RESEARCH ON TROPICAL DISEASES (1985) p. 4 of 12
GORGAS MEMORIAL LABORATORY, PANAMA
This laboratory for the study of tropical diseases was founded in
1928 by the Gorgas Memorial Institute, an American private, nonprofit
organization, in memory of Major General William Crawford Gorgas.
The Government of Panama donated the land and original buildings,
and the U.S. Congress authorized an annual contribution for operating
This contribution continues today in amounts up to $2 million.
Panama contributes a modest research fund and grants tax
contracts and grants for research are received from U.S. agencies and
international programs for specific projects.
Originally, the core support for operating expenses passed
through the Department of State. In
the mid-1950s, NIAID administered the award, and this responsibility was
passed to the Fogarty International Center of NIH in 1971.
Administration of the grant does not carry with it the power to
govern or control the laboratory. It
remains in private hands, governed by a 47-member Board of Directors
based in Washington, D.C.
In 1983, NIH responded to pressures on its budget by including no
funds for the laboratory in its budgetary request.
NIH cited the fact that funds provided to the laboratory were not
subject to the same peer review process as were other NIH programs, and
proposed to use the savings to fund additional investigator-initiated
There can be no doubt that NIH does not welcome the role of
conduit for funds over which it can exercise no control for quality or
process. The decision to
omit funds for the laboratory altogether from the budget may, however,
have reflected an awareness that neither the Congress nor the Department
of State was likely to permit the laboratory to founder at a time of
heightened political tension in Central America.
In any event, the U.S. Senate requested that the General
Accounting Office (GAO) report on the scientific review procedures
applied to work at the laboratory, the similarity of research at Gorgas
to other federally-funded research, and the extent of efforts to broaden
the base of financial support for the laboratory.
At the same time, the Senate requested the Office of Technology
Assessment (OTA) to examine the quality and relevance of research at the
Laboratory. The two ensuing
reports, of August 1983, provide most of the information for this
The Gorgas Laboratory began, and achieved distinction, as a
research institute concentrating on malaria, trypanosomiasis, and
leishmaniasis. It has
always played a role in surveillance of yellow fever.
More recently, increased attention has been given to other
insect-borne diseases and their vectors.
In addition, current projects concern sexually-transmitted
diseases, specific cancers, and ecological studies.
Some projects involve clinical work; about 1000 patients are
treated yearly, as a service to the community and as a source of
learning about the natural history and treatment of disease invasions of
the isthmus from South America. The
Laboratory also offers access to a supply of Aotus monkeys, an animal useful for malaria studies.
A six-week course on tropical medicine sponsored by the Navy is
the principal training activity; but the Laboratory also hosts
predoctoral and postdoctoral students and scientists.
The scientific staff of the Laboratory in 1983 consisted of six
Americans, nine Panamanians and one Peruvian, under the direction of
Raymond H. Watten, Phillip’s colleague in Bangkok and later commander
of NAMRU-3 in Cairo.
The budget of the Laboratory over the last several years has run
about $2.5 million, of which about $1.8 million consisted of core
support. In fiscal year
1985 the budget was over $3 million, with $2 million in core support.
The OTA review of the scientific facility and the relevance of
work at Gorgas gave the Laboratory high marks.
OTA noted the special value to American science of a laboratory
located in the tropics, and found overall scientific quality at the
laboratory to be high, if a bit uneven.
Similarly, with some exceptions found almost entirely in the
core-funded activities, OTA found the research relevant to the various
parties at interest. OTA
did make several suggestions for improvement, including the proposal
that Gorgas make more of an effort to seek out associations with
universities and collaboration with groups from other countries and
international organizations. The
report also recommended that better use be made of the Advisory
Scientific Board, in planning research and as part of an improved peer
review process. Also, the
Laboratory should plan to move more fully into modern scientific
technologies, such as the use of monoclonal antibodies and other
immunological diagnostics, and biotechnology approaches to vaccine
research and development. The
overall conclusion of OTA was that the positive attributes of the Gorgas
Laboratory far outweighed its costs, and that defunding would be a
The GAO report was somewhat more critical in tone, but found no
evidence which would support termination of U.S. funding on grounds that
the Laboratory’s research was not needed, duplicative, or of a poor
GAO was particularly critical of the fact that Gorgas had made
little effort to expand the financial base of its activities.
