FY99 CDMRP Annual Report
Section III. Capacity Building Initiatives
Minority Health Initiative
Special Populations Program
Programs managed by the office of the Congressionally Directed Medical Research Programs (CDMRP) fill unique niches within the research community. To fill these niches without duplicating work performed by other organizations, it is critical that the CDMRP work in a spirit of cooperation. Therefore, a central element of all programs within the CDMRP is the formation of partnerships. Public/private/government/military partnerships occur in all aspects of the programs and have been key to the success of the CDMRP.
The CDMRP uses several types of advisory panels in the execution of its programs. Separate peer and programmatic review panels are used to perform the two-tier review for all research awards made by the CDMRP. These panels are composed of consumers (public representatives), and scientific and clinical representatives from private industry, universities, and other government agencies. Panel members represent both the civilian and military perspectives. The consumer perspective is an important perspective that is part of every program in the CDMRP since it reminds all participants of the urgency of the issues and the impact decisions will have on individuals affected by a particular disease. The active involvement of clinicians, laboratory scientists, and consumers ensures that due consideration is given to balancing all perspectives that are critical in waging war against a particular disease.
In addition to developing partnerships among public/private/government/military, the CDMRP ensures that advisory panels are multidisciplinary. Since cancer and other diseases are complex and multifaceted, the CDMRP fosters partnerships and collaborations that are interdisciplinary. The CDMRP supports the concept that collaboration among disciplines that infrequently interact may provide the communication and perspectives necessary to tackle the complex issues associated with cancer and other diseases. For example, the Breast Cancer Research Program (BCRP) Integration Panel (IP) includes practicing clinicians, radiation scientists, behavioral scientists, molecular biologists, and consumers (see Section V). It is hoped that these partnerships will translate into improvements in disease prevention, patient survival, and quality of life for patients and all individuals affected by disease.
The military is the central partner in the CDMRP. It has spearheaded efforts that ensure all interested parties have a voice in making important decisions that will affect the lives of all Americans. While the CDMRP is a directorate within the U.S Army Medical Research and Materiel Command, the CDMRP staff has been composed of representatives of the Army, Air Force, Navy, and Public Health Services, as well as civilian government employees.
Military partnerships are also encouraged in projects managed by the CDMRP. The office began soliciting and tracking this information on projects submitted by military agencies in FY95 and projects involving civilian/military collaborations in FY97.
The execution of all programs involves partnerships between the CDMRP Program Staff and the support contractors who provide technical expertise to administer programs in a cost-effective manner. By utilizing contractors, the CDMRP can quickly adapt to new directives received from Congress. Contractors are also often utilized on short-term tasks that require specific technical expertise.
In Program Announcements, the CDMRP strongly encourages eligible institutions, including colleges, universities, hospitals, laboratories, military institutes, and other federal, state, and local governments, to work together on multi- and interdisciplinary efforts, including subgrants and subcontracts.
Partnerships are key components of many of the successful large multi-disciplinary awards, e.g., cancer centers, offered by the CDMRP. In addition, partnerships have been mandatory components of some of the recent award mechanisms utilized by the CDMRP. Both the BCRP and the Prostate Cancer Research Program (PCRP) have employed award mechanisms that involve partnerships between Historically Black Colleges and Universities/Minority Institutions (HBCU/MI) and another institution (see Minority Health Initiative). Furthermore, in FY99 the BCRP instituted a new award mechanism, Collaborative-Clinical Translational Research Awards, that required collaborations between community-based oncology practices, the private sector, and academic centers to develop new consortium models for the purpose of performing clinical trials.
The CDMRP recognizes that one means to expedite meeting the ultimate goal of each program is to maximize the money available for research. One mechanism used for reducing overhead costs is to share the high cost of performing the review of research proposals. To this end, the CDMRP has partnered with philanthropic foundations and other funding agencies interested in sponsoring scientifically meritorious, targeted research. With the permission of principal investigators, high-scoring unfunded proposals are forwarded to other agencies that have limited research budgets.
The CDMRP has co-funded projects with other funding agencies such as the National Institutes of Health, the National Cancer Institute (NCI), the Department of Health and Human Services (DHHS) Office on Women’s Health, the Agency for Health Care Policy and Research, and the California BCRP. In fact, the NCI has provided funds to supplement 12 BCRP awards in support of the National Action Plan on Breast Cancer. In another instance, the DHHS and the Federal Coordinating Committee on Breast Cancer have provided additional support for one BCRP award. In the Defense Women’s Health Research Program (DWHRP), the women’s information clearinghouse was co-funded with the DHHS. Finally, the Osteoporosis Research Program has also worked with other funding agencies, including the National Institute for Arthritis and Musculoskeletal and Skin Diseases, to co-fund projects.
Cost sharing was also a key element of proposals submitted to the FY97 PCRP. In these awards, institution award recipients were requested to cost share in the research expenses, thus maximizing the number of projects that could be supported with the Congressional appropriation for prostate cancer research. Refer to Section VI (Program Initiatives) for more information regarding cost sharing.
