Breakthroughs Blog: NIH

Research!America, a member of the GHTC, recently conducted analyses in target states to measure the health and economic impact of global health research and development (R&D), highlighting its benefits for states across the nation and strengthening the evidence base for Congress’ support of federal investments in global health R&D. Danielle Doughman, program manager for global health R&D advocacy, shares the organization’s findings in Maryland. This is the third post in a series. If it’s true that health is wealth, Maryland has both in abundance. Maryland is home to two federal health powerhouses, the Food and Drug Administration and the National Institutes of Health (NIH), the world’s largest medical research institute. Together, they employ 25,000 people. Silver Spring’s Walter Reed Army Institute of Research is engaged in global health research to protect our military personnel from infectious threats they may encounter in the field. And Marylanders see the direct benefits of that research: 82 percent recognize that American civilians benefit from the health research conducted by the military, according to a poll commissioned by Research!America. Maryland is home to two federal health powerhouses, the Food and Drug Administration and the National Institutes of Health (NIH), the world’s largest medical research institute. Photo credit:PATH What’s more, Maryland’s life sciences sector supported 71,600 jobs in 2010. Workers in the life sciences industry earned, on average, more than $91,000 annually—76 percent more than the state average. Of the nearly $52.7 million in extramural funding that flowed to Maryland from NIH in fiscal year 2012, over 70 percent, or $37.8 million, was awarded through contracts and grants to Johns Hopkins University. Hopkins is among Maryland’s largest employers, with 47,000 employees across the university and affiliated health system, and it contributes more than $10 billion per year to the state’s economy. Nonprofit global health “product development partnerships” use a unique business model to work across sectors to accelerate the creation of low-cost drugs, vaccines, and diagnostics to advance health for the most vulnerable populations. Two such nonprofits are headquartered in Maryland. Rockville’s Aeras, another GHTC member, engages in the development of new tuberculosis (TB) vaccines and other prevention technologies, capitalizing on the expertise of its partners to accelerate the development of the six vaccines in its R&D pipeline. Aeras’ 135 Maryland-based employees understand that the sooner effective products are available, the closer we are to dramatically reducing the 1.4 million lives lost to TB every year. Just last week, Aeras announced its partnership with NIH’s National Institute of Allergy and Infectious Diseases for a Phase II clinical trial of a TB vaccine. With the first cases of totally drug-resistant TB coming to international attention earlier this year, aggressive pursuit of vastly improved TB drugs, vaccines, and diagnostics has never been more crucial than it is now. With support from the US Agency for International Development and NIH, Maryland’s International Partnership for Microbicides (IPM) is helping to lead the charge to design products to protect women from HIV and AIDS, the leading cause of death for women ages 15-44 worldwide. In addition to the support of the US government, IPM works with partners around the world to develop antiretroviral-based microbicides to safely and effectively protect women against HIV. Later this year, IPM and the NIH-funded Microbicide Trials Network will move a promising product into late-stage clinical trials. The robust federal investment and presence in Maryland reflects the fact that more than three-quarters of Marylanders say Americans should be concerned about global diseases like malaria, cholera, and other infectious diseases that mostly affect poorer countries. More than ever before, America’s health—in both economic and medical terms—is global health.

