Remarks of U.S. Representative John EH. Fogarty
Panel on Health for Peace,
Citizens Committee for World Health Organization
Mayflower Hotel, September 26, 1963

I am pleased to participate in this panel discussion, particularly
in view of the illustrious company comprising the panel and the importance
of the subject matter, namely, Health for Peace.

Five years ago I introduced into the House of Representatives a
bill (H.J. Res. 698) as a companion bill to the measure introduced in the
Senate by Lister Hill (S.J. Res. 41) which was known as the Health for
Peace legislation. These bills proposed providing broad authorities to.
the Surgeon General and the Public Health Service to extend medical
research on an international basis and to otherwise provide for inter-
national exchange in the health sciences. Personally, I have had a
long-term, intense interest in matters relating to international health
and scientific exchange amongst nations because of their significance
both for the solution of health problems and as a contribution to peace.

The original Health for Peace legislation had as its objectives
three major concepts:

First--Support of medical research outside of the borders of
the United States is of great importance to the advancement of our
national health programs because of the many scientific opportunities
presented by the differing character of disease and health problems

in other countries, the existence of unique scientific talent and
facilities abroad and the importance of expanding on an inter~

national basis the research attack upon disease problems of major

concern.
Second~-The development of the medical sciences in the United

States requires close and intimate relationship with scientific

activity and medical research in other countries. The United

States, because of its leadership in this field, could do much

to advance the international status of the health sciences and

thereby engender broad progress in the field of health generally

through collaboration with foreign institutions and investigators
in medical research.

Third--Research directed towards the solution of the disease
and health problems of man on an international basis constitutes

a powerful force for mutual understanding among nations. This

is a prime work of peace and one in which this Nation should be

in the forefront.

The above ideas motivated the affirmative Congressional action on
this legislation, however, in this process the terms of the original
proposals such as had been introduced by Senator Hill and myself were
substantially modified. The legislation, as finally enacted in Public
Law 86-610-~-"The International Health Research Act of 1961"--made clear
distinctions between the purposes for which the United States would

provide support for foreign research and scientific activities:
3

First--The Surgeon General of the Public Health Service was
authorized to participate through grants and other cooperative
arrangement with other countries in the furtherance of health
research and research training for the purpose of advancing the
health status of the people of the United States. This is the
national aspect of foreign activities in this field.

Second--The President, on the other hand, was authorized to ©
make grants and awards and to otherwise participate financially |
in international health research and research training activities
to further the international status of the health sciences. This
is the international aspect of the programs authorized by this
legislation.

This latter authority was svecifically reserved to the President.
However, the legislation provided he could delegate such authority if
he so chose to the Department of Health, Education, and Welfare. This
delegation, although requested by DHEW, has never been acted upon by
the President, a matter I shall discuss later.

Since the passage of this legislation there has been a substantial
expansion in the international scientific activities of the Public Health
Service. During fiscal year 1962 I am informed that the Public Health
Service expended approximately $30.0 million in support of a variety of
international research and research training activities. The largest
portion of this expenditure, $17.5 million, has been directed towards

the support of medical research by foreign institutions and investigators
through grants, contracts, and P.L. 480 agreements. Approximately
$11.8 million has gone for a variety of research training and fellowship
programs, a major portion of which has been almost $2 million for the
support of U.S. nationals studying at advanced levels in foreign institu-
“ions.

The Public Health Service has participated extensively in providing

S

substantial support to the research activities of the World Health

Organization and the Pan American Health Organization. Apart from its
extensive participation through staff assignment, technical consultation
and exchange, the Public Health Service has contributed financially to

both the development of the research capability and the conduct of

research programs by these two organizations. All of us will remember

the initial award in 1958 of $300,000 to the World Health Organization

for the beginning of its research program. Similarly, in 1961, a research
planning grant was made to the Pan American Health Organization of $150,000.
These two awards have contributed extensively to the development of the
international research programs of these two organizations. In addition,
“the Public Health Service has also supported, through a variety of

project grants, individual research projects conducted by these two
organizations. Current annual support to the research activities of

these two organizations through PHS programs now is of the order of $700.000.