In recent years, only Panama has made financial contributions, in
addition to those of U.S. agencies, in amounts under 4% of total cost.
The Institute did contact 150 foundations and other private
funding organizations without encouraging results.
Other countries in Central America were not solicited because
they were thought to be too poor to contribute.
WHO and PAHO, contacted by GAO, indicated they could not provide
Among the alternatives for funding the laboratory suggested to
GAO in the course of the study was the internationalization or
regionalization of Gorgas. Internationalization could be modeled on the experience of
the ICDDR/B, which will be discussed in more detail later.
Regionalization might be modeled on INCAP, which it will be
recalled was the model for the original SEATO cholera laboratory in
The Panamanian Minister of Health formally proposed
internationalization in 1982, suggesting that his country and other
states of the region would be more willing to contribute if they were
invited to play a greater role in the decision-making process, and
received greater benefits from the research.
The Minister later had reservations about his own idea because
the Laboratory could end up like INCAP, where some member countries are
far in arrears in their payments, but still participate in
decision-making. A State Department official also was negative about
internationalization because some of the purposes of the Laboratory,
such as improving environmental and health quality in Panama, training
military physicians, and offering a means of applying political leverage
in dealing with the Government of Panama, would not be well served.
Another set of critical GAO findings concerned the processes of
planning and administering research at the Laboratory.
GAO could identify no formal long-range program plan or planning
process for the work of the Laboratory.
The shape of the program is said to be set by the recruitment
appointed to staff positions are free to determine their own research
directions, subject to an internal review.
The review process is informal, and given the small number of
scientists at the institution and the diversity of their interests,
cannot approximate the quality of the internal review process at NIH.
External reviews are conducted approximately every three years by
the Fogarty Center. The
24-member Advisory Scientific Board has been rarely utilized, and has
never met as an entity.
All this does not necessarily reflect adversely on the quality or
productivity of the Laboratory. Both
OTA and GAO found the publication record of Gorgas scientists to be
good, and the Fogarty external review team in 1980 concluded that the
Laboratory’s studies were of scientific importance to the United
States, Panama, and the region. The
overall research quality was of a high standard; and the scientific
value and benefits derived from the Laboratory were a worthwhile
investment of U.S. funds.
The two reports offered ample grounds for the Congress to insist
that funding be restored to the endangered Laboratory, and within the
Executive Branch, the Secretary of State took the unusual action of
addressing a letter to the Secretary of Health and Human Services urging
that the matter be reconsidered. The Secretary felt defunding to be inconsistent with our
posture of constructive engagement with Panama and other countries in
the region. This action by
the Secretary of State, while admirable in itself, reveals a serious
shortcoming in the budgetary decision-making processes of our
Government. There is no
mechanism for the consideration of diverse elements of the national
interest in assigning budgetary priority to a project other than
intervention at the Secretary level.
Each agency defines its priorities under its own terms of
reference and authorizations, taking no formal notice of the multiple
benefits that an activity may produce.
It is difficult to see how this system could produce optimal
results in terms of the national interest.
Turning to the comparative framework, the following observations
can be made about the Gorgas Memorial Laboratory:
Scope of the Program
The Laboratory is an unusual resource, able to conduct basic and
applied research in a tropical setting with an extraordinary diversity
of endemic problems. The
range of activities, including some clinical research and drug and
vaccine testing, is very broad, but it is not broad along the spectrum
of a particular disease. That
is to say, the Gorgas Laboratory is not focused, as was the Pakistan-SEATO
lab, on a single family of diseases.
Nor is it part of a coherent targeted effort against a disease,
as are the military labs, except for those parts of its work that are
contracted for by the armed forces or other agencies.
The result is not a wide range of activities along a single
spectrum, but a wide variety of activities along disjointed segments of
different disease spectra.
This may be a problem of “critical mass.”
