A meeting was held in Bethesda under the auspices of the Fogarty International Institute of the National Institutes of Health, attended by Minister of Health Jorbenadze, Deputy Minister Gamkrelidze, and other scientific leaders of Georgia. A follow up visit was made to Tbilisi by Dr. Richard Krause of the Fogarty, accompanying Atlanta-Tbilisi partnership members. At this latter meeting Dr. Krause gave an assessment of the state of biomedical research in Georgia, and made explicit recommendations for the future. A third meeting was held in Tbilisi in 1998, with leading scientists working in AIDS from the NIH. Invited members of this group were Atlanta-Tbilisi partners working with AIDS and tuberculosis in Georgia. Three grants, totaling $385,000, have been obtained from the NIH and the World AIDS Foundation by joint proposals of Georgian and U.S. Atlanta-Tbilisi partners for research in AIDS and tuberculosis.
Excerpts from the Briefing Document (June 17, 1998) of the NIH visit:
U.S.-GEORGIA JOINT SYMPOSIUM: RESEARCH OPPORTUNITIES
IN HIV/AIDS, EMERGING INFECTIOUS DISEASES AND IMMUNODEFICIENCIES
History of the U.S.-Georgia Scientific Collaboration
The National Institutes of Health has participated in an expanding collaboration with the Republic of Georgia over the past several years. The collaboration has involved primarily the National Institute of Allergy and Infectious Diseases (NIAID) and the Fogarty International Center (FIC); other NIH Institutes have been involved to a lesser extent. The recent jointly sponsored symposium grew primarily out of the relationships developed over the past three years, outlined below, between NIAID and researchers in Georgia.
In 1996 the Georgian Minister of Health, Dr. Avtandil Jorbenadze, visited the NIH and met with Dr. Anthony Fauci, Director, NIAID, as well as Dr. Richard Krause, Director, FIC. At that time, he discussed specific health issues in Georgia, such as tuberculosis and the threat of an HIV epidemic, and expressed a desire to collaborate with NIH and obtain NIH support in the Georgian government's efforts to address these issues and rebuild the public health and science infrastructure of the Republic. This initial visit was followed in 1997 by a one week grantsmanship workshop, sponsored primarily by the FIC and the Civilian Research Development Foundation (CRDF), for which a team of Georgian scientists was brought to the NIH campus in Bethesda to work with representatives of several NIH Institutes in developing proposals for the CRDF grant program. Two of the Georgian/U.S. collaborative proposals competed successfully for CRDF funding: a collaboration between the Georgian Tuberculosis and Pulmonary Research Institute (Dr. George Khechinashvili) and Dr. Henry Blumberg at Emory University, and a collaboration between the Georgian AIDS and Clinical Immunology Research Center (Dr. Tengiz Tsertsvadze) and Dr. Kenrad Nelson of Johns Hopkins University. In addition, Dr. Tsertvadze had established collaborations with Dr. Jack DeHovitz, SUNY-Brooklyn, and had spent a sabbatical working in Dr. De Hovitz' laboratory (through the SUNY-FIC AIDRP program). He also has a World AIDS Foundation grant to collaborate with Dr. Carlos Del Rio of Emory University in studies of HIV prevalence. Finally, FIC supports EREIDS training awards to the University of Maryland and SUNY/Albany that involve Georgia.
The NIAID was encouraged by this success on the part of Georgian scientists to obtain U.S. research funding. In addition, Dr. Jorbenadze (Minister of Health) continued to demonstrate a commitment on the part of the government of Georgia to the support of rebuilding not only the public health infrastructure of the country, but also investing in basic science and biomedical research. Because many of the pressing health needs in Georgia are in the areas of emerging infectious diseases, including HIV, the NIAID and the Ministry of Health of Georgia agreed it would be beneficial to sponsor a joint symposium, to be held in Georgia, to assess the needs of Georgia and further establish collaborations between Georgian and U.S. scientists in these areas. The workshop, held the week of May 12 in Tbilisi, Georgia, also received co-sponsorship from the Georgian AIDS and Clinical Immunology Research Center; Fogarty International Center; PHS Office of Refugee and International Health; NIH Office of AIDS Research; and the National Institute of Drug Abuse, NIH. The U.S. delegation was led by Dr. Sharilyn Stanley, Special Liason for Science and Health Policy, NIAID, representing Dr. Fauci who could not attend due to scheduling conflicts. Also attending from NIH were Dr. Karl Western, Assistant Director for International Research, NIAID; Dr. Paolo Miotti, Basic Science Program, Division of AIDS, NIAID; Dr. Dianne Tingley, Chief, AIDS Preclinical Research Review Branch, NIAID; and Dr. Henry Francis, NIDA. The remainder of the U.S. delegation consisted of 8 infectious disease researchers who are NIH grantees. This includes 6 current NIAID grantees (Dr. Jack DeHovitz, SUNY; Dr. Warren Johnson, Cornell University Medical College; Dr. Glenn Morris, University of Maryland; Dr. Dale Morse, SUNY, Wadsworth Center; Dr. Kenrad Nelson, JHU; and Dr. Kent Sepkowitz, Memorial Sloan-Kettering Cancer Center), and 2 researchers from Emory University who have active collaborations in Georiga through the long-standing USAID- sponsored Georgia (U.S.)-Georgia initiative (Dr. Henry Blumberg, Emory, who is NHLBI-funded and is collaborating through the previously mentioned CRDF grant, and Dr. Carlos Del Rio, Emory, collaborating through the World AIDS Foundation grant and the Georgia-Georgia initiative).
Dr. Jorbenadze expressed his personal commitment to health issues in several substantive efforts. First, recognizing the barrier that language poses for his young scientists, he has made a commitment to provide free English courses for this group of individuals. Second, he has created a mandatory set-aside of funds, 3% of all health care dollars in central programs (total health care dollars approximately 60 million Lari), to be dedicated to medical research (1.8 million Lari or about$1.35 million, [1 US $ ~ 1.33 Lari]). Finally, his government has spent approximately 3 million Lari on the diagnosis, treatment and prevention of tuberculosis last year; he intends to double this to approximately 6 million Lari next year, if this proves fiscally feasible. Dr. Jorbenadze expressed his desire that we focus our collaborations and efforts on the population of young scientists in Georgia and emphasize as much as possible training opportunities in the United States or the West for these investigators.
The U.S. scientists met on the last morning of the symposium to discuss our impressions and findings. These were conveyed to the Georgians at the closing session and are listed in priority order below. Underlying all of the specific disease priorities is the condition of the research infrastructure in Georgia. Specifically, buildings, laboratories and equipment are in great need of repair, upgrade, or procurement. In addition, with continued (although diminishing) armed rebellion in the country, electrical power is sometimes interrupted, creating a need for individual generators for equipment supplying critical services. Finally, the 'Soviet-style' vertical structure of the medical institutions, with responsibility for specific scientific areas assigned to distinct institutes that are not prone to collaboration, must become flexible to allow the coordinated approach necessary for successful biomedical research. The obvious commitment of the Georgian government, including President Shevardnadze and Minister Jorbenadze, to developing public health and research programs gives us optimism that these infrastructure difficulties will be addressed as resources allow.
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