Breakthroughs Blog: CDC

On Monday, Congress struck a deal finalizing government spending legislation for the remainder of fiscal year (FY) 2017. Since October 1, 2016, the government has been operating on a series of continuing resolutions (CR)—maintaining government spending at FY16 levels until a full deal for FY17 could be negotiated. With the omnibus legislation in place, we expect both houses of Congress to pass the final FY17 bill this week.  There was strong bipartisan, bicameral support for advancing FY17 omnibus legislation that reflected priorities, compromises, and negotiations reached during the regular FY17 appropriations process. This means that strong congressional support for protecting medical research and global health in individual FY17 appropriations bills was carried through in the final legislation. While we know there will be more challenges in the FY18 budget and appropriations process, the FY17 omnibus was an encouraging sign that Congress understands the vital role of US global health and medical research programs. US Agency for International Development and State Department While the Trump Administration proposed rescissions for the US Agency for International Development’s (USAID) global health funding for FY17—including cuts to the President’s Emergency Plans for AIDS Relief (PEPFAR), polio, tuberculosis (TB), neglected tropical diseases (NTDs), and eliminating global health security funding—in the final FY17 omnibus, global health programs at USAID saw an 8 percent boost in funding, totaling just over US$3 billion versus $2.83 billion in FY16. Notable increases included $5 million for TB, $81 million for malaria, $40 million for Gavi, the Vaccine Alliance, and $70 million for global health security to create a new Emergency Reserve Fund to respond rapidly to emerging health threats. Other global health accounts within USAID and the State Department received level funding.USAID continues to play a leading role in the US government’s action on global health research and development (R&D), and it is critical that global health programs receive appropriate funding so that investments in R&D will continue to be prioritized among other activities. The combination of increased funding for some key programs and level funding for others in FY17 is a positive sign that Congress shares our priorities and will work to protect these accounts in more challenging budget and appropriations conversations for FY18.National Institutes of Health Strong bipartisan support for the National Institutes of Health (NIH) continued in the FY17 bill. Overall, NIH received a $2 billion increase, raising total funding for FY17 to $34 billion. However, it’s important to note that little of this increase will likely support global health programming. Much of this increase was to fund enactment of the 21st Century Cures Act, but notable increases that could benefit global health R&D included a 6 percent or $277 million increase for the National Institute of Allergy and Infectious Diseases, a $1.76 million increase for the Fogarty International Center, and additional funding for the National Center for Advancing Translational Sciences.While NIH has long enjoyed bipartisan support—and thus it is not surprising to see a funding boost in FY17—it was notable that the Trump Administration proposed over $1.2 billion in rescissions for NIH for FY17 and a 19 percent cut to NIH funding for FY18, including eliminating the Fogarty International Center. NIH leads the world in global health R&D, and its work in basic research is vital to advancing new drugs, vaccines, therapeutics, and other tools for neglected diseases and conditions. It is encouraging to see Congress maintain and increase NIH funding overall and prioritize US leadership in medical research for FY17; however, greater support is needed for NIH programs that advance research for neglected diseases and conditionsCenters for Disease Control and Prevention A laboratory worker wearing a surgical mask works with samples. (Photo: PATH/Mike Wang) The Centers for Disease Control and Prevention’s (CDC) funding for global health was also protected in the final FY17 omnibus. Overall, the CDC Center for Global Health saw an $8 million increase from FY16 funding levels, including targeted increases for global public health protection and global disease protection activities.Funding for polio and measles was increased, while parasitic diseases, malaria, and global HIV and AIDS funding remained level. In addition, the National Center for Emerging and Zoonotic Infectious Diseases received a $5 million increase. CDC plays an important role in detecting, preventing, and responding to infectious disease threats at home and around the world. This work is critical to developing new prevention and diagnosis technologies, particularly those to address endemic and emerging global health threats. Robust funding for CDC’s global health programs is vital to advancing global health R&D and promoting global health security. Department of Defense The Department of Defense’s (DoD) work in infectious disease R&D was also strengthened in the final FY17 omnibus. DoD’s Peer Reviewed Medical Research Program—which conducts research on antimicrobial resistance, diarrheal diseases, emerging infectious diseases, malaria, TB, and vaccine development for infectious diseases—received $300 million in funding. In addition, the bill included strong report language supporting DoD’s critical work in global health R&D and supporting continued and robust investments. The final FY17 spending bill is encouraging news for global health R&D as it protected funding for critical global health and medical research accounts across USAID, NIH, CDC, and DoD. However, this victory may be only temporary, as we know that many of these same accounts will face intense pressures in FY18 budget negotiations, given aggressive action by the Trump Administration to downsize activities and reduce government spending. GHTC will continue to champion strong US leadership in global health R&D and stress the impacts of these important programs in protecting health at home and around the world.  

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. Researchers in Brazil have discovered the structure of the protein responsible for replicating the Zika virus thousands of times in cells, causing the virus to break through the cell wall and infect the body. Through many months of collecting data and studying the origins of the virus, the researchers put together a three-dimensional model of the protein and published their findings in Nature Communications. Zika is a flavivirus and in the same genus as diseases like yellow fever, dengue, and hepatitis C. Because of the genetic similarity, researchers and scientists have found that sofosbovir, a commonly used drug to treat hepatitis C, is a good therapeutic option for those suffering from Zika. The unlocking of Zika’s genetic code will lead to the development of new solutions to the virus. It recently became global news that RTS,S (trade name Mosquirix™), the candidate malaria vaccine furthest along in development, is beginning vaccine pilot programs in three chosen countries: Ghana, Kenya, and Malawi. The vaccine, created through a partnership with PATH’s Malaria Vaccine Initiative and GlaxoSmithKline, is given in four doses over a specific period of time. It is not yet known if tracking of these vaccine doses will be 100 percent. Any vaccine administered in multiple doses, whether for malaria or HPV, requires a lot more work in educating individuals about the need to return for all treatments necessary to ensure the vaccine’s success. UNICEF and members of the vaccine community will work with government authorities to ensure the supply chain delivers vaccines to children in need. If successful, the burden of malaria could decrease drastically. While this vaccine is promising to many individuals in these three countries, the search for a more perfect vaccine is high on the priority list for health researchers around the globe. In order to increase global access to immunization, successful and smooth-moving supply chains are necessary. The problem? Immunization supply chains are complex and every part of the chain needs to be working perfectly to ensure access to the vaccines. Many members of the immunization community have neglected the supply chain facet of vaccine delivery, and as a result, these supply chains have suffered and grown obsolete. With these chains being out-of-date, many children remain unvaccinated from even the most common diseases. A special issue published in Vaccine highlights these issues and brings the need for supply chain renewal to the forefront of the conversation. But even after this publication, more has to be done to ensure all members of the vaccine community work together to guarantee access to vaccines is in reach for all. Despite vaccine initiatives being stronger than ever, there is still a glaring gap in the number of children receiving basic vaccines. Currently, there are over 19 million children who are unvaccinated, leaving them susceptible to diseases that can be protected against. The American Academy of Pediatrics and the Centers for Disease Control worked together to establish the Global Vaccine Action Plan (GVAP) aimed at closing the gap of vaccine inequality around the globe. GVAP has already seen many successes, including fostering a working relationship with government institutions to implement surveillance techniques to figure out what vaccines children need most in each country. Kenya and Nepal, for example, have initiatives through pediatricians to educate families about the importance of vaccines for children’s development and longevity of life. GVAP is in the forefront of bridging the gap of health inequity and bringing immunization to all.

CDC microbiologist Brian Yoo prepares a panel of isolates. Photo: CDCThe threat of antibiotic