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Forum on Drug Discovery, Development, and Translation; Board on Health Sciences Policy; Institute of Medicine. The Global Crisis of Drug-Resistant Tuberculosis and Leadership of China and the BRICS: Challenges and Opportunities: Summary of a Joint Workshop by the Institute of Medicine and the Institute of Microbiology, Chinese Academy of Sciences. Washington (DC): National Academies Press (US); 2014 Feb 28.

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The Global Crisis of Drug-Resistant Tuberculosis and Leadership of China and the BRICS: Challenges and Opportunities: Summary of a Joint Workshop by the Institute of Medicine and the Institute of Microbiology, Chinese Academy of Sciences.

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Appendix AWorkshop Agenda

THE GLOBAL CRISIS OF DRUG-RESISTANT TUBERCULOSIS AND THE LEADERSHIP OF THE BRICS COUNTRIES: CHALLENGES AND OPPORTUNITIES

Wednesday–Friday, January 16–18, 2013

Beijing, China

The increasing burden of drug-resistant tuberculosis introduces new challenges to traditional TB control and treatment programs and calls upon the global health community to collaborate and share scientific information in new and different ways. This 3-day workshop is sponsored by the Forum on Drug Discovery, Development, and Translation of the U.S. National Academy of Sciences, the Institute of Medicine (IOM), and the Institute of Microbiology of the Chinese Academy of Sciences (CAS). Following an inaugural meeting in Washington, DC, in 2008, this workshop in Beijing is the fourth in a series of international workshops convened by the U.S. IOM. The objective of the workshop series is to realistically assess the impact of and challenges resulting from drug-resistant TB globally and in the four countries with the most people affected (China, India, Russia, and South Africa). A public workshop was also convened in July/August 2012 in Washington, DC, to identify opportunities to improve the global supply chain for second-line TB drugs. Specifically, the goals of the workshop series include

  • Consider a wide spectrum of issues pertaining to the science and policy around drug-resistant tuberculosis—from biology, epidemiology, and surveillance; to diagnosis, treatment, and infection control; to issues pertaining to the drug supply chain, laboratory capacity, and needs of vulnerable populations. Each workshop will address some or all of these multiple disciplines and facilitate discussion about a global “blueprint for action.”
  • Present promising new research, and also to identify specific gaps in knowledge and consider potential needs for additional research, funding, and international attention.

The workshop series has been hosted over a period of several years, creating a venue and body of knowledge that explicitly considers and addresses developments over a period of time, thus permitting relatively quick adjustments in knowledge and strategy. The workshop series convenes international experts, permitting exchange of information among experts from each of the participating countries and globally. Each workshop in the series results in a U.S. National Academies publication summarizing the workshop presentations and discussions.

This workshop in Beijing will address the current status of drug-resistant tuberculosis globally, and in China, and consider lessons learned from the other three high burden countries; highlight global challenges to controlling the spread of drug-resistant strains; and discuss innovative strategies to advance and harmonize local and international efforts to prevent and treat drug-resistant TB. The workshop will consider urgent themes relating to the problem of multidrug-resistant (MDR) TB, extensively drug resistant (XDR) TB, and emergent TB strains that are potentially untreatable with drugs available and will consider the critical leadership role of the BRICS countries in addressing the threats and opportunities in drug-resistant TB.

