Global Health and Infectious Disease Working Group Report

Working group members include: Stephen Thomas (chair), Katie Anderson, Elizabeth Asiago- Reddy, Joseph Domochowski, Tim Endy, Margaret Formica, Chirs Morley, Harry Taylor

Current strengths include a relatively small number of faculty with experience conducting global health research initiatives in both the US and abroad. Relationships with partners in overseas locations exist at different levels of maturity and productivity. Faculty and students appear to have a great interest in the concept of global health. The refugee population in Central New York provides a unique opportunity to bridge global health issues abroad with domestic stakeholders. The infectious diseases group has had success in the global health research space, but all agree global health extends beyond ID and there is great potential in these other areas.

The most important message from this discussion was that without modifying or replacing compensation plans that disincentivize physicians from pursuing scholarly activities, there is no mechanism to protect time and allow the pursuit of meaningful research opportunities. There were very good ideas about holding summits or symposia to bring together successful faculty and potential collaborators. A systematic inclusion of potential researchers on projects of established researchers was also discussed. Finally, targeting the hiring of physician-scientists with a robust vetting process was proposed.

A list of technical capabilities, both through personnel expertise and specialized instrumentation;

Summary: A genomics core, bioinformatics, histopathology, imaging, biocontainment facilities, and a strategy around the execution of clinical research (support services and infrastructure) and developing a population health program were all discussed.

The takeaway from this discussion is that there are not enough opportunities for clinical and basic science faculty to engage. Clinicians are underrepresented on in-house grant review committees. There are also no inhouse funding calls for translational projects. Creating venues for idea exchange and learning what each side is doing would helpful.

There was discussion about focusing on more ID type hires (support global health strength) to build a powerhouse capability that would drive excellence and forward movement in other areas. Others advocated for an approach with more breadth versus depth and hiring from non-ID global health areas.

Expanding capabilities and capacities in histopathology, genomics, bioinformatics and disciplines within population health were all suggested as crucial for success of the Upstate research enterprise. Additional bandwidth is required for clinical research infrastructure to include a re-look at operations in the CRU. Others also proposed that significant holes exist in research administration to include capacity within contract and agreement review and execution, technology transfer and services to support identifying and capturing funding opportunities. Finally, the entire finance and accounting infrastructure needs a re-look.

A more productive relationship with the county DOH would go a long way in developing a health equity research portfolio. Expertise and resources for a broad population health agenda across clinical service lines would also support exploring social determinants of health in CNY. It is unclear what expertise Upstate has in this area; a portfolio review would be advised.

The issue is less about specific funding targets and more about defining the identity of the Upstate research enterprise today and what we want it to be in 5-10 years. We have a tripartite mission to educate, provide clinical care, and conduct research. These are looked at individually versus identifying where the overlap exists and trying to leverage our unique circumstances that differentiate us from other research enterprises. The identity crisis is one reason even the definition of “global health” needs to be explored and defined for our context. It appears to be ID centered, but only because ID folks established the center and now institute for global health. In fact, the group believes it is a much broader definition. It was mentioned numerous times that success will beget success and investment should be increased in and around highly performing research areas, and then expanding additional areas of research on these platforms. For example, diabetes intersects with ID, health disparities, inflammation, psychosocial, cardiology, etc. Programs must be run as programs and not as silos. There must also be a complete re-look at the business of research at Upstate. The current finance and accounting models and business practices require a strategic re-look with alignment between hospital and University.

There was consensus the current research culture of silos versus collaboration hurts the greater University research enterprise.

• One of the biggest barriers to moving the needle in this area (and more generally) is an unwillingness or an inability to work together across some departments/silos. There is a lack of inter-departmental and interdisciplinary collaboration between basic and clinical research faculty; and faculty with a particular expertise tend to stay within their silo;

• More clinical research space

• BSL4 or higher lab space

• Build a capacity for GMP production of biologicals, and training in GMP production of biologicals, to support pre-clinical and early-stage clinical trials.

• Robotics to further enhance nucleic acid and protein processing

• We are growing in terms of vaccine development and clinical trials; perhaps expand institutional capabilities in drug discovery and pathways (basic science faculty, bioinformatics)

• Global health pathway for residents (find ways to support international rotations at field sites?) with associated administrative support

• Global health seed grants (focused on projects at our field sites)

• Global health travel grants (to explore projects at our field sites)

• Global health research journal club

• Gap in population/public health funding, health disparities research – an area that has seen an increase in funding externally.

The desired end state is a well-resourced and strongly led University research platform with the expertise, capabilities, and capacities to support University faculty and staff as they identify global health problems and conceptualize and develop relevant and accessible solutions to the same (idea to bedside). We envision a platform capable of supporting basic science and development of new technologies, small and larger animal-based research, a biologic containment facility supporting small animal and vector-pathogen research, a regulatory science and sponsor office, a biomanufacturing facility developing vaccines and immunotherapeutics, a network of clinical research sites, and a robust research support core.

The platform would be a foundation supporting applications for CTSA status or becoming parts of NIH collaborative networks such as the VTEUs (vaccine evaluation), CIVIC (universal influenza), or similar networks across cancer, diabetes, rheumatologic diseases, stroke, cardiovascular disease, neurologic diseases, refugee health, etc.

A robust and well-resourced platform would encourage greater participation in the research mission by reducing the entry costs for individual investigators and groups. Resources and expertise would be centralized across many of the processes and costs which currently act as barriers to entry and participation. Operational and financial efficiencies would be introduced lowering the overall costs to the University to support research while at the same time increasing engagement and output. The platform would centralize scientific leadership and expertise across the many domains of translational and clinical research offering an opportunity for mentorship and instruction which is currently lacking. Strategic investment and business plans would not only reduce financial burdens, but offer the potential for revenue generation allowing for reinvestment, costsharing, and collaboration with clinical service lines and the basic science enterprise to recruit, resource, and retain the best and brightest.