

childhood obesity in the U.S. and abroad.

44 FOGARTY STRATEGIC PLAN

s
Center for Global Health Studies

A New Tool for Innovation and Scholarship in Global Health Science and Policy

In 2012, Fogarty 

launched the Center for 

Global Health Studies 

(CGHS) as a physical 

and virtual space to 

support innovation 

and multidisciplinary 

scholarship and training 

to address pressing 

global health problems.

CGHS PROJECTS: 

• Cut across the missions of multiple NIH Institutes 

 and Centers and involve at least one NIH IC partner 

• Engage collaborators from different sectors with 

 unique expertise and resources 

• Foster multidisciplinary and/or multi-sector 

 approaches

• Produce concrete, implementable deliverables and 

 recommendations for action

• Engage LMIC scientists, program implementers and/ 

 or policymakers

AREAS OF FOCUS:

Implementation science: 

Developing the new approaches and skills needed to 

better translate scientific 

evidence into health policy 

and practice

For example, the 

prevention of mother-tochild transmission (PMTCT) 

of HIV is one of the most 

cost-effective methods to 

prevent new cases of HIV. 

From 2013–2015, CGHS 

will bring together a network of PMTCT researchers and 

implementers to enable research to be better informed 

by the implementer community and encourage policies 

and programs based on robust scientific evidence. 

Scientific roadmaps

Development of research agendas that tackle specific 

global health problems.

For example, HIV is 

no longer a death 

sentence and as more 

people live longer, 

the disease treatment 

can lead to other 

substantial problems. 

In 2013, CGHS brought together small groups of U.S. 

and LMIC scientific experts to identify key research and 

capacity building priorities to confront the growing 

burden of HIV and NCD co-morbidities in LMICs. A 

resulting publication in 2014 is intended to stimulate 

new research and scientific collaborations, and creative 

partnerships among a broad range of sectors and 

stakeholders. 

Scientific exchange and training

Opportunities for U.S. and foreign investigators, 

including mentored research projects, workshops, or 

short-term training institutes 

For example, household 

air pollution (HAP) 

affects more than 3 

billion people in the 

world and is estimated 

to cause greater than 

2 million deaths. In 

2012, CGHS held a 3-day training course for scientists 

from the U.S. and low- and middle-income countries 

interested in developing research projects on the 

health effects of HAP from traditional versus improved 

cookstoves. The training institute helped prepare a new 

cadre of researchers to better define and understand the 

health risks associated with HAP, the epidemiological 

principles that inform robust and appropriate research 

study designs, the critical role of the social, behavioral 

and cultural factors influencing stove adoption and the 

evolving technologies for improved cookstoves, new 

fuels, exposure monitoring, and biomarker development.
46 FOGARTY STRATEGIC PLAN
CONCLUSION

The world is becoming smaller as it becomes more interconnected, 

and national boundaries are now much less relevant to the conduct 

of scientific research. This makes Fogarty’s mission of catalyzing 

and supporting research and research training partnerships across 

countries, regions and continents all the more critical. Fogarty 

investments have made significant contributions to global health, 

harnessing the capabilities of the United States and the NIH as 

leaders of biomedical research, helping to extend the frontiers of 

science and accelerate discovery. Above all, Fogarty has invested and 

will continue to invest in people—the most important resource in 

global health research, serving on the front lines in our fight against 

disease and disability that affect populations in the U.S. and across 

the globe. 

FOGARTY STRATEGIC PLAN 47
Photo Credits

Cover: (clockwise from top left) photo by Rhoda Baer courtesy of NCI, 

photo by David Rochkind, photo courtesy of Dr. Marc Mitchell, 

image courtesy of NIAID.

Inside cover: photo courtesy of the Fogarty family.

Page 1: photo by David Snyder.

Page 2: photo courtesy of USAID.

Page 5: photo courtesy of Dr. James Kiarie/University of Nairobi.

Page 6: photo courtesy of USAID.

Page 7: photo by David Rochkind.

Page 8: (top and bottom left) photos by David Snyder, (right) 

photo courtesy of PATH.

Page 9: photos by David Rochkind.