If Gorgas had a single disease concentration, or if it were an
integral part of the research program of a major laboratory such as
NIAID or WRAIR, it could perhaps have a more focused impact on one or
At one time, Gorgas appears to have had a somewhat greater
concentration on a single disease: malaria.
Over the years, investigators have worked on vector biology,
vector control, response of the parasites to drugs, drug resistance,
epidemiology, monkey hosts and other aspects of malaria.
Naturally Gorgas has established good working relationships with
the Panamanian Ministry of Health and hospital authorities, without
whose cooperation field and clinical studies could not be carried out.
Relationships outside Panama have occurred with the Medical
Entomology Research and Training Unit in Guatemala, the Centers for
Disease Control, NIH, Louisiana State University, the University of
Alabama at Birmingham, Johns Hopkins University, and other academic and
scientific institutions. It
has undertaken a number of activities, such as conducting environmental
assessments of major project proposals, which are of service to the
Government of Panama. It
has not, in general, sought to establish collaborative relationships
with other institutions in the region, nor to expand its training
programs to accommodate very many scientists from the region.
3. Results: Impact on
OTA sought to determine the value of the research done at the
Gorgas Laboratory by examining the quality of its output and the
relevance of the topics studied to the health concerns of the United
States, Panama and the region, and to biomedical research generally,
with positive conclusions as noted above.
The major accomplishments of the Laboratory from 1970 to 1983
were the following:
Continued yellow fever surveillance and
monitoring of vectors of St. Louis encephalitis and Venezuelan equine
encephalitis vectors and reservoirs
Insect genetic studies using isozyme markers
Transovarial transmission of yellow fever
virus in mosquitoes
Use of Aotus monkey model for testing of
therapeutic agents for malaria
Several new viral isolates in area
WHO regional center for bloodmeal analysis
Improved identification of insect vectors:
sandflies, triatomids, blackflies, etc.
Development of cancer registry in the
Republic of Panama
Discovery of high incidence of cervical and
penile cancer in Herrera Province (Republic of Panama)
Studies of sexually transmitted diseases in
the Republic of Panama (the first such studies in Latin America)
identification of viral agent in recent epidemics of conjunctivitis and
encephalitis in the Republic of Panama
Discovery of high prevalence of HTLV
antibodies in the Republic of Panama
impact assessment of Tabasara hydroelectric project
Gorgas Memorial Laboratory, Office of the Director.)
The Laboratory helps to expand the U.S. capacity for research and
disease control through its training course and its facilities, which
offer access to a useful primate population and to areas in which many
insect-borne diseases are endemic. A substantial number of Panamanian researchers are trained
and employed at Gorgas, frequently moving on to university or public
health positions in which their Gorgas experience is invaluable.
In general, however, the Gorgas Laboratory has not had, as part
of its mission in its fifty-six year history, the building of local and
regional research capacities. This
would appear to be a major shortcoming of the present operation, one
that could probably not be remedied with existing resources.
It is worth noting that the Department of State, while able to
exercise influence at the highest level to head off a budget cut that
would damage our diplomatic posture in the region, is unable, in terms
of budgetary authorities or scientific expertise, to stimulate an
expanded course of action that would positively benefit U.S. standing in
the region. NIH has no
mandate to initiate medical activities for diplomatic purposes.
The State Department lacks the expertise as well as the mandate.
No agency is in a position to, or expected to, define the optimal
use of U.S. resources for medical research in the Caribbean, weighing in
the balance scientific, diplomatic, military, developmental and
humanitarian considerations, all of which are elements of the national
The situation in the case of the Gorgas, in which the U.S.
Government is supplying 75-80% of the core funding and most of the grant
and contract funding for a private institution, is something of an
anomaly. Some sources referenced in the OTA report thought that the
Board of the Institute was and remains an obstacle to the
internationalization of the Laboratory.
On the other hand, two official U.S. laboratory facilities were
established in Panama since the Gorgas Laboratory was set up (the Middle
America Research Unit of NIH and a USAMRU) and both have had to close
for budgetary or personnel reasons.
Gorgas has survived, perhaps, because
it is not a part of the federal system and can if necessary take its
case directly to Congress.