Thank you for your letter requesting a short report on the status of our cooperative activities in health with the Soviet Union. I am pleased to provide the enclosed report. I apologize for the delay in responding to you.

The November 19-21 meeting in Geneva between President Reagan and General Secretary Gorbachev opened the way for renewed cultural and scientific contacts between the United States and the Soviet Union. We in the Department of Health and Human Services have welcomed the opportunity to expand our existing collaborative health activities with the Soviet Union.

With the approval of the National Security Council and the Department of State, we are now in the process of revitalizing our program of cooperation with the Soviets. The Soviets have agreed, in principle, to receive two highlevel delegations from our Department later this year. The first will be headed by the Surgeon General, Dr. C. Everett Koop, who will be accompanied by the Director, Centers for Disease Control, Dr. James Mason. They will explore the potential for new initiatives in public health and develop an agenda for a Joint Committee Meeting to be held in Washington sometime next year. The second delegation will be headed by the Director, National Institutes of Health, Dr. James Wyngaarden, and will explore the potential for new cooperation in biomedical research including cancer research.

We believe that we have derived substantial benefit from the program of research and exchanges summarized in the enclosed report. Thus, we plan to continue our efforts and look for opportunities for modest expansion.

Please contact Dr. Peter Henry of Dr. Koop's staff, on 443-4010, if you have additional questions or need further information.

Sincerely,

Oh BBowen

Otis R. Bowen, M.D.

Secretary

Enclosure

BACKGROUND SUMMARY OF COOPERATION IN HEALTH BETWEEN
THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
AND THE U.S.S.R. MINISTRY OF HEALTH

Agreements

There are two major agreements with the Soviets under which nearly all of HHS cooperative activity takes place:

I.

U.S.-U.S.S.R. Agreement on Cooperation in the Field of Medical Science and Public Health. Signed May 23, 1972, extended for 5 years in 1977; extended for 5 years in 1983; now expires in May, 1988.

II. Agreement Between the U.S. and U.S.S.R. on Cooperation in Artificial Heart Research and Development. Signed June 28, 1974; extended for 5 years in 1977; extended for five years in 1983; now expires in June, 1988.

Unless either party announces their intention to terminate six months prior to expiration, these agreements will automatically be renewed for successive five-year terms.

Organization:

The U.S. Department of Health and Human Services (HRS) is considered the U.S. Executive Agency for these bilateral agreements. The Office of International Health (OIH) of the U.S. Public Health Service (PHS) provides administrative support and a U.S. Executive Secretary.

A Joint Committee, co-chaired by the U.S. Assistant Secretary for Health and the U.S.S.R. Deputy Minister of Health, was formed to annually review the progress of this program. Since the Soviet invasion of Afghanistan, however, there have been no high-level contacts with the Soviet health counterparts and the Joint Committee has not met. At the working level, Scientific Area Coordinators have continued their regular contacts, exchanges, and conduct of cooperative research activities. Recently, the National Security Council has authorized resumption of high-level visits and Joint Committee Meetings.

D.

E.

Arthritis

F.

G.

H.

I.

J.

Environmental Health (Coordinated with the Environmental
Protection Agency Agreement)

Influenza, Acute Respiratory Disease and Viral Hepatitis
Mental Health

Eye Diseases

Biomedical Communications

Individual Health Scientist Exchanges (on various topics)

Financing

The Public Health Service (PHS) does not specifically set aside any funds for U.S.-Soviet collaboration. Instead, each activity and exchange is judged on the basis of its merits and competes with other foreign and domestic research opportunities. We are thus assured that the collaborative activities, as judged by each participating agency, strongly supports their domestic health mission.

Level of Activity and Estimated Cost

Over the past ten years, as a rough estimate, for comparison purposes, the PHS has spent approximately one to five million dollars per year in direct costs (exclusive of administrative staff and support) to fund its portion of collaborative research and exchanges with the Soviet Union. The current levels of exchange are roughly one third of the levels of the mid-1970's and involve some 40 Soviet scientists coming to the U.S. for 30 person/months and 35 U.S. scientists going to the Soviet Union for 15 person/months. For more detailed statistics, see charts following the summary of activity below.

