U.S. Department of Health and Human Services,
Press Office, (202) 690-6343
July 3, 2002
HHS Leading Efforts to Reduce Illness and
Disease in the Global Community
Overview: As nations become more interdependent and the health of people influences the health of national economies, countries are increasingly recognizing the importance of global health. Diseases and other health threats do not stop at national borders. In addition, the political instability that can arise from one nation's health crisis may affect an entire region and perhaps the world as a whole.
The U.S. Department of Health and Human Services (HHS) plays an integral role in shaping the federal government's global health policies. Other federal agencies involved in global health include the Department of State, leading the diplomatic efforts; the U.S. Agency for International Development
(USAID), responsible for U.S. foreign assistance; the Department of Defense, supporting communicable disease control throughout the world; the Department of Agriculture, leading efforts on food safety; and the Peace Corps, supporting numerous health programs.
The Bush administration is committed to making the health of Americans and of the world a priority, and is helping lead efforts to reduce the spread of illness and disease, both domestic and internationally, of some of the world's deadliest diseases. Underscoring this commitment, on Jan. 28, 2002, HHS Secretary Tommy G. Thompson announced that the President's fiscal year 2003 budget included a $100 million contribution from HHS and another $100 million from USAID to support the work of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The contribution builds upon the $300 million the President already pledged, for a combined U.S. total of $500 million. Total contributions for the Fund from public and private donors stand at nearly $2 billion.
The President's budget request for HHS in fiscal year 2003 for domestic and international HIV/AIDS programs and activities is $12.9 billion, an increase of more than $906 million from fiscal year 2002.
In addition, on June 19, President Bush announced a new $500 million International Mother and Child HIV Prevention Initiative that seeks to prevent the transmission of HIV/AIDS from mothers to infants and to improve health care delivery in Africa and the Caribbean.
Over the past four generations, public health tools and interventions have dramatically improved life expectancy and quality of life in many areas of the world. However, significant disparities continue to exist across countries. Low- and middle-income nations suffer more than 90 percent of the burden of premature mortality as measured in lost years of life.
In today's global economy, no nation lives in a vacuum. Diseases once endemic only to certain regions of the world can be spread thousands of miles away in only a few hours. The movement of more than 2 million people each day across national borders and the growth of international commerce are responsible for health risks ranging from infectious diseases in travelers to contaminated foods. Nations also trade billions of dollars' worth of foods and other products that may present health risks to importing countries.
SECRETARY THOMPSON VISITS FOREIGN NATIONS ON HIV/AIDS
An estimated 40 million people are living with HIV/AIDS around the world, with 70 percent living in Sub-Saharan African. In April 2002, Secretary Thompson led a White House mission to Africa to strengthen partnerships and continue dialogue on strategies to combat HIV/AIDS. Stops were made in Mozambique, South Africa, Botswana and Côte
d'Ivoire. The Secretary made three announcements during his week-long visit:
* Memorandum of Understanding (MOU) for Voluntary HIV Counseling and Testing Centers. Secretary Thompson and the Mozambique Minister of Health signed a MOU to support collaborative efforts to enhance in-country HIV surveillance systems. The MOU solidifies Mozambique relationships among
HHS, U.S. Department of State, U.S. Agency for International Development, non-governmental agencies and private partners.
* MOU Signing for the American Center for International Labor Solidarity. While in South Africa, Secretary Thompson participated in a cooperative agreement signing ceremony, further expanding operations of the American Center for International Labor Solidarity. The agreement allows HHS to provide nearly $1 million in funds to strengthen the capacity of South African trade unions to implement effective HIV/AIDS prevention and education programs.
* Announcement of First-Ever U.S. Health Attaché for Africa. Secretary Thompson announced the appointment of F. Gray
Handley, M.S.P.H., as the first-ever health attaché in Africa, based at the U.S. Embassy in Pretoria.
The Caribbean has an estimated 420,000 individuals living with HIV/AIDS, and another 1.4 million living with HIV/AIDS in Latin America. On April 20, 2002 Secretary Thompson and other U.S. health officials participated in the signing of a Pan-Caribbean Partnership Agreement in Georgetown, Guyana, to bolster
U.S.-Caribbean collaborations on the prevention and treatment of HIV/AIDS. The Caribbean visit comes less than a month after Secretary Thompson's return from Africa to explore strategies to combat HIV/AIDS, tuberculosis and malaria.