DAY 1

Wednesday, January 16, 2013

Beijing, China

7:00 a.m.Registration
8:30 a.m.Welcome and Introductory Remarks
(Moderator: LIXIN ZHANG)
YAPING ZHANG
  • Vice President
  • Chinese Academy of Sciences
9:00 a.m.Group Photo
9:15 a.m.Global Burden, Themes from Institute of Medicine Workshops in Other BRICS Countries, and Workshop Goals
GAIL CASSELL
  • Chair, IOM Planning Committee
  • Harvard Medical School
  • Infectious Disease Research Institute
GEORGE FU GAO
  • Vice Director General
  • Chinese Center for Disease Control and Prevention
  • Beijing Institute of Biological Sciences, CAS
9:45 a.m.Opening Keynote Address
Twenty-Five Years After the First Major MDR TB Outbreak: Is It Time for a New Strategy?
PAUL FARMER
  • Chair, Department of Global Health and Social Medicine
  • Harvard Medical School
10:15 a.m.BREAK
10:45 a.m.Panel Discussion: Challenges and Opportunities for the BRICS Country Leadership
The BRICS countries, represented by the Ministers of Health of the Federative Republic of Brazil, the Russian Federation, India, People's Republic of China, and Republic of South Africa, met in New Delhi on 11 January 2013 at the Second BRICS Health Ministers' Meeting. The Ministers recognized that multidrug-resistant tuberculosis is a major public health problem for the BRICS countries due to its high prevalence and incidence mostly on the marginalized and vulnerable sections of society. They resolved to
  • collaborate and cooperate for development of capacity and infrastructure to reduce the prevalence and incidence of tuberculosis through innovation for new drugs/vaccines, diagnostics; and
  • promotion of consortia of tuberculosis researchers to collaborate on clinical trials of drugs and vaccines;
  • strengthening access to affordable medicines and delivery of quality care.
The Ministers also recognized the need to cooperate for adopting and improving systems for notification of tuberculosis patients, availability of anti-tuberculosis drugs at facilities by improving supplier performance, and procurement systems and logistics and management of HIV-associated tuberculosis in the primary health care system.
The Ministers also recognized the importance and need of technology transfer as a means to empower developing countries. In this context, they underlined the important role of generic medicines in the realization of the right to health. The Ministers renewed their commitment to strengthening international cooperation in health, in particular south–south cooperation, with a view to supporting efforts in developing countries to promote health for all and resolve to establish the BRICS network of technological cooperation. (Delhi Communiqué, January 12, 2013, http://pib​.nic.in/newsite/erelease​.aspx?relid=91533)
RIFAT ATUN
  • Professor of International Health Management
  • Imperial College
  • London
KRISTINA WALLENGREN
  • Clinical Advisor
  • KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH)
SALMAAN KESHAVJEE
  • Associate Professor, Department of Global Health and Social Medicine
  • Harvard Medical School
GRIGORY VOLCHENKOV
  • Head Doctor
  • Vladimir Oblast TB Dispensary
  • Center of Excellence for TB Infection Control
YANLIN ZHAO
  • Vice Director, National Center for Disease Control and Prevention
  • Director, National Tuberculosis Reference Laboratory
  • Chinese Center for Disease Control and Prevention
11:30 a.m.Discussion with speakers and audience
Moderators:
GAIL CASSELL
  • Harvard Medical School
  • Infectious Disease Research Institute
YANLIN ZHAO
  • Vice Director, National Center for Disease Control and Prevention
  • Director, National Tuberculosis Reference Laboratory
  • Chinese Center for Disease Control and Prevention
12:00 p.m.LUNCH

SESSION I: DRUG-RESISTANT TB IN CHINA

Session Objectives:

  • Describe the health care delivery system in China and recent surveillance results of drug-resistant TB in China. Identify where data are missing and are most needed.
  • Discuss the burden of drug-resistant TB in China from the perspective of clinicians and health care providers.
  • Present data on the burden of drug-resistant TB in vulnerable populations such as domestic migrant workers and individuals with comorbidities, including HIV and diabetes.
  • Present international perspectives on the impact of health delivery systems on DR TB control and care.

Session Chairs:

  • China co-chair: FABIO SCANO, World Health Organization
  • U.S. co-chair: PAUL FARMER, Harvard Medical School
1:30 p.m.Overview of the Health Care Delivery System and Programmatic Management of MDR TB in China
MINGTING CHEN
  • Vice Director/Researcher
  • National Center for Tuberculosis Control and Prevention
  • Chinese Center for Disease Control and Prevention
2:00 p.m.2007 National Survey of Drug Resistance in China
YANLIN ZHAO
  • Vice Director, National Center for Disease Control and Prevention
  • Director, National Tuberculosis Reference Laboratory
  • Chinese Center for Disease Control and Prevention
2:30 p.m.Panel Discussion: Perspectives from Public Health and Hospital Systems in China
[20 min. each speaker]
Clinical Diagnosis and Treatment of Drug-Resistant TB
WENHONG ZHANG
  • Huashan Hospital of Fudan University, Shanghai, China
M/XDR TB Chemotherapy in China
SHOU-YONG TAN
  • Guangzhou Chest Hospital
3:10 p.m.BREAK
3:30 p.m.Panel Discussion: Treating Drug-Resistant TB in Vulnerable Populations in China
[20 min. each speaker]
Drug-Resistant TB and HIV in China
LIU FEIYING
  • Guangxi Center for Disease Control and Prevention, China
Drug-Resistant TB and Diabetes in China
CHU NAIHUI
  • (Oral presentation by Duan Hongfei)
  • Beijing Chest Hospital
4:10 p.m.Discussion with speakers and audience
4:30 p.m.Panel Discussion: Impact of Health Care Delivery Systems on DR TB
[20 min. each speaker]
Peru, Russia, and Lesotho
SALMAAN KESHAVJEE
  • Associate Professor
  • Department of Global Health and Social Medicine
  • Harvard Medical School
Community-Based Care in South Africa
KRISTINA WALLENGREN
  • Clinical Advisor
  • KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH)
Direct Collaboration and “South-to-South Transfer” in Cambodia and Ethiopia
ANNE GOLDFELD
  • Harvard Medical School/Global Health Committee
5:30 p.m.Discussion with speakers and audience
6:00 p.m.Closing remarks and adjourn day 1

DAY 2

Thursday, January 17, 2013

Beijing, China

SESSION II: TRANSMISSION AND INFECTION CONTROL: EPIDEMIOLOGICAL AND GENOTYPIC EVIDENCE AND CONSEQUENCES

Session Objectives:

  • Provide an overview of the epidemiological, phenotypic, and genotypic evidence for primary transmission of drug-resistant TB.
  • Discuss the consequences of transmission of drug-resistant TB in communities and hospitals.
  • Consider the scientific evidence for active case finding, rapid diagnosis, and treatment based on drug-susceptibility testing (DST) to stop transmission.
  • Discuss the role of infection control in China today and consider infection control policies and practices in other countries with a high prevalence of drug-resistant TB.
  • Describe drug-resistant TB risk factors (e.g., inadequate treatment, losing patients during follow-up, drug shortages, exposure to drug-resistant TB due to inadequate infection control) and provide in-country perspectives of the issues and current strategies for prevention and control.

Session Chairs:

  • China co-chair: WENHONG ZHANG, Huashan Hospital of Fudan University
  • U.S. co-chair: EDWARD NARDELL, Harvard School of Public Health
8:00 a.m.Global Perspective on Transmission: Value in Genotype Mapping of Disease Transmission Dynamics
NEEL GANDHI
  • Associate Professor
  • Department of Epidemiology
  • Rollins School of Public Health
  • Emory University
8:30 a.m.Current Status of Infection Control in China: Different Perspectives
[20 min. each speaker]
Hospital System Perspective
LIANG LI
  • Clinical Center for Tuberculosis, China CDC
Public Health Systems
GUANGXUE HE
  • Chinese Center for Disease Control and Prevention
Infection Control Challenges
CAROL RAO
  • U.S. Centers for Disease Control and Prevention
9:30 a.m.Discussion with speakers, panelists and audience
10:00 a.m.BREAK
10:20 a.m.Perspectives on Infection Control in Other Countries
[20 min. each speaker]
South Africa
CARRIE TUDOR
  • Fogarty Global Health Postdoctoral Fellow
  • Johns Hopkins School of Nursing
Institutional Infection Control in Russia
GRIGORY VOLCHENKOV
  • Head Doctor
  • Vladimir Oblast TB Dispensary
  • Center of Excellence for TB Infection Control
11:00 a.m.Redesign of Health Care Facilities, Active Case Finding, Rapid Diagnosis, and Effective Treatment Based on DST to Stop Transmission in Institutional and Community Settings
EDWARD NARDELL
  • Associate Professor
  • Departments of Environmental Health and Immunology and Infectious Diseases, Harvard School of Public Health
11:30 a.m.Discussion with speakers and audience
11:45 a.m.LUNCH

SESSION III: RAPID DIAGNOSTIC TECHNOLOGY: CURRENT STATUS AND LIMITATIONS

Session Objectives:

  • Provide an overview of the methods of DST used globally and the advantages and disadvantages of different tests.
  • Discuss the current use of diagnostic tests for drug-susceptible and drug-resistant TB in China and identify the barriers to rapid diagnosis and management of patients. Consider challenges in diagnosing TB and drug-resistant TB vs. nontuberculous mycobacteria (NTM). Provide a laboratory- and hospital-based perspective on DST.
  • Discuss work from other countries in implementing programs for rapid diagnosis of drug-resistant TB and consider the populations in which various DSTs work best.

