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

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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

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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