Fogarty at

5

Advancing science for global health since 1968

FOGARTY INTERNATIONAL CENTER

NATIONAL INSTITUTES OF HEALTH 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Fogarty at

5

Advancing science for global health since 1968
4 Fogarty at 50
“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

”

www.fic.nih.gov 5
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.

6 Fogarty at 50
TABLE OF CONTENTS

Message from the Director........................................................................9

How do Americans benefit from global health research?......................10

Fogarty at 50: an introduction.................................................................12

Congressman John Edward Fogarty........................................................17

Fogarty International Center: a brief history.........................................18

Sparking a scientific revolution to address the HIV/AIDS crisis...........22

Promoting bioethics to protect lives in service to research..................30

Advancing research through technology...............................................36

Constructing a multidisciplinary framework for research.....................40

Cultivating the next generation of global health leaders.....................44

Exploring natural products to discover new treatments and cures......48

Making implementation science a priority..............................................50

Training to meet the needs of the shifting disease burden...................53

Including brain disorders in the global health research agenda..........56

Protecting the environment and ensuring worker safety.......................62

Reducing death and disability from trauma and injury..........................64

Lowering tobacco consumption through research................................66

Transforming African medical education................................................69

Modeling disease trends and predicting spread of outbreaks.............73

Promoting science diplomacy for global health.....................................77

Studying global health science and policy.............................................79

Expanding Fogarty’s reach with NIH co-funding....................................81

Photo credits.............................................................................................82

Acknowledgements.................................................................................83

www.fic.nih.gov 7

MESSAGE FROM THE DIRECTOR

Dear Colleagues and Friends,

As we mark our 50th year, it is appropriate that we 

both celebrate our many accomplishments and 

consider how best to tackle the new global health 

challenges of the 21st century.

The Fogarty International Center at NIH has had a rich 

and varied legacy since its establishment in 1968. 

In our first decade, our infancy, Fogarty served as a 

conference center for global health policy discussions 

and a convener of outstanding scientists from 

around the world to build collaborations with U.S. 

investigators. In the 1980s, as the extent of the global 

HIV/AIDS epidemic became clear, we began our first institutional extramural 

grant program, the AIDS International Training and Research Program or 

AITRP. Fogarty developed a model of partnering U.S. and foreign institutions 

in low- and middle-income countries to train the next generation of young 

investigators, to build a research base in areas where this was lacking, with 

the infrastructure required to conduct ethical, groundbreaking research. This 

approach has become the hallmark of Fogarty programs—taking science 

where the problems are and building local research capacity to solve them. 

The scientists who were first trained through our programs have become 

world leaders on the front lines in the battle to staunch the global epidemic of 

HIV/AIDS through innovative research, in collaboration with U.S. investigators, 

and with additional support from many others at NIH and beyond. The return 

on investment in people, partnerships and policies has truly changed the 

world. 

More recently, this model has been extended beyond infectious diseases 

to chronic, noncommunicable diseases and disciplines critical to advancing 

the global health agenda from every specialty of the medical and health 

sciences—including areas not traditionally considered part of global health—

such as economics, law, business, architecture, engineering and others. 

Fogarty remains the smallest center at NIH with what is perhaps the broadest 

goal—investing to build the next generation of leaders in biomedical research 

and supporting training to make them productive collaborators who can 

contribute to discoveries that improve health globally, as well as in the U.S. 

For the last 50 years, Fogarty’s focus has been on cultivating partnerships that 

advance science for global health. On behalf of all of our staff and our alumni, 

we thank you for your continued support. 

Warm regards, 

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

Director, Fogarty International Center 

Associate Director for Global Health Research, NIH

www.fic.nih.gov 9
How do Americans benefit

from global health research?

Ensuring our nation’s safety and security

As people and goods travel ever more quickly around the globe, so too do diseases. To 

protect Americans from deadly outbreaks of SARS, Ebola, bird flu and Zika, it is in our own 

best interest to train scientists in developing countries so that they are equipped to study 

pandemics at their origin, contain outbreaks and minimize their impact. We are all only as 

safe as our weakest link, and preparedness is much less expensive than disaster response.

At Fogarty, our core mission is to build research capacity in low- and middle-income 

countries—a long-term investment that pays huge dividends. In the case of the Ebola 

outbreak, countries with little or no scientific capacity suffered the most, and the cost of 

unpreparedness soared above $2 billion. Sufficiently strengthening expertise at local 

institutions, training health leaders and linking them to the global network of experts 

would require just a fraction of that amount. We know people with Ebola traveled across 

borders into some of the countries surrounding Guinea, Liberia and Sierra Leone. Why 

didn’t outbreaks occur there? Because well-trained epidemiologists, lab technicians and 

others were on the scene, prepared to identify and treat those who were infected and 

ensure the disease did not spread. They were linked to global resources, and had access 

to technical advice and support—essential for pandemic response.

Promoting stability and economic development abroad

By supporting research that improves health in developing countries, NIH and Fogarty are 

also helping ensure societal stability and a 

healthy workforce, which can drive economic 

productivity. Data show malaria-free countries 

have economic growth that is five times 

greater than that of countries struggling with 

the disease. 

Life expectancy has risen dramatically across 

sub-Saharan Africa as HIV/AIDS treatment and 

prevention programs have made inroads, but

now chronic illnesses of aging pose new 

threats and require research to determine 

cost-effective interventions. Six of the fastest 

growing global economies are located in 

Africa, according to the World Bank, which 

makes the continent an increasingly important 

U.S. trading partner.

10 Fogarty at 50
Remaining globally competitive in science

The growing complexity of health problems, advances in genomics and other 

fields, and the explosion of resulting data make international scientific 

collaboration more important than ever, if we are to maintain our position 

as a global leader in biomedical research. After all, good ideas can come 

from anywhere. Only by collaborating with others can Americans remain at 

the forefront of scientific discovery, in a position to rapidly move new drugs, 

diagnostics, vaccines and other advances from the lab to the clinic. 

Producing discoveries that improve health

Global health research also pays dividends through scientific 

breakthroughs that result in new treatments that benefit Americans:

 Chemotherapy

Research conducted in Uganda in the 1960s laid the groundwork for chemotherapy 

treatment and accelerated research into whether viruses can cause cancer. After 

establishing a link between the newly discovered Epstein-Barr virus and a disfiguring 

form of non-Hodgkin lymphoma that mainly affected African children, Dr. Denis Burkitt 

brought chemotherapy drugs from the U.S., where they were being developed, back 

to Uganda and administered them to a child with full-blown disease. The child’s tumor 

melted away in several weeks and chemotherapy became the treatment of choice for 

this lymphoma. 

 Alzheimer’s disease

We may learn the key to preventing the ravages of Alzheimer’s disease by studying 

a small population in Colombia. Members of an extended family carry an unusual 

genetic mutation that raises the risk of both early onset Alzheimer’s—as young as 35

years—and its rapid progression to severe senility. A U.S.-Colombian research collaboration is studying the relatives for genetic clues, trying to identify new biomarkers 

to monitor disease progression, and testing new treatments to slow down or ultimately 

halt its progression. With the economic cost of Alzheimer’s set to reach $1 trillion 

annually by 2050, this is critically important work.

 Oral rehydration therapy

Studies conducted during a deadly cholera epidemic in 

s

s

s

Bangladesh in the 1970s, showed a simple, homebased remedy—

a package of oral rehydration salts—when added to water could 

exactly replace the fluids and electrolytes lost from the disease 

and save the patient’s life. The medical journal The Lancet touted

this as one of the greatest public health breakthroughs of the 

20th century and has attributed the treatment to saving one 

million lives a year. Today, many parents in America treat their sick 

children with Pedialyte® and similar products, which have their 

roots in the original cholera research.

In almost every branch of medicine, research conducted overseas has allowed us to advance 

our discoveries faster, cheaper and more efficiently than we ever could have at home. 

Americans are leaders in global health because we have been able to engage others to do 

studies that are not only locally relevant but also have clear implications for the U.S. 

Global health research truly is the new frontier of science.

www.fic.nih.gov 11
These are exciting times for global health, with new opportunities for 

partnerships, emerging technologies with the potential to transform 

research, 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.

Over the decades, Fogarty’s programs have made significant contributions 

by filling the pipeline of global health leaders, extending the frontiers of 

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

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

health research—who serve on the front lines of the fight against diseases 

that threaten populations in the U.S. and around the world. 

Since its formation, Fogarty has served as a bridge between NIH and 

the greater global health community by facilitating exchanges among 

investigators, providing training opportunities and supporting promising 

research initiatives in developing countries. Over the last five decades, 

Fogarty programs have provided significant research training for about 

6,000 scientists worldwide. 

Fogarty at 50: an introduction

Fogarty supports research training at all career stages

Initial Experience Fogarty Scholars

Dr. Magaly Blas began her global 

health career as a Fogarty Scholar, with a 

year of mentored research on HIV/AIDS. 

After earning her master’s and Ph.D., 

she was able to conduct independent 

research as a Fogarty Fellow. Like her, 

80 percent of all program participants 

continue in global health.

Early Career Fogarty Fellows

Post-docs like Dr. Bhakti Hansoti can receive 

support for a year or two to continue field 

research and generate findings necessary to 

secure future funding, in addition to helping 

train foreign scientists. Participants form 

international research partnerships they 

often maintain throughout their careers.

12 Fogarty at 50
Today, Fogarty funds some 500 research and training projects involving 

about 100 U.S. and foreign universities, as well as supporting activities 

in 120 countries. Fogarty research training programs are anchored to 

peer-reviewed research grants and designed to be collaborative, longterm, and flexible, meeting the research priorities of both the U.S. and 

foreign collaborators. Newly trained foreign scientists are encouraged 

to return home with the skills that allow them to conduct research. In 

countries where a critical mass of scientific capacity has been developed, 

local training programs are created and customized to address national 

research needs and priorities. 

Health research in the 21st century is increasingly a team effort. 

Interdisciplinary research groups have been prime movers in the 

development of low-cost diagnostics and cost-efficient ways to prevent 

and treat disease. Research groups are best suited to address global health 

issues when the teams are multinational and sensitive to local culture and 

context. Building such teams in institutions around the world has been an 

important Fogarty strategy for decades.

To ensure research discoveries are more efficiently translated into health 

policy and practice, Fogarty has supported implementation science across 

its programs. Another area of focus has been to explore how mobile

Mid-Career Support to bridge the gap

Bridging support is available to enable mid-career scientists, 

such as Dr. Thomas Gaziano, to advance to the next stage. 

He received a Fogarty Independent Research Scientist 

Development Award, which provided a stepping stone to 

competing successfully for an R01. 

Senior Scientist

Trainee becomes trainer, research leader

After earning her master’s and Ph.D. 

with Fogarty support, Dr. Patty Garcia 

became a principal investigator and mentor, 

building a research and training grant 

portfolio that encompasses more than 

40 NIH awards at her institution in Peru. 

Recently, she served as her country’s 

Minister of Health.

www.fic.nih.gov 13
 
devices, electronic medical records and new technologies can be leveraged 

to revolutionize research approaches, support online collaborations and 

develop new teaching tools and methods of knowledge exchange.

Fogarty also convenes the best scientific minds around the world to 

address critical global health research problems such as polio eradication, 

the impact of climate change on disease outbreaks and strengthening 

research capacity in Africa. The Center’s in-house scientists collaborate 

with colleagues globally to conduct research on the epidemiology 

and modeling of infectious diseases, producing data used to develop 

countermeasures for potential bioterror agents and public health actions 

to control the spread of infectious diseases. Meanwhile, Fogarty’s 

international relations team identifies opportunities for collaboration 

and develops new partnerships among U.S. scientists, institutions and 

counterparts abroad to advance research and training. 

Given the success of international efforts to prevent and treat HIV/AIDS, 

malaria and TB, life expectancy has risen dramatically in low- and middleincome countries (LMICs). These countries now share the same health 

challenges that we are facing in the U.S., such as cardiovascular disease, 

cancer, diabetes and other chronic diseases. Today, global health and local 

health are becoming one and the same and research conducted anywhere 

can help people everywhere.

Fogarty principles of successful programs

Responsive to national 

and global priorities

Durable national 

commitment

Long-term and multigenerational 

institutional and individual partnerships

Training linked directly 

to innovative research

Mutually beneficial 

to collaborators

Selection of trainees and research 

projects by collaborating LMIC institutions

Long-term 

commitment 

Flexibility in types of training, research

and management mechanisms

Over time, center of gravity shifts 

to the lower-income countries

Research capacity strengthening 

tied to public health

Program outcomes: scientific 

and public health leaders

Collaborating institutions 

develop winning partnerships

www.nih.fic.gov www.fic.nih.gov 15
Rep. John Fogarty was a champion for NIH and for medical research

16 Fogarty at 50
Congressman John Edward Fogarty:

champion for global health research

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 chairman 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.

Fogarty’s remarkable achievements belie his humble beginnings. Born 

in Rhode Island to a second-generation Irish immigrant family, his formal 

education was limited and he followed his father into the bricklaying 

trade. His political career began when he was elected president of the 

local bricklayers’ union. Three years later, he defeated five prominent 

Democrats in the primaries and went on to win a seat in Congress. He 

was a mere 26 years old. 

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 

scientific capacity at home and abroad.

www.fic.nih.gov 17
Fogarty International Center: a brief history

When World War II ended, the nations of Europe were devastated, their 

economies destroyed, their cities in ruin, their populations starving. In 1948, the 

U.S. implemented the European Recovery Program—popularly known as the 

“Marshall Plan.” The idea was to provide financial and material assistance to 

participating countries in Western Europe to aid them in rebuilding. A decade 

later, NIH launched its version of the Marshall Plan to replace and strengthen 

European capacity to conduct biomedical research. The International Research 

Fellowship (IRF) program aimed to develop a cadre of foreign investigators who 

would be trained at the NIH and in American academic institutions, and return to 

take their places in Europe’s leading universities and research centers. 

After the Fogarty International Center was established at NIH in 1968, management of the fellowship program was transferred to the new Center. During three 

decades of the program, more than 2,500 scientists from 55 countries were trained 

at a total cost of $50 million. The majority of fellows returned home to pursue 

careers in research, teaching and administration, often keeping in close touch 

with their American colleagues. The list of mentors in the early decades reads like 

a Who’s Who of leading American scientists, including a number who became 

Nobel laureates, among them Drs. Christian Anfinson, Julius Axelrod, David 

Baltimore, Baruj Benacerraf, Arthur Kornberg and Severo Ochoa.