Session Chairs:

  • China co-chair: JACK ZHANG, PATH
  • U.S. co-chair: JEAN-LUC BERLAND, Fondation Mérieux
1:00 p.m.DST in Detecting DR TB, Overview of Other Technologies, and Rollout of GeneXpert in South Africa: What Are the Gaps?
MARK NICOL
  • Division of Medical Microbiology and Institute for Infectious Diseases and Molecular Medicine
  • University of Cape Town and National Health Laboratory Service
  • South Africa
1:30 p.m.Panel Discussion: Perspectives on Drug-Resistant TB Diagnostic Technologies in Use in China
[15 min. each speaker]
SAT-TB Assay
JIN CHEN
  • Shanghai Pulmonary Disease Hospital
GeneXpert
YAO-JU TAN
  • Guangzhou Chest Hospital
GenoType MTBDRplus
WEI GE
  • Shandong Chest Hospital
Line Probe Assay (LPA)
HAIRONG HUANG
  • Beijing Chest Hospital
Cross Priming Amplification (CPA)
PANG YU
  • Chinese Center for Disease Control and Prevention
2:45 p.m.Genetic Diversity of DR TB: Implication for Future Diagnostics
MEGAN MURRAY
  • Professor
  • Department of Global Health and Social Medicine
  • Harvard Medical School
3:15 p.m.Discussion with speakers and audience
3:30 p.m.BREAK

SESSION IV: ADDRESSING DIAGNOSIS AND TREATMENT ACROSS THE SPECTRUM OF DRUG RESISTANCE

Session Objectives:

  • Describe the prevalence of MDR, pre-XDR, XDR, and untreatable TB in key countries.
  • Consider the diagnosis and treatment challenges associated with MDR, pre-XDR, and XDR TB. How can a TB program effectively meet the needs of patients?

Session Chairs:

  • China co-chair: JIN LIANG JU, Shanghai Pulmonary Disease Hospital
  • U.S. co-chair: NEEL GANDHI, Emory University
3:45 p.m.MDR and XDR TB
Clinical Perspective
RICHARD CHAISSON
  • Johns Hopkins University
4:05 p.m.Panel Discussion: Treating the Spectrum of Drug Resistance in China
[20 min. each speaker]
New Diagnostic Marker Screening in TB Meningitis
XIAOYOU CHEN
  • Tuberculosis Department, Beijing Chest Hospital
  • Beijing Tuberculosis & Thoracic Tumor Research Institute
Surgical Treatment of M/XDR TB
XIAO NING
  • Beijing Chest Hospital, Capital Medical University
4:45 p.m.The Need for a Paradigm Shift in Treatment of the Spectrum of Drug Resistant TB
MARKUS MAEURER
  • Professor and Head, Therapeutic Immunology Division
  • Karolinska Institute
5:15 p.m.MDR, XDR, and Untreatable TB from a Laboratory Perspective
[20 min. each speaker]
MARTIE VAN DER WALT
  • Interim Director, TB Epidemiology and Intervention Research Unit
  • South African Medical Research Council
SVEN HOFFNER
  • Director, WHO Supranational TB Reference Laboratory
  • Associate Professor, Department for Preparedness
  • Swedish Institute for Communicable Disease Control
5:55 p.m.Totally Drug-Resistant TB in India: Lessons and Opportunities from a Clinical Perspective
ZARIR UDWADIA
  • Consultant Chest Physician
  • Hinduja Hospital
  • Mumbai, India
6:25 p.m.Discussion with speakers, panelists, and audience
7:15 p.m.Closing remarks and adjourn day 2

DAY 3

Friday, January 18, 2013

Beijing, China

SESSION V: DRUG-RESISTANT TB IN PEDIATRIC POPULATIONS

Session Objectives:

  • Review the global burden and transmission of pediatric DR TB.
  • Discuss challenges in diagnosis and treatment of DR TB in children.

