VZCZCXRO3311
RR RUEHAST RUEHDH RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD RUEHTM RUEHTRO
DE RUEHBR #0606/01 1331328
ZNR UUUUU ZZH
R 131328Z MAY 09
FM AMEMBASSY BRASILIA
TO RUEHC/SECSTATE WASHDC 4286
INFO RUEHSO/AMCONSUL SAO PAULO 4030
RUEHRI/AMCONSUL RIO DE JANEIRO 7719
RUEHRG/AMCONSUL RECIFE 9522
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHDC

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