HHS GLOBAL HEALTH PROGRAMS
HHS conducts and supports a number of programs to advance global health issues, including policy development; prevention and treatment of infectious diseases; strengthening public health infrastructure; scientific research and research training; tobacco control; food safety; drug quality and medical device safety.
HHS' fiscal year 2003 budget includes $477 million for a multifaceted effort to combat HIV/AIDS in developing countries, including:
* A total of $100 million from HHS for the Global Fund to Fight AIDS, Tuberculosis and Malaria;
* $144 million for Centers for Disease Control and Prevention's (CDC) prevention, care and treatment capacity development activities to slow the spread of AIDS in 25 nations in Asia, Africa, Latin America and the Caribbean. CDC's budget also includes $11 million for applied prevention research on HIV vaccine, microbicides and treatments; and
* $222 million for NIH to support comprehensive international research efforts, including vaccine development, training and infrastructure and capacity building.
HHS' Office of Global Health Affairs facilitates and supports the department's global strategies and partnerships to best serve the health of the American people. The office represents the department to other governments, international organizations and the private sector on international health issues; develops and facilitates global health policy and strategy positions; provides leadership and coordination for select bilateral programs with other nations; and provides policy guidance and coordination on refugee resettlement health issues. In addition, the office supports an information portal on global health issues, including reports, statistics and links to international organizations at
PREVENTION AND TREATMENT OF INFECTIOUS DISEASES
Infectious diseases such as AIDS, malaria and tuberculosis kill millions of people worldwide each year. The World Health Organization (WHO) estimates that 1,500 people die each hour from infectious disease. Half of these deaths occur in children under five years of age, and most of the remaining deaths are in working adults who frequently are breadwinners and parents. In addition to the vast emotional toll of these diseases, their impact can leave economic and political instability both in countries and in large regions of the world. Without adequate worldwide efforts, infectious diseases can pose a health and an economic threat to every nation.
HIV/AIDS, Malaria and Tuberculosis
An estimated 40 million people worldwide were living with HIV/AIDS at the end of 2001, with more than 6,500 young people aged 15 to 24 becoming HIV infected every day. More than 70 percent of these people live in Sub-Saharan Africa, with another 16 percent living in South and Southeast Asia. In addition, malaria claims 1.5 million to 2.7 million lives in tropical and subtropical climates each year, and tuberculosis claims the lives of 2 million people each year.
Within HHS, the National Institutes of Health (NIH) represents the largest single public investment in AIDS research in the world, supporting a comprehensive program of basic, clinical and behavioral research on HIV infection and its associated infections, such as tuberculosis. NIH's international AIDS research effort began in 1985 and now encompasses more than 50 countries in Africa, Asia, Europe and Latin America.
* NIH's National Institute of Allergy and Infectious Diseases (NIAID): On June 28, NIAID announced the awarding a $14.8 million five-year grant to the CDC in China. This
multi-project grant, known as the Comprehensive International Program of Research on AIDS
(CIPRA), will expand China's research activities in HIV/AIDS prevention, treatment and vaccine development, in cooperation with experts from U.S. universities and medical schools. The CIPRA grant is an important new element in NIH's portfolio of research efforts in China, including China's participation as sites in three major domestic/international research networks; collaborative studies between U.S. and Chinese investigators; and research training for Chinese scientists.
