A proposal to cut funding for the John E Fogarty International Center from the upcoming United States federal government budget by President Donald Trump’s administration has prompted an outcry from academics and educators across Africa.
For decades Fogarty, part of the US National Institutes of Health, has been instrumental in developing medical teaching and research capacity on the African continent. And while its shuttering could have an outsized impact on Africa, academics say everyone – including Americans – would feel the impact of its closure. The US Congress has yet to say whether it will accept cutting the Fogarty budget, but in the meantime, its future is unclear.
“Fogarty had a vision for developing capacity in Africa,” said Dr Julius Ecuru, a Ugandan academic, currently programme manager at the Nairobi-based International Centre of Insect Physiology and Ecology, who went through a Fogarty-sponsored training on research ethics starting in 2004.
Researchers who went through a similar training in Nigeria helped lay the groundwork for clinical trials of a prospective vaccine for the Ebola virus disease – one of the most promising in development.
Africa joins global discussions
“This is really, really great, for Africa to begin contributing in the global discussions on these issues. It’s something you couldn’t find there before Fogarty,” said Ecuru.
Established in 1968, the Fogarty centre is a federally-funded endeavour to promote global health research and build partnerships between US institutions and those abroad. It was awarded US$69 million under the last federal budget and sent the vast majority of this money in the form of relatively small grants to US institutions whose researchers would then collaborate with universities abroad, including in dozens of African countries.
This has been critical, grant recipients said, to building the capacity both of African researchers, but also their US counterparts.
That the centre encourages those collaborations reflects the state of the increasingly globalised health system, where diseases like Ebola or Zika can spread easily between countries. Some of Fogarty’s earliest work in Africa focused on HIV research, which has contributed to the development of cutting-edge prevention and treatment interventions.
Improving awareness of global health threats also requires increasing local medical training and research programmes, both to help recognise the start of a potential outbreak and to help quickly stem its spread.
“The impact on research on the continent has been impressive,” Dr Roger Glass, Fogarty’s director, told University World News. “It has helped centres of excellence grow up around Africa that can deal with problems there that are also global problems. Everyone benefits from this.”
That will be lost, he said, if the Trump administration’s proposal is adopted. Now beneficiaries in Africa have joined with global health advocates to push the US Congress, which still has to consider and pass the federal budget, to prevent this cut.
Within the global health community, the move to shutter Fogarty has been met with some surprise, in part because the centre’s funding is relatively modest. The National Institute of General Medical Sciences, for instance, has a US$2.5 billion annual budget.
But while the US National Institutes of Health are facing a US$7.7 billion overall budget cut from the previous fiscal year, Fogarty is the only institute facing elimination. The Trump administration did not respond to requests for comments on why it has specifically targeted Fogarty for closing, though the budget document is clearly targeting global programmes.
The centre awards grants that further its mission through a rigorous, peer-reviewed mechanism. Glass said over its history, Fogarty has chosen the kinds of cross-institution initiatives that offer dramatic benefits to both local and international communities, but that lack domestic prioritisation, global awareness or, simply, enough money.
The proposal to close Fogarty is especially galling to beneficiaries in Africa, who say they have been able to achieve outsized, globally significant results because of Fogarty funding.
In Ghana that has meant significant assistance in creating West Africa’s first emergency medical training programme. Fogarty awarded a grant, beginning in 2010, under a five-year, US$130 million Medical Education Partnership Initiative that helped establish an exchange programme between Kwame Nkrumah University of Science and Technology, or KNUST, in Kumasi, Ghana’s second-largest city, and the US’s University of Michigan.
Over these five years, emergency physicians and nurses travelled regularly to Kumasi from Ann Arbor, Michigan, to help teach classes and offer on-site training at the hospital. And KNUST faculty received funding to visit the University of Michigan, which helped guide them in drafting their curriculum and setting up their emergency training programmes, said Victoria Bam, the senior lecturer in KNUST’s department of nursing.
Without the grant, “that would have meant the government would have had to sponsor people to go outside to have the training and then come back to Ghana,” she said. With the programme in place, though, more than 200 nurses have already graduated and been positioned at health centres across the country. “It has improved our workforce,” Bam said. “And it’s bringing down the mortality.”
For Dr Oathokwa Nkomazana, the acting deputy dean of the faculty of medicine at the University of Botswana, the move to close Fogarty is a failure on the part of the US administration to understand that “health is global now. To lose sight of that fact would be a real pity.”
Fogarty was instrumental in getting her university’s medical programme off the ground. Officials in Botswana had long worried that the cost of opening a new medical faculty would be prohibitively expensive and they had preferred to pay to send prospective doctors abroad for training. The problem was that many did not return and those who did were “trained from other health systems”, she said.
“That doesn’t lend itself to good health outcomes and a good system.” So, in 2009, the country opened the medical school and a year later the new faculty learned they had also received a five-year Medical Education Partnership Initiative grant to be administered by Fogarty.
That money dramatically accelerated the development of the new medical school, Nkomazana said, creating opportunities for Botswanan faculty to train at the Perelman School of Medicine of the University of Pennsylvania and the Harvard University School of Public Health and building the research capacity of the programme.
“The grant came at a really good time,” she said. “Had we not had the initial grant money, the university may have stumbled.”
Aside from the benefits to Botswana, which she said have been enormous, the opening of the school also presented significant opportunities to researchers and students from Harvard and the University of Pennsylvania. And she said the Trump administration should not lose sight of that.
They come away from their collaboration with the University of Botswana with a variety of knowledge: a better understanding of some of the diseases that are prevalent in the region, awareness of gaps in surveillance that could fuel later outbreaks, but also how to better work with their colleagues from around the world.
“With Fogarty’s closure, Africa will definitely lose,” she said. “But the US will lose a lot, lot more.”
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