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Senator HARKIN. Dr. Schambra, you have a request for a new program called neuroscience fellowships. What is this?

Dr. SCHAMBRA. Sir, this is a part of our participation in the Decade of the Brain-it's the international dimensions. With the encouragement of the Congress in our 1991 budget, and in collaboration with the Neurology Institute, we plan to initiate a special program of fellowships for senior neuroscientists from Eastern European countries. These people for a number of years have not fully been in contact with the leading scientists in the West and the United States. This new fellowship will bring them to the United States for periods of up to 3 months, which may then be repeated in successive years, to bring their skills up to date. We are providing the travel and the stipend for these senior fellows. The Neurology Institute is providing the support for their research while they are in the United States.


Senator HARKIN. The President sent Secretary Sullivan to Africa in January to determine ways the United States could improve the dismal health situation for children on that continent.

Does the Fogarty International Center have any plans to help this situation?

Dr. SCHAMBRA. Yes, sir; indeed we have. To place them in perspective, you may recall that last December there was held in New York, at the United Nations, the World Summit for Children, which was the greatest gathering of the largest number of heads of state and heads of government in history. President Bush in his appearance before the summit declared that he was sending Secretary Sullivan and a team to Africa to study the health situation there, especially as it involved children, and to report back on what the United States might do to respond to that situation. I might mention in addition to Secretary Sullivan, Assistant Secretary Mason and the Director of the Child Health Institute, Duane Alexander, participated in that delegation.

The information that they came back with is really quite striking and disturbing. Just to cite some of the information that they reported, of the 15 countries in the world with the highest infant mortality rates, 14 are found in Africa. The child mortality rate is 10 to 15 times higher in sub-Saharan Africa than it is in the United States, and maternal mortality is up to 100 times higher. Major causes of childhood morbidity and mortality include respiratory diseases, diarrheal diseases, malaria, and other parasitic diseasesabout 1 million children a year die from malaria-malnutrition and HIV infections acquired from mothers. There are about 500,000 children in Africa now that are infected with the AIDS virus transmitted from their mothers. And then, of course, the problems associated with high frequency of pregnancies in the population.

What they reported and what they found was that there are needs and opportunities to train African biomedical scientists and health professionals so that they can participate in understanding and assessing their health and population problems and participate in their solution. There is a need to strengthen a few selected

health and medical education centers throughout Africa that can provide training, conduct research, disseminate information, and help local governments set priorities for delivery of health services. And there is a need to apply American scientific skills in cooperation with African scientists to find some solutions, such as new and improved vaccines and other means of preventing these diseases.

Even prior to Secretary Sullivan's departure for Africa in January, we worked with our Child Health Institute and our Allergy and Infectious Diseases Institute to try to find ways that we might be prepared to respond to the opportunities and the needs identified there and, in fact, came up with a five-point program. I would be pleased to submit the details for the record. But basically it would consist of a child survival training grant that would be modeled on our very successful AIDS international training grants that we have now, fellowships for Americans to go to Africa and for Africans to come to leading U.S. institutions to gain the necessary skills.

Senator HARKIN. When would that start? Would that start soon? Dr. SCHAMBRA. As soon as we find the money to do it, sir. [Laughter.]

We would also provide research grant supplements to American scientists already supported by NIH but who need a little extra money to develop the knowledge needed to solve some of these problems.

Senator HARKIN. Well, is that part of your budget request for next year?

Dr. SCHAMBRA. No, sir; this proposal was developed since the visit of the Secretary and others to Africa in January.

Senator HARKIN. Well, I think we ought to ask the Secretary if he would like to increase your budget a little bit to do that then. Dr. SCHAMBRA. I would be pleased if you would.

Senator HARKIN. We will ask the Secretary. If he wants to follow through, let's match the rhetoric with some resources here. Thank you very much, Dr. Schambra.


Dr. RAUB. Mr. Chairman, you might be interested to know that, complementing the efforts Dr. Schambra was describing, is an activity that is the byproduct of the revenues from the AIDS test kit. The Department of Health and Human Services and the Pasteur Institute in Paris are the co-owners of that invention, which provides a substantial revenue stream. A big fraction of that goes into a foundation called the World AIDS Foundation that is jointly overseen by the two institutions. Dr. Schambra and his staff provide the principal staff support for it. It has created the means to give various types of grants for training especially related to health services associated with AIDS in Africa and Central America, the Far East, and other regions where the AIDS epidemic is either already burgeoning or threatening. It is emerging as a very important complement to the research training and research activities that we do.


Senator HARKIN. Thank you both very much. Again, I appreciate your staying here over the lunch hour. There will be some additional questions which will be submitted for your response in the record.