By 1969, the new Center began to establish a program of workshops and 

conferences designed to foster international scientific collaborations on common 

challenges. It also began the Scholars in Residence, or SIR, program to bring 

internationally renowned scientists—both American and foreign—to NIH, some 

for a year or more. At any given time, there would be half a dozen or more of 

1967

Congressman

John E. Fogarty 

dies

1968

Congress establishes 

the Fogarty 

International Center

Dr. Milo Leavitt is 

named director

The Center takes 

over management 

of the International 

Research Fellowship 

program

1969

Scholars in 

Residence program 

begins

Drs. Albert Sabin 

and Margaret 

Mead were among 

the illustrious 

scientists who 

conducted 

research in 

residency at NIH

1975

Senior 

International 

Fellowship 

program begins 

1978

Dr. Leon Jacobs 

becomes director

18 Fogarty at 50
these scholars in residence at Stone House on the NIH campus. During their stay, 

they would hold seminars and workshops, write books and conduct research in 

collaboration with colleagues in other NIH institutes. Housing scholars together 

prompted informal discussions and daily exchanges, which helped spark creative 

ideas and innovations. The program succeeded in bringing a pantheon of gifted 

scientists to NIH over the years—more than 200—including Drs. Margaret Mead 

and Albert Sabin; Nobel prize winners Drs. Daniel Bovet, Rita Levi-Montalcini, 

Sir Hans Krebs and Ragnar Granit; a number of Lasker award winners and others 

recognized as leaders in their fields.

As a Fogarty Scholar in Residence, Sabin brought to NIH his commitment to 

rid the world of polio using his oral vaccine, which had already debuted on the 

international scene having been tested in Russian schoolchildren. During his 

periodic stays at NIH in the early 1980s, Sabin oversaw strategies that would 

lead to the complete elimination of polio in the Western Hemisphere by 1993. 

He worked with governments, international organizations such as Rotary 

International, and the World Health Organization to incorporate annual national 

vaccination programs into routine health services in developing countries. 

Among the earliest Scholars was Sir George Godber, the architect of the British 

National Health Service. Other notables over the years included Peter Perlmann, 

from the University of Stockholm, who developed the ELISA technique, widely 

used in research and diagnostics, such as blood tests for HIV and other pathogens. 

In 1990, Fogarty welcomed its first African scholar, Olufemi Williams from 

Nigeria, who completed a book while in residence detailing comparisons between 

AIDS in Africa and AIDS in the U.S. 

1980

The Center hosts 

international 

meetings on 

eradication of 

polio and other 

diseases

1981

Dr. Claude Lenfant 

becomes director

1984

Dr. Craig K. 

Wallace becomes 

director

1987

The Center serves 

as co-chair and 

secretariat of Third 

International AIDS 

Conference

1988

Dr. Philip E. 

Schambra 

becomes director 

Institutional awards 

begin through

AIDS International 

Training and 

Research Program

www.fic.nih.gov 19
In 1992, Dr. Lev Bergelson arrived as the first scholar from Russia, noted for 

his studies of the role of lipids in heart disease and cancer.

Another fellowship established during Fogarty’s first decade, the Senior 

International Fellowship (SIF) program, sought to recruit leading U.S. 

investigators to travel abroad—perhaps during sabbatical years—to 

take advantage of outstanding research opportunities at other major 

centers, study unique patient populations or learn new techniques from 

international colleagues. While Fogarty primarily managed fellowship 

programs and convened scientific symposia for its first two decades, it also 

began facilitating and implementing international agreements for scientist 

exchanges and research collaborations.

Fogarty as a convener

The decade of the 1970s marked one of the greatest global health 

achievements of all time, the eradication of smallpox. While Fogarty was 

not directly involved in this monumental achievement, the global scientific 

community turned to the Center as a place to examine the potential to 

control or even eradicate other major infectious diseases. In 1979, Fogarty 

convened a conference of the world’s leading infectious disease experts 

to consider what diseases might potentially be eliminated. Polio, measles, 

rubella, yaws and other endemic treponematoses were recommended as 

candidates. Following this initial gathering, the Center convened a series of 

discussions to examine each disease in more detail. These meetings are now 

recognized as the beginning of the global campaign to eliminate polio. 

In the mid-1990s, Fogarty brought together U.S., British and French 

scientists and officials to consider a study the Center conducted on the 

1989

Fogarty’s 

“Stone House” 

renamed the 

Lawton Chiles 

International 

House to honor 

the Florida 

senator

1998

Dr. Gerald T. 

Keusch becomes 

director

Division of 

International 

Epidemiology 

and Population 

Studies is 

launched

2000 2001

Fogarty hosts 

international 

conference on 

stigma and global 

health

2002

Fogarty organizes 

the Pan-African 

Conference on 

Malaria 

Disease Control 

Priorities Project 

begins

20 Fogarty at 50
scope of biomedical research in Africa, and for subsequent discussions on how 

best to deploy research to improve African health. It was decided that a focus 

on malaria would be the most productive. From these meetings sprang the idea 

to plan and host the first Pan-African Conference on Malaria, held in Senegal in 

1997, which brought together funding agencies and malariologists to develop 

a research agenda and prioritize needs. The meeting marked the birth of a new 

global effort, the Multilateral Initiative on Malaria, which continues today.

Stigma was the topic of another landmark symposium organized by Fogarty in 

2001. Attendees considered the relationship between stigma and public health, 

how stigma prevents people from seeking diagnosis or treatment—such as 

for HIV/AIDS—and the related research agenda needed to advance the field, 

especially as it pertains to the developing world. The discussion led to Fogarty’s 

establishment of a stigma research program the following year, which awarded 

$17 million in 18 grants. Although the program was discontinued in 2009, stigma 

research continues to be supported through other Fogarty and NIH initiatives.

The AIDS epidemic causes a shift in direction

Perhaps the most pivotal gathering of all was the third International Conference 

on AIDS, held in Washington, D.C., in 1987. Fogarty served as co-chair and 

secretariat, engagement that motivated the Center to focus its activities on lowand middle-income countries (LMICs)—beginning with a major effort to build 

research capacity to combat the emerging HIV/AIDS epidemic. This program 

is largely credited with building the scientific leadership in LMICs that helped 

change an HIV diagnosis from a death sentence to a manageable disease. With 

proof of concept, Fogarty transformed its entire extramural portfolio to focus 

on building core foundational capacity through research training programs in 

bioethics, genetics, informatics, stigma, and health and economic development.

2006

Dr. Roger I. Glass 

is named director

2009

Fogarty becomes 

founding member 

of the Global 

Alliance for 

Chronic Diseases

Fogarty co-hosts 

inaugural meeting 

of the Consortium 

of Universities for 

Global Health 

2010

Medical Education 

Partnership 

Initiative launches 

Fogarty partners 

with the Fulbright 

Program to offer 

Fulbright-Fogarty 

fellowships

Fogarty and NIH 

help found the 

Global Alliance for 

Clean Cookstoves

2012

Center for 

Global Health 

Studies forms 

at Fogarty

2018

Fogarty International 

Center marks 50th 

anniversary

Fogarty at

5

www.fic.nih.gov 21
Sparking a scientific revolution 

to address the HIV/AIDS crisis

Turn back the clock several decades and research laboratory 

equipment in some developing countries amounted to no more than 

a mirror and a light microscope sitting on a desk. As a result, it was 

not uncommon for so-called “parachute scientists” from the U.S. or 

Europe to drop in for a quick visit to collect data and samples and 

take them home for analysis. Today, the scene is much different, with 

well-trained local researchers using cutting-edge equipment and 

working as equal partners in collaboration with their counterparts 

around the world.

Driving this dramatic change has been a devastating catalyst: the 

HIV/AIDS epidemic. More than 35 million people have succumbed 

globally and more than 36 million are living with HIV, as of 2015. 

Sub-Saharan Africa has borne the heaviest burden, virtually losing a 

generation and now harboring two-thirds of all people in the world 

who are HIV positive.

From the start, scientists recognized that research into this mysterious 

new disease was badly needed, not only in the developed world, but 

also in countries with different experiences in transmission, testing 

and patient care. But there was an enormous barrier: the lack of 

research capacity in areas most severely hit by the epidemic.

An idea for a novel program takes place

Moved by the scale of the epidemic, Fogarty’s Dr. Ken Bridbord 

took action. He sketched out a novel research training program that 

would arm promising developing country scientists with skills in 

epidemiology, lab techniques, ethical research practices and data 

analysis—in addition to subject matter expertise in HIV/AIDS and 

related diseases. The trainees would remain engaged in research 

studies of importance to their own communities and receive support 

to continue their projects when they returned home, a feature 

designed to prevent brain drain and ensure their expertise was 

deployed where it was needed most.

The AIDS International Training and Research Program, known as 

AITRP, began in 1988 and provided significant research training to 

more than 2,000 individuals from more than 100 countries. 

22 Fogarty at 50
One U.S. investigator recalls the void 

in which AITRP germinated. “We got a 

lot of samples from different places in 

Africa and Asia and brought them to 

Boston for testing, because there was 

no way to test them there—they didn’t 

have the equipment or personnel, didn’t 

have the tests,” said Dr. Max Essex of 

the Harvard School of Public Health. 

Essex received one of the first AITRP 

grants.

Fogarty’s approach was groundbreaking and helped to build the level of 

expertise necessary for sustained 

research efforts to study the HIV/AIDS 

epidemic on the ground in the locations 

where suffering was greatest. AITRP 

alumni returned to their home countries 

where they not only conducted critical 

research projects but also trained others, 

adding to the impact.

“It was clear we needed to enter into a 

partnership with colleagues in countries 

hardest hit,” said Bridbord. “Perhaps 

no single word captures the essence 

of AITRP more than empowerment. 

AITRP trainees are empowered with the 

knowledge, experience and increased 

confidence to return home and help 

their countries to craft and implement 

locally relevant strategies to tackle 

HIV/AIDS. This empowerment has 

enabled them to work on a par with 

scientists in the developed world.”

O

 n his first visit to the Rakai district in western Uganda, Fred 

 Nalugoda was horrified by the numerous worn-out people 

 he saw wandering around listlessly, open sores evident, and 

being shunned by all. “I got chills and thought I could not go back,” 

he said.

Nonetheless, Nalugoda joined Rakai’s Health Sciences Program, which 

conducts extensive community epidemiologic and behavioral studies 

in HIV/AIDS. In 1999, he received his master’s degree under Johns 

Hopkins University’s AITRP grant.

Nalugoda says skills in demography and biostatistics have enabled 

him to collect, manage, analyze and interpret data and get his studies 

published. He’s been involved in many key Rakai trials, including the 

landmark study that found male circumcision was a highly effective 

barrier to HIV transmission. His mentorship experience has given him 

the blueprint he uses to mentor others. He’s now program director 

responsible for all field studies and is highly regarded for his deep 

knowledge of the Rakai communities.

Public awareness and the availability of interventions have changed 

the situation remarkably, Nalugoda noted. “People know about 

strategies for prevention and stigma has been reduced very much. 

Now HIV treatment is widely available and denial is not a big issue, 

especially in Rakai.”

www.fic.nih.gov 23
AITRP offered an unusual degree of flexibility, allowing the 

grantees to adapt to changing conditions. “As the epidemics 

evolve, the position of Fogarty has always been that if it was 

logical to change directions, follow new opportunities, fine, go 

ahead and do it,” said Dr. Warren Johnson, a longtime AITRP 

grantee at Weill Cornell Medical College. “It was visionary.”

A cadre of developing country scientists is trained

Under the program, developing country trainees were selected 

to come to U.S. grantee institutions to learn from experts and 

work in well-equipped laboratories. Training courses were 

short- or long-term and covered many different levels and topics, 

including master’s and doctoral degrees, laboratory skills, 

proposal and paper writing, epidemiology, biostatistics, ethics 

and HIV/AIDS related biology.

“The training provided people with a skill set that they didn’t 

have before, how to approach and analyze a problem, design 

a study, choose the right study, conducting perhaps more 

quantitative epidemiologic types of research,” said Dr. Art 

Reingold, who managed an AITRP grant at the University of 

California, Berkeley. “We also stressed the ethical aspects of 

research and encouraged a more questioning, intellectually 

stimulating approach in general.”

Another unique aspect of AITRP was how it encouraged trainees 

to exercise their new skills back at home. After their education 

there, many scientists face the temptation to remain abroad in 

relatively well-paid jobs, leaving their home country no better 

off. So the AITRP grantees incorporated both a carrot and a stick. 

The carrot was re-entry funding for mentored research projects 

at home, where support might otherwise be hard to obtain. The 

stick was an explicit expectation that the trainees should return 

home and put their new knowledge and skills to work, as a way 

to repay their AITRP support. These conditions encouraged 

the flow of bright, qualified and empowered scientists back to 

developing countries, making the overall AITRP re-entry success 

rate in excess of 80 percent.

24 Fogarty at 50
Changing the research landscape 

in developing countries

As skilled scientists became 

established in developing countries 

and rose to leadership positions in 

academia, health ministries and the 

private sector, they made attractive 

partners for global collaborations 

and began to successfully compete 

for NIH research grants, in addition 

to funding from international 

foundations and other sources.

“We’ve seen a whole series 

of individuals go through the 

program who are back in their 

home countries now and doing 

pretty phenomenal work; whether 

it’s in Uganda, Zimbabwe, or some 

other institutions or countries, it’s 

the collective effort that is really 

impressive in terms of what has 

come out of all of this,” Reingold 

said.

One shining example of AITRP’s 

impact is in Malawi. “When we 

started the program, Malawi did 

not have a medical school. It had 

a very limited professional base. 

Malawians who had medical 

training were trained either in the 

UK or other African countries. 

There was really very little in the 

way of advanced technical capacity 

to respond to the epidemic and to 

do research,” said Dr. Christopher 

“ I can say that for us in Haiti, 

Fogarty has been the cornerstone of 

our entire program. Fogarty support 

has allowed us to train the leaders 

in our field, who themselves have 

trained thousands of others. We rest 

on three legs—research, training 

and service. They are all interrelated and one makes the other one 

stronger. So it is through research 

that we find results and it is through 

training that we expand the results. 

The services we provide get the 

benefit of both the research and 

the training. And Fogarty has been 

instrumental in all three aspects.”

Dr. Bill Pape

GHESKIO Director

Fogarty grantee

www.fic.nih.gov 25
Beyrer, of Johns Hopkins Bloomberg 

School of Public Health.

On a visit to Malawi, Beyrer was 

encouraged to hold discussions with 

policymakers. “I met with the Minister 

of Health, the head of the national 

AIDS program and the head of the 

immunization program—and all of 

them had had training through our 

AITRP. You realize that you have really 

helped build in-country expertise. That 

was very powerful for me,” he said.

Longtime AITRP collaborator in 

Uganda, Dr. David Serwadda, of 

Makerere University, said the program 

concept is unique. “Fogarty’s model 

of integrating training and research 

has been more successful than the 

model in which scholarships are given, 

Ugandans go to train, and they come 

back and say ‘Now, what? What am 

I going to do?’ Those programs tend 

to have a much higher brain drain 

compared to Fogarty’s.”

AITRP trainees contribute to discoveries

Former AITRP trainees around the 

world have made an enormous impact 

on virtually every area of HIV/AIDS 

science. “The trainees contribute to 

critical research projects,” said Myron 

(Mike) Cohen, of the University of 

North Carolina. “This is not a hobby. 

