Foodborne Disease and Public Health: Summary of an Iranian-American Workshop (2008)

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7 Opportunities for Future Collaboration Moderators: Michael Doyle and Mohammad Reza Zali D uring the final session of the workshop, all the participants were invited to share their views concerning possible topics for future workshops and concerning opportunities for future collaboration. As a part of the discussion, U.S. participants suggested some potentially fruitful contacts that the Iranians might make during their remaining two weeks in the United States. The text below summarizes points made dur- ing the discussion. No decisions were made by the participants. JOINT WORKSHOP TOPICS Potential topics that were mentioned for future Iranian–U.S work- shops include the following: • Applying lessons learned from the surveillance pilot project carried out near Damovand to help strengthen the Iranian surveillance system • Using experiences from Iranian and American foodborne surveil- lance systems to develop intervention programs to prevent foodborne illness • Expanding the topic of foodborne disease to include the role of bac- teria in chronic diseases such as cancer and inflammatory bowel disease,   To provide context for some of the points made during the session, the reader is referred to the Preface for brief background information on the current relationship between the United States and Iran. 72 

OPPORTUNITIES FOR FUTURE COLLABORATION 73 with a goal of improving disease prevention and limiting the progression of diseases • Applying best microbiological methods and practices—including purchasing appropriate equipment • Using database networks such as FoodNet and PulseNet to iden- tify foodborne diseases related to food production in Iran In addition, looking forward to future joint workshops in Iran, several suggestions were made about strengthening the exchange of information at such workshops. The suggestions included the following: • Incorporating into the formal workshop experiences from field visits and the conclusions of interdisciplinary discussions with experts in related fields. This could involve including reports on site visits in the United States, followed by planning for future collaboration between the United States and Iran. • Integrating additional scientific disciplines, including basic sciences in fields such as chemistry. As noted by several Iranians, the basic sciences have in many ways been segregated from medical science in recent years. Thus, work may be needed to convince Iranian leaders to adequately integrate these fields once again. • Developing programs and strategies to bring together the natural sciences and the medical sciences. This would be consistent with efforts being made in both countries to integrate medical research training on a broad basis. OTHER FORMS OF COLLABORATION Participants expressed interest in the exchange of ideas, information, and experience among Iranian and U.S. colleagues on a variety of topics. These topics include the following: • Conducting well-designed studies to obtain the type of data that will inform strategies for the prevention of foodborne illness • Establishing an effective foodborne disease surveillance system and outbreak investigation program • Reporting on relevant clinical trials Several strategies were suggested for facilitating collaboration between the countries. These included the following: • Arranging for student exchanges and faculty visits. The National Acad- emies or the U.S. Department of State may be able to help facilitate faculty visits, but neither is involved in student exchanges. 

74 FOODBORNE DISEASE AND PUBLIC HEALTH • Collaboration between international laboratorians and state public health laboratorians. This might be facilitated by the Association of Public Health Laboratories. • Assisting Iranian researchers to identify and make contact with potential U.S. colleagues in universities. U.S. participants in this workshop might be able to facilitate introductions—especially while the Iranians are on their U.S. tour. For the names of U.S. scientists who might be able to collaborate with Iranian scientists in the study of specific microorganisms, Doyle sug- gested that the Iranian scientists submit a list of the pathogens of interest and the names of appropriate Iranian contacts. • Training programs. Schweitzer indicated that licenses may be required for programs involving training. Training in quality assurance and quality-control procedures for international laboratorians is offered by the Association of Public Health Laboratories in cooperation with George Washington University. • Publications having Iranian authors. Schweitzer reported that sev- eral years earlier a general license was issued by the U.S. government to permit publication of Iranian reports in the United States even if they required considerable revision and editing by American publishers; the license also facilitates the preparation of joint U.S.–Iranian publications. • Membership in professional societies. Schweitzer reported that ser- vices offered by professional societies may also be subject to licenses and noted that this issue compelled the American Chemical Society to cancel Iranian membership. This problem has been partially resolved, however, and members have been reinstated. • Institutional relationships. The Bureau of Educational and Cultural Exchanges of the U.S. Department of State encourages the establishment of institutional relationships. The U.S. Department of State provided financial support for this workshop. Larry A. Moody, speaking on behalf of the U.S. Department of State, indicated that he knew of no restrictions on U.S. citizens traveling to Iran in furtherance of collaborative efforts in non-sensitive areas other than the need to receive a visa from Iran. Participants were cautioned, however, that the transfers of money or equipment could cause problems. Ardalan noted that it had been possible to transfer money through the Iranian Epidemiological Association as part of an official epidemiology project with the University of California at Los Angeles. Yazdanparast suggested expanding collaborative efforts to more Ira- nian universities. With regard to collaborative relationships, Keene noted that they are easier to establish in fields that are universal in methodology and intellec- tual approach than in areas such as clinical trials and disease surveillance. 

OPPORTUNITIES FOR FUTURE COLLABORATION 75 Essentially all the public health surveillance activities in the United States are managed by state and local governments. This local responsibility in the United States may limit the possibility of establishing official relation- ships between experts in the two countries. Moreover, Keene noted that surveillance activities and outbreak investigations involve many practical problems—problems that may be peculiar to the particular state or country in question. One such problem in the United States relates to the various options that telephone custom- ers have to limit their accessibility via phone. A growing number of tele- phone customers, for example, are choosing to have unlisted telephone numbers, and many of them also use call-screening methods to decide which calls they will answer. Such options make it more difficult to reach patients in order to collect necessary information for studies. Because legal authority and various practical matters differ from one country to the other, surveillance systems that work well in many American states may need to be adapted considerably if they are to fit with approaches of Iranian institutions and social customs. Iranian participants indicated that among the steps they might be able to take to strengthen field laboratories would be a series of training work- shops and the outfitting of facilities so that they will meet the minimum requirements of surveillance systems. CLOSING REMARKS On behalf of the Iranian scientists, Mohammad Reza Zali expressed sincere appreciation for the opportunity to meet with U.S. colleagues. Recognizing that both countries have many problems, he said that he views the establishment and expansion of scientific relationships to be an important step for scientists and also for the general populations in both countries. Doyle expressed appreciation to all those involved in carry- ing out an excellent workshop. He said that the presentations had been of high quality and commended the Iranians for the excellent research they are conducting. Both moderators expressed the hope that collabora- tions between scientists in the two countries may flourish, resulting in improved science and improved health.