SUMMARY OF RECENT ACTIVITY

Discussions are currently underway with the PHS principal point of contact with the Soviet Ministry of Health (Dr. L.I. Malyshev, Executive Secretary, U.S.-U.S.S.R. Health Agreement) to receive two senior-level delegations and to schedule a Joint Health Committee meeting. The Surgeon General, PHS, and Director CDC are expected to visit the Soviet Union in October. A visit by the Director, NIH, and a biomedical research delegation, was expected to take place in July but is being rescheduled at Soviet request to a later date. Brief summaries for each of the ten areas follows:

A.

Cancer

Coordinators:

National Cancer Institute;

All-Union Oncologic Research Center

From inception in 1972, until late 1981, the American-Soviet collaborative cancer activities spanned a scientific spectrum that included cancer treatment, tumor immunology, viral oncology, the genetic aspects of neoplasia, epidemiology, cancer pathomorphology, cancer control measures and technologies, and the role of cancer centers in the education and training of personnel in health fields and the lay public. These broad approaches were modified and the objectives were restructured in September 1981. Thus, the priority areas for continued collaboration now include cancer treatment, carcinogenesis, and cancer prevention. Annual meetings of delegations have been deemphasized in favor of individual scientific exchanges.

Coordinators: National Heart, Lung, and Blood Institute;
All-Union Cardiology Research Center

Area 1, Pathogenesis of Arteriosclerosis

Epidemiological studies which take a multidisciplinary and
multiclinic approach to research on plasma lipids and
lipoproteins as they relate to atherosclerotic disease.
Cross-cultural comparisons of differences in cardiovascular
risk factors between U.S. and Soviet populations. The joint
studies are an extension of the NHLBI-sponsored Lipid
Research Clinics Program. Soviet studies are conducted in
Moscow and Leningrad.

Area 2, Management of Ischemic Heart Disease

Joint investigation of the relative effectiveness of differing approaches to the management of advanced coronary heart disease manifest by angina pectoris. A total of 1,648 patients were studied to evaluate three sets of therapies:

differential intensive medical management in the
U.S.S.R.;

conventional medical management in both countries;

and

coronary artery bypass surgery in the United States.

Area 3, Heart and Lung Metabolism

Basic research on the biochemical, biophysical, and cellular
aspects of the heart and lung metabolism in health and
disease. Soviet scientists have made two recent
contributions to research on myocardial metabolism; first,
the use of liposomes for delivery and targeting of drugs to
damaged heart muscle following a heart attack; and second,
basic research on the production and identification of
monoclonal antibodies to cell surface constituents in heart
and lung cells. The latter technology will have wide-ranging
application to the study of platelet adhesion,

atherosclerotic plaque formation, and proteins that are
important in cardiovascular disease.

Area 4, Congenital Heart Disease

Exploration of new methods of diagnosis, surgical treatment and post-operative care of complex heart defects to reduce mortality from this disease.

Area 5, Sudden Death

Joint investigation of the fundamental mechanisms governing the normal and ischemic myocardium and their relationship to sudden death. Collaborative studies of the effects of antiarrhythmic drugs have been an area of major emphasis.

Area 6, Blood Transfusion

Primary themes of cooperation have been: prevention of posttransfusion hepatitis in cardiovascular surgery; transfusion of blood, blood components and blood substitutes during cardiovascular surgery; the preservation of blood and its cellular elements; and the treatment and management of patients with abnormal hemostatic mechanisms.

Area 7, Hypertension

Collaboration in basic and biobehavioral research; studies on the primary prevention of hypertension. Comparative studies by both countries to develop better methods of prevention and control of the sequelae of this disease.

C. Artificial Heart Research

Coordinators: NHLBI and USSR Ministry of Health.

Scientists have cooperated on a joint program of artificial heart research and development. Current cooperation is focused on the development and testing of biomaterials for use in circulatory diseases.

D. Environmental Health

E.

Coordinators:

National Institute of Environmental Health
Sciences;

A. N. Sysin Institute of General and
Communal Hygiene

Joint research on the effects of physical and chemical environmental agents on human health. Joint studies of the biological effects caused by microwave radiation and static and low frequency electromagnetic fields.

NIEHS also participates in the US-USSR Agreement on Cooperation in the Field of Environmental Protection, which is administered by EPA.

Three epidemiological studies of juvenile rheumatoid arthritis (JRA) were carried out initially. A Cooperative Pediatric Rheumatology Study was initiated in 1974 and completed in 1984. It included 18 centers and compared the efficacy of d-penicillamine and hydroxychloraquine with a placebo control in the treatment of JRA. Results were presented at the annual meeting of the American Rheumatism Association in 1985. A study of the effectiveness of oral gold in treatment of JRA is in progress.