Ensuring wise US investments
The United States has long been a leader in discovering game-changing scientific breakthroughs, a role that has served as both a source of pride for the American people as well as an economic driver. This is particularly apparent in global health, where US-driven efforts have led to the development of effective tools to prevent, diagnose, and treat illnesses around the world. Many of this past year’s advances in global public health are the result of the continued commitment to innovation by the US Government, including the Centers for Disease Control (CDC), Department of Defense (DoD), Food and Drug Administration (FDA), National Institutes of Health (NIH), and US Agency for International Development (USAID). Each of these agencies plays a unique role in global health research, which taken together complement each other in important ways. (See “Recent breakthroughs supported by US agencies”and “The National Institutes of Health and global health.”)
The benefits of a strong US commitment to global health research are also evident domestically, where investments in scientific innovation for global health diseases—some of which affect the US population—propel American job creation and business activity. In California, for example, global health activities in 2007 generated an estimated $50 billion in business. The global health sector supported 350,000 high-quality jobs and $19.7 billion in wages and salaries in the state alone.3
Innovation in US international development strategies
During the course of the past year, the administration released three important and related strategies that will guide how the United States approaches international development and global health. All three highlight the vital role of science, technology, and innovation.
The White House reinforced the importance of research and product development to global health when it released new documents about the Global Health Initiative (GHI)—one of the administration’s signature development initiatives—in September 2010 and March 2011. An updated version of the administration’s GHI strategy document released in March 2011 says that under the initiative, “research will continue to spur innovation for the discovery and development of new biomedical interventions and technologies, such as drugs, diagnostics, and vaccines; medical devices, such as safe syringes; and information and communication technologies, such as mobile telephones and other data-transmitting devices that have the potential to improve people’s health.”4 Also in March 2011, the State Department hosted a symposium to highlight the role of innovation in global health, at which US officials emphasized the role of science diplomacy in US foreign policy through programs such as the GHI. Stakeholders at the symposium also emphasized that innovation is central to improving health outcomes and livelihoods of people worldwide.5
In September 2010, following a year-long review, the administration unveiled the US Government’s first-ever Presidential Policy Directive (PPD) on global development. When releasing the PPD, President Obama said that the United States is “expanding scientific collaboration with other countries and investing in game changing science and technology to help spark historic leaps in development.”6 President Obama also stressed the importance of innovation, research, and development in his annual State of the Union address.7 In December 2010, the US Department of State and USAID released the Quadrennial Diplomacy and Development Review (QDDR), a process to recommend updated approaches to international development, including commitments to invest in science, research, and innovation.8
Transparency and coordination of US investments
A range of federal agencies participate in global health research; however, to maximize this US investment, their efforts need to be strategically coordinated. Given the significance of US contributions to global health research, improved documentation and transparency of American investments will be important to aid policymakers to make fully informed budgetary, regulatory, and programmatic decisions. Improved documentation and transparency can also provide American taxpayers with a greater understanding of how these funds are being used.
The administration took an encouraging step toward improving coordination when it convened leading experts to address research activities under the GHI. The committee is led by the NIH director and includes all agencies engaged in global health research. Its mission is to improve coordination of global health-related research and innovation efforts.
US investments in global health research are currently documented in a number of ways. The NIH tracks its activities through its Research Portfolio Online Reporting Tools,9 and USAID recently launched a Foreign Assistance Dashboard10 that is beginning to detail US foreign assistance funding. Various efforts have also attempted to show expenditures made by the DoD and the CDC. In 2006, USAID developed a five-year health research strategy and has since released reports documenting its progress in implementing this strategy.11 To maintain a high level of transparency, Congress should request that USAID and other agencies engaged in global health research develop a five-year research strategy and publicly release annual progress reports.
In focus
Recent breakthroughs supported by US agencies
In July, a USAID-supported study showed proof-of-concept that a microbicide gel could provide women with protection against HIV and herpes. USAID over the past year has also continued to support research for an experimental drug that could cure malaria in one dose, called OZ439.
The NIH’s Therapeutics for Rare and Neglected Diseases program launched five pilot projects in July to spur drug development for diseases including schistosomiasis and hookworm. And in December, the World Health Organization endorsed a novel, rapid, and easy-to-use diagnostic test for TB and drug-resistant TB. Development of this test received critical support from the NIH.
In December, a new meningitis vaccine was distributed for the first time in Africa. Development of the vaccine was supported by the FDA, CDC, NIH, and USAID.
In November, the DoD’s Walter Reed Army Institute of Research launched the first clinical trials for a vaccine against the most widespread strain of malaria, Plasmodium vivax.
For many of these breakthroughs, public private partnerships—such as product development partnerships—helped to usher these tools through the research and development process. Once fully developed and distributed to people in need, the tools listed here, along with others under development, will significantly improve public health worldwide by making sustained headway against global diseases.
In focus
The National Institutes of Health and global health
The NIH is the largest funder in the US Government of global health research, and the agency has recently demonstrated a growing interest in global health issues. In June 2010, the NIH and partners launched the Human Heredity and Health in Africa Project, which aims to build the long-term capacity of African scientists and research institutions to conduct scientific studies on diseases such as HIV/AIDS, TB, and malaria. Additionally, the NIH’s Fogarty International Center recently began collaborating with the Department of Health and Human Services’ Health Research Services Administration and the State Department’s Office of the US Global AIDS Coordinator on the Medical Education Partnership Initiative (MEPI). MEPI supports foreign institutions in sub-Saharan African countries that receive support from the US President’s Emergency Plan for AIDS Relief to develop, expand, and enhance models of medical education. This includes enhancing the capacity of local individuals to conduct research on global health diseases.
The NIH also plans to open a new center by October 2011, called the National Center for Advancing Translational Sciences (NCATS). NCATS would establish a focused, integrated, and systematic approach to link basic research with therapeutic development and clinical care. The new center will focus on neglected diseases of the developing world, as well as rare diseases. NIH Director Francis Collins has said that NCATS will impact new technologies for global health, such as new treatments for the parasitic infection schistosomiasis.