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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:]

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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 kin' 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

Volunteer Program and several other smaller programs which bring foreign scientists into NIH's intramural research program. Specifically, FIC staff analyze visa and immigration requirements, and prepare all documents needed to permit a foreign scientist to come to the United States and to NIH. After arrival, FIC staff handle paperwork necessary to place the foreign scientist into the appropriate intramural research program; provide in-depth orientation to the NIH and the community; arrange for documentation in connection with temporary and permanent departure from the U.S., visa renewal or change of visa status, transfer, and conversion between programs and/or institutes; nonimmigrant tax matters; work authorization for dependents; and a great number of other matters. FIC staff also provide expert advice on the

effects of changing immigration policy on scientific exchange.

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It should be noted that three non-NIH agencies participate in the NIH intramural research program the National Institute of Mental Health and the National Institute on Alcohol Abuse and Alcoholism, both of ADAMHA, and the Center for Biologics Evaluation and Research of FDA. FIC provides the same support services to the foreign scientists invited to work in the intramural research laboratories of these agencies.

Question. How is the responsibility for hosting these scientists shared with the host NIH Institute?

Answer. The host Institute is responsible for supporting the cost of the research and the fellowship stipend or salary, depending on the program, of each foreign scientist. FIC's role is limited to the administrative management of these programs, as described earlier.

Furthermore, FIC's Volunteer Services Office offers assistance to NIH's foreign scientists in a wide variety of nonresearch related matters, such as orientation to life in the U.S. and the Washington metropolitan area, housing, furniture, child care and schooling, community resources, and cultural events. Although there are no formal rules governing the hosting of foreign scientists, the sponsoring scientist in the host Institute often will provide some assistance on those orientation matters as well.


Question. The President sent Secretary Sullivan to Africa in January to determine ways the U.S. could improve the dismal health situation for children on that continent. Does the Fogarty International Center have any plans to help in this situation?

Answer. In response to findings of the Presidential mission to Africa, FIC is developing an African Child Survival Initiative to strengthen health research, training and disease intervention capabilities in Africa. The program will build on our successful experience with regional initiatives in Latin America and the Caribbean, and Central and Eastern Europe, which supplement

existing NIH research and training programs relevant to the health problems of these respective regions.

The objectives of the FIC African Child Survival Initiative will be:

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To increase the biomedical research capacity in
Africa by training biomedical scientists and
health professionals in skills necessary to assess
African health and population problems and

cooperate in research studies necessary for their

To share and transfer research findings in the
diagnosis, treatment and prevention of childhood
and maternal diseases and disorders;

To apply the skills of the U.S. biomedical

research community, in cooperation with African
scientists, to develop new and improved
diagnostics, vaccines and other means of
prevention and treatment of disease.

This initiative will offer the dual benefit of increasing biomedical research capacity in Africa and advancing domestic research programs on global determinants of child and maternal health. Expanded cooperation between U.S. and African scientists will enable us to accelerate studies on the transmission of the AIDS virus from mother to child and possibly develop treatment approaches to prevent the onset and progression of the disease. We could advance our understanding of drug and insecticide resistance mechanisms to control the spread of malaria, devise better diagnostic assays and a possible anti-malaria vaccine. could explore better methods of surveillance for new microbial threats to health, more reliable diagnostic tests and possible new vaccines for pneumococcal infections, pertussis and other respiratory infections of shared public health concern; and we could advance our understanding of viral-induced cancer, a frontier field of oncology with global implications for the prevention of certain cancers. And finally, we could contribute

to critical efforts of African nations to devise and implement culturally appropriate and effective family planning and reproductive health programs.


The proposed research program will likely encompass a fivepoint plan consisting of:

1) training grants to U.S. medical institutions to build linkages with African institutions and provide training in laboratory, clinical and epidemiological skills; 2) fellowships for African scientists to undertake training and research activities in U.S. laboratories and for U.S. medical faculty to undertake visiting professorships in Africa; 3) research grant supplements to U.S. institutions to develop sister-institute relationships and research partnerships with African institutions; 4) support for the development of five Regional Health Information Centers in Africa to provide research and health care professionals with current biomedical information; and 5) workshops to promote information exchange and research cooperation between U.S. and African health professionals.

This proposed program will be considered for funding in the FY 1993 budget.

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