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with NCI investigators on the relationship between dietary nutrients and


These efforts will include research on the role of retinoids--vitamin A and related compounds--on cell growth. Such studies may lead to new

strategies for cancer therapy.

The FIC AIDS research and fellowship training programs, mandated by Congress, have been established in 11 U.S. universities. Now in their third year of operation, they have trained epidemiologists, postdoctoral scientists, and clinical investigators from 44 countries primarily in the developing world. By the end of this fiscal year, 90 scientists will have received a graduate degree in public health or science, and 50 will have received postdoctoral research training. Approximately 3,500 health care workers will have taken U.S. supervised short-term courses in their own country in epidemiology and laboratory procedures. Through these efforts these countries can and are joining with us in international cooperation in AIDS research.

Under this AIDS training program two scientists from Uganda are in advanced training at Case Western Reserve University. One scientist is conducting research on the influence of the AIDS epidemic on the occurrence of tuberculosis (TB). TB has become a major complication in AIDS patients in all parts of the world including the United States. New strategies must be developed to combat this double threat. The other scientist is examining the influence of protein-energy-malnutrition (PEM) on HIV infection in infants and young children. The seriousness of PEM as a common problem in Africa is compounded by the alarming increase in AIDS in infants and young children. This research should lead to new strategies for nutrition therapy in AIDS

infected infants.

The Fogarty Center plays a major role within the NIH in facilitating scientific cooperation between NIH scientists and those of other countries of the world. Staff of the Center provide policy guidance and direction, assist in the development and management of bilateral and multilateral biomedical agreements, programs and initiatives, and analyze international health and biomedical issues to support NIH, Departmental, and Administration decision makers. The Center also links the NIH with other international components of the Department of Health and Human Services, the Department of State, the White House Office of Science and Technology Policy, foreign scientific

institutions, multilateral organizations and non-governmental bodies concerned with international health and biomedical research. FIC currently administers NIH participation in 73 formal biomedical agreements with 39 countries. To illustrate our role in providing policy guidance and technical support, in FY 1990 I was appointed Vice Chairman of the Federal Coordinating Council for Science, Engineering and Technology Committee on International Science, Engineering and Technology, and Chairman of its Subcommittee on Cooperation with Industrialized Countries. These bodies provide governmentwide policy guidance on international S&T issues and serve as mechanisms for interagency planning and coordination. FIC staff led committee activities to assess the effects of European economic integration on science and technology relations with the U.S. and provided guidance for the White House Office of Science and Technology Policy in this critical area. As a result of these efforts, the United States has formed a Joint Consultative Group with the Commission of the European Economic Community which is chaired on the U.S. side by the Science Advisor to the President.

In conclusion, the budget request before you will enable the Fogarty Center to significantly enhance its ability to promote international cooperation in the biomedical sciences for the benefit of all mankind. We will be able to expand research in the neurosciences as our contribution to the "Decade of the Brain," as well as expand activities under our two regional


We stand on the threshold of a rapidly changing world that offers new opportunities for scientific collaboration and the exchange of


Through our expanded outreach efforts, we can bring home to the American people the best dividends that derive from medical research wherever

it occurs in the world--better health for all.

Mr. Chairman, I will be pleased Thank you.

Our 1992 budget request is $19,922.00.

to answer any questions you may have.

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1967-1968 1968-1971






Research Assistant, Biophysics Department, Yale

Predoctoral Fellow, National Cancer Institute,
Biophysics Department, Yale University.

Research Associate, Institut für Strahlenbiologie,
Karlsruhe, Germany.

Instructor, Department of Medical Physics,
University of California, Berkeley.

Research Biophysicist, University of California,

Laboratory Director, National Science Foundation
Summer Institute in Radiobiology, University of
California, Berkeley.

Grants Associate, National Institutes of Health.
Budget Examiner, Office of Management and Budget,
Executive Office of the President.

Staff Member, Council on Environmental Quality,
Executive Office of the President.

Associate Director for Interagency Programs,

National Institute of Environmental Health Sciences,

Chief, International Coordination and Liaison
Branch, Fogarty International Center, NIH.
Science Attache and PHS International Health
Representative, U.S. Embassy, New Delhi, India.
Director, Fogarty International Center, National
Institutes of Health

Honors and Awards:







PHS Superior Service Award

Outstanding Performance Ratings

Merit Performance Awards

NIH Merit Award

Secretary DHHS Certificate of Appreciation

NASA Research Fellowship, University of California,


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.

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