Page 10: (from top) photo by David Snyder, 

photo courtesy of Dr. Amy Sims.

Page 11: photo by Be inda O’Donnell.

Page 12: photo by James Pursey/USAID.

Page 13: (top left) photo by Hugues Robert Marsan, 

(top right and bottom right) photos by David Snyder.

Page 14: photo by Hugues Robert Marsan.

Page 15: photo by David Snyder.

Page 16: photo by David Snyder.

Page 17: (top) photo by David Snyder, (bottom) 

photo by James Gathany/CDC.

Page 18: photo courtesy of DataDyne.org.

Page 19: (clockwise from top) photo courtesy of Dr. Mark Siedner, 

photo by Dominic Sansoni/World Bank, photo by Gautam Pandey/

Photoshare.

Page 20: (from top) photo by Richard Lord, photo by David Snyder.

Page 21: (from left) photo by Douglas Levere/State University of New 

York at Buffalo, photo by Linda A. Cicero/Stanford News Service.

Page 22: (from top) photos by Joel Sadler/Jaipur Foot Organization, 

photo courtesy of Dr. Marc Mitchell, photo courtesy of Dr. Oluwatoyin 

Fafowora.

Page 23: (from top) photo by Dr. James Smith, photo courtesy 

of Dr. Manisha Nair.

Page 24: photo by Richard Lord.

Page 25: (left) photos by David Snyder, (right) 

photo courtesy of Dr. Pawan Sinha/Project Prakash.

Page 26: (from left) photo by Dr. D.P. Singh/Photoshare, image courtesy 

of NIAID, photo by P. Virot/WHO.

Page 27: (from top) image courtesy of NIAID, 

photos by David Snyder.

Page 28: photo by David Snyder.

Page 29: photo by Dr. Sarah Tishkoff/University of Pennsylvania.

Page 30: (from top) photo courtesy of Dr. Gerald Bloomfield, 

photo by David Snyder.

Page 31: photo courtesy of Dr. Krista Pfaendler.

Page 32: (from top) photo by Ray Witlin/World Bank, 

image courtesy of NIAID, photo by Sebastian Szyd/World Bank.

Page 33: (from left) photos courtesy of Drs. Karim, Wu and Nduati.

Page 34: (from top) photo by David Snyder, 

photo by Rose Reis/Photoshare.

Page 35: (from top) photo by Alan Gignoux/World Bank, 

photo by Richard Lord.

Page 36: photo by K.M. Asad/Photoshare.

Page 37: photo courtesy of NIAID, image by Dr. Van Wedeen/Harvard University.

Page 38: (from top) photo by Curt Carnemark/World Bank, 

photo by Shehzad Noorani/World Bank.

Page 39: (clockwise from top) photo courtesy of Dr. Joseph Vinetz, photo courtesy 

of Dr. Joe Tucker, image courtesy of WHO, photo by Curt Carnemark/World Bank.

Page 40: photo courtesy of U.S. Department of State.

Page 41: (from left) photos courtesy of MEPI Ethiopia, 

photo by Richard Lord.

Page 42: (clockwise from top) photo courtesy of CDC, 

photo by Jeff Gray, photo by Leesha Manju/Photoshare.

Page 43: (from top) photo by David Snyder, 

photo courtesy of NovoNordisk R&D Center China.

Page 44: (top left) photos by David Snyder, 

(bottom from left) photo courtesy of USAID, photo by David Rochkind.

Page 45: (clockwise from top) photos by Fogarty staff.

Page 46: photo courtesy of Aga Khan University.

Page 47: (from top) photo by Richard Lord, photo by David Rochkind.

Page 48: (clockwise) photo courtesy of Dr. Shweta Bansal, 

photo courtesy of Dr. Krista Pfaendler, photo by Richard Lord. 

Back cover: photo by Scott Wallace/World Bank.

48 FOGARTY STRATEGIC PLAN
The John E. Fogarty

International Center

31 Center Drive

MSC 2220

Bethesda, Maryland 20892

301-496-2075

www.fic.nih.gov

NIH Publication No. 14-8016

March 2014