* In recognition of World AIDS Day -- December 1, 2001 -- NIH launched a new Web resource that provides comprehensive information about the diverse array of
NIH-supported HIV/AIDS research at its Bethesda, Md., campus, across the United States, and around the world. The site features information for researchers, health care workers and the general public. Included are links to information on clinical trials, scientific and medical literature, on-line order forms for publications, counseling resources, plus seminar information for the general community. Support for HIV/AIDS-related domestic and international programs at NIH totaled $2.5 billion in fiscal year 2002 and is nearly $2.8 billion within the fiscal year 2003 President's budget request. Visit the Web site at
* NIH's Office of AIDS Research (OAR) has developed a strategic plan for international AIDS research to lead to better therapies and prevention strategies for HIV and AIDS. Major areas of the NIH international AIDS research strategic plan include: vaccine research; development of topical microbicides to prevent sexual transmission of HIV infection; prevention of disease transmission and progression; research on women and AIDS; prevention and treatment of HIV infection in children; prevention and treatment of opportunistic infections such as tuberculosis; training of foreign scientists; and research collaboration with other countries. Information on the NIH Global AIDS Research Initiative and Strategic Plan is available at
* NIH institutes committed to carrying out the goals of the initiative and strategic plan, among others, include NIAID and the Fogarty International Center
(FIC). In May 2001, NIAID released its Global Health Research Plan for HIV/AIDS, Malaria and Tuberculosis, which can be found at
http://www.niaid.nih.gov/publications/globalhealth/global.pdf. Information on AIDS and related programs supported by FIC can be found at
* The HHS Global AIDS Program, a partnership of CDC and the Health Resources and Services Administration
(HRSA), works in 25 countries to help prevent HIV infection, improve care and treatment and build capacity to address the global HIV/AIDS pandemic. The program includes: assistance to countries for programs to prevent sexual, mother-to-child and blood transmission of HIV; capacity development to assist countries to implement, monitor and evaluate their national HIV/AIDS programs; and supporting countries' efforts to strengthen and expand care, support and treatment options for people with HIV/AIDS and related infections, such as tuberculosis. HRSA provides technical support for addressing care, support and treatment within the overall Global AIDS Program. Information on the Global AIDS Program is available at
* Safe and effective vaccines are needed to prevent further spread of HIV, malaria and tuberculosis as well as to prevent acute respiratory infections and other diseases. The Food and Drug Administration (FDA) supports global efforts in vaccine research, development and regulation, including the development of standards for vaccine quality control and the development of new methods of monitoring and assessing the safety of vaccines. In addition, FDA supports global efforts to ensure the availability and use of safe blood to limit the transmission of viral and bacterial diseases and other pathogens.
Other Infectious Disease Efforts
In addition to conducting and supporting programs to combat HIV/AIDS, malaria and tuberculosis -- the world's deadliest infectious diseases -- HHS programs are tracking, researching and combating a wide range of international health threats caused by infectious diseases. Recent high-profile examples include surveillance and prevention efforts against the West Nile virus and bovine spongiform encephalopathy
(BSE, also known as "mad cow" disease). Other HHS initiatives include the following:
* CDC has developed a strategy to prevent emerging infectious diseases, including new drug-resistant forms of familiar diseases like bacterial pneumonia. The plan, Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, establishes strategies under four goals, both within the United States and internationally: improving surveillance and response; conducting applied research; strengthening infrastructure and health professions training; and expanding prevention and control efforts. More information on the strategy is available at
* United States and internationally: improving surveillance and response; conducting applied research; strengthening infrastructure and health professions training; and expanding prevention and control efforts. More information on the strategy is available at
* NIAID supports research to control and prevent diseases caused by virtually all infectious agents. A major focus is on the problem of emerging infectious diseases. Information on NIAID's program can be found at
* FDA is involved in a number of international activities to combat infectious diseases, including efforts to combat foodborne microorganisms, to provide safe and effective drugs and vaccines, and to reduce the emergence of antimicrobial resistant microorganisms. More information on FDA programs can be found at
STRENGTHENING PUBLIC HEALTH INFRASTRUCTURE
One essential tool for combating the full range of public health priorities is strengthening health care infrastructure. HHS is committed to working with scientists, physicians and policymakers internationally to strengthen the health care infrastructure in nations battling infectious diseases, non-communicable diseases, injuries and other major health problems. HHS efforts include:
* CDC and the Agency for Toxic Substances and Disease Registry (ATSDR) have prepared a Global Health Strategy to respond to the public health issues impacting the global community. The strategy defines goals in five critical areas of public health: strengthening global public health surveillance and response; working with countries to establish and maintain public health infrastructure systems; collaborating with international partners to develop, implement and evaluate public health prevention and control strategies; assisting global partners to conduct applied research to improve public health policies and programs; and promoting the free international exchange of lessons learned. More information on the Global Health Strategy is available at
http://www.cdc.gov/ogh. CDC also sponsors the Field Epidemiology Training Program, which has helped more than 20 nations develop their own national epidemiology training programs.
* HRSA International AIDS Education and Training Center. On March 29, 2002, HRSA launched a three-year, $1.5 million agreement to provide overseas health care providers with the latest training and education on caring for people with HIV/AIDS. The project will allow health care providers in Africa and India to receive information about the diagnosis, treatment and prevention of HIV. Participating are the schools of medicine of the University of Washington-Seattle, and the University of California-San Francisco. For more information on the partnership, visit
* FDA promotes strengthening regulatory systems and resources globally to ensure that regulated products are effective, of good quality and monitored for safety. FDA's Office of International Programs also promotes and supports international efforts to strengthen regulatory authorities, encourage harmonization of standards, and bolster cooperative efforts in product safety monitoring and staff training.
