CONFERENCES HIGHLIGHT SUCCESSES AND REMAINING CHALLENGES

UNCLAS SECTION 01 OF 03 BRASILIA 000606 SENSITIVE SIPDIS STATE DEPARTMENT FOR OES/IHB, OES/STC:K.DELAK, WHA:F.COLON, WHA/BSC:D.SCHNIER E.O. 12958: N/A TAGS: TBIO KSCA NIH CDC BR SUBJECT: CONFERENCES HIGHLIGHT SUCCESSES AND REMAINING CHALLENGES IN HEALTH COOPERATION BETWEEN THE US AND BRAZIL BRASILIA 00000606 001.2 OF 003 (U) THIS CABLE IS SENSITIVE BUT UNCLASSIFIED AND NOT FOR INTERNET DISTRIBUTION. ¶1. (SBU) SUMMARY: Two recent conferences in Rio de Janeiro highlighted both the successes and obstacles remaining in health cooperation between the United States and Brazil. Current bilateral cooperation programs that have staff actually working within Government of Brazil (GOB) health agencies have been successful, such as with the HIV/AIDS program, while other efforts to spur joint research have often encountered serious bureaucratic delays. Fortunately, there are some positive signs that change may be on the horizon, and the Embassy will continue to engage with GOB officials in an effort to make progress overcoming the outstanding issues. END SUMMARY. CDC'S PARTNERSHIP WITH THE NATIONAL AIDS PROGRAM ¶2. (SBU) A shining example of successful cooperation between the United States and Brazil in the field of public health is the Center for Disease Control and Prevention (CDC)'s Global AIDS Program (GAP). CDC/GAP is integrated into Brazil's National AIDS program, functioning as a part of their larger organization. This integration has lead to a strong partnership that not only benefits the United States and Brazil, but which also is a model for other countries in Latin America and Africa. The model for monitoring and evaluating AIDS patients developed by the CDC/GAP program is now being exported to third countries to help them strengthen their public health systems as well. ¶3. (SBU) This program was highlighted at the Monitoring and Evaluation International Seminar held at the Brazilian National School of Public Health (a part of the Oswaldo Cruz Foundation (Fiocruz)) from March 23 through April 3, 2009. The seminar was held in three languages (Portuguese, English, and Spanish) and had participants from a variety of countries throughout Latin America and Africa. The seminar included two weeks of courses and lectures on best practices in HIV/AIDS monitoring and evaluation. ¶4. (SBU) In a side conversation during the monitoring and evaluation conference, the Director of the National AIDS Program, Mariangela Batista Galvao Simao, spoke very highly of the CDC/GAP program and the work that it does in conjunction with the National AIDS Program. She also had praise for the current CDC/GAP Director, Dr. Aristides Barbosa. NOTE. Dr. Barbosa's position is unique as he is the only non-American to be appointed as the Director of a CDC program abroad. Dr. Barbosa's familiarity with the Brazilian public health system and the key players within the system has increased the Brazilians' comfort level with this program and contributed to its success. END NOTE. NIH ACTIVITIES IN BRAZIL: A MIXED BAG ¶5. (SBU) The National Institutes of Health (NIH) have a long history of cooperation in Brazil. Brazil is one of the largest recipient countries of NIH grants, with approximately 170 active projects and at least $28 million dollars in research grants in FY08. NIH representatives indicated that there is great interest among US researchers in collaborating with their Brazilian counterparts because Brazilian researchers and institutions are capable of engaging in high quality research. ¶6. (SBU) Brazil is also one of the few countries in which an NIH alumni association (NIH Alumni Association of Brazil - NIHAABR) has grown into an active organization with a serious agenda. The NIHAABR consists of Brazilian researchers with previous exposure to the NIH, either through training at NIH intramural laboratories, collaboration with NIH scientists or NIH funding for extramural research. These scientists place great importance on both the experience they gained with the NIH and the value of the NIH as a resource for collaborative scientific efforts. ¶7. (SBU) The NIHAABR has an ambitious agenda of supporting collaborative biomedical research, as well as exchanges of US and Brazilian scientists. For example, the NIHAABR has helped to facilitate a proposal by the Brazilian Federal Agency for Support and Evaluation of Graduate Education (CAPES) to support Brazilian researchers who may be able to work at NIH laboratories. ¶8. (SBU) Despite strong incentives for NIH-supported research in Brazil, there are significant bureaucratic hurdles that impact NIH-funded research. The GOB has established a complex approval BRASILIA 00000606 002.2 OF 003 process for all biomedical research funded by a foreign government. The