This is deadly serious science.”

Many of the scientific advances 

preventing mother-to-child 

transmission, therapy as prevention, 

and the benefits of microbicides 

and male circumcision—have been 

discovered by research teams led by or 

including former AITRP trainees.

“Fogarty training has given us 

Africans the skills we need to 

conduct research, document illness 

and look at possible interventions 

that work in Africa. Fogarty has 

changed the face of HIV medicine.”

Dr. Ruth Nduati

University of Nairobi

Fogarty trainee and grantee

“Without Fogarty, I quite simply 

wouldn’t be who I am today.”

Dr. Elioda Tumwesigye

Uganda’s Minister of Science, 

Technology and Innovation

Former Fogarty trainee

26 Fogarty at 50
Fostering long-term research 

collaborations is a key factor in 

AITRP’s success. By providing a 

forum for sharing information and 

lessons learned, the program’s impact 

is multiplied. One grantee cited how 

the head of China’s AIDS program, 

after observing HIV was spreading 

in sex workers, reached out to AITRP 

alumni in Thailand who had already 

implemented an effective condom 

promotion program to reduce 

transmission.

“When you go through graduate 

training together, it’s like being in 

the trenches, you sort of become 

buddies,” said Dr. Roger Detels of the 

University of California, Los Angeles. 

“That kind of interaction and mutual 

support between people from 

different countries really wasn’t going 

on in the ‘80s, but it is now.”

As former AITRP trainees have added 

to their country’s pool of skilled 

scientists and health leaders, they 

have helped lay the groundwork 

for other U.S. efforts, such as the 

President’s Emergency Plan for AIDS 

Relief (PEPFAR). These projects 

then feed research further, allowing 

experts on the ground to craft new 

research projects involving PEPFAR 

patients, AITRP grantees noted.

AITRP changes the academic culture

Visiting the U.S. for training has 

been a valuable experience on many 

Scientific advances made 

with assistance from Fogarty trainees 

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 highrisk 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 encounters 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.

www.fic.nih.gov 27
levels for AITRP trainees, some of whom had not traveled outside 

their country before. The U.S. academic teaching styles often differ 

substantially from what they were used to, for instance in the 

interaction with mentors, style of networking and examples of role 

models.

Many trainees came from former British or French colonies, 

where the education system remains based on top-down, didactic 

teaching. 

“Education there basically amounts to professors talking to you, 

you writing it all down, being tested on how well you wrote it 

down and remembered it. It’s not an interactive process where you 

argue, disagree, discuss, and that is central to the way we educate 

people in our graduate school,” Reingold observed. “I think many 

of them did go home with a refreshingly more candid, open, 

argumentative (in a good way) approach to things, questioning 

their elders or the system or how things are done—and that’s a 

good thing.”

Many developing countries did not have a tradition of research as 

part of academia and AITRP provided a roadmap for success. “It 

really helped lay down the template showing that a large part of 

achieving academic success is through international-level research, 

collaboration, publication and presentations,” Beyrer said.

AITRP has also benefited U.S. institutions, as visiting trainees bring 

an added dimension to classroom discussions with their firsthand 

knowledge of conditions and needs. The connections formed often 

lead to long-term research collaborations and lasting friendships.

Faculty members and both U.S. and visiting trainees gain 

from their experience of working together. “We develop these 

relationships which shape our lives. We don’t look at the world 

the same way, because we’re working with people from other 

countries,” Cohen said. “I can see generations of people from other 

countries, as well as from our faculty, whose not just careers but 

28 Fogarty at 50
personal lives, personalities, view 

of the world are all really shaped 

by AITRP.”

Preparing to meet new challenges

Several decades on, research 

priorities are shifting toward 

treating HIV as a chronic disease, 

dealing with co-infections and 

studying the effects of treatment 

over time. For instance, scientists 

do not understand why long-term 

antiretroviral treatment, while 

extending life, also accelerates 

aging and the development 

of related conditions such as 

cardiovascular disease and 

certain cancers. To meet these 

new challenges, Fogarty has 

consolidated AITRP with another 

implementation research training 

effort, the Fogarty HIV Research 

Training Program. 

“I remember when AITRP was 

just an idea in ‘85. To see it evolve 

in the magnificent way it has is 

really hard to believe. The breadth 

of the effect of AITRP has been 

remarkable,” said Dr. Charles 

Carpenter of Brown University.

“There’s no question that the 

training and the empowerment of 

the developing country scientists 

and their institutions to do AIDS 

research has just been enormous,” 

Beyrer said. “Without it, we 

would not be anywhere near 

where we are today in the global 

response. It is a powerful legacy.”

“I will never forget meeting these three 

young women in Uganda who told their 

stories about how research made it possible 

for them to be alive, all of them having 

participated in clinical trials. One had 

become HIV-infected early on when there 

was no treatment available except in trials. 

Another was able to prevent her baby from 

becoming infected as part of a PMTCT 

study. And a third, who was participating 

in a trial of a female vaginal ring approach 

to HIV prevention, putting women more 

in charge of their own destiny, instead of 

having to depend on men.

With tears in their eyes and sincerity in 

their voices, the women said ‘Thank you, 

America, you saved us.’ And they meant it. 

People need to be reminded that the human 

consequences of what we do are really 

quite profound.”

Dr. Francis S. Collins

NIH Director

www.fic.nih.gov 29
Promoting bioethics to protect 

lives in service to research 

The rising death toll of the AIDS epidemic created an urgent need 

for investigators to conduct research in developing countries, yet 

there was little framework to guide the ethical dilemmas involved. 

Clinical trials often provided participants the only access to 

treatment. How could scientists ensure consent was freely given 

and that subjects understood the risks? What obligation, if any, did 

the researchers have to treat those found to be HIV positive? How 

could privacy be preserved, especially in small communities? 

Bioethics and the protection of human subjects are the foundation 

that enables clinical research. The combination of the globalization 

of the biomedical industry and the surge in research activity to 

address HIV and malaria proved overwhelming in many low- and 

middle-income countries (LMICs). To participate in NIH trials or 

receive NIH funding, studies must be designed and implemented 

to conform to the same standards as U.S. clinical trials. In locations 

with little expertise in bioethics, that proved extremely challenging.

Concern for research subjects grew from the horror of the Nazi 

experiments on humans, spurring an effort to lay out ethical 

guidelines in the Nuremberg Code in 1947, followed by the World 

Medical Association’s Declaration of Helsinki in 1964. The field of 

bioethics was largely the domain of philosophers and theologians 

until the 1970s, when the tremendous growth of biomedical 

science expanded it to a multidisciplinary endeavor involving 

anthropologists, policymakers, physicians, sociologists and the 

public at large.

“In order to preserve the health of society and its overall humanity, 

it’s important that research be conducted in an ethical fashion,” 

according to Nigerian scientist, Dr. Clement Adebamowo, who 

directs the Fogarty bioethics program at the University of Ibadan. 

“Invariably some participants will go before others in helping us 

to understand diseases, the treatments and the impact of those 

treatments. So, we owe those participants a debt of gratitude and 

we have a duty to protect them.”
In 2000, Fogarty began a bioethics 

program designed to develop 

culturally relevant bioethics 

curricula for developing country 

scientists and support training 

to produce leaders who could 

advise on policy and help train the 

next generation. Since then, it’s 

enabled hundreds of scientists and 

administrators to complete master’slevel training in bioethics. 

“What Fogarty has created with 

minimal funding and the impact 

that these programs have had is 

remarkable,” said bioethics professor 

and Fogarty grantee Dr. Nancy Kass, 

of Johns Hopkins University.

Fogarty has worked in partnership 

with co-funders across NIH, 

including the NIH Clinical 

Center, which provides significant 

leadership and expertise, as well 

as online and in-person bioethics 

training courses geared to 

developing country researchers.

“Good ethical research requires a 

lot from top to bottom—from what 

questions to ask, how to design 

studies, how to do them, how to 

get them designed in a way that 

recognizes risks,” said Dr. Christine 

Grady, chief of the bioethics 

department at the Clinical Center.

“ My Fogarty training was 

a defining experience in my 

career...Fogarty gave me 

the opportunity of my life, 

professionally. It opened up 

my world completely, gave 

me another view and I fell in 

love with public health and 

research.”

Dr. Marcos Espinal

Director, Communicable Diseases, 

Pan American Health Organization

Former Fogarty trainee

www.fic.nih.gov 31
Many bioethicists 

agree that 

regulation is necessary but not sufficient to ensure ethical 

research. Examination by an ethics committee or an Institutional 

Review Board (IRB) only goes so far. Training is geared to 

creating a culture of responsibility, so that ethical approaches are 

accepted by investigators, the teams that work with them and 

institutions that host them. 

The review process is critical. “If the review is done incorrectly, 

you risk people getting harmed,” said Dr. Joseph Millum, 

bioethicist at Fogarty. “If you do it inefficiently, you hold up the 

process of research.” The IRB is further limited by its function, 

reviewing the protocol and the consent form, but not overseeing 

the actual research process.

Fogarty’s program aims to produce bioethics leaders who can 

advise developing country institutions how to formulate and 

strengthen local bioethics guidelines, build well-informed review 

bodies capable of evaluating research proposals, and train 

others in the principles of ethical research conduct. Given the 

increasingly collaborative nature of research, it’s also important 

to bring new voices with different perspectives to the global 

ethics conversation.

Fogarty’s Dr. Barbara Sina, who has managed the program since 

its inception, said she’s encouraged at the progress LMIC trainees 

have made. “Our ultimate goal is to develop research ethics 

capacity and expertise so that countries can create their own 

ethical oversight processes and participate equally in the global 

dialogue on research ethics.”
www.fic.nih.gov 33

Bioethics takes 

root in Nigeria

Examining the bioethics landscape in Nigeria 

today, it’s difficult to imagine how recently it was 

a barren plain. Nigerian scientist Dr. Clement 

Adebamowo recalls a “perfect storm” of events 

that spurred him to develop a bioethics research 

training program at the University of Ibadan.

In 1996, a controversial drug trial conducted 

during a meningitis outbreak caused fatalities, 

triggering a backlash against researchers. 

Meanwhile, global outsourcing of clinical trials 

was growing in popularity, taking advantage 

of low-cost settings with little or no regulation. 

Finally, the “Out of Africa” theory of evolution 

was generating interest among researchers 

keen to conduct population studies that might 

determine the genetic basis of diseases.

Adebamowo began his bioethics training 

program with a Fogarty planning grant in 2004. 

He and his team developed web resources, 

conducted sensitivity and public awareness 

campaigns, and offered training to institutions 

to strengthen their research ethics committees. 

Once he received a full grant, he launched a 

master’s degree program designed to serve 

as a bioethics resource for all of West Africa. 

The first class of master’s students was drawn 

from nursing, biomedical research and public 

health. Coursework included classes on 

informed consent, research design, philosophy 

of bioethics, religion and ethics, and qualitative 

and quantitative research methods.

Eight of his faculty obtained master’s degrees in 

bioethics through established Fogarty training 

programs in the U.S. and Canada. They in turn 

have provided instruction at Ibadan, mentoring 

20 students through the master’s program 

and more than 1,000 West African researchers 

through a short course. The “multiplier effect” is 

huge, Adebamowo observed. “For us in Nigeria, 

the Fogarty funding for bioethics changed the 

entire landscape. What we have now would have 

been impossible without the Fogarty funding,” 

he said. 

In concert with his training efforts, Adebamowo also helped the 

health ministry transform Nigeria’s national ethics system and 

drafted the country’s first formal code for research ethics. His 

trainees held or assumed positions in state and federal institutions, 

creating a framework and resource as the code was implemented. 

His NIH funding provided credibility, he said, which was helpful 

as he re-established and chaired the national ethics committee, 

created a web-based research protocol tracking system, and 

initiated or strengthened 25 Institutional Review Boards across the 

country. 

The cultural shift has been enormous and will have lasting impact, 

he said. “The most significant thing we’ve achieved is elevating 

the status of research ethics and helping researchers and Nigerians 

in general appreciate the value of ethical conduct of research,” 

said Adebamowo. “We have more people who know that there is 

a way of doing research that is both scientifically appropriate and 

ethically sound. Those people will pass this down to their trainees, 

so over time a better research culture will develop.”

“ For us in Nigeria, the Fogarty 

funding for bioethics changed the 

entire landscape. What we have 

now would have been impossible 

without the Fogarty funding.”

Dr. Clement Adebamowo

University of Ibadan

Fogarty bioethics grantee
Fogarty program develops bioethics expertise in Uganda 

Ugandans were quick 

to participate in the 

master’s-level bioethics 

programs Fogarty 

began supporting 

at institutions in 

the U.S., Canada 

and South Africa. 

When the trainees 

returned home, they worked as a team to develop a national 

bioethics framework for Uganda, which is now the third largest 

destination for clinical trials in Africa.

“Fogarty trainees have been very active in developing the 

research ethics landscape in Uganda,” said Dr. Julius Ecuru, 

of the Uganda National Council for Science and Technology 

(UNCST), the government agency that oversees research and 

development. With Fogarty support, he earned a diploma in 

research ethics from the University of Cape Town in 2005. He 

said the experience gave him the inspiration to help bring 

about many of the reforms in his country.

“We felt the guidelines must be driven by some kind of value 

judgment,” Ecuru explained. “Every statement we put in there 

has an ethical justification of why it is there.”

In the first decade of the Fogarty bioethics program, nine 

Ugandans from Makerere University traveled abroad for 

master’s-level training. They studied the principles of ethics, 

international guidelines, research methodologies and other 

topics. They were also immersed in the practical application of 

coursework, by observing Institutional Review Boards (IRBs) 

in action and developing case studies relevant to the research 

issues they were facing at home. Throughout the process, they 

were mentored by experienced bioethicists.

Seven faculty members with substantial training returned to 

Uganda and formed the core leadership for bioethics in the 

country. In addition to helping shape national guidelines, 

they developed workshops and short courses to expand the 

number of experts in human research protection, responsible 

conduct of research, clinical ethics and research ethics. They 

also assisted in organizing national and regional conferences 

to share information and build capacity.

In 2014, Makerere had developed sufficient bioethics expertise 

to successfully compete for its own Fogarty bioethics grant, 

allowing the university to expand activities and establish a 

bioethics master’s degree program. Researchers no longer 

have to leave the country, or learn from a foreign trainer 

who comes in and teaches with examples from elsewhere, 

explained Dr. Joseph Ochieng, who was one of the first 

Ugandans to receive bioethics training. Ochieng, a professor 

at Makerere, received a master’s in bioethics from the 

University of Toronto with Fogarty support, and continues to 

be heavily involved in bioethics.

“We are training individuals in the context of Uganda, in the 

context of where they live and practice, so they connect much 

better,” Ochieng said, noting the approach also reduces brain 

drain and is cost-effective. “The only sustainable way you 

can do it adequately is by training locally. You can train more 

people with less funding.”

