The Fogarty International Center at 50: Accomplishments and Priorities for the Next 50 Years.

The future of the Fogarty International Center (FIC) at the National Institutes of Health (NIH) seemed to be in jeopardy early in Donald Trump’s presidency, when the FIC was slated for elimination [1]. Fortunately, the Trump administration’s plans to reduce global health research and eliminate the FIC were rejected by Congress. The FIC’s strong global health agenda, and its benefits to the global population and the American people, will help support its long-term sustainability and prominent role in global health research and training. Despite having a smaller budget than any NIH institute ($70.1 million in fiscal year 2017), the FIC has been a leader in US global health research efforts for the past 50 years.

The FIC was founded in 1968 to support basic, clinical, and applied research and training for US and foreign investigators working in the developing world [2]. The man for whom the FIC is named, Representative John Edward Fogarty (D-RI), served as chair of the US House Appropriations Subcommittee [2]. The FIC vision was 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.” [3] Over the last 5 decades, the FIC has supported global health research, built synergistic research partnerships with many NIH institutes, facilitated health research globally, and trained >6000 scientists around the world [4]. The FIC has fully surpassed initial expectations and now looks to identify and address global health priorities that may emerge over the next 50 years.

Roger Glass has served as director of the FIC and associate director of International Research at NIH since 2006, and oversees 4 FIC working divisions: International Relations, International Epidemiology and Population Studies; International Science Policy, Planning and Evaluation; and International Research and Training. During his tenure, the FIC has allocated one-third of its annual budget for scientific discovery and two-thirds for research training.

FIC grantees rank among the most productive researchers supported by the NIH [5,6], publishing research findings that are relevant to both US and global populations. The FIC’s successes in cross-institutional networking within the NIH and with other US-based institutes, as well as its international capacity building, have provided a broad foundation for collaborative global health research. Two examples were the Medical Education Partnership Initiative (MEPI) and the Nursing Education Partnership Initiative, established in 2010 to support foreign institutions in sub-Saharan Africa to develop or expand models of medical education and research training, to build clinical and research capacity throughout Africa, and to advance the President’s Emergency Plan for AIDS Relief goal of increasing the number of new healthcare workers [7]. Currently, MEPI supports African institutions in a dozen countries, forming a network with >30 regional partners and country health ministries. The successes of the MEPI program led to recent establishment of the African Forum for Research and Education in Health (AFREhealth) and the FIC’s Health-Professional Education Partnership Initiative [8].

FIC investments in global research capacity building have facilitated important research involving mental health, cancer, infectious diseases, and the neurosciences by creating new partnerships with related NIH institutes and US scientists. The FIC has accepted a critical role in coordinating global health efforts by serving as a primary link between international and domestic US institutions. Its agenda may evolve as medicine and global health continue entering an era with advanced technologies and more global travel and migration.

In 2017, both the World Bank and the US National Academies of Science, Engineering, and Medicine published extensive perspectives on disease control priorities and recommendations for future roles for the United States in global health [9,10]. The National Academies’ 2017 Consensus Study Report on Global Health emphasized the historical context of the importance of US foreign aid in global health and the key successes of US programs for global health since 2006. These successes include the President’s Emergency Plan for AIDS Relief, the President’s Malaria Initiative, Biomedical Advanced Research and Development, and the United States Agency for International Development’s Ending Preventable Child and Maternal Deaths program. The report included 14 recommended research priorities, many of which are currently being addressed by the FIC or fall within the scope of experience in research and training of the FIC and its partner NIH institutes. We highlight some of those evolving global health priorities and suggest several areas in which the FIC will have opportunities to contribute additional global health leadership (Table 1).

Table 1.