research protocol must be submitted through the foreign government's embassy and the Ministry of External Relations (MRE) to the Ministry of Health (MS) for approval by the Ministry of Health, the Ministry of Science and Technology (MCT),and the National Commission on Ethics in Research (CONEP). In certain cases, additional approvals are required from the National Agency on Health Vigilance (ANVISA) and the National Technical Biosafety Committee (CTnBio). ¶9. (SBU) The approval process for NIH-supported research routinely requires many months and often more than a year to complete. In some situations delays have resulted in a loss of funding. In other situations, researchers have chosen to conduct their research in neighboring countries rather than pursue Brazilian approvals. ¶10. (SBU) Post has engaged with counterparts in the GOB to identify changes in procedure that can speed up grant approvals. Post also regularly works with GOB officials to facilitate the clearance of grants as researchers navigate this approval process. ¶11. (SBU) This topic has been discussed at the United States-Brazil Joint Commission and at the United States Brazil Working Group on Public Health. The Working Group established a bilateral Task Group on Regulatory and Ethical Affairs and Joint Research Review. The Task Group has not made any significant progress toward resolving these issues, and the US has consistently met with resistance in attempts to develop concrete steps for addressing this problem. ¶12. (SBU) The Brazilian researchers in attendance at the NIHAABR's First International Workshop expressed a great degree of concern over the problem of delays in research approvals. They indicated that some of these problems apply to purely domestic research as well. ¶13. (SBU) The component of the review process that causes the longest delays relates to ethical approval by CONEP. All in attendance at the NIHAABR meeting expressed concern with not only the delays, but also the lack of transparency in the approval process and the capriciousness of the outcomes. For example, researchers noted that they would receive varying, and often contradictory, guidance from CONEP for different projects. The MS representative at the NIHAABR meeting, Ms. Jamile Menezes, noted that CONEP refuses to discuss individual reviews, generally does not attend meetings related to this process, and is quite difficult to contact. The researchers echoed this sentiment, lamenting their inability to contact CONEP regarding their projects. ¶14. (SBU) The new Director of the Ministry of External Relations' Office of Science and Technical Cooperation (DCTEC),Ademar Seabra Cruz Junior, attended the NIHAABR meeting and noted that this was the first he had heard of the problem. He indicated that this was, in his opinion, a serious issue that adversely affected the need to increase, rather than impede, health cooperation between our countries. He told the participants that upon returning to Brasilia he would look into ways to begin tackling this problem. NOTE. In a subsequent meeting Mr. Cruz asked ESTH Officer for help in putting together data about the most egregious cases of delays in this process. He confided with Environment, Science and Technology, and Health (ESTH) Officer that he plans to personally take these cases to CONEP to start a conversation about improving the process. END NOTE. ¶15. (SBU) The Brazilian scientists attending the NIHAABR meeting have also begun a dialog with Brazilian government officials regarding the regulatory delays. As Brazilian scientists, the NIHAABR may have some influence that is more effective than Embassy and NIH officials. COMMENT ¶16. (SBU) The success of the CDC/GAP program, and another CDC integrated program (the Field Epidemiology Training Program),show that there is a space in which U.S. and Brazilian health institutions can cooperate in a productive manner. Similarly, the NIH supports a broad portfolio of biomedical research in Brazil. ¶17. (SBU) While there have been several false starts in efforts to overcome the bureaucratic hurdles that impede increased health cooperation between the US and Brazil, the Post has recently seen some encouraging signs. Mr. Cruz seems to be a strong proponent for BRASILIA 00000606 003.2 OF 003 addressing these issues and recent organizational changes within the Ministry of Health may put some of the Post's best health contacts in a position to help move these issues forward. It is still too early to know if these developments will lead to significant progress in this area, but they may present an important opportunity for the USG. END COMMENT. ¶18. (U) This cable was written in conjunction with Consulate General Rio de Janeiro, CDC/GAP in Brasilia, and the National Institutes of Health. SOBEL