Session Chairs:

  • China co-chair: QIAN GAO, Fudan University, China
  • U.S. co-chair: MERCEDES BECERRA, Harvard Medical School
8:00 a.m.Children as Sentinels for Transmission and Policy Response
MERCEDES BECERRA
  • Associate Professor
  • Department of Global Health and Social Medicine
  • Harvard Medical School
8:30 a.m.Pediatric Drug-Resistant TB in China
TAO LI
  • Shanghai Public Health Clinical Center
8:50 a.m.Drug-Resistant TB in Meningitis
SHUNYING ZHAO
  • (Oral presentation by Huimin Li)
  • Beijing Children's Hospital
9:10 a.m.Status of Pediatric MDR/XDR TB in the Russian Federation and Other Former Soviet Union Countries: Managing Pediatric Drug-Resistant TB in a Setting with Separate Medical Structures for Adults and Children
VALENTINA AKSENOVA
  • (Oral presentation by Rita Guenther)
  • Head, Childhood and Adolescent Tuberculosis Department
  • Research Institute of Phthisiopulmonology
  • First Moscow Sechenov State Medical University
  • Chief Pediatric Phthisiologist, Ministry of Health, Russian Federation
9:30 a.m.Discussion with speakers and audience
9:45 a.m.BREAK

SESSION VI: LOOKING FORWARD: DEVELOPING AND STRENGTHENING THE DRUG SUPPLY CHAIN FOR DRUG-RESISTANT TB

Session Objectives:

  • Consider to what extent and in what ways current supply chain mechanisms are or are not effectively accomplishing what is needed, in China and beyond, including consideration of bottlenecks.
  • Consider the current allocation of responsibilities and roles of the private (including industry and not-for-profit public health organizations) and public sectors, and examination of opportunities for enhancing and optimizing collaboration.
  • Identify potential innovative solutions to the supply chain problem.

Session Chairs:

  • China co-chair: WENHONG ZHANG, Huashan Hospital, Fudan University
  • U.S. co-chair: BARRY BLOOM, Harvard School of Public Health
10:00 a.m.Barriers, Challenges, Needs, and Potential Solutions for the SLD Supply Chain
BARRY BLOOM
  • Co-chair, IOM workshop, Developing and Strengthening the Global Supply Chain for Second-Line Drugs for MDR TB
  • Distinguished Service Professor
  • Department of Immunology and Infectious Diseases
  • Harvard University
  • Dean of the Harvard School of Public Health (former)
10:20 a.m.Panel: Different Perspectives on the Global Supply Chain
RIFAT ATUN
  • Professor of International Health Management
  • Imperial College
  • London
DAN COLLINS
  • Corporate Affairs
  • Eli Lilly and Company
MINGTING CHEN
  • Chinese Center for Disease Control and Prevention
DALE NORDENBERG
  • Chief Executive Officer
  • Novasano Health and Science
OSKAR SLOTBOOM
  • Head, Vaccine and Infectious Diseases
  • Xian Janssen Pharmaceutical Ltd., Johnson & Johnson
11:30 a.m.Discussion with speakers and audience
11:45 a.m.LUNCH

SESSION VII: LOOKING FORWARD: EMBRACING A NEW VISION FOR RESEARCH

Session Objective:

  • Review the state of the art in TB research and identify opportunities to apply new research tools to the problem of DR TB.

Session Chairs:

  • China co-chair: MIN FANG, Institute of Microbiology, Chinese Academy of Sciences
  • U.S. co-chair: ANNE GOLDFELD, Harvard Medical School/Global Health Committee
1:00 p.m.The Need for a Paradigm Shift in TB Research: Synergy of Discovery and Delivery of Care
ANNE GOLDFELD
  • Harvard Medical School/Global Health Committee
1:30 p.m.New Tools to Facilitate TB Research
[10 min. each speaker]
NIH Global TB Research Resources
MARIA GIOVANNI
  • Director, Office of Genomics and Advanced Technologies
  • Division of Microbiology and Infectious Diseases
  • National Institute of Allergy and Infectious Diseases
  • U.S. National Institutes of Health
TBResist: A Global Consortium for Whole Genome Sequencing of Drug-Resistant TB
GAIL CASSELL
  • Harvard Medical School
  • Infectious Disease Research Institute
Chemogenomics
PATRICK TAO LI
  • BGI (formerly Beijing Genomics Institute)
Meta-Analysis
KATHRYN DERIEMER
  • University of California, Davis
2:10 p.m.Discussion with speakers, panelists, and audience

SESSION VIII: CREATING AN EVIDENCE-BASED BLUEPRINT FOR ACTION: IDENTIFICATION OF FOUR STEPS

Session Objective:

  • Present highlights from the workshop and identify a blueprint for action based on discussions from the previous 2.5 days.