Under the program, bioethics short courses have been 

presented to several hundred individuals, case studies specific 

to Uganda have been developed and online training tools are 

being produced, which will reduce costs and increase capacity. 

In addition to supporting trainees’ participation in national 

and international research ethics conferences, the grant also 

helps fund the study of emerging issues such as genetics 

research in Africa.

“Strengthening research ethics has given us a good 

environment to support quality research,” Ecuru said. “Our 

regulatory system should not be a hindrance to scientific 

progress. Rather, we want scientific progress that also ensures 

respect for human participants and causes less harm to 

participating communities.”

34 Fogarty at 50 
www.fic.nih.gov 35

“ Fogarty understands that global change starts 

within individual countries, and during its 50 

years of existence, its unique, sustained focus on 

supporting people in their own countries to solve 

their own problems has been a critical piece of the 

architecture and development of global health.”

Dr. Peter Singer

University of Toronto

CEO of Grand Challenges Canada

Fogarty bioethics grantee
Advancing research 

through technology

Whether analyzing and comparing large data sets, tracking 

disease outbreaks or using text messages to communicate with 

study participants, global health scientists increasingly rely on 

information and communication technologies (ICT) to advance 

their research. ICT is a broad concept that encompasses 

computers, cellphones, broadband, videoconferencing and 

distance learning—and Fogarty grantees are at the forefront of 

the movement, working to adapt cutting-edge technologies to 

low-resource settings.

Since 1998, Fogarty has provided funding to catalyze 

implementation of ICT by supporting research and training in 

informatics, mobile health and electronic learning programs.
W

 ith computers, cellphones and other information 

 and communications technology (ICT) becoming 

 more widely available, Dr. Patty Garcia of the 

University of Cayetano Heredia applied for and received a 

Fogarty grant in 1999. That award enabled her to provide 

training for young Peruvian scientists in the use, development 

and application of informatics for health, linking them with 

ongoing research that uses new technologies.

Garcia created a range of options for emerging investigators, 

from diplomas to master’s degrees to doctoral degrees, 

and also small grants for innovative, closely mentored 

research. Topics included improving home blood pressure 

monitors, using bioinformatics for cysticercosis control and 

incorporating electronic health records in the fight against 

tuberculosis.

To ensure broad access to the new bioinformatics curricula, 

both in Peru and other countries, many of the training 

materials were made available online. Having developed a 

critical mass of researchers with informatics expertise in Peru, 

additional Fogarty support allowed Garcia to create a hub to 

share that knowledge across the Andean region, with a focus 

on Colombia, Ecuador and Peru.

“We envision global health informatics as an umbrella for 

integrating health informatics and bioinformatics into clinical, 

biomedical and behavioral research issues that are vital to 

advancing the health of populations in our area and around 

the globe,” Garcia said. “So, we are creating the critical mass 

to sustain and expand our progress. We are positioned as a 

leader in the field.”

“I imagine Fogarty’s 

training programs as a 

very rich soil. People, our 

trainees, are the seeds. 

The seeds, in a good soil, 

will grow into plants that 

eventually produce fruits—

in the form of funding, 

scientific discoveries or even 

the ability to have research 

results influence policies that 

will improve public health. 

So, Fogarty plays a unique 

and crucial role by providing 

this fertile soil.”

Dr. Patty Garcia

University of Cayetano Heredia

Lima, Peru

Fogarty grantee and former trainee

www.fic.nih.gov 37
Fogarty’s informatics 

program supported 

training for scientists 

to design information 

systems and apply 

computer-supported 

management 

and analysis to 

biomedical research. 

Informatics, the 

science of handling 

large volumes of 

information, helps link physicians and researchers around the 

world so that they can share knowledge and collaborate on 

research.

Several of Fogarty’s informatics projects expanded to form 

regional networks, leveraging tools and hard-earned lessons to 

benefit additional developing country researchers. A program in 

Brazil shared its materials with Mozambique, where Portuguese 

is also the national language. Researchers in Peru have built 

a Latin American training network, and a university in South 

Africa formed a consortium to strengthen biomedical informatics 

throughout the region.

The arrival of broadband internet access in Africa and 

other developing countries has made distance learning and 

videoconferencing possible, creating opportunities for new 

collaborative teaching tools and resource sharing, greatly 

expanding the possibilities for research training.

As cellphones became ubiquitous throughout the developing 

world, Fogarty’s grantees have studied ways to deploy them 

for disease surveillance, health program management, patient 

monitoring and global health research. They’ve also developed 

new software and hardware to turn cellphones into microscopes, 

diagnostic devices and training tools.
“Something that’s unique about Fogarty 

is the group learning that goes on among 

its grantees because they convene us 

regularly. It isn’t just ‘here’s money, go 

away,’ it’s ‘here’s money, come and 

share what you’ve learned.’ And in 

my experience, that’s unique—that’s 

something that nobody else does.”

Dr. Bill Tierney

University of Texas at Austin

Fogarty informatics grantee

U

 ntil recently, clinicians and researchers working in sub-Saharan Africa relied 

 on a paper-based system of medical records that was time-consuming and 

 often inaccurate. In 1998, Dr. Bill Tierney, then of Indiana University, and 

his team used a Fogarty informatics grant to begin work on the first electronic 

medical record system in the region, the Mosoriot Medical Record System or MMRS, 

supporting Kenyan clinics. Tierney faced a number of challenges—establishing 

reliable computer service in an area with a meager supply of electricity and training 

local health workers who had little or no experience with computers were just a few.

MMRS, which was developed in Microsoft Access, allowed clinic staff to store data 

electronically and use it in ways they had never imagined. Staff could now identify 

villages where too few children had been vaccinated and take steps to rectify the 

situation. In another case, a rabies cluster was identified and the rabid animal was 

found and exterminated. The new system created efficiencies, too, reducing patient 

visit duration, enabling the clinic to double its patient load with no additional staff.

Tierney later went on to play an instrumental role in the creation of both the AMPATH 

system in Kenya and OpenMRS, a medical record system used in HIV/AIDS clinics 

in Tanzania and Uganda. Drawing on their experiences with MMRS, Tierney and a 

group of collaborators from other institutions chose tools that were freely available 

and open source when designing OpenMRS, guaranteeing that the overall project 

would remain low-cost and easy to update. Since then, OpenMRS has grown beyond 

expectation, having been implemented in more than a dozen other countries on 

three continents.

If it hadn’t been for the initial Fogarty funding, Tierney says the MMRS and its 

successors, AMPATH and OpenMRS, would never have been conceived.

www.fic.nih.gov 39
Constructing a multidisciplinary 

framework for research

An explosion of interest in global health on U.S. college and 

university campuses coincided with the 2005 launch of the Fogarty 

Framework program, designed to encourage multidisciplinary 

approaches required to tackle increasingly complex global health 

problems. Involving more than 30 U.S. and foreign universities, the 

program succeeded beyond all expectations, nudging faculty—who 

might never have crossed the quad to meet one another—to create 

new multidisciplinary curricula and harness previously untapped 

expertise. As a result, anthropologists, engineers, lawyers, business 

students, physicians and communicators all began collaborating on 

public health projects around the world.

“It was meant to be catalytic, and it was,” recalled Fogarty program 

director Dr. Flora Katz. “It was transformative at a time when money 

was coming into the field.”

Recipients call the program indispensable to their universities’ efforts 

to win more money from other sources and to provide students 

clamoring for global health training with foreign research experience.

Johns Hopkins, the oldest and largest U.S. university addressing 

global health issues, used its Framework grant not only to pull 

together faculty from a number of schools and departments on two 

different campuses, but also to develop courses for undergraduates. 

The program, which combined curricula from the schools of 

medicine, nursing and public health, awarded travel grants on

40 Fogarty at 50 
 

a competitive basis, with matching 

funds raised by the university’s 

Center for Global Health. 

When Hopkins received its 

Framework grant, public health 

had become the number one 

major among arts and sciences 

undergraduates. “The timing was 

perfect,” says Center director Dr. 

Thomas C. Quinn. “It’s one of the 

best grant mechanisms that Fogarty 

ever launched for universities,” he 

said.

Framework support allowed the 

University of Virginia to develop 12 

new courses across the campus. One 

of them, “Financing a Sustainable 

Future,” teamed a professor of 

commerce with an infectious disease 

professor who went to Tanzania 

with a group of students from a 

variety of disciplines. They looked 

into establishing a business there for 

the production of HIV testing kits, 

which were prohibitively expensive 

to import. Working closely with 

Tanzanian students, the group 

created a business plan to build a 

factory and formed a foundation to 

raise seed money.

Program co-directors Dr. Rebecca 

Dillingham and Dr. Richard 

Guerrant said the Framework 

program not only advanced global 

health research, it also directly 

benefited individual students and 

faculty.

International collaboration literally 

bore fruit in one case, Dillingham 

recounted. As a result of coursework 

on urban agriculture in foreign 

“I’m an anthropologist, so what’s 

important to me when we train our 

students to get them ready to go 

overseas to do research, or when 

we bring international students 

to North Carolina for training, is 

that they really need the kind of 

interdisciplinary grounding that 

the Fogarty Framework program 

encouraged. Our trainees really 

need to understand the social 

and cultural context of the places 

where they’re going to be doing 

their research.”

Dr. Peggy Bentley

University of North Carolina

Fogarty Framework grantee

www.fic.nih.gov 41
countries, students presented their findings to the city council and 

established a consortium to reduce the costs of locally grown food 

for all residents of Charlottesville, Virginia, where the University’s 

main campus is located.

As for faculty, Guerrant said, “Just applying for the grant 

transformed our institutions. It really caused us to break out of our 

silos for our own good.”

At the University of California, San Diego (UCSD), Framework 

support allowed students the opportunity to get practical experience 

with global health issues, particularly the cross-border spread of 

narcotics and sexually transmitted infections. More significantly, the 

funding helped spur creation of a joint doctoral program between 

UCSD and San Diego State University. “Global health is so popular 

as a field that students heard about it through the grapevine and 

were applying before the ink was even dry on the announcement,” 

the UCSD’s Dr. Steffanie Strathdee said.

Tufts University created a global health concentration in its Master 

of Public Health program, bringing together not only the medical, 

veterinary and engineering schools but also the renowned nutrition 

and diplomacy schools. It quickly became the most popular 

concentration, said program director Dr. Jeffrey K. Griffiths.

Tufts has partnerships with universities in Tanzania, Uganda 

and Kenya and uses an electronic library and other information 

technology to co-develop curricula. “We built capacity to share 

content and share discussion,” said Griffiths. “Faculty had to change 

the way they taught, and students pushed the faculty to start using 

electronic means to get content up on the internet.”

Fostering global health innovations 

In a second phase of the Framework program, Fogarty provided 

funding to generate innovation in health products, processes and 

policies. Multidisciplinary teams identified critical health needs, then 

conducted research to develop and test solutions.

One project is tackling the problem of accurately diagnosing 

malaria in low-resource settings, so that appropriate treatment can 

be provided in a timely manner. A grant to Vanderbilt University 

is enabling a dozen American and Zambian research trainees to 

develop and deploy a new inexpensive, portable test for malaria. The 

scientists previously produced a related low-cost tool that primes 

blood samples for malaria testing, using magnets to attract molecules 

from the malaria parasite. 

42 Fogarty at 50
Harnessing excitement on campus 

Capitalizing on the skyrocketing interest in global 

health on campuses across the U.S., the Consortium of 

Universities for Global Health (CUGH) was established in 

2008. The following year, Fogarty co-hosted the group’s 

inaugural meeting on the NIH campus. The rapidly growing 

Washington, D.C.-based organization now comprises more 

than 145 academic institutions and other organizations from 

around the world. Its annual meeting draws nearly 2,000 

attendees to share 

expertise and form 

collaborations that 

translate knowledge 

into action. 

Another growing problem is the spread of drug-resistant TB, which 

poses a serious threat in confined, crowded spaces such as hospitals, 

clinics, prisons and refugee camps. A Framework grant at Brigham 

and Women’s Hospital in Boston is bringing together architects and 

engineers with infectious disease researchers and others to study new 

ways to slow the spread of TB. 

The work is drawing inspiration from a previous project in Rwanda, 

where the nonprofit MASS Design Group constructed a new hospital 

specifically to minimize airborne TB spread. They located it on the 

top of a hill to maximize natural airflow, incorporated plenty of 

windows for cross-ventilation, changed the ward layout, added large 

fans and installed ultraviolet lights to deactivate TB bacteria.

Promising innovations resulting from the Framework program will 

be studied for effectiveness and 

practicality, with a view to scaling 

up those that have the potential for 

impact.

“Not all of the innovation projects 

will succeed,” Katz acknowledged. 

“But it is our intention that, by 

going through this process, the 

participants will learn to think 

more creatively and gain experience 

bringing different disciplines to bear 

on a single problem.”
Cultivating the next generation 

of global health leaders

Fogarty Scholars and Fellows can be found in rural villages and urban 

capitals throughout the developing world, engaged in research to 

prevent HIV transmission, diagnose and treat heart disease, and study 

the causes of mental illness and other conditions. These motivated 

individuals are students, health scientists, medical doctors, nurses, 

dentists and veterinarians. 

Since 2004, Fogarty has been offering one-year, mentored clinical 

research training overseas to pre-doctoral U.S. students in the health 

professions. In 2007, the program was expanded to include Fellows 

who are post-doctoral scientists already on a global health career path. 

Fogarty began a partnership with the Fulbright Program in 2010 to 

increase fellowship opportunities.

Originally supported by a single private donation, the program now 

receives funding from 17 NIH Institutes, Centers and Offices. There is 

broad recognition of the importance of providing support to bridge the 

gap between doctoral work and a solid career pathway in global health 

research.

The program has provided hundreds of early-career scientists the 

opportunity to participate in mentored research at top-ranked sites 

globally that have active NIH grants and a proven track record of 

scientific productivity. There are patient-oriented activities as well as 

epidemiologic and behavioral studies, operations research and health 

outcomes evaluations.

44 Fogarty at 50 
www.fic.nih.gov 45
Exposure at this point in their careers is critical, said Fogarty 

director Dr. Roger I. Glass. “When young people go overseas to 

work in a low-resource setting, they get hooked on global health 

research. Their enthusiasm is contagious and it’s exciting to see 

leaders emerging from this program.” 

The experience gives participants firsthand exposure to difficult 

issues on the ground, while providing the opportunity to forge 

relationships and scientific collaborations that can boost their career 

trajectory and lead to a lifetime of global health accomplishments.

Over the years, participants have published more than 500 articles 

in peer-reviewed journals and presented findings at numerous 

scientific meetings. Another measure of the program’s success 

is the growing number of alumni whose NIH applications have 

been funded. But perhaps the most meaningful outcome is the 

formation of international scientific collaborations that deepen over 

time and gain significance as today’s Scholars and Fellows become 

tomorrow’s global health leaders.

