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Appendix C.6 Centers for Disease Control and Prevention In the mid-1990s, the Gore-Chernomyrdin Commission facilitated collabo- rations between U.S. and Russian scientists in a number of fields. The secre- tary of health and human services played an important role in maintaining an open dialogue concerning mutual interests in public health and medical science. Against this background, the Centers for Disease Control and Prevention (CDC) were among the U.S. agencies to expand collaborative partnerships with Russian scientists. The expansion of CDC’s interests included a new focus on engagement of former Russian defense scientists, with special financing provided through the Defense Threat Reduction Agency (DTRA) and through the Department of State to pursue this expanding interest. An initial effort was directed to activities at the State Research Center of Virology and Biotechnology Vector, in Koltsovo, and the State Research Center for Applied Microbiology in Obolensk. In the late 1990s, DTRA launched a demonstration project involving five col- laborative pilot projects based in Koltsovo and three in Obolensk, at an average cost of $55,000 each. These projects linked U.S. and Russian experts who were experienced in handling especially dangerous pathogens. The initial emphasis was on partnerships involving U.S. government specialists, which led to involve- ment of CDC personnel. Building on these early efforts, DTRA financed Russian participation in sev- eral follow-on projects, calling on CDC specialists for assistance. However, the sustainability of some projects was questionable because of (a) lack of adequate funding for U.S. participants, (b) limitations of appropriate U.S. investigators’ availability to ensure project success, given their other responsibilities, and (c) administrative hurdles that disrupted schedules and led to long delays. Also, 173
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174 APPENDIX C.6 on the Russian side there was limited capacity of partner scientists to actively contribute to the collaborations, due in large measure to the poor state of their facilities and the economic crisis disrupting activities at the institutes. Nevertheless, these initial partnerships helped demonstrate that even under very difficult conditions, it was possible to work together and contribute to sci- entific progress. Most important, lasting relationships were created. A number of joint research projects eventually evolved in Russia, and CDC personnel continued to play important roles. These projects facilitated transparency and confidence building at a time when serious security issues were paramount. In the early 2000s, the BioTechnology Engagement Program was developed, with the Department of State transferring funds from its nonproliferation portfolio to several government agencies to support research at Russian institutions, includ- ing the Department of Health and Human Services (HHS). HHS in turn arranged for the participation of CDC and other HHS entities in collaborative endeavors. In parallel, DTRA continued to provide funding to CDC for its continued sup- port of DTRA’s nonproliferation efforts in Russia, including both research and capacity-building efforts. Also, the U.S. Agency for International Development relied on CDC support as it expanded its health-oriented programs, particularly with regard to AIDS and multidrug-resistant tuberculosis (MDR-TB). Then in 2008, the Department of State terminated the transfer of its nonpro- liferation funds to HHS, as the government cut back support for activities in Rus- sia. But a series of disease outbreaks involving Russia led to a continued presence of CDC in Russia and to training of Russian counterparts in Atlanta. Longstand- ing collaborations on important public health infectious diseases, specifically HIV and MDR-TB (especially within high-risk populations such as prisoners), have remained in place for many years. At least in the case of TB, there have been projects that involved pharmaceutical industry partners such as Eli Lilly. Also, during the past decade, CDC collaborations have expanded to include a wider range of infectious diseases, with perhaps the most emphasis being placed on influenza surveillance. This focus was stimulated, at least in part, by the Group of Eight (G-8) summit in St. Petersburg in 2006 and global concern regarding possible pandemic avian influenza (influenza A/H5N1). Russia took this opportunity to focus the G-8 health discussion on influenza and to expand Russian programs in influenza. More recently, collaborations have expanded to a wide range of Russian institutions and a broad set of joint topics. In addition to studies undertaken at the State Research Center of Virology and Biotechnology, Vector, and the State Research Center for Applied Microbiology (four projects), collabora- tions with CDC principal investigators have involved the (a) Central Institute of Epidemiology (two projects), (b) Engelhardt Institute of Molecular Biology, (c) Gamaleya Institute of Epidemiology and Microbiology, (d) I.I. Mechnikov Moscow Research Institute of Vaccines and Sera, (e) Sechenov Moscow Medical Academy, (f) National Research Institute of Antibiotics, (g) Pokrov Plant of Bio-
