Back in the 1950s, there was a global effort to control mosquito populations with the hope of eradicating mosquito-borne diseases such as malaria and yellow fever. Unfortunately, the program was stopped before its goals could be met. Fast forward to the present where the issue of mosquito-borne diseases in some countries is much bigger than it was 50 years ago.

Investigators working to stop the spread of infectious disease around the world, including those at Massachusetts General Hospital, are worried that this same cycle could repeat itself if President Trump’s proposed cuts to the National Institutes of Health (NIH) budget are approved, which would eliminate the Fogarty International Center, a key resource for global health efforts.

“To avoid repeating the same mistake with infectious diseases, we must look ahead and provide the resources necessary now to find an answer to Ebola, HIV, cholera and many other diseases internationally,” explains Stephen Calderwood, MD, former Chief of the Division of Infectious Disease at Mass General.

“People are often unaware of what has been prevented, since by definition what has been prevented has not occurred,” adds Edward Ryan, MD, Director of Global Infectious Disease at Mass General. “The U.S. has and will continue to dodge bullets because of the Fogarty. We would be short-sighted to let this defensive wall fall.”

Closing the Fogarty could put an end to decades of progress into international infectious disease research, say advocates at Mass General. Moreover, doctors and scientists from at-risk countries could face even more barriers to conducting their own research and finding solutions that could directly benefit their communities and curb the spread of infectious diseases around the world.

The Fogarty International Center

The Fogarty International Center supports basic, clinical and applied research and training for U.S. and foreign investigators working in the developing world. For nearly 50 years, the Fogarty has served as a bridge between NIH and the greater global health community — facilitating and supporting promising global health research, building partnerships between health research institutions in the U.S. and abroad, and training the next generation of scientists to address global health needs.

Fogarty programs have trained 6,000 scientists worldwide who have gone on to become established experts and leaders in academia, health ministries and the private sector—both within their home countries and as part of the global scientific community.

“The U.S. has and will continue to dodge bullets because of the Fogarty. We would be short-sighted to let this defensive wall fall,” Edward Ryan, MD, Director of Global Infectious Disease, Massachusetts General Hospital

For 17 years, Fogarty funding has supported a training and academic exchange program between Mass General and the International Centre for Diarrheal Disease Research in Dhaka, Bangladesh. The highly competitive exchange program provides mentored clinical research training opportunities for doctoral students and post-doctoral candidates from the U.S. and abroad. Selected U.S. researchers spend time working at NIH-funded research sites in low- and middle-income countries, while a researcher from the international host site comes to the U.S. for training.

The exchange program, led by Dr. Ryan, has trained more than 50 Bangladeshi and American scientists. Researchers Regina LaRocque, MD, MPH, and Ana Weil, MD, from the Mass General Division of Infectious Disease are among the alumni. They both credit the program for jumpstarting their careers.

“I received a career development award from the Fogarty International Center more than a decade ago, just when I had to decide whether to pursue a research career or move on to something else," says Dr. LaRocque. "Without the support from the Fogarty, I would not have become the scientist I am today.”

Dr. Weil says support from Fogarty has shaped her career in more ways than one. It not only influenced her career path, but also helped her build long term relationships with infectious disease researchers from Bangladesh, who have made valuable contributions to her research.

The Fogarty’s Support at Mass General

Fogarty funding has provided Drs. Calderwood, Ryan, LaRocque, Weil, and other colleagues in the Division of Infectious Disease including Jason Harris, MD, and Richelle Charles, MD, with numerous opportunities to partner with international sites and conduct collaborative research.

“Our work would not be possible without the support of the center,” says LaRocque. “Grants from the Fogarty have funded dozens of American and Bangladeshi scientists who have supported these research efforts over the years.”

The Mass General team works closely with their colleagues in Bangladesh to better understand the causes of and potential treatments for cholera, an acute diarrheal disease caused by ingestion of contaminated food or water that can kill within hours if left untreated.

Although largely eliminated from industrialized countries over a century ago by water and sewage treatment, cholera remains a significant cause of illness and death in developing countries such as Bangladesh, Haiti and certain African countries. A current outbreak in Yemen has led to over 500,000 reported cases and nearly 2,000 deaths in just five months, according to a recent World Health Organization report.

“Our research has provided fundamental insights into which people living in an endemic setting like Bangladesh get sick with cholera and why,” says LaRocque. “This work has advanced the development of improved cholera vaccines, and has helped provide the knowledge underpinning the policy decision to develop and use a global stockpile of cholera vaccines.”

Creating Sustainable Programs

Weil credits their team’s ability to conduct this research to their partnership with the team at the International Centre for Diarrheal Disease Research. “All of this work can’t be done without close relationships and collaborators in the countries where these diseases are most prominent,” she says.

The Mass General team fears that eliminating funding for the Fogarty International Center would severely impact these close connections. Their collaboration has helped to build the local infrastructure and train Bangladeshi investigators to independently continue their research in the hopes of one day finding a solution to the cholera epidemic.

“If we don’t build capacity in the places where diseases are occurring, we’re never going to solve these problems, and it’s going to cost us more in the long run,” says Calderwood. “The Fogarty is really a small investment for a huge return internationally.”