Closing the NIH Fogarty Center threatens US and global health.

The budget set out by the Trump administration for the 2018 fiscal year proposes cutting about US$6 billion from the National Institutes of Health (NIH). Specifically, this budget intends to eliminate the John E Fogarty International Center, which currently receives 0·2% of the NIH's 2017 budget of $33·1 billion. Despite its modest size, the Fogarty Center has become a crucial contributor to health research worldwide over the past 50 years by funding the training of over 6000 scientists in developing countries, including many of the world's leading scientists in infectious disease research. The advancement of scientific expertise in developing countries is essential to ensure sufficient local capacity to detect and rapidly respond to epidemics at their point of origin. This local expertise will allow outbreaks to be quickly contained and their effects minimised, thereby directly protecting the health and safety of people in the USA and worldwide. The 2014 Ebola outbreak is a sobering reminder of the need to improve the capacity to detect, respond to, and prevent the spread of health threats in developing countries. Several clinicians and scientists involved in the local response to the Ebola outbreak in Africa were Fogarty Center trainees. The Fogarty Center is now leading an initiative to develop scientific expertise in Guinea, Liberia, and Sierra Leone to bolster the local response to the next outbreak of a fatal infectious disease.1Zeitvogel K Fogarty protects Americans by building pandemic response capacity in Ebola-hit West Africa.Global Health Matters. March/April 2017; 16 (accessed May 10, 2017).: 1-3https://www.fic.nih.gov/News/GlobalHealthMatters/march-april-2017/Pages/building-capacity-for-ebola-west-africa.aspxGoogle Scholar, 2Fogarty International CenterFogarty provides support to Ebola-affected countries.https://www.fic.nih.gov/News/GlobalHealthMatters/november-december-2016/Pages/research-capacity-in-countries-affected-by-ebola.aspxDate: November, 2016Google Scholar The response to the Ebola outbreak was further to the key role served by the Fogarty Center in developing local expertise to effectively respond to the outbreaks of avian influenza and severe acute respiratory syndrome that began in China and subsequently spread to several countries, including the USA. Research by Fogarty trainees has frequently benefited the USA. For example, a clinical trial3Abdool Karim SS Naidoo K Grobler A et al.Timing of initiation of antiretroviral drugs during tuberculosis therapy.N Engl J Med. 2010; 362: 697-706Crossref PubMed Scopus (559) Google Scholar done in South Africa by several Fogarty Center trainees and grantees on the management of HIV and tuberculosis co-infection is saving lives in many countries, including in the USA. The results of this trial contributed to the revision of the US Department of Health and Human Services4Panel on Antiretroviral Guidelines for Adults and AdolescentsGuidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents.http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdfDate: July 14, 2016Google Scholar and WHO5WHORapid advice. Antiretroviral therapy for HIV infection in adults and adolescents.http://www.who.int/hiv/pub/arv/rapid_advice_art.pdfDate: November, 2009Google Scholar guidelines on the treatment of patients co-infected with HIV and tuberculosis. Implementation of the treatment approach proposed by the trial is preventing many deaths across Africa, Asia, and the Americas.6WHOGlobal tuberculosis report.http://www.who.int/tb/publications/global_report/en/Date: 2016Google Scholar Infectious diseases have no nationality and respect no borders, even in countries that restrict immigration. Global health research involves and benefits all countries. As a major beneficiary of global health initiatives, the USA should therefore value and expand the work of the Fogarty Center. This centre is a major contributor to global health, both domestically and internationally, and to safeguarding the USA and the world against future epidemics. All authors have been trainees at Fogarty International Center, recipients of grants from this centre, or both.