The Minority Health Initiative became a CDMRP focus in 1996 when it became clear that appropriations for targeted research efforts were likely to continue in future years. In November 1996, the BCRP launched an initiative for Biomedical Minority Health to address long range goals of the CDMRP. The primary purpose of the initiative was to increase the quantity of breast cancer research studying minority populations and to address the disparities in the incidence, prevalence, morbidity, and mortality rates of breast cancer. The goal is to increase the number of funded research proposals from HBCU/MI, including Hispanic Serving Institutions (HSI) and Tribal Colleges and Universities (TCU), and from those researchers that study minority populations.
A 5-year initiative was visualized, which included the initial planning year, 3 years of implementation, and a final evaluation year. The effort began with input from diverse minority communities including scientists and researchers of minority descent as well as representatives of governmental, professional, academic, and community-based organizations interested in reducing cancer in minority populations. Their input resulted in the development of a phased research effort that combined qualitative and quantitative research techniques for needs assessment and an inclusive, staged consensus development process.
The initiative was guided by the Minority Initiative Committee (ad hoc BCRP IP committee), CDMRP management, and leaders in outreach to the medically underserved. During the initial planning year, vital data needed to make informed recommendations were collected. The planning year was followed by two Consensus Conferences with representatives from the five largest minority groups in the United States (African American, Asian, Hispanic or Latino, Native American or Alaska Native, and Native Hawaiian or Other Pacific Islander). Consensus Conference I deliberations yielded 199 recommendations that were evaluated and distilled at Consensus Conference II. The Minority Initiative Committee further consolidated the list of recommendations to 12 focus areas.
In an effort to facilitate the implementation of the Minority Health Initiative and other strategies that promote cultural competency throughout all deliberations and products of the CDMRP, the Special Populations Program (SPP) was formed in 1998. The vision of the SPP is to support research that addresses the disparities in the incidence, prevalence, morbidity, and mortality rates of cancer or disease among underserved and underrepresented populations. The mission of the program is to enhance the CDMRP’s efforts to address disease disparities by creating new funding mechanisms, reaching out to the scientific community, and partnering with other agencies.
The SPP has oversight of the CDMRP’s response to the Secretary of the Army’s directive to comply with Executive Orders directing that a percentage of program funds be used to support proposals submitted by HBCU/MI.1 Proposals from HBCU/MI are evaluated concurrently with all other proposals in the same research category during scientific peer review. Proposals are evaluated separately during programmatic review when award recommendations are determined. Consistent with the CDMRP’s goal, the final investment strategy for HBCU/MI funds is determined based upon scientific excellence and program relevance.
Both the BCRP and PCRP have enhanced their efforts to attract grants from investigators at HBCU/MI (including HSI and TCU) as well as proposals that study minority populations. The FY98 BCRP offered Career Development Awards with a 1-year extension for HBCU/MI awardees to provide time for the research or database development necessary to support the proposed research, including time to foster inter-institution collaboration and/or community involvement. In this same award category, an additional $25,000 per year in direct costs can be requested by HBCU/MI to support collaborations with scientists outside of the HBCU/MI or with other institutions to provide support mechanisms not available at the applicant institutions.
In FY99, the BCRP offered two new award mechanisms, HBCU/MI Partnership Training Awards and HBCU/MI-Focused Training Awards, that are focused on building collaborations and training investigators at HBCU/MI. These training awards were designed to increase the number of HBCU/MI investigators working in breast cancer as well as assist investigators so they could better compete for future breast cancer funds.
The PCRP supported Minority Population Focused Training Awards in FY98. These awards enabled investigators to develop a prostate cancer research concept that focuses on the higher rate of prostate cancer incidence and mortality among different ethnic groups. The awards provided concept development support for researchers with minimal or no other funding. The FY99 PCRP continued to offer these awards but placed emphasis on fostering collaborations between applicants and researchers established in the field of prostate cancer. Collaborations among different institutions were encouraged. To reflect the new emphasis, these awards were renamed Minority Population Focused Collaborative Training Awards. It is anticipated that this award mechanism will allow investigators to collaborate, train, and acquire the experience and resources needed to design and conduct a fundable plan for prostate cancer research.
Additionally, the CDMRP has ensured the participation of minority scientists and consumers on all of its review panels. To enhance participation of these groups, the CDMRP has successfully networked with organizations that serve different communities. Through these relationships, fostered by annual attendance at conferences such as the Society for the Advancement of Chicanos and Native Americans, and Minority Health Professions Foundation, and affiliations with organizations such as the Hispanic Association of Colleges and Universities, the National Medical Association, and the National Association of Native American Physicians, the CDMRP has developed and maintains a current database of potential minority reviewers for future programs and potential applicants from HBCU/MI.
In summary, the SPP is making every effort to ensure that research scientists and consumer advocates from all populations participate in the development of investment strategies and the review of proposals and have access to program research funds. Representation of diverse communities in all phases of the programs will ensure a further understanding of and reduce the disease disparities among different populations.