Accelerating disease diagnoses

As a medical student on a Fogarty Fellowship in Dar es Salaam, Tanzania, 

in 2005, Paul Drain watched AIDS patients die because they couldn’t afford 

needed medicines. After each day’s rounds, Drain would spend hours 

writing in a journal just to keep from feeling totally powerless.

Eight years later, on his second Fogarty-sponsored research experience, 

in South Africa, the drugs were available—at least for HIV patients. But 

keeping patients alive after diagnosis 

still involves hurdles. The focus of his 

work today is developing easy, cheap 

ways around them.

“My group at Harvard has done several 

studies showing that when these 

patients leave the clinic, around 40 

percent never come back,” Drain said. 

Many of those told to return for the HIV 

or TB test results, never do. Drain used 

his two-year Fogarty Fellowship to assess 

point-of-care diagnostics that can shortcircuit such delays.

“Young people are thinking more 

globally than generations before,” 

Drain said. “Fogarty’s funding has 

allowed me and many other people to 

continue doing global work. Without 

their funding, a lot of this wouldn’t be 

possible.”

 
Studying water purity in India 

Dr. Arti Kundu spends her days looking closely at dirty water. Trained in civil and environmental engineering—as well 

as public health—she applies problem-solving techniques to improve water quality and prevent disease around the 

world.

As a Fogarty Fellow, she investigated whether hands and drinking water in an Indian urban community were 

contaminated with E. coli bacteria and had any association with household diarrhea. Each year, diarrheal diseases kill 

about 10 percent of Indian children under the age of five.

“Today’s challenges in global health include providing clean water and enough food for people, and protecting vital 

ecosystems,” Kundu said. “I believe the mammoth task of improving health in developing countries can only be 

achieved through multidisciplinary research.”

Kundu is contributing to that varied approach with her engineering training and specialization in water. She has 

learned techniques for state-of-the-art molecular diagnoses and computer modeling of the physical, chemical and 

biological processes in the environment.

In her study, she discovered that source water from community pumps, municipal taps and commercial tankers 

was generally clean, but more than 65 percent of water in household storage vessels had fecal contamination. 

Additionally, she found a high correlation between gastrointestinal symptoms and the presence of E. coli on family 

members’ hands—especially the mothers’. Kundu shared her study results with affected households and visited local 

schools to teach the importance of handwashing and encourage each child with a gift of soap.

Kundu intends to apply for an NIH career development award to advance her multidisciplinary research. “I want to 

continue to make changes in society, reducing diarrheal diseases,” she said. “You feel very good when you can see 

you’re making an impact on peoples’ lives. I would like to keep doing that.”

www.fic.nih.gov 47
Exploring natural products to 

discover new treatments and cures

Seaweed, mollusks and ants are 

just some of the diverse life forms 

being studied for their potential to 

treat infections, malaria, cancer or 

other diseases. Fogarty has been 

encouraging natural products 

discovery since 1993, when the 

Center helped found the International 

Cooperative Biodiversity Groups 

(ICBG) program in partnership with 

the National Science Foundation. 

In addition to investing in biodiversity exploration for potential 

health applications, the projects also develop research capacity to 

support sustainable use of these resources, conservation knowledge 

and equitable partnerships among U.S. and low- and middleincome country research organizations.

In Fiji, a scientific team found a promising compound to fight 

malaria by studying how marine plants and animals defend 

themselves against infections. Under the project led by the Georgia 

Institute of Technology, scientists collected seaweed and other 

marine species to look for natural antibiotics. They also screened 

compounds from these organisms for biomedical properties and 

discovered that a type of red algae contained compounds called 

bromophycolides, one of which was found to have strong antimalarial properties. Animal studies have begun to determine the 

compound’s effectiveness and suitability as an antimalarial.

Fungal-farming ants are being studied in Brazil in a search for 

potential therapies for a range of conditions. Research teams from 

48 Fogarty at 50
Harvard Medical School and the University of São Paulo are 

investigating symbiotic bacteria that live in specialized anatomical 

features of the ants, called crypts. The bacteria produce small 

molecules that act as antifungal agents, inhibiting invasive 

fungal pathogens but not the crop fungus that the ants rely on for 

nutrition. The researchers hope to identify the antifungal agents to 

develop treatments for invasive fungal diseases that affect humans 

and may be active against blood cancers, and protozoal parasite 

infections like Chagas disease and leishmaniasis.

In the Philippines, mollusks are the subject of a project seeking 

to discover therapies for bacterial infections, cancer, pain and 

other neurological conditions, and parasitic diseases such as 

toxoplasmosis and cryptosporidiosis. A team headed by grantees 

from the University of Utah, in collaboration with the University 

of the Philippines, is studying a variety of mollusks and their 

associated bacteria, which represent an unexplored trove of 

chemical diversity. 

A potent new cancer toxin was discovered in a species of algae 

in Panama’s coastal waters by grantee Dr. William Gerwick, of 

the University of California, San Diego. In addition to possibly 

leading to a new form of chemotherapy, the project is also 

preserving biodiversity resources for the future. Gerwick and 

his partners helped to successfully make the case for the island 

of Coiba—which houses diverse species including some that are 

endangered—to receive protected status as a UNESCO World 

Heritage Site. 

“There is a very keen 

sense that we are 

doing something 

great in science 

but doing more 

than just science,” 

said Gerwick. “We 

are builders, not 

destroyers. We are 

attaching value to 

these life forms.”
Making implementation 

science a priority

An enduring challenge in global health is discovering how best 

to quickly adapt and implement research advances so they work 

effectively in low-resource settings. Implementation science—

research to translate evidence-based findings into common practice—

is a Fogarty priority and has been supported in projects across its 

portfolio of research and training programs. Sometimes referred 

to as the “know-do gap,” implementation science is the difference 

between what is known to work and what is done in practice.

Cultural practices—such as the tradition 

of early marriage for Nigerian girls—pose 

significant barriers to implementing 

programs that would improve maternal 

health. It’s not uncommon for rural Nigerian 

women to deliver an infant without medical 

care. Complications, such as hemorrhaging, 

can prove fatal before the woman can reach 

a hospital. In northern Nigeria, there are 

as many as 1,000 deaths for every 100,000 

births.

To address this tragedy, Fogarty grantees Drs. Daniel Perlman 

and Malcolm Potts and their colleagues at the University 

of California, Berkeley, studied how best to implement a 

maternal health research program in partnership with their 

Nigerian counterparts at Ahmadu Bello University. As a first 

step, they introduced community-based use of misoprostol, 

a drug proven to safely prevent post-partum bleeding during 

Studying ways to prevent maternal deaths in Nigeria

home births in other parts of Africa. They also determined 

that lack of electricity in remote areas seriously impaired 

the ability of hospitals to deliver care, leading to the 

development of solar energy systems that now power blood 

bank refrigerators, ultrasound machines, communications 

equipment and lights in operating rooms.

The research project also led to a partnership with village 

parent-teacher associations, schools and religious groups, 

with the goal of promoting the education of girls and 

increasing the age of marriage. One of the researchers 

discovered that many parents are open to the possibility of 

leaving their daughters in school and delaying matrimony 

when offered assistance with school fees, books and related 

expenses.

“Our research showed that school attendance could provide 

teenage girls with a socially acceptable alternative to early 

marriage,” said Perlman. 

50 Fogarty at 50
Research on implementation 

identifies barriers to proven 

interventions and facilitates 

the creation of local strategies 

to overcome them. Bottlenecks 

may include cultural, behavioral, 

economic or management factors. 

Often a collaborative process 

involving experts from a 

wide range of disciplines, 

implementation research in the 

global health field has helped 

clinicians to identify and solve 

problems more quickly, while 

improving the performance of 

programs using scientifically 

valid methods. It has also 

allowed program managers 

and policymakers to come to 

decisions based on evidence 

instead of assumptions, and 

has even helped managers and 

staff at health facilities better 

understand how their own 

programs work.

“Effective program 

implementation must be 

multidisciplinary,” said Fogarty 

Director Dr. Roger I. Glass. “We 

need to think with an open mind 

how to make programs work 

more effectively. In every realm 

of interventions, we have lots of 

knowledge that isn’t applied.” 

Researchers tackle fetal alcohol 

syndrome in Russia 

High alcohol 

consumption—

common in Russia—

is another barrier 

to implementing 

research findings 

that would improve 

health. Alcohol 

use poses an 

alarmingly high risk 

for pregnancies, 

and fetal alcohol 

spectrum disorders are common in Russia. The leading cause of 

preventable mental retardation in the world, fetal alcohol syndrome 

can cause abnormal facial features, growth problems, difficulties 

with memory or learning, vision or hearing deficiencies and 

behavioral issues.

The first step for Fogarty grantee Dr. Tatiana Balachova, of the 

University of Oklahoma, was to assess the scale of the problem. 

“Alcohol consumption is widespread in Russia,” said Balachova. “It 

is a social norm and a part of everyday functioning that affects the 

society in many ways.”

In a survey, she and her team 

found more than half of nonpregnant women reported 

inconsistent birth control 

practices, with more than 70 

percent of them admitting binge 

drinking. Even among women 

trying to conceive, 66 percent 

reported binge drinking.

Balachova and her colleagues used the information to create 

educational materials and online training programs for medical 

personnel and the general public. Her hope is interventions will 

ultimately be delivered routinely to large numbers of women in 

obstetrics clinics across Russia.

She faced cultural and institutional obstacles to implementing 

the programs, such as misconceptions that harm is only caused if 

parents are intoxicated at conception and the idea that “normal” 

women don’t drink and are not at risk. “There is a major lack of 

knowledge,” Balachova said. “We need to base our interventions 

on assessments, not assumptions.” 

Signs of fetal alcohol syndrome

www.fic.nih.gov 51

Training to meet the needs 

of the shifting disease burden

Growing urbanization, increasingly sedentary lifestyles, 

consumption of fast food and other factors mean people in 

developing countries are now facing many of the same health 

challenges as Americans. Successful programs have slowed 

deaths from AIDS, TB and malaria, but now populations are 

living long enough to develop diabetes, heart disease, dementia 

and other chronic, noncommunicable diseases (NCDs). Indeed, 

80 percent of the world’s NCD-related deaths now occur in 

developing nations, with the toll rising quickly.

Fogarty views NCD research and training as key priorities and 

has created a number of grant programs to support research 

and help develop the necessary skill set for NCD studies. 

Confronting the global chronic disease 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 diverse settings in response to 

local needs and research priorities. Given the burden of NCDs 

in the U.S. and other high-income countries as well as LMICs, 

this research is ripe for knowledge exchange, collaboration and 

team science. 

Determining “best buys” in global health

To shed light on the complexities 

of infectious diseases and 

NCDs, Fogarty helped lead 

an effort that resulted in a 

landmark set of studies, known 

as the Disease Control Priorities 

Project 2. Published in 2006, 

the encyclopedic volumes 

quantified the global burden 

of disease by geographic region, assessed epidemiologic 

and demographic trends and projections, and computed 

the cost-effectiveness of interventions to manage, control 

and prevent those diseases. “Best buys” in health were 

calculated by a comprehensive set of cost-effectiveness 

analyses addressing more than 300 conditions for which 

proven personal and community-based interventions 

were available.

Fogarty was secretariat for the project, an alliance that 

included the World Bank, World Health Organization, 

and the Population Reference Bureau, with funding from 

the Bill & Melinda Gates Foundation. The project, today 

managed by the University of Washington, has continued 

to release new data.

www.fic.nih.gov 53
“With its mission to uplift science 

internationally, Fogarty is hugely 

important and has really had an 

impact on global health. Researchers 

in low- to middle-income countries 

struggle to secure funding to move 

forward in their careers, and often 

couldn’t do it without Fogarty.”

Dr. Michèle Ramsay

University of Witwatersrand

Fogarty is also studying how 

to leverage its long-standing 

investments in research and 

training on HIV/AIDS to now 

tackle NCDs, and address the 

interrelationships between 

infectious diseases and NCDs. 

For example, as access to 

antiretroviral therapy has 

increased and HIV-infected 

individuals are living longer, 

a new research agenda has 

emerged around HIV and 

NCD comorbidities. This 

includes epidemiological 

studies regarding the 

incidence and prevalence of 

comorbidities, the potential 

effects of antiretroviral 

therapy on pathogenesis, costeffective ways to integrate 

HIV and NCD services that 

improve health outcomes, and 

prevention of NCDs in the 

HIV-positive population.

Global Burden of Disease Study

Both sexes, All ages, DALYs per 100,000

1 Cardiovascular diseases

2 Diarrhea/LRI/other

3 Neoplasms

4 Neonatal disorders

5 Other noncommunicable

6 Mental & substance use

7 Musculoskeletal disorders

8 Diabetes/urog/blood/endo

9 Unintentional injuries

10 HIV/AIDS & tuberculosis

11 Chronic respiratory

12 Neurological disorders

13 NTDs & malaria

14 Nutritional deficiencies

15 Transport injuries

2015 rank

Communicable, maternal, neonatal, and nutritional diseases

1990 rank

Injuries

Institute for Health Metrics and Evaluation (IHME). GBD Compare Data 

Visualization. Seattle, WA: IHME, University of Washington, 2017. 

Available from http://vizhub.healthdata.org/gbd-compare (Accessed 3/17)

54 Fogarty at 50

1 Diarrhea/LRI/other

2 Neonatal disorders

3 Cardiovascular diseases

4 Other noncommunicable

5 Neoplasms

6 Unintentional injuries

7 Mental & substance use

8 NTDs & malaria

9 Chronic respiratory

10 Nutritional deficiencies

11 Diabetes/urog/blood/endo

12 Musculoskeletal disorders

13 HIV/AIDS & tuberculosis

14 Transport injuries

15 Neurological disorders

Non-communicable diseases
Training the next 

generation of 

scientists in NCDs 

During a Fogarty Fellowship in Kenya in 

2009, 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 

at Duke University, Bloomfield currently 

researches the epidemiology of heart failure 

and cardiovascular risk factors in subSaharan Africa. He also works closely with the 

National Heart, Lung and Blood Institute’s 

Cardiovascular and Pulmonary Disease Center 

of Excellence at Moi University, located in 

Eldoret, Kenya, where he spends six months a 

year studying heart failure epidemiology, the 

cardiovascular effects of indoor air pollution 

and cardiovascular risk factors among HIVpositive patients. By demonstrating the burden 

of chronic, noncommunicable disease through 

epidemiology, Bloomfield hopes to use 

research evidence to influence policy change.

“There is no substitute for experience. 

While many trainees have ample 

passion and interest, the opportunity 

to directly experience the day-to-day 

of global health clinical research for 

one year is uncommon. Thanks to the 

Fogarty Fellows program, I have been 

able to add knowledge and experience 

to the passion I have for cardiovascular 

global health.”