[The following questions were not asked at the hearing, but were submitted to the Center for response subsequent to the hearing:]



Question. I see in your 1992 budget for the first time a request for a new program called Neuroscience Fellowships. Since this is a new program could you tell the Committee the program's purpose and how it will operate?

Answer. Recognizing the need for a worldwide effort on research in the neurosciences, and in response to the declaration by the Congress of the 1990s as the "Decade of the Brain," the FIC and NINDS have jointly established the Central and Eastern Europe Senior Fellowships in the Neurosciences (CEESFN). This program is responsive to the new scientific opportunities that have recently become available as a result of political changes in Central and Eastern Europe and the Soviet Union. It is intended to provide opportunities for established scientists and health professionals from Central and Eastern Europe and the U.S.S.R. to conduct research in U.S. laboratories and to exchange ideas about the latest advances in the neurosciences.

The CEESFN Program has been structured to encourage long term research collaborations. Fellowships will be awarded for three visits of no less than 3 months each over a period of 3 years. The fellowship costs will be borne by the FIC and the research supplement costs will be paid by the NINDS. Further, U.S. sponsors are encouraged to obtain support for collaboration with the foreign institution through a Senior International Fellowship from the FIC. It is expected that six (6) CEESFN fellowships will be awarded the first year.

Response to this program has been excellent. Both U.S. and Central and Eastern European neuroscientists have expressed enthusiasm for the program and have noted that it fills an important need to strengthen research collaboration between established investigators.


Question. Your FY 1992 request of $19,922,000 is an increase of almost $2.4 million, or 13.7 percent. A million dollars of that increase is explained by your requested increases for the central and eastern European initiative and the American and Caribbean initiative. Tell the Committee, from a scientific perspective, the purpose for increasing the scientific exchanges between the U.S. and these two areas of the world.

Answer. The democracy movements in the Central and East European region, including the Soviet Union, have eliminated many of the former political barriers to research cooperation. The region has many excellent scientists who are now able to travel more freely and to be abroad for longer periods of time. In the Soviet Union, direct contacts with scientists in the different republics are now possible. This new situation offers unprecedented opportunities for U.S. scientists to cooperate on mutually beneficial biomedical research projects and to examine disease patterns different from ours, to study problems

characteristic of the region, and to benefit from the special scientific strengths of scientists in the region.

Specific research opportunities offered by the Central and East European region include: neurobiology and neuroepidemiology; environmental pollution causing high mortality from cancer, heart and lung disease, and genetic defects and mental retardation in children; Lyme disease, which appears to have different clinical manifestations in Central and Eastern Europe than it does in North America; and AIDS. Some areas of research strength in the region from which American scientists can profit include neurosciences, molecular biology, mathematical modelling, basic research on cardiovascular disease, orthopedics and sports medicine.

The Latin American and Caribbean region also has many untapped research opportunities of mutual interest. These include neuroepidemiology, neurological and genetic diseases, cellular and molecular biology related to the Decade of the Brain; maternal and child health (low birth weight, human lactation, adolescent pregnancy); AIDS, including interaction with parasitic diseases and compromised immune systems; infection with the HTLV virus and its relationship to cancer; Chagas' disease, malaria, schistosomiasis and other parasitic diseases; effects of high altitude physiology on pulmonary and cardiovascular function; environmental health and conditions related to rapid social and economic change.

An example of the research opportunities supported under these regional initiatives is that provided for a Czechoslovakian scientist to work in the laboratory of an NIH Nobel Laureate to develop an understanding of an epidemic of spongiform encephalopathy in her native country, and its relationship to similar devastating neurological diseases such as Creuzfeldt-Jacob (CJD) Disease. This collaboration appears to have led to the discovery of a genetic defect in CJD victims.

It is important to encourage the best biomedical scientists to remain and work in their countries by offering them cooperation with their U.S. counterparts, including providing modest support for research supplies and equipment, and opportunities for training in the United States. In view of the exceptional response to our two regional initiatives in FYs 1990 and 1991, we see a growing need to continue and expand the cooperation already begun and to support a new level of scientific activities between U.S. researchers and scientists in the two regions.


Question. As you know the FY 1992 budget projects that there will be over 2,300 foreign scientists on the NIH campus in 1992. These scientists are brought to NIH by the other Institutes and are over and above the foreign scientists that are served by your International Research Fellowships and other programs. I understand that approximately one third of your staff goes to support these foreign scientists on the campus at NIH. What kind of services do you provide for these scientists?

Answer. The FIC provides complete management support of the NIH Visiting Program, Guest Researcher Program, and Special

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