Examples of Changing Global Health Terminology and Priorities

Terminology in 1968	Terminology in 2018	Existing and Potential Future Goals for FIC’s Agenda
Tropical medicine	Global health	Support global health research conducted by US and international investigatorsa; help apply global health research to underserved areas of the United States
Colonialism of international aid	Partnerships between academic research centers	Build partnerships between research institutions in the United States and abroada; develop tools and mechanisms for foundations, philanthropists, and citizens to connect with global health researchers and leaders to crowd-source proposals or fund global health challenges
Study abroad	Global health exchange	Train the next generation of scientists to address global health needsa; establish formal or informal groups of students and teachers who can provide bidirectional training and ongoing education
Engineering	Bioengineering	Aid in development and diffusion of affordable technological innovation and encourage manufacturing in local settings
Smallpox eradication and “the end of infectious diseases”	HIV/AIDS, MDR tuberculosis, antimicrobial resistance	Encourage new vaccine and drug development and only judicious antimicrobial use among humans and livestock worldwide; continue efforts for eradication of select infectious diseases (eg, polio and guinea worm)
DNA double helix	Personalized genomic medicine	Promote the development and adoption of genomic medicine globally, including underserved populations
The age of coal and oil	Planetary health, climate change, renewable energy	Help ensure that global climate change is being addressed by all parties, with emphasis on renewable energies for human health
Civil rights	Reduce health disparities and inequalities	Oversee planning for societal equality in health, as it pertains to race, sex, gender, religion, sexual orientation, or beliefs

Abbreviations: FIC, Fogarty International Center; HIV, human immunodeficiency virus; MDR, multidrug-resistant.

aExisting goal of the FIC.

First and foremost, the FIC should continue to serve as a hub to connect researchers and institutions and their international partners with each other and with potential research funding organizations. To this end, FIC and the NIH director’s office recently established WorldRePORT, a powerful tool for setting priorities, fostering collaborations, identifying research opportunities, and avoiding duplication of efforts. Facilitating a bidirectional flow of information between the United States and other countries will help ensure that healthcare innovations in international resource-limited settings could be implemented to benefit persons in the United States, and vice versa.

Second, the FIC could take an increasing role in research involving planetary health dynamics, including impact of climate change and environmental health policy, on human health. Our rapidly growing global population increasingly faces threats to human health attributable to limited natural resources. To address this paradigm, the FIC recently launched the Global Environmental and Occupational Health program, in collaboration with several NIH institutes and the US Centers for Disease Control and Prevention. This collaboration and agenda could be vastly expanded over time.

Third, the FIC can continue to play a leading role in diffusion of innovation to improve global access to new medical technologies and promote local solutions, where possible. Simple, inexpensive, and reusable products designed for use in resource-limited settings could be licensed for manufacture in the local community. The overburdened workforce in many low-resource settings can adapt and use modern tools, including mobile health technologies for local data collection, diagnosis, and treatment. The FIC’s Mobile Health program supports research on the use of mobile devices to provide access to disease prevention and healthcare and to generate better health outcomes at reduced costs, which has global relevance. Additional telemedicine advances will help consultant specialists provide advice to healthcare providers and public health leadership working in more remote settings.

Fourth, the FIC will help ensure that existing prevention approaches, medical treatments, and new scientific discoveries reach underserved populations across the globe. Many global citizens have diseases that are simply not diagnosed, receive improper medical treatment, or are not benefiting from the scientific discoveries happening within their own communities. Solutions may be challenging, but will need to include trained global health researchers from low-income countries. Progress in reducing global health disparities will be a primary indicator of success over the next 50 years.

In summary, the FIC has been instrumental in reducing disease burden, promoting health, and extending longevity for persons around the world [1]. By facilitating and integrating unique research and training experiences for scientists and clinicians in the United States and in low- and middle-income countries, the FIC has created a large and growing cadre of highly effective research teams. These teams have the capacity to guide clinical and public health interventions to address diseases in both low- and high-income countries. The goal of training researchers from low- and middle-income countries has bolstered the capacity of the NIH to conduct multinational studies that are transforming the prevention of disease and the care of patients not only in resource-limited settings, but also in the United States and other developed countries. Continued support of the FIC and its globally oriented biomedical research mission represents a critical and highly cost-effective investment in global health and the health of the American people.