National Cancer Institute NCI Cancer Bulletin: A Trusted Source for Cancer Research News
September 20, 2011 • Volume 8 / Number 18

A Conversation With

A Conversation with Dr. Ted Trimble on NCI's Center for Global Health

Dr. Ted TrimbleDr. Ted Trimble

Dr. Ted Trimble was recently named director of NCI's Center for Global Health, which was created earlier this year. Dr. Trimble was previously head of Gynecological Cancer Therapeutics in the Division of Cancer Treatment and Diagnosis (DCTD). NCI Director Dr. Harold Varmus cited Dr. Trimble's leadership role in the trans-NCI International Clinical Trials Collaboration Working Group and other global health experiences as important to developing the new center.

Why was the NCI Center for Global Health created?

The burden of cancer is felt worldwide and is expected to grow larger in the coming years. In 2008, approximately 7.6 million people died from cancer worldwide, and 64 percent of these deaths occurred in developing countries. These numbers are up from 2002, and by 2030 the number of cancer deaths may rise as high as 13.2 million, with 69 percent occurring in developing countries.

Global health issues have been a high priority for Dr. Varmus since he was NIH director, and the same is true for current NIH Director Dr. Francis Collins, who made global health one of his top five priorities at NIH. When Dr. Varmus returned to NIH in July 2010 to lead NCI, creating the Center for Global Health was on his short list of things to do. He has spent a lot of time talking to people inside and outside of NIH about how best to structure the center.

Directing the center is an exciting opportunity for me. The center can help NCI partner with our sister NIH institutes to build on the great work that's been done in terms of controlling infectious diseases and to expand the range of NCI's research globally in epidemiology and cancer genetics. We'll also be looking at how we can deliver cancer care, prevention, and screening interventions more effectively around the globe.

How does your background prepare you for this new leadership role?

Because of my responsibilities in DCTD, I became aware of the increasing need for international collaboration on clinical trials. In order to study these diseases as quickly as possible, we needed larger sample sizes and more patients, and we needed to build on the investments in research infrastructure that other countries are making, in addition to the clinical trials infrastructure we've built in the United States. This remains true for studying common and rare cancers.

At about the time that Dr. Collins arrived as NIH director, I discovered, in conversations with clinical trials staff at the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID), that staff at those institutes and NCI were encountering many of the same problems in our work. As a result, my NHLBI and NIAID colleagues and I put together an informal working group of the three institutes, the three largest NIH institutes with the largest international footprints. Our informal working group is now a subcommittee of Dr. Collins' Trans-NIH Global Health Research Working Group.

As part of these efforts, we've worked closely with the European Science Foundation and the European Medical Research Councils to help them identify some of the problems they've had with their Clinical Trials Directive in Europe, which have stymied academic research in Europe and trans-Atlantic collaboration.  We've also worked with the Organization for Economic Cooperation and Development. We hope our work will get national governments around the world to realize that they have to support the building of clinical trials infrastructure and undo some of the red tape that exists.

I have also traveled the world representing NCI over the past several years to try to figure out how we can implement widespread human papillomavirus vaccination and improve screening and treatment for cervical cancer. I've talked with people outside the United States, at the World Health Organization (WHO), WHO regional offices, the Union for International Cancer Control, and the International Agency for Research on Cancer (IARC). In the process, I've gained perspectives on where things stand with global control of cervical cancer, which is the second or third leading cause of cancer death for women in many developing countries.

How does the new center differ from NCI's previous approaches to international collaboration?

NCI has done a lot globally in the past, but these efforts have been spread across the institute. We haven't done as good a job as we might have done in coordinating those efforts. Nor have we learned, across NCI, about the best ways to work with other countries' ministries of health to, for example, transport biospecimens across borders, address intellectual property issues, or address informed consent issues. Each NCI division was forced to invent the wheel for itself when trying to set up international research collaborations.

NCI's Office of International Affairs and, more recently, the Office of Latin American Cancer Program Development have helped with these challenges. However, there wasn't a coordinating office for all of these activities so we could share information. 

Nor was NCI looking at what other NIH institutes were doing internationally that NCI could build upon. For example, in the developing world at least 20 percent of cancers are related to infectious disease, so there is a great opportunity for NCI to collaborate with our colleagues at NIAID. We really haven't had a coordinated effort to look for synergies like that until now.

Cancer Prevention and Control a Key Focus at United Nations Meeting

NCI and a number of other federal agencies are participating this week in a high-level meeting of the United Nations General Assembly on noncommunicable diseases. The goal of the meeting in New York is to address the prevention and control of noncommunicable diseases worldwide, including many cancers. Participants are focusing on developmental and other challenges, as well as social and economic impacts, particularly for developing countries.

More information about the meeting and this worldwide effort can be found online.

We're also excited about the opportunity to work with the Centers for Disease Control and Prevention (CDC). CDC Director Dr. Thomas Frieden has a new initiative to help promote control of noncommunicable diseases internationally. NCI can work well with CDC in this area, and Dr. Varmus and Dr. Frieden have spoken extensively about how our organizations can work together on control of infectious diseases linked to cancer, as well as other risk factors like obesity and tobacco use.

What are the goals of the Center for Global Health?

First, we want to coordinate NCI's international activities internally. The center will provide support to the other NCI divisions, offices, and centers (DOCs) as they conduct international projects. In addition, the center will work with the DOCs to help develop new scientific initiatives in global health.

Dr. Varmus and I also want the center to strengthen NCI's dialogue with other NIH institutes and centers, particularly the Fogarty International Center. We want to help develop a global cancer research strategy with the CDC, nongovernmental organizations, and universities and cancer centers that have strong global health programs. We also plan to work with the WHO and its regional offices and IARC to coordinate global health programs for cancer control.  As part of that effort, Dr. Varmus is attending the United Nations' High-Level Meeting on Noncommunicable Diseases, which is the first time that the UN General Assembly has focused on health issues other than HIV/AIDS. (See the sidebar for more about the meeting.)

In addition, the center will work with pharmaceutical and biotechnology companies to help develop new, inexpensive diagnostic tools and figure out how to make novel cancer therapeutics available in a cost-effective manner to people in low- and middle-income countries.  

What specific global initiatives will NCI and the new center launch in the next year or so?

Dr. Varmus has charged the center with sitting down with our colleagues in the DOCs to determine where there are gaps in NCI's global health research portfolio and come up with some initiatives. I don't anticipate that the center, on its own, will be sponsoring those projects. We would need to do it in partnership with the NCI DOCs or with Fogarty and other NIH institutes.