Dr. Gerald Bloomfield

Fogarty Fellow in Kenya

Uniting to fight NCDs

To focus attention and funding on chronic, noncommunicable diseases, 

the world’s major funding agencies have banded together to form the 

Global Alliance for Chronic Diseases (GACD). Fogarty helped start the 

partnership, which began in 2007 with four founding members and has 

grown to include the European Commission and research funding bodies 

in Argentina, Australia, Brazil, Canada, China, India, Japan, Mexico, 

South Africa, Thailand, the U.K. and the U.S. The GACD was established to 

facilitate collaborative funding activities for innovative, original research 

directed at the prevention and treatment of chronic diseases. In the first 

few years of its existence, GACD members invested more than $100 

million in joint research on hypertension, diabetes and lung disease.

www.fic.nih.gov 55
Including brain disorders 

in the global health research agenda

The breadth and complexity of brain disorders make them some 

of the most difficult conditions to diagnose and treat, especially in 

the developing world, where there may only be one psychiatrist or 

neurologist in an entire country. These disorders occur throughout 

the lifespan—from infants starved of oxygen during difficult births, 

to children whose development is stunted due to malnutrition or 

exposure to infections or toxins, to adults who develop depression 

or dementia. Such mental and behavioral issues cause the world’s 

largest burden of disability, according to the Institute for Health 

Metrics and Evaluation.

That’s why Fogarty launched an initiative in 2003, called Brain 

Disorders in the Developing World: Research Across the Lifespan 

Program, managed by Dr. Kathy Michels. The goal was to catalyze 

this field of research and develop badly needed expertise in lowand middle-income countries (LMICs). Since it began, more than 

150 grants have been awarded, generating nearly 500 peer-reviewed 

articles and facilitating training of at least 150 scientists.

“Many people in developing countries suffer from conditions that 

affect their brains and devastate their lives, but we don’t have 

much data documenting the underlying causes of the disorders and 

interventions that might be effective,” said Fogarty Director Dr. Roger 

I. Glass. “By supporting research and training in countries where 

resources are limited, we hope to generate research capacity that 

could ultimately improve the lives of those suffering from the burden 

of these neurologic diseases.”

56 Fogarty at 50
Colombian family may hold clue to Alzheimer’s cure

Dr. Francisco Lopera was 

a resident in neurology 

when the first patient 

with dementia walked 

into the San Vicente 

de Paul hospital in 

Medellin, Colombia 

in 1984. “He was 47 

years old and he had 

completely lost his memory over the past three or four years,” 

Lopera recalled. “What was truly remarkable was, exactly the 

same thing had happened to his father and grandfather at the 

same age.”

Over the next several years Lopera visited the man’s family, 

where he identified several other cases with the same complex 

set of symptoms. He eventually found more patients in nine 

other mountain villages, as well as in Medellin itself. The 

families even had a name for the ailment: la bobera, “the 

idiocy.” Nearly all of the cases of this heritable variant of earlyonset Alzheimer’s disease share a common ancestor. He was 

a 16th-century Spanish colonist who carried a particularly 

devastating genetic mutation to Antioquia province, where 

it spread through isolated villages. To date, Lopera and his 

colleagues have identified 5,000 patients in 25 families with 

the mutation.

In 1991, after Lopera, chief of the neurosciences program at 

the University of Antioquia, published a case study of this 

“founder” cohort, Dr. Kenneth Kosik of University of California, 

Santa Barbara got in contact. They began a collaboration that, 

with assistance from Fogarty’s brain disorders program, has 

turned what Kosik calls the “natural laboratory” of Antioquia 

into a leading center for the study of Alzheimer’s disease.

The Lopera-Kosik collaboration, funded by Fogarty and the 

National Institute on Aging beginning in 2004, has taken on 

added significance in the last few years because of the unique 

characteristics of the Antioquia population, by far the world’s 

largest occurrence of early-onset familial Alzheimer’s.

Most Alzheimer’s researchers believe that beta-amyloid protein 

accumulations in the brain cause the disease. But trials of 

drugs designed to attack amyloid in sick patients have in 

recent years failed to slow or reverse its symptoms. Lopera, 

a co-director of the Colombian trial, is hopeful that these 

same drugs might be more successful if given to patients 

before they develop disease symptoms, by preventing the 

accumulation of the dangerous protein.

The Antioquia cohort presents a unique opportunity to study 

this hypothesis, because the carriers of the presenilin-1 

mutation always develop early-onset disease. No such large, 

asymptomatic-yet-doomed group of Alzheimer’s patients 

exists anywhere else in the world.

Kosik attributes much of what has been accomplished in 

Antioquia to Lopera’s “tireless work” doing science, building 

relations and providing social services to affected families. 

“He will spend hours and days and weeks going from village 

to village to collect stories and histories, do neurological 

exams and make all this happen,” says Kosik, who also praises 

Fogarty’s role.

“Fogarty has made an enormous contribution,” he says,

because by strengthening local capacity it enabled a powerful 

platform for collaboration between foreign and local scientists.

“I can’t emphasize how much that is the key to success of 

this project. We are not just going down there, taking genes, 

publishing papers and ignoring the people,” Kosik said. 

“The Colombian researchers are not just collecting samples, 

they are thinking and designing experiments at the same 

level as we are.”

www.fic.nih.gov 57
Disease and malnutrition hamper 

intellectual development 

During the past several decades, global improvements in health care 

have permitted more children to survive to adulthood, even as they 

bear the lasting effects of early disease and malnutrition. These can 

Before testing their intervention, scientists gathered pilot 

data about the prevalence of cysticercosis, measuring 

antibodies in the blood of pigs and humans in three villages. 

Concentrations were highest in villages where pigs roamed 

freely and lowest in predominantly Muslim areas where pig 

farming was negligible.

The research team’s main goal was to lock up the pigs. 

“Initially, we thought we’d focus on better pig management,” 

Carabin said. “But when we talked to people, they said, ‘well, 

this is all nice and good keeping pigs in pens, but there is 

nothing to feed them. We can barely feed ourselves. They 

need to find their own food.’”

The team produced educational materials conveying the 

importance of personal hygiene, cooking pork meat well, 

keeping pigs in pens and restricting animal access to human 

feces. Preliminary results confirm a very high prevalence of 

larval infection in pigs; human data are still being analyzed. 

Carabin, hopes the intervention successfully changes 

personal and village hygiene practices, lowers infection rates 

and ultimately is extended throughout Burkina Faso.

Education may curb epilepsy linked to pig parasite 

Three-quarters of people with epilepsy live in the developing 

world and a major cause is a tapeworm infection transmitted 

between humans and pigs—known as cysticercosis. Inside 

humans, the larvae can reach the brain and trigger severe 

headaches, stroke, hydrocephalus or epilepsy, which occurs 

in up to 70 percent of those 

infected.

Researchers investigated the 

problem in Burkina Faso, with 

support from Fogarty’s brain 

disorders program and led by Dr. 

Hélène Carabin of the University 

of Oklahoma.

“Epilepsy is attributed to evil 

spirits,” Carabin said. “People 

with it cannot marry or work or share utensils with the family. 

Often, the family will build them a little hut, not too close. 

If they believed it is from a natural cause, then modern 

medicine would be sought, but if blamed on evil spirits, then 

they seek out spirit doctors.”
“I think Fogarty is the bridge to 

global health. It was for me in 

my career, taking me from Johns 

Hopkins out into the world, out into 

Asia, giving me the opportunity to 

start my career here. I continue 

to benefit from the relationships I 

formed then. I’m incredibly grateful.”

Dr. Brian Hall

University of Macau

Fogarty Fellow

include lower cognitive ability and the development of 

chronic neurodegenerative disorders. Developmental 

disabilities have many causes, from genetic anomalies to 

poor nutrition, infectious diseases, environmental toxins and 

trauma. Some of these are particularly common in resourcepoor countries. At the same time, very little data exist in 

developing countries on the epidemiology, natural history 

and pathogenesis of neurological problems and there is a 

severe lack of care available for them. Fogarty’s initiative 

specifically aims to support teams of researchers from both 

low- and high-resource institutions as they study brain 

disorders relevant to developing countries that occur at any 

stage of life. The projects are intended to provide scientific 

evidence and also help build the skills needed to research the 

nervous system and what can undermine it.

One grantee who collaborates with researchers on different 

continents is Dr. Richard Guerrant at the University of 

Virginia. His projects in Brazil and South Africa have 

shown how child malnutrition impairs cognition and 

can be prevented by low-cost interventions such as zinc 

supplementation and reducing the incidence of diarrhea. 

This type of research evidence, Guerrant noted, is essential 

for “driving future policy decisions.”

Cognitively 

Health Person

Person 

with AD

www.fic.nih.gov 59
Cassava root causes cognitive 

damage in Congolese villages 

In impoverished 

regions of subSaharan Africa, 

some villagers 

need sticks to 

walk because 

of neurological 

damage from 

the very food 

that keeps them 

from starvation—

cassava. Toxins in 

the tuber can cause sudden and irreversible paralysis and, 

researchers have learned, also undermine cognitive ability 

even without overt physical symptoms.

This problem has widespread public health implications 

because cassava, also known as yucca, manioc and tapioca, is a 

dietary staple for more than 600 million people globally. The 

cyanide it contains as a chemical defense against herbivores 

and insects is normally removed by processing through 

soaking, peeling and drying, but in stressed conditions 

such as drought, famine and armed conflict, people may eat 

partially processed cassava and risk neurological damage.

The one country with the highest prevalence of this paralysis 

is the Democratic Republic of Congo, where the condition is 

known as konzo and can affect up to 5 percent of people in 

some villages. A research team supported by Fogarty’s brain 

program decided to investigate the extent of neurological 

damage from cassava as a first step toward finding 

interventions to reduce it.

The scientists enrolled preteens from villages with and 

without konzo and gave them standard cognitive and motor 

proficiency tests. All children in konzo-harboring villages—

even without physical symptoms—showed poorer memory 

than children from konzo-free villages. Those in konzo villages 

additionally lagged in visual-spatial aptitude and in mental 

processing. These results suggest that even without physical 

manifestations from cassava toxins, some children suffer 

damage and the overall burden of cassava-related brain 

impact may have been underestimated. The team is also 

working on a biomarker to predict deficits in konzo patients 

and is investigating whether genetic susceptibility or dietary 

patterns can explain the spate of cases within families.

Fogarty’s brain program covers 

conditions that strike at all 

ages, including adult onset 

neurodegenerative disorders 

and dementias. National 

Institute on Aging (NIA) 

Director Dr. Richard Hodes 

noted about 15 percent of the 

world’s population will be over 

65 in a few years.

“The challenges are going to 

be absolutely enormous, in 

particular those posed by agerelated diseases,” Hodes said. 

To maximize progress, he urged 

researchers to share their data 

widely and in interoperable 

forms.

One new arena for brain 

researchers is HIV/AIDS, where 

antiretrovirals have dramatically 

extended patients’ lives but little 

is known about the long-term 

neurological impact of either 

the virus or the drugs. Fogarty 

brain program projects include 

studies of cognition in children 

exposed to HIV at birth, and the 

link between HIV and cerebral 

malaria.

Researchers seeking low-cost 

interventions in developing 

countries have produced novel, 

inexpensive approaches relevant 

for developed countries as well. 

Dr. Benjamin Warf, a Fogarty 

grantee, in earlier research in 

Uganda devised a minimally 

invasive procedure for treating 

hydrocephalus. Now in use in 

60 Fogarty at 50 
 

the U.S., this procedure has greatly reduced the number of 

patients receiving brain shunts, which carry a higher risk of 

infection.

In another example of two-way benefit, a study in Latin 

America compared treatment of traumatic brain injury using 

the expensive high-tech equipment common in the U.S. 

with its own practice of clinician monitoring, and found no 

difference in patient outcome. “It has caused us to rethink our 

care and ask what really, truly is important,” said Dr. Randall 

Chesnut of the University of Washington. “By corroborating 

across borders, we can come to a better understanding of what 

we do.”

The grants also expand research capacity. Chesnut’s project, 

for example, involves 13 intensive care units in Latin America 

where many former trainees are conducting their own research 

and training programs. With Fogarty brain program awards, 

“you’re making researchers as you’re doing research,” he said. 

“It’s a bit like building the bridge as you’re driving across it. 

We need to integrate the idea that research is not what you 

read in a journal, it’s what you do in the educational process 

and in the machinery of medicine.”
Protecting the 

environment 

and ensuring 

worker safety

Pesticides contaminate 

drinking water supplies, 

air pollution causes asthma 

and lung diseases, and 

unregulated mining harms 

workers and produces toxic 

runoff. These are everyday 

occurrences in much of the 

world and cause untold 

harm to human health. To 

help address them, Fogarty 

has been supporting research and training in environmental and 

occupational health issues since 1995.

Fogarty began by making grants to individual institutions, supporting 

activities in more than 30 countries to improve work safety and protect 

the environment. Through the International Training and Research in 

Environmental and Occupational Health (ITREOH) program, grants 

funded training for hundreds of scientists, clinicians, epidemiologists, 

toxicologists, engineers, industrial hygienists, chemists and allied 

health workers from developing countries and emerging democracies.

With a critical mass of expertise in place, in 2012 Fogarty launched 

a new program to develop regional hubs so that scientists can 

collaborate, share findings and leverage resources. Partners include the 

National Cancer Institute and the National Institute of Environmental 

Health Sciences at NIH, and the National Institute for Occupational 

Safety and Health at the CDC, the International Development Research 

Centre in Canada, and the Global Alliance for Clean Cookstoves. This 

initiative is developing regional hubs so that scientists can collaborate, 

share findings and leverage resources. Seven GEOHealth Hubs are 

being funded to strengthen research collaborations, accelerate scientific 

infrastructure development, enhance research training and curricula, 

support research, and inform nationally relevant policies.

Neurotoxins related to mining and agriculture and their impact on 

62 Fogarty at 50
Simply preparing the family meal poses a deadly health 

hazard in much of the developing world. Household 

cooking and heating fires contribute to almost 2 million 

deaths annually, with women and children most affected 

by breathing in toxic smoke for hours a day.

Fogarty has been leading NIH efforts and participating 

in interagency partnerships to help solve the problem. 

It’s surprisingly complicated, with numerous devices 

being developed that use a variety of fuels, but with little 

evidence they actually improve air quality or benefit 

health. The NIH has joined the Global Alliance for Clean 

Cookstoves as it works to make safer solutions available, 

and is funding a large multi-country trial to see if stoves 

that run on liquefied petroleum gas improve air quality 

sufficiently to provide measurable health benefits.

In addition, Fogarty has organized several indoor air pollution workshops to examine the latest research and train scientists 

in various aspects of the issues involved, including how to accurately measure stove emissions.

Making cooking safer with cleaner burning stoves 

maternal and child health throughout the Caribbean are being 

examined from a hub based in Suriname. Meanwhile, scientists 

at a center in Thailand are investigating pesticides commonly 

used in agriculture across Southeast Asia, to see if they act 

as endocrine disrupters, which increase the risk of metabolic 

syndrome and associated diseases such as diabetes, stroke and 

heart disease.