Session Chairs:

  • China co-chair: YANLIN ZHAO, Chinese Center for Disease Control and Prevention
  • U.S. co-chair: GAIL CASSELL, Harvard Medical School and Infectious Disease Research Institute
2:30 p.m.Action #1: Expose and Address the Silent Epidemic of DR TB in Children: Evidence Challenges and Mobilization of a Global Network
MERCEDES BECERRA
  • Associate Professor
  • Department of Global Health and Social Medicine
  • Harvard Medical School
QIAN GAO
  • Fudan University, Shanghai
2:45 p.m.Action #2: Adopt Genomic Tools to Map the Epidemic of Drug-Resistant TB and Address Diagnostic Challenges
SVEN HOFFNER
  • Director, WHO Supranational TB Reference Laboratory
  • Associate Professor, Department for Preparedness
  • Swedish Institute for Communicable Disease Control
YANLIN ZHAO
  • Vice Director, National Center for Disease Control and Prevention
  • Director, National Tuberculosis Reference Laboratory
  • Chinese Center for Disease Control and Prevention
3:00 p.m.Action #3: Block Transmission of Drug-Resistant TB
EDWARD NARDELL
  • Associate Professor
  • Departments of Environmental Health and Immunology and Infectious Diseases
  • Harvard School of Public Health
LIXIN ZHANG
  • Deputy Director, CAS Key Laboratory of Pathogenic Microbiology & Immunology
  • Inaugural Director of Drug Discovery Center for Tuberculosis
  • Institute of Microbiology, Chinese Academy of Sciences
3:15 p.m.Action #4: Revolutionize Drug Distribution, Guarantee Drug Quality, and Reform Regulatory Approval and Registration Policies
BARRY BLOOM
  • Distinguished Service Professor
  • Department of Immunology and Infectious Diseases
  • Harvard University
  • Dean of the Harvard School of Public Health (former)
3:30 p.m.BREAK

SESSION IX: A BIOSOCIAL APPROACH: SCIENCE AND ECONOMIC INTERVENTION FOR DR TB CONTROL—BRICS AT THE FOREFRONT

Session Objective:

  • Discuss the leading role of BRICS countries in the effort to combine science and evidence-based policies with economic interventions to combat DR TB.

Session Chairs:

  • China co-chair: YANLIN ZHAO, Chinese Center for Disease Control and Prevention
  • U.S. co-chair: RIFAT ATUN, Professor of International Health Management, Imperial College London
3:45 p.m.What Will Be Required for Zero Deaths from Drug-Resistant TB?
SALMAAN KESHAVJEE
  • Associate Professor
  • Department of Global Health and Social Medicine
  • Harvard Medical School
4:15 p.m.Reflections from BRICS Countries: What Are the Next Steps?
RIFAT ATUN
  • Professor of International Health Management
  • Imperial College
  • London
PAUL FARMER
  • Chair, Department of Global Health and Social Medicine
  • Harvard Medical School
KRISTINA WALLENGREN
  • Clinical Advisor
  • KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH)
GRIGORY VOLCHENKOV
  • Head Doctor
  • Vladimir Oblast TB Dispensary
  • Center of Excellence for TB Infection Control
YANLIN ZHAO
  • Vice Director, National Center for Disease Control and Prevention
  • Director, National Tuberculosis Reference Laboratory
  • Chinese Center for Disease Control and Prevention
5:15 p.m.Discussion with speakers and audience
6:00 p.m.Reflections on the New Delhi Communiqué
JARBAS BARBOSA (by teleconference)
  • Vice-Minister of Health
  • Federative Republic of Brazil
6:15 p.m.Adjourn day 3 and workshop
7:00 p.m.BANQUET
Copyright 2014 by the National Academy of Sciences. All rights reserved.
Bookshelf ID: NBK195968

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