The international scientific activity generated through the support

provided by the Public Health Service under the provisions of P.L. 86-610

has most certainly had a profound effect upon the enlargement of knowledge
important in the health field and in the advancement of scientific effort
in the medical sciences. However, I am now informed that this extra-
ordinarily productive program is now confronted with problems which it
may be worthwhile to discuss here today.

in the first place, we are all aware of the problems generated by
the adverse balance of international payments with which the United
States has been confronted. I have been told that as a result of this
situtation efforts are being made to significantly reduce the extent
of support being provided foreign institutions and investigators under the
Public Health Service program. While the complexities of international
balance of payments are difficult to comprehend fully, it dees not seem
to me to be sound policy to arbitrarily restrict and diminish the PHS
program. It has resulted in extensive scientific achievement. It has
contributed substantially to the foreign policy objectives of the United
States through the leadership which the United States has assumed in
this area of such great importance t all people. These programs must
not be crippled because of a bad misassessment of their total benefits
as contrasted with their insignificant effect on the balance of payments
picture. |

Another matter with which I must admit concern is the fact that the
authorities made available to the President under P-L. 86-610 to further
international scientific activity in the medical sciences have not yet
been delegated. In terms of solutions for our domestic health problems

and in terms of an enlightened foreign policy, international medical
research programs have the greatest potential for good. Reluctance to
delegate the Presidential authority in this area has prevented the most
effective exploitation of this potential.

I am personally of the conviction that through leadership in
international medical research and research training activities the
United States can contribute in a particularly meaningful and effective
way to the solution of health problems specifically and to the cause of
peace generally. I think, therefore, that we shouid make the fullest
use of the legislation which, after extensive debate and consideration,
was enacted by the Congress.

To restrict these programs, either through reduction in the funds
made available to them or through the unwise separation of authorities
in their conduct, will result in loss in the long run, both for our
gseience and our international posture. The small amount of U.S. dollars
exported under these programs are well spent. They are worth dollar
for dollar many times the uncertain benefits of other forms of foreign
aid. |

Similarly, I urge delegation of the Presidential authorities under
this legislation. I believe delay in this delegation prevents the
development of a comprehensive, hard-hitting, unified program of U.S.
participation in the advancement of the health sciences. Only through
such a unified program can the objectives set forth by the President
in his address on peace before the United Nations General Assembly be
accomplished. In like manner, it will take unified effort to undertake

the development of the specific programs that the President proposed
therein, namely, the establishment of a world center for health com-
munications under the World Health Organization and the creation of
regional research centers for collaborative international effort in
medical research and training.

As Chairman of the Appropriations Subcommittee on Labor-HEW
programs, I would be very much interested in seeing 4 separate appro-
priation request by the Executive Branch for international health
research activities. The separate presentation of such a program could
encompass the full scope of the activities envisaged in the International
Health Research Act of 1961. In this way the Congress would have an
opportunity to specifically and directly consider in a cohesive form
these valuable and important programs in the context of both their
meaning for U.S. health problems and their potential for further peaceful
cooperation amongst nations. |

In coneluding my remarks I would like to set forth an idea and a
view which I feel to be of the greatest importance and significance.
Instead of a curtailment of the programs and activities of the United
States in the field of international health research, I should like to
see a plan to bring into being at Bethesda a great international center
for research in biology and medicine dedicated to international cooperation
and collaboration in the interests of the health of mankind as so boldly

envisaged by the President. This center would encompass conference
facilities, laboratory and study space, and living quarters to permit
the assembly for discussion, study, and research of the outstanding
health scientists of the world. I visualize this center associated with
the great facilities of the NIH and the NLM as representing the visible
and tangible embodiment of this Nation's devotion to the use of seience

for peaceful purposes and the good of mankind.