A collaboration in India is focusing on air pollution and 

developing the scientific expertise to study the unique 

characteristics of exposures in that country, while a center in 

Bangladesh is addressing household air pollution, climate 

change and hazards in the the garment worker industry. A 

partnership based in Peru is working with the neighboring 

countries of Ecuador, Bolivia and Chile to build regional 

scientific capacity and support research on air pollution and 

climate change. 

A hub based in Ethiopia is developing spokes in Kenya, 

Rwanda and Uganda to study air pollution, climate change and 

occupational health related to temperature. Finally, a center 

in Ghana is leading research and training in West Africa to 

address health threats from electronic waste, gold mining and 

transportation-related ambient air pollution. 

www.fic.nih.gov 63
Reducing death and disability 

from trauma and injury

Traffic accidents, drownings, 

agricultural injuries, burns, falls, 

poisonings and other types of 

injuries together claim more than 

5 million lives each year. Yet, 

there is little relevant research or 

scientific expertise in developing 

countries where 90 percent of 

these fatalities occur.

In 2005, Fogarty began a 

trauma and injury research 

training program that funded more than a dozen projects in six 

world regions. In addition to spurring discoveries that resulted in 

over 100 publications, about 300 individuals received long-term 

training. The program fills a gap in low-resource settings where 

life poses hazardous situations on a daily basis. For example, 

pedestrians on unsafe, overcrowded and badly maintained roads 

are at greater risk of being hit by cars, buses or other vehicles. 

People living in poorly constructed homes without safety devices 

are more susceptible to burns and falls. In addition, many countries 

have inadequate health care and lack infrastructure such as paved 

roads and emergency response systems.

A number of the Fogarty projects involve road safety, such as 

one in Egypt, led by Dr. Jon Mark Hirshon of the University of 

Maryland, Baltimore. Hirshon has trained hundreds of health 

professionals across the Middle East region in initial evaluation 

and management of trauma patients, and injury epidemiology. His 

work guiding assessment of injury-related death and disability in 

Cairo is helping public health officials plan and implement

64 Fogarty at 50
appropriate and 

cost-effective 

prevention 

strategies. Issues 

include the time it 

takes for the injured 

to reach hospitals, the ability of 

emergency personnel to triage 

injuries, as well as populations with 

an ingrained belief in fate. 

Despite expressing little faith that 

injuries can be prevented and a high 

reliance on fate, surveys revealed 

that young, educated Egyptians are 

ready for, and would benefit from, 

injury prevention programs, Hirshon 

has discovered. “As in much of the 

Middle East,” he said, “there is work 

underway in Egypt to create a shift 

in thinking of accidents as random 

and unavoidable to preventable, 

predictable and avoidable.”

Another global cause of deaths and 

disfiguring injuries is agricultural 

work, which leaves farmers with 

everything from back pain to deep 

cuts, contusions, broken and even 

lost limbs, especially as heavy 

machinery is replacing hand tools. In 

China, a Fogarty project supported 

training for nearly 100 researchers 

who studied various risk factors 

for agricultural injuries related to 

alcohol consumption, sleep patterns, 

pesticide exposure and others. The 

need is great—a study in rural 

China found that more than 590,000 

farmers die from injuries every 

year and 3.5 million workers are 

permanently disabled.

“Fogarty’s been great to 

me. I met so many people at 

orientation who introduced 

me to the next person and the 

next person. The opportunity 

to be involved, to be invited 

into this community has been 

amazing. I appreciate the 

chance that Fogarty has given 

me to develop my own skill 

set and help turn my passion 

for global health research into 

a career.

”

Dr. Cameron E. Gaskill

Surgical resident, 

University of Washington

Fogarty Fellow

www.fic.nih.gov 65
Lowering tobacco consumption 

through research

Global efforts to curb smoking 

and secondhand exposure have 

increased, but so has the problem, 

with one person dying every 

six seconds because of tobacco 

use, according to WHO data. 

Alarmingly, new usage patterns 

are emerging, with women, young 

people and developing country 

populations taking up smoking at 

increasing rates.

With tobacco use rising fastest in low- and middle-income countries 

(LMICs) that are least-equipped to tackle the associated health 

burdens from cancer and cardiovascular conditions, Fogarty 

established a new program to target the problem in 2002. The 

initiative has two distinct approaches—supporting observational 

intervention and policy research, as well as building capacity 

in fields such as epidemiology, behavior, prevention, treatment, 

implementation science and health services. Like many Fogarty 

programs, it encourages partnerships between LMIC and U.S. 

scientists, and emphasizes training and capacity building—the 

foundations of a robust research infrastructure.

“Our support has helped generate tobacco research capacity in 

many countries that had minimal or no quality data,” said Fogarty 

Director Dr. Roger I. Glass. “Establishing reliable epidemiological 

information is essential if countries are to develop a tobacco control 

program that will be cost-effective and have an impact on their atrisk populations.” 

66 Fogarty at 50
In its first decade of investments, Fogarty supported 

collaborations among investigators in more than 30 countries, 

trained at least 3,500 individuals and contributed to the 

publication of over 415 scientific papers. A number of program 

participants have reached leadership positions in their home 

countries, facilitating communication between researchers and 

policymakers and broadening recognition of the health burden 

from tobacco use. In Cambodia, for example, one grantee 

became an in-country WHO tobacco control representative 

and, in Laos, another became a finance ministry coordinator of 

the Southeast Asian Initiative on Tobacco Tax.

Projects have covered a wide range of topics, including 

study of behavioral, susceptibility and risk interventions. 

For instance, they counseled pregnant women in Argentina 

to avoid smoking, and successfully advocated for an indoor 

smoking ban in China. Other common topics have involved 

epidemiology and policy research, such as generating data on 

tobacco and cancer in Kenya. A few projects have examined 

economics, including strategies tobacco companies are 

using to promote products in Africa. One grant supported 

the world’s first research demonstrating the dangers of 

consuming tobacco via waterpipes or hookahs. The findings 

are important for the U.S., where youth have increasingly 

adopted the practice with the mistaken belief it is a “cleaner” 

way to smoke.

www.fic.nih.gov 69

Transforming African medical education

Medical education in sub-Saharan 

Africa is being revitalized and 

expanded through a U.S.-funded 

effort that is dramatically increasing 

enrollment, broadening curricula, 

upgrading internet access and 

incorporating cutting-edge skills 

training labs and other technologies. 

Begun in 2010 with direct awards to 

African institutions in 12 countries, the 

Medical Education Partnership Initiative (MEPI) has empowered 

grantees to take ownership and responsibility to develop lasting 

resources that will improve the region’s health care for decades 

to come. MEPI institutions have formed partnerships with other 

medical schools in their own countries, as well as with other MEPI 

grantees, creating a network that now includes representatives from 

some 40 member institutions, a quarter of sub-Saharan Africa’s 

medical schools. Deans, faculty and other policymakers traveled 

frequently among sites to learn about successful programs they 

might also adopt and to relay their own experiences. Through these 

collaborations, they are leveraging resources and expertise so all can 

benefit from the lessons learned.

Funded by the President’s Emergency Plan for AIDS Relief 

(PEPFAR) and NIH, MEPI is co-administered by Fogarty and the 

Health Resources and Services Administration. More than $165 

million has been invested, creating a movement and building a 

network of African health leaders. A new program, the HealthProfessional Education Partnership Initiative (HEPI), will leverage 

achievements and lessons learned from MEPI with an additional $37 

million in funding over five years.
The critical shortage of 

physicians, researchers and 

health care workers across subSaharan Africa spurred MEPI’s 

creation. While the region suffers 

25 percent of the global burden 

of disease, it has only 3 percent of 

the world’s health care workers, 

according to the World Health 

Organization. While serving as 

U.S. Global AIDS Coordinator 

with oversight of PEPFAR, Ambassador Eric Goosby was a strong 

proponent of the program and allocated much of the funding for 

MEPI’s first phase.

Brain drain still takes a devastating toll on Africa’s medical 

workforce, so MEPI funds supported research grants for faculty 

as both an enticement for them to remain in-country and also 

to ensure health care quality continues to improve as science 

evolves. That investment is already paying dividends. MEPI 

institutions currently receive support from about 150 NIH grants, 

double the level when the program began, reflecting their growing 

research capacity and ability to handle ethical review, manage 

financial programs, and compete in grant writing.

MEPI also expanded the subject matter included in curricula 

beyond infectious disease topics to include emergency medicine, 

mental health, surgery, cardiology, cancer, and maternal and child 

health. Developing expertise in these areas is critical to addressing 

current health challenges, as well as the rising tide of chronic 

illness sweeping the continent.

Another dramatic shift in MEPI institutions has been the adoption 

of information communication technologies (ICT) to enhance 

teaching methods and greatly improve students’ access to 

electronic education materials and current journal articles. Some 

MEPI sites are supplying students and faculty with personal 

tablet computers loaded with medical books, national health 

guidelines and other valuable resources. Many are also deploying 

ICT to bring video recorded lectures, interactive procedure 

BEFORE MEPI

AFTER MEPI
demonstrations and other e-learning materials to rural training 

sites. Because the need for health care workers is greatest outside 

urban areas, MEPI schools 

posted faculty and students 

at these remote locations 

to give them experience in 

community-based health 

care and offer local trainees 

quality mentorship. 

In order to ensure the 

program’s sustainability, 

participants were required 

to work in partnership 

with national education 

and finance ministers to 

encourage support and 

to align their goals with 

national health priorities.

There is growing interaction 

between MEPI and another major NIH initiative in Africa, 

intended to build expertise in genomics studies and support 

biorepositories and additional scientific infrastructure. The 

Human Heredity and Health in Africa (H3Africa) program, 

launched by NIH and the Wellcome Trust in 2010, has invested 

more than $70 million so far.

Both H3Africa and MEPI were cultivated by the NIH Common 

Fund, the crosscutting NIH program intended to catalyze highimpact ventures that are broadly relevant to improving health. 

The expanding network of African researchers involved in the 

endeavors includes a number of alumni of Fogarty’s research 

training programs.

“We are increasingly seeing synergies build in African research, 

as targeted training programs supported by Fogarty and other 

funders produce a cadre of scientists with excellent skills and 

knowledge who can then contribute to cutting-edge research 

across Africa,” according to Fogarty Director Dr. Roger I. Glass.

www.fic.nih.gov 71

Modeling disease trends

and predicting spread of outbreaks

To help guide policy decisions and disease outbreak responses, 

in 2000 Fogarty began building an in-house team of scientists 

to conduct research in the epidemiology and mathematical 

modeling of infectious diseases. Primary concentrations include 

cross-national studies of epidemiological patterns with special 

emphasis on influenza-associated disease, malaria and other 

vector-borne and vaccine-preventable diseases. Research 

outcomes have helped prompt changes in public health policies 

and practices to decrease disease burdens.

Leading an international collaboration to study flu 

One of the group’s first activities was to establish the MISMS 

project, originally called the Multinational Influenza Seasonal 

Mortality Study. Its aim is to advance understanding of flu virus 

transmission, vaccination practices, disease burden and evolution 

on a global scale through multinational collaborations.

The group’s research findings have had significant policy 

implications. Assessments of the low effectiveness of vaccines 

among elderly populations have led to new strategies to optimize 

protection for vulnerable populations and decrease transmission. 

During the 2009 H1N1 influenza pandemic, MISMS scientists 

www.fic.nih.gov 73
were at the forefront, publishing 

key studies of the evolution of the 

virus in pigs, and research on the 

impact of the international trade 

of live swine on the spread of 

viruses. Other studies examined 

the role of tropical climates in 

the evolution and persistence of 

influenza viruses globally.

Investigating how malnutrition 

and disease impact child 

development

One in five children in developing countries experiences 

malnutrition, which is linked to 

physical and cognitive impairment and greater risk of early 

death. Many children undergo repeated bouts of diarrheal 

disease, but the role this plays in their development is not 

well understood. To investigate these and other related issues, 

an international network of scientists, led by Fogarty and 

the Foundation for the NIH, was formed in 2009 to conduct 

an unprecedented study of early childhood health in eight 

countries on three continents.

Scientists hypothesize that childhood gut 

infections cause intestinal dysfunction that 

negatively impacts nutrient absorption, leading 

to stunted growth and cognitive deficits. 

They also suspect that repeated infections, 

combined with malnutrition, can undermine 

the effectiveness of vaccines. The $45 million 

project, Etiology, Risk Factors and Interactions 

of Enteric Infections and Malnutrition and the 

Consequences for Child Health (MAL-ED), is 

funded by the Bill & Melinda Gates Foundation. 
“Modeling is a very cost-effective 

way of thinking about how to 

control an outbreak. It helps 

us to summarize our biological 

understanding, and suggests what 

key data we need to collect next. 

In RAPIDD, we were able to bring 

together preeminent researchers 

whose modeling work will impact 

policymaking long into the future.”

Dr. Bryan Grenfell

Princeton University 

RAPIDD co-founder

Risk of local

Zika transmission

Disease modelers aim to inform policy decisions

Infectious disease outbreaks, such as Ebola and Zika, pose 

difficult decisions for policymakers who must decide how to most 

effectively deploy resources in response. Mathematical modeling 

can provide valuable clues in predicting how diseases might spread 

and how to best control them. To catalyze the field of infectious 

disease modeling, Fogarty formed the Research and Policy for 

Infectious Disease Dynamics (RAPIDD) group in 2008. Supported 

with funding from the Department of Homeland Security, RAPIDD 

researchers have published over 900 peer-reviewed papers and 

organized more than 100 workshops that have drawn at least 800 

scientists from 40 countries. Another sign of the program’s success 

is that most of the group’s postdoctoral fellows have gone on to 

tenure-track faculty positions at top U.S. universities, where they 

are educating future generations of modelers to further strengthen 

the field.

RAPIDD is helping to narrow the gap between what modeling can 

do—provide information that allows scientists to compare strategies 

for tackling an outbreak and identify knowledge gaps—and the 

actionable data that policymakers seek.

 
76 Fogarty at 50
Promoting science diplomacy 

for global health

Since its creation, Fogarty has served as a mini-State Department 

for the NIH, forging international partnerships between U.S. 

scientists and institutions and their counterparts abroad to 

advance research and training, as well as coordinating meetings 

for visiting heads of state, health ministers and others. Working 

closely with the State Department and the Office of Global 

Affairs at the Department of Health and Human Services, 

Fogarty has brokered hundreds of agreements between the U.S. 

and other countries. 

Fogarty also conducts outreach to promote the economic and 

health benefits of science to foreign governments, encouraging 

ministers of health, education and finance to consider evidence 

for increasing investments in research and training. In recent 

years, a number of partnerships have been negotiated with 

other countries to support investigations that are jointly funded 

by both sides. In others, foreign governments have provided 

funding so their countries’ scientists can gain experience 

working with experts on the NIH campus. 

