Introduction

The US government has long supported innovation for global health, aiding the development and delivery of lifesaving vaccines, drugs, diagnostics, and other health tools around the world. Photo: PATH/Evelyn Hockstein.

The fruits of science have saved the lives of millions around the world. Investments in research from a range of global partners has led to the creation of new vaccines, drugs, and other health tools that eliminated smallpox, dramatically reduced measles cases, and contributed to the near-eradication of polio across the globe. More recent scientific breakthroughs contributed to the development of lifesaving vaccines, drugs, diagnostics, devices, insecticides and other products for HIV/AIDS,¹ tuberculosis (TB),^2,3 malaria,^4,5 women’s health,^6,7 neglected tropical diseases,^8-10 and childhood killers such as diarrhea and pneumonia.¹¹

The United States government and its citizens have long invested in the promise of science and innovation, supporting lifesaving health discoveries like those listed above. In fact, the US government is the largest supporter of global health research and development (R&D) in the world.¹² Health research breakthroughs not only serve a remarkable humanitarian purpose; US investments in global health R&D reap domestic rewards by creating US jobs, spurring business activity, and engaging a range of partners in the US private, nonprofit, public, and academic sectors. R&D also guarantees that new medical products will have a much greater public health impact at a lower cost, thereby reducing expenditures over the long term.

In order to sustain the progress in global health product development and to address emerging and evolving needs, continued support from the US government and its domestic and international partners is needed. For many neglected diseases, adequate drugs, vaccines, and diagnostics simply do not exist. Infectious diseases still claim the lives of millions each year, and emerging challenges such as drug and insecticide resistance pose a threat to health across the globe. New vaccines, drugs, tests, and other health tools are desperately needed, and progress cannot be made without a sustained investment in R&D.

This report offers actionable recommendations that Congress and the administration can implement to strengthen the US legacy in global health R&D and, more importantly, save lives around the world. These recommendations are especially timely, given that the US government is facing contentious budget negotiations that will have critical implications for its wide range of R&D activities that stretch across numerous federal agencies, departments, and branches. Recommendations include:

• Congress and the administration must protect and—where possible—increase funding for global health research and product development. Policymakers must prevent sequestration and ensure that the 2014 federal budget demonstrates a renewed commitment to global health research, with bolstered funding levels across the US government for R&D programs.
• Where they have budget discretion, US agencies engaged in global health research and product development must sustain robust investments in the development and delivery of new tools for public health worldwide.
• The US government should develop a strategy to coordinate its global health research and product development efforts.
• The US Food and Drug Administration (FDA) should continue to elevate global health in its mandate by creating an office of neglected diseases, building stronger partnerships with global regulatory stakeholders, ensuring that it can review health products for all neglected diseases, taking steps to increase transparency by reporting to Congress on its neglected disease activities, and strengthening its internal capacity on global health.
• The US government should collaborate with other governments and donors worldwide on incentives, innovative financing, and R&D funding coordination—particularly at the upcoming World Health Assembly (WHA) negotiations on a proposed global health R&D framework.

There could not be a better time for the United States to renew its global health R&D legacy, as President Obama’s administration—now charting a course for its second term—and new and returning lawmakers in Congress are setting the country’s fiscal and policy priorities. Global health R&D must be among these priorities. The global magnitude of sickness and death caused by these infectious diseases is enormous, and Americans are increasingly at risk. US leaders must address fiscal challenges and simultaneously strengthen the country’s resolve to prevent millions of needless deaths, harnessing American ingenuity and partnerships with the private, philanthropic, and academic sectors to catalyze the development of products needed to disarm major global health threats. Science offers great promise, and there is much to lose by pulling back now.