IAS 2017: Pioneering HIV researchers tell how public health leadership started with Fogarty fellowships

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Science Speaks continues coverage this week of the July 23-26 9th IAS Conference on HIV Science in Paris.

Paris – When Dr. Jean Pape began his medical training in the 1970s, he didn’t see what research could do to solve the problems facing his country. Ranked among the most fragile countries on earth, home to one-sixth of deaths from disasters occurring worldwide, and situated — in the crosswinds of trade and tourism, limited health services and historic economic inequities — to become home to the highest HIV prevalence and highest TB incidence in the Western hemisphere, Haiti’s needs were too immediate to wait for answers.

Linda-Gail Bekker grew up in pre-Independence Zimbabwe to become as she puts it now, “a passionate, curious, energetic but inconsequential young African doctor,” determined to do something about the health inequities she saw in post-Apartheid South Africa, but with no idea how, with the limited opportunities at hand.

In a second-day IAS 2017 session, Dr. Pape, now founder and leader of GHESKIO in Haiti, the first ever comprehensive AIDS center dedicated to research, training and care, and Dr. Bekker, now president of the International AIDS Society and deputy director of the Desmond Tutu HIV Centre in South Africa, told conference attendees how a training opportunity named after a Rhode Island Congressman changed the course of not just their work, but of capacities in their countries to prevent, detect and respond to global health threats.

The Congressman was John E. Fogarty, who explained his philosophy in a 1962 Science magazine interview quoted by Dr. Bekker: “I feel that as long as people are sick, something has to be done to make them better. The government has to give most of the help, because there’s no one else to give it. If kids are handicapped or sick and no one else is going to try everything possible, well it just can’t be that way.” In a sign that they agreed with him, upon the congressman’s death in 1967 Rep. Fogarty’s colleagues named and launched the National Institutes of Health Fogarty International Center where both Dr. Pape’s and Dr. Bekker’s research careers, as well as hundreds of trainees who preceded and followed them began. With the Center up for elimination under a Trump administration budget plan proposing deep cuts to biomedical research and international aid, the physician scientists described some of the continuing benefits of the training and research grants they received, and the ongoing ways Fogarty grants have strengthened their countries’ abilities to contain infectious diseases.

For Dr. Pape, a 1989 to 1990 Fogarty trainee, and a 1990 to 1997 Fogarty grantee, they include the MD, PhD, and Masters-level training of 482 Haitians that enabled them to conduct research on opportunistic infections, tuberculosis, and HIV treatment leading to HIV prevention and care models. Those trainees, in turn, trained more than 16,000 more health workers to build GHESKIO’s capacities to respond to HIV, sexually transmitted diseases, and, now, cholera, to establish public health programs with Haitian organizations and agencies, and to develop research networks across the Caribbean and Central America. Fogarty support led to findings in Haiti that isoniazid preventive therapy is the most cost-effective way to prevent people with HIV from developing TB, laid the foundation for the initiation of antiretroviral treatment in 2003 for the first 2000 HIV patients — 70 percent of whom remain alive, to findings on decreases in tuberculosis and deaths caused by HIV when treatment is initiated prior to HIV disease progression, and recently published data on the improved health and outcomes that come with following HIV test and treat guidelines. Fogarty trainees not only made Haiti’s ability to effectively scale up access to antiretroviral treatment possible, but enabled local responses to the outbreak of cholera that followed the 2010 earthquake and arrival of United Nations responders there, Dr. Pape said. Today GHESKIO is credited with slowing spread of HIV across a country that is one of the United States’ closest neighbors.

Dr. Bekker,  who trained to become a doctor as the HIV epidemic in South Africa become the largest in the world, learned “If anyone has HIV, it was almost certain they would get TB.” She saw an urgent need to investigate the interaction of the two epidemics,  and how to contain them, on individual and community levels, but had neither money or resources to support an investigation. She wasn’t alone. South Africa, where fewer than 5 percent of doctoral candidates were completing their studies — largely because of financial constraints — needed at least 5,000 new Ph.Ds. The Fogarty fellowship she received allowed her to work in the United States, where she said, she found state of the art laboratories, inspirational colleagues, and the beginnings of strong networks of fellow investigators. Most importantly, she then was able to return to where the burden of disease was greatest. Now, at the Desmond Tutu Center, she has seen Fogarty fellowships since create new leaders in vaccinology, implementation science and HIV prevention and treatment.

When she heard the White House proposal to eliminate Fogarty, she was devastated, she said, “The last thing we should be doing is remove research training and capacity building.”

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