Fogarty also serves as the nexus for NIH engagement with 

international organizations such as the United Nations, World 

Health Organization, Global Alliance for Chronic Diseases and 

others. One of Fogarty’s chief roles is to coordinate broad NIH 

input on health issues under consideration in intergovernmental 

discussions. 

www.fic.nih.gov 77
Notable partnerships formed with 

Fogarty’s help include the IndoU.S. Vaccine Action Program, 

which has for decades supported 

collaborations on lab research, 

epidemiological studies, field 

trials, vaccine quality control and 

delivery. Priority topics include 

dengue, enteric diseases, influenza, 

malaria and tuberculosis. 

Another agreement facilitated by Fogarty is the South AfricaU.S. Program for Collaborative Biomedical Research, which 

supports U.S. and South African scientists to conduct research 

targeting HIV/AIDS, tuberculosis and HIV-related comorbidities 

and cancers. Scientists located at eight South African institutions 

are collaborating with investigators at more than 20 U.S.-based 

organizations, including NIH. 

In the 1980s, Fogarty launched an Eastern European initiative to 

strengthen international collaborations and identify new openings 

to advance key areas of science at the end of the Cold War. U.S. 

researchers responded enthusiastically to opportunities to work 

with counterparts in Hungary, Poland and other Eastern bloc 

countries.

Fogarty helps produce resource 

to analyze global health funding

Fogarty helped NIH and other global funding 

partners to produce an online database and 

mapping tool of research projects funded 

globally. Known as World Report, the interactive, 

open-access site depicts investments and 

partnerships from some of the largest biomedical 

research funders. The project is intended 

to improve understanding of the research 

landscape, identify gaps in funding and areas 

where there might be a duplication of effort, and 

enable funders to synergize investments.

78 Fogarty at 50
Studying global health 

science and policy

A 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 partner

 • Engage collaborators from different sectors with unique 

 expertise and resources

 • Foster multidisciplinary and/or multisector approaches

 • Produce concrete, implementable deliverables and 

 recommendations for action

 • Engage LMIC scientists, program implementers and/ 

 or policymakers

AREAS OF FOCUS:

Implementation science:

Projects develop new approaches and 

skills needed to better translate scientific 

evidence into health policy and practice. 

For example, the number of adolescents 

dying of AIDS is increasing even as the 

number of overall AIDS-related deaths are 

on the decline. To address this vulnerable 

population, CGHS has assembled a network 

of researchers, program implementers and 

policymakers to address the problem.

Scientific roadmaps:

Collaborations develop research agendas 

that tackle specific global health problems. 

For example, investments made in HIV, 

which have enabled millions of people 

living with HIV to live longer, healthier lives, 

are being undermined by the escalating 

epidemic of noncommunicable diseases 

(NCDs). To stimulate country-relevant 

research, CGHS has brought together 

researchers, implementers and government 

representatives to articulate practical goals, 

approaches, and a related research agenda to 

incorporate prevention, care and treatment 

for NCDs into HIV/AIDS platforms.

Scientific exchange and training: 

Opportunities for U.S. and foreign 

investigators are offered, including mentored 

research projects, workshops, or short-term 

training institutes. For example, CGHS 

hosted the Global mHealth Research Training 

Institute at NIH in June 2016. The scenariobased training promoted multidisciplinary 

research, implementation science and 

novel research methodologies to a cohort of 

researchers from diverse fields.

www.fic.nih.gov 79
“We are often reminded 

in medicine that we can 

only do so much. But 

shortcomings are what 

drive our desire to do 

clinical research—to 

improve, to advance, to 

care—so that one day 

when someone is looking 

for a miracle, we can 

deliver.”

Dr. Jessica Manning

Fogarty Fellow in Mali

80 Fogarty at 50
Expanding Fogarty’s reach with NIH co-funding

0 

20 

40 

60 

80 

100 

120 

140 

1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 

Dollars in Millions 

 

FIC Extramural Co-Funding 

Fogarty’s extramural grants are leveraged with generous support—financial and otherwise—

from many NIH Institutes and Centers, which greatly expands the reach and impact of Fogarty 

programs to advance science and build the next generation of global health leaders:

NIH Office of the Director

 NIH Common Fund

 Division of Program Coordination, Planning, and Strategic Initiatives (DPCPSI)

 Office of AIDS Research (OAR)

 Office of Behavioral and Social Sciences Research (OBSSR)

 Office of Dietary Supplements (ODS)

 Office of Research on Women’s Health (ORWH)

National Cancer Institute (NCI)

National Eye Institute (NEI)

National Heart, Lung, and Blood Institute (NHLBI)

National Human Genome Research Institute (NHGRI)

National Institute on Aging (NIA)

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

National Institute of Allergy and Infectious Diseases (NIAID)

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

National Institute of Biomedical Imaging and Bioengineering (NIBIB)

National Institute of Child Health and Human Development (NICHD)

National Institute on Deafness and Other Communication Disorders (NIDCD)

National Institute of Dental and Craniofacial Research (NIDCR)

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

National Institute on Drug Abuse (NIDA)

National Institute of Environmental Health Sciences (NIEHS)

National Institute of General Medical Sciences (NIGMS)

National Institute of Mental Health (NIMH)

National Institute on Minority Health and Health Disparities (NIMHD)

National Institute of Neurological Disorders and Stroke (NINDS)

National Institute of Nursing Research (NINR)

National Library of Medicine (NLM)

Clinical Center (CC)

Center for Information Technology (CIT)

Center for Scientific Review (CSR)

National Center for Advancing Translational Sciences (NCATS)

National Center for Complementary and Integrative Health (NCCIH)

www.fic.nih.gov 81
Photo Credits 

Front cover: (from top left) By Ryan McVay/Photodisc/Thinkstock; 

courtesy of CDC; by Boniface Mwangi/Africa Knows; by rmnunes/

iStock/Thinkstock; (bottom) by Richard Lord for Fogarty

Page 5: Courtesy of the Fogarty family

Page 6: (right) By Ansem Ansari, courtesy of Photoshare; (from 

bottom left) by Miguel Marzal/Universidad Cayetano Heredia; by 

David Rochkind for Fogarty; courtesy of NIAID; by David Snyder for 

Fogarty; courtesy of NIAID

Page 7: By Joshua Wanyama/Africa Knows

Page 8: By poco_bw/iStock/Thinkstock

Page 9: Courtesy of Dr. Roger Glass

Page 10: By Dr. Carrie Nielsen/CDC

Page 11: (clockwise from top right) by David Snyder for Fogarty; 

by Dr. Benjamin Dahl/CDC; by George Doyle/Stockbyte/Thinkstock; 

by Richard Lord for Fogarty; courtesy of NIA; by Rhoda Baer, 

courtesy of NCI

Page 12: (from left) By David Snyder for Fogarty; courtesy of 

Dr. Bhakti Hansoti

Page 13: (from left) Courtesy of Dr. Thomas Gaziano; by David 

Snyder for Fogarty

Page 14: By Richard Lord for Fogarty

Page 16: All courtesy of the Fogarty family

Page 17: Courtesy of the Fogarty family

Page 18: (from left) Courtesy of the Fogarty family; Fogarty 

archive; courtesy of NLM; courtesy of NLM; Fogarty archive

Page 19: (from left) All Fogarty archive

Page 20: (from left) Courtesy of NIH; Fogarty archive

Page 21: Courtesy of NIH

Page 22: (from top) © UNICEF/UNI103221/Nesbitt; by Paballo 

Thekiso/AFP/Getty Images

Page 23: (from left) Courtesy of NIAID; by Per-Anders Pettersson/

Getty Images

Page 24: By David Snyder for Fogarty

Page 25: (from left) By David Snyder for Fogarty; by Malcolm 

Linton

Page 26: (from top) Courtesy of Dr. Ruth Nduati; courtesy of 

Dr. Tumwesigye

Page 27: (from top) Courtesy of NIAID; by Richard Lord for Fogarty

Page 28: (top) By Lucian Coman/Hemera/Thinkstock; all others by 

David Snyder for Fogarty

Page 29: (from left) Courtesy of NIAID; by Dr. Roger Glass

Page 30: All by David Snyder for Fogarty

Page 31: (from left) Courtesy of NIAID; by Saul Loeb/AFP/Getty 

Images

Page 32: (from top) By Mario Tama/Getty Images; by China 

Photos/Getty Images

Page 33: Courtesy of Dr. Clement Adebamowo

Page 34: All by Richard Lord for Fogarty

Page 35: (top) © Click Pictureworks Africa; (from bottom left) by 

veronicadana/iStock/Thinkstock; by markirk/iStock/Thinkstock; 

by poco_bw/iStock/Thinkstock; by Songpin/iStock/Thinkstock; by 

David Snyder for Fogarty

Page 36: (from top) Courtesy of Dr. Marc Mitchell; by KRISS75/

iStock/Thinkstock

Page 37: All by David Snyder for Fogarty

Page 38: (from top) © 2015 Girdhari Bora/IntraHealth 

International, courtesy of Photoshare; courtesy of AMPATH/Moi 

Teaching and Referral Hospital; by Comstock/Stockbyte/Thinkstock

Page 39: (from top) By Jeff Gray; by Dr. Bill Tierney

Page 40: (top) By Rhoda Baer, courtesy of NCI; all others courtesy 

of NIAID

Page 41: Courtesy of Dr. Margaret Bentley

Page 42: (from top) Courtesy of NIAID; courtesy of NIAID; by 

Susan Urmy/Vanderbilt University

Page 43: (from top) By Ross Marlow/CUGH; by Alan Ricks/MASS 

Design Group

Page 44: By David Snyder for Fogarty

Page 45: (clockwise from top) Courtesy of Dr. Robin Petroze; 

courtesy of Dr. Kogieleum Naidoo; courtesy of Navid Shams; 

courtesy of Dr. Cameron Gaskill; courtesy of Dr. Lilliam Pinzón; 

(center) courtesy of Dr. Amy Sims

Page 46: (from top) Courtesy of Dr. Mohammad Aminul Islam; 

courtesy of Dr. Paul Drain

Page 47: Courtesy of Dr. Arti Kundu

Page 48: (top) By Joe Pawlik/UNC-Wilmington; (from bottom left) 

courtesy of Dr. Mark Hay; courtesy of Dr. Cameron Currie; by Julia 

Kubanek; courtesy of U.S. Geological Survey; by Kim Diver

Page 49: All by Kim Diver

Page 50: (from top) By Akintunde Akinleye/NURHI, courtesy of 

Photoshare; by Terry Lo

Page 51: (clockwise from top) by Michelle Berdy/CCP, courtesy of 

Photoshare; courtesy of NLM; by David Snyder for Fogarty

Page 51: By In Pictures Ltd./Corbis via Getty Images

Page 53: By David Snyder for Fogarty

Page 54: Courtesy of Michèle Ramsay

Page 55: (from top) Courtesy of Dr. Gerald Bloomfield; by 

heckepics/iStock/Thinkstock

Page 56: Courtesy of NIMH

Page 57: (from top) Courtesy of Dr. Kenneth Kosik; courtesy of Dr. 

Yakeel Quiroz

Page 58: (from top) By alptraum/iStock/Thinkstock; courtesy of Dr. 

Hélène Carabin and Souleymane Kékélé

Page 59: (from top) Courtesy of University of Macau; courtesy of 

Dr. Joseph Vinetz; courtesy of NIA

Page 60: Courtesy of Dr. Desire Tshala-Katumbay/Oregon Health 

and Science University

Page 61: (from top) Courtesy of NIAID; by Alvin Gogineni/

Genentech, courtesy of NIH; by Ernie Branson/NIH

Page 62: Courtesy of Mahidol-UMass Lowell Center for Work, 

Environment, Nutrition and Human Development

Page 63: (from top) By Jeff Gray, by Leesha Manju, courtesy of 

Photoshare

Page 64: (top) © 2012 David Davies-Deis, courtesy of Photoshare; 

(from bottom left) © 2013 JMM Bimbo Brillo, courtesy of 

Photoshare; courtesy of Dr. Huiyan Xiang; courtesy of Dr. Junaid 

Razzak/Aga Khan University; courtesy of Dr. Junaid Razzak/Aga 

Khan University; © 2009 Edson E. Whitney, courtesy of Photoshare

Page 65: (from left) By David Rochkind for Fogarty; courtesy of 

Dr. Cameron Gaskill

Page 66: (top) By Bruce Northam; all others by David Snyder for 

Fogarty

Page 67: (from top) By Cathy Kristiansen; by David Snyder for 

Fogarty; by Cathy Kristiansen

Page 68: By Richard Lord for Fogarty

Page 69: (top) Courtesy of Dr. James Kiarie; (from bottom left) 

courtesy of University of Ca ifornia, San Diego; courtesy of the 

MEPI Coordinating Center; courtesy of Peter Donkor; courtesy of 

University of KwaZulu-Natal; by Richard Lord for Fogarty

Page 70: (top) By Bill Branson/NIH; (bottom) all others courtesy 

of MEPI Ethiopia

Page 71: By Richard Lord for Fogarty

Page 72: By John Moore/Getty Images

Page 73: By James Gathaney/CDC; courtesy of NIAID in 

collaboration with Colorado State University

Page 74: (clockwise from top) By Boniface Mwangi/Africa Knows; 

courtesy of USDA/ARS; by Boniface Mwangi/Africa Knows

Page 75: (from top) Courtesy of Dr. Kamran Khan et al; courtesy of 

Dr. Shweta Bansal; courtesy of Dr. Wendy Prudhomme O’Meara

Page 76: (clockwise from top) By Bill Branson/NIH; courtesy of 

NIH; by Karin Zeitvogel; by Dr. Susan Shurin; by Bill Branson/NIH; 

(center) courtesy of U.S. State Department

Page 77: (from top) Courtesy of World Health Summit 2014; 

courtesy of NIH

Page 78: (from top) By Michael Spencer for Fogarty 

Page 79: Photos by Fogarty staff; s ide courtesy of Drs. Gari C ifford 

and Omer Inan

Page 80: (top) Courtesy of Dr. Jessica Manning; (from bottom left) 

courtesy of NIAID; by James Gathany/CDC; by Boniface Mwangi/

Africa Knows; by David Snyder for Fogarty; by Gautier Willaume/

Hemera/Thinkstock

Page 82: (from left) Courtesy of NIAID; © 2011 Cameron Taylor, 

courtesy of Photoshare; by Goodshoot/Thinkstock; by Tjui Tjioe/

Hemera/Thinkstock; by Stockbyte/Thinkstock

Back cover: By Riccardo Lennart Niels Mayer/iStock/Thinkstock

82 Fogarty at 50
Acknowledgements — 

We are grateful to Fogarty Director Dr. Roger Glass for his leadership, 

to Dr. Ken Bridbord for his historical knowledge, and to the Fogarty 

staff, past and present, who contributed to this book.

Writer/Editors: Cathy Kristiansen, Shana Potash and Karin Zeitvogel

Editor and Web Producer: Anna Pruett Ellis

Managing Editor: Ann Puderbaugh

Designed by Carla Conway, Creative Director, Uncommon Design, LLC

www.fic.nih.gov 83
The John E. Fogarty International Center

31 Center Drive

MSC 2220

Bethesda, Maryland 20892

301-496-2075

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