INTERNATIONAL RESEARCH AND TRAINING
Because research advances made abroad have a positive impact on the health and lives of Americans, HHS has long made a commitment to support basic science and rigorous clinical and applied studies in other countries. Over the past decade, NIH's international research and research training expenditures have totaled more than $1.66 billion in a wide range of biomedical and behavioral research areas. Examples of these global efforts follow:
* Training and Scientific Capacity Building: Since 1988, FIC, working in partnership with other components of
NIH, has supported a number of international research and training programs focused on global health priorities such as HIV/AIDS, emerging infectious diseases, environmental and occupational health, maternal and child health, population research and demographic science, and other areas. These programs provide training and support to scientists primarily from developing countries so that those countries may begin to build the interdisciplinary skills necessary to meet these global health challenges. In February 2001, FIC announced a new grant program to provide research support to junior
U.S.-trained investigators from the developing world to promote their re-entry to their home countries. More detailed information is available at
* NIAID supports the HIV Vaccine Trials Network and the HIV Prevention Trials Network, an international group of research sites that carries out clinical trials of HIV vaccines and explores non-vaccine prevention strategies to reduce HIV transmission. The networks include sites in the United States, Africa, Asia, South America, and the Caribbean. The HIV Vaccine Trials Network's global capacity will allow for rapid expansion as more vaccine candidates enter the pipeline for testing and development, and for executing larger scale studies of suitable vaccines. Details about the networks are available at
* Sequencing the Human Genome. The Human Genome Project is a research program that, through international scientific collaboration, could lead to scientific advances that would drastically alter scientists' understanding, diagnosis and treatment of hereditary diseases. Alterations in human genes are responsible for an estimated 5,000 hereditary diseases and influence the development of thousands of other diseases. Through the Human Genome Project,
HHS' National Human Genome Research Institute (NHGRI) at NIH works with international partners in the United Kingdom, France, Germany, Japan and China and with partners in the private sector to locate and map the genes in the human genome -- the genetic blueprint for human beings. More information on the Human Genome Project is available at
* Bioethics. As research activities in other countries have increased in recent years, so has the number of complex questions concerning the social and ethical dimensions of collaborative research. NIH has developed a number of programs to improve the quality of ethics training both in the United States and abroad and has worked with international partners to support the development of the Global Forum on Bioethics in Research. More information about international
bioethics-related activities can be found at http://www.nih.gov/fic/programs/bioethics.html.
INTERNATIONAL TOBACCO CONTROL
HHS continues to provide leadership in international tobacco control efforts in collaboration with the World Bank, the UN Foundation, the United Nations Children's Fund
(UNICEF), and the World Health Organization (WHO) along with other international organizations. As the North American WHO Collaborating Center for Smoking and Health, CDC's Office on Smoking and Health
(OSH) is providing training, technical assistance and scientific collaboration to support the development of national plans of action for tobacco control, conduct country-level surveillance of tobacco use and foster epidemiologic research.
By the end of 2001, nearly 100 of the 191 WHO member states have been assisted by OSH in planning for or implementing the Global Youth Tobacco Survey. In the fall of 2001, the Web-based National Tobacco Information On-Line System was released to provide comprehensive country-specific tobacco-related data. Following the continuing success of capacity-building efforts, OSH in May 2001 announced the expansion of tobacco programs into Southeast Asia, particularly Vietnam, Laos and Malaysia. In addition, HHS led the U.S. Delegation to the Third International negotiating sessions for the Framework Convention on Tobacco Control.
Building upon the Global Smoke-Free Soccer initiative, the HHS Tobacco-Free Sports Initiative has continued to expand and is currently being featured at the 2002 Winter Olympics in Salt Lake City.
FOOD, DRUG AND MEDICAL DEVICE SAFETY
Within HHS, FDA is responsible for ensuring that foods, human and veterinary drugs, biological products, medical devices, cosmetics, and electronic devices that emit radiation are safe and comply with U.S. laws and regulations. The rapid increase in the development of products and process standards in foreign countries and the dramatic rise of FDA-regulated imports to the United States have heightened the importance of the agency's international role. Through collaboration and cooperation with its foreign regulatory counterparts and through on-site inspection of imported products, FDA works to ensure that international products are safe and effective for American consumers. FDA also represents HHS on U.S. government delegations to international and multilateral negotiations involving food safety and sanitary regulations. Most of FDA's international activities are managed through its Office of International Programs. More information on FDA's international activities can be found at
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