Roger I. Glass, M.D., Ph.D., is director of the Fogarty International Center at the National Institutes of Health (NIH), where he oversees research and research training programs for U.S. and foreign scientists working to improve health in the developing world. Over the last four decades, about 5,000 scientists worldwide have received significant training through Fogarty programs. In addition, Dr. Glass serves as Associate Director for Global Health to the NIH Director, providing guidance on global health, facilitating international research collaborations and convening the world’s best scientific minds to address the most pressing health research questions. As we commemorate World AIDS Day 2011, I am both encouraged by the recent discoveries that are improving and prolonging lives and reminded of the challenges that remain in our battle to defeat this terrible disease. I was heartened to gather earlier this year with many of Africa’s premier infectious disease scientists and medical educators as we—together with PEPFAR—launched our Medical Education Partnership Initiative. Through this effort, we hope to make an enduring impact on the quality and availability of health care workers and researchers throughout the continent. This is vital to our goal to establish true country ownership and enable Africans to set their own research agendas, based on the most pressing local needs. Peruvian scientist Dr. Isaac Alva, of Universidad Peruana Cayetano Heredia, has conducted extensive field work studying HIV and AIDS and other diseases among indigenous communities in Peru. He is currently earning his master’s in public health through Fogarty’s AIDS International Training and Research Program. (Photo by David Snyder for Fogarty/NIH) I was also fortunate to see firsthand many of the researchers funded by the National Institutes of Health who are working on the front lines. During this year—the 30th anniversary of the beginning of this epidemic—it is appropriate we acknowledge the advances made against this and other infectious diseases by the National Institute of Allergy and Infectious Diseases (NIAID) and its director, Dr. Anthony S. Fauci, and by the many scientists around the world supported by NIAID and other institutes and centers of the NIH. But if the great advances have been made standing on the shoulders of giants, in Isaac Newton's phrase, I think Fogarty has a hand—or a shoulder, perhaps—in a number of the research breakthroughs. Trainees supported through Fogarty-funded grants have helped contribute to the work that led to this progress. We're pleased to see our 20-year investment in some of these developing country sites paying off with trainees who are well qualified to move forward the research funded by NIAID and others. A singular breakthrough in the news is the study known as HPTN 052, which revealed that men and women infected with HIV reduced the risk of transmitting the virus to their sexual partners through early initiation of oral antiretroviral therapy (ART). Fogarty grantee Dr. Myron "Mike" Cohen, who runs the global health institute at the University of North Carolina, is the principal investigator of the study, funded mainly by NIAID with additional funding from other institutes. Dr. Roger I. Glass, director of Fogarty International Center at the National Institutes of Health, visited Africa to see firsthand the health improvements HIV and AIDS advances have brought to the continent. (Photo courtesy of Fogarty/NIH) This is the first randomized trial to definitively indicate that an HIV-infected individual can reduce sexual transmission of HIV to an uninfected partner by beginning ART sooner. This adds very strong scientific evidence that you can use treatment of HIV as an effective prevention modality by decreasing the possibility that a person who is infected would transmit HIV to their sexual partner. More than 30 Fogarty-supported trainees in Malawi, India, Botswana and Thailand worked on the study. Very recently, the conclusions of this discordant couples trial were buttressed by results from a pre-exposure prophylaxis, or PrEP, trial that showed that heterosexual participants who took a daily Truvada pill had a significantly lower chance of being infected. Fogarty trainees are also at the forefront of the studies to determine the effectiveness of an antiretroviral microbicide (tenofovir gel) in preventing sexually transmitted HIV infection in women. The training was supported by a grant under Fogarty's AIDS International Training and Research Program (AITRP). Dr. Quarraisha Abdol Karim of Columbia University, who directed the CAPRISA-004 study, is the director of the Fogarty training grant and has mentored many trainees continuing this work. Moreover, Fogarty Scholar Dr. Kogie Naidoo has reported a randomized clinical trial conducted at Durban demonstrated that antiretroviral treatment should begin at the same time as TB treatment. This result has caused the WHO to change its guidelines for TB treatment. Finally, Dr. Sten Vermund of Vanderbilt University has directed a multi-country study, funded partly by NIAID with some Fogarty trainees participating, demonstrating the effectiveness of ART therapies in stopping mother-to-child transmission of the HIV virus. Sten's program has trained 64 individuals in degree programs, nearly all of whom have returned to their home countries. There remains much to be done in the effort to achieve "a world without AIDS," in Dr. Fauci's phrase. As we mark World AIDS Day and the 30th anniversary of that effort, Fogarty is pleased to have played a significant role in training many of the researchers who are positioned to lead the battle.

GHTC Director Kaitlin Christenson attended Secretary of State Hillary Clinton’s speech at the National Institutes for Health (NIH) yesterday and blogged her reaction to the address for Breakthroughs. To a room full of dignitaries, US policymakers, members of Congress, research leaders, and global health advocates at NIH yesterday, Secretary of State Hillary Clinton declared that in the midst of difficult budget times, “investing in our future is the smartest investment we can make.” The Secretary spoke with pride and hope about the historic leadership that the US government has played in advancing progress to combat HIV and AIDS, and the need to stay the course—even as Congress considers budget cuts which may affect global health and HIV and AIDS funding—as we work toward the previously unimaginable goal of an AIDS-free generation. "An AIDS-free generation would be one of the greatest gifts the United States could give to our collective future." -Secretary of State Hillary Clinton at speech on Tuesday. Photo: Wendy Stone/PATH During her speech, Clinton highlighted the numerous advances made possible through an investment in science by the US government: American scientists were the first to report the AIDS epidemic; NIH research provided proof that HIV causes AIDS; the US government supported the development of the first drugs to treat AIDS; and continued US investments are supporting the search for a vaccine, microbicides, and other tools. But she could have added even more successes to this list. In the past two years, US-funded research has: Led to the first-ever proof of concept that both an HIV vaccine and a vaginal microbicide could work. Provided evidence that treatment of individuals who are HIV positive can actually help prevent new infections--potentially reducing the risk of transmission up to 96%. Shown that once-daily pills can work to reduce the risk of HIV in high-risk groups. It is scientific advances like these that will lead us to a new era in the AIDS epidemic, and US policymakers must do all that they can to protect our investment in the research that will yield the new tools that are so critically needed. In Washington, she joked, some would prefer that we operate in an “evidence-free zone.” But she called on all of us to stand up for science and evidence, and keep our focus on the future, urging us to consider what the world would look like if we succeeded in our goal of an AIDS-free generation. “That is the world that has always been at the core of American belief, and we have worked toward it in our own history. It’s the world I think we all would like to live in. An AIDS-free generation would be one of the greatest gifts the United States could give to our collective future.” Thanks to the scientific advances in recent years, the global community is finally positioned to end the AIDS epidemic. The US government must answer Secretary Clinton’s call to keep the momentum going and seize this historic opportunity.