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APPENDIX C.6 175 preparations, (h) Research Institute of Phthisiopulmonology, (i) State Research Institute of Biological Instrument-Making, and (j) Shemyakin-Ovchinnikov Insti- tute of Bioorganic Chemistry. At present, CDC has a long-term collaborative arrangement with the Research Institute of Influenza. Topics that have been undertaken include studies on (a) smallpox, although a genome project on smallpox was approved but not implemented, (b) influenza surveillance, (c) rabies, (d) antimicrobial-resistant Streptococcus pneumoniae, (e) beta-lactamase resistance in gram-negative bacteria, (f) improvement of diag- nostics for HIV and hepatitis in donor blood, (g) hepatitis C reference pan- els, (h) investigations of clinical isolates of M. tuberculosis, (i) tuberculosis clinical trials, (j) rapid diagnosis of susceptibility testing for M. tuberculosis, (k) laboratory determination of resistance to MDR-TB drugs, (l) molecular char- acterization of rubella virus strains in Russia, (m) rubella epidemiology and surveillance, (n) molecular diagnostics of mixed tick-borne infections (Ixodes persulcatus ticks), including tick-borne encephalitis and Lyme disease (borrelio- sis), Bartonella, and gastroenteritis viruses, and (o) Salmonella surveillance. The total cost to the U.S. government for 19 collaborations in these areas involving 13 Russian institutes has been about $12,200,000. Most of these projects have been successfully completed. CDC also maintains technical relationships with different counterparts in Russia built around certain categorical disease issues. These involve joint par- ticipation in scientific meetings, seminars, and workshops. An example is col- laborations on polio eradication. CDC is engaged with Russian partners in several studies on HIV, including mother-to-child transmission, attitudes toward HIV testing, seroprevalence studies, and development of pediatric AIDS guidelines, generally through the Global AIDS Program. Joint efforts also exist on tobacco control. CDC took the lead in Russia in implementing joint efforts in tobacco control. An Adult Tobacco Survey became the foundation for the efforts of the Ministry of Health and Social Development to develop robust antismoking legislations. There are occasional information exchanges between public health officials in Russia and CDC dealing with emergent issues, such as outbreaks of food- borne diseases or circulations of influenza strains. This informal dialogue has been in place for many years on a scientist-to-scientist basis, and considerable mutual respect has been engendered through these informal communications. In at least one case, contacts and communications were a direct result of personal friendships made during the early engagement with Vector scientists following the collapse of the Soviet Union. Plans are in place for joint meetings between U.S. and Russian officials to discuss collaborations in health that will focus on tobacco control, food safety, HIV/AIDS, and TB, with CDC as a primary U.S. partner. However, CDC is primarily a technical agency with expertise in disease detection, surveillance, epidemiology, and laboratory capacity, in addition to public health program
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176 APPENDIX C.6 implementation; and the involvement of other U.S. agencies seems appropriate. It is not yet clear how such collaboration might progress in the absence of the International Science and Technology Center (ISTC) to facilitate program man- agement and accounting or where funding might originate. Over the years, the following Russian institutes have been the principal partners of CDC: State Research Center of Virology and Biotechnology Vector State Research Center for Applied Microbiology Central Institute of Epidemiology Mechnikov Institute of Vaccines and Sera Research Institute of Influenza Sustaining advances that have been made will depend upon access to limited funds to allow continued scientist-to-scientist dialogue and technical exchanges coupled with more significant investments in major projects that can be under- taken in true partnership, including shared costs and personnel commitments divided by the two sides. Collaborative projects between CDC and Russian partners have relied on the ISTC to facilitate program management and to handle financial resources. The ISTC consistently played a critical role in this regard and has been part of the basic infrastructure required for the program’s success. With changes in management procedures on the U.S. side and the closure of the ISTC in Russia, there are significant hurdles to be overcome in moving resources between countries and distribution and accounting procedures if a similar model of collaboration is to continue in the future. Of special significance for future activities is the Protocol of Intent between CDC and the Federal Service for Surveillance on Consumer Rights Protection and Human Well-Being to Combat Communicable and Non-Communicable Dis- eases, signed in 2012 for an indefinite duration. SOURCE: Information provided by CDC, November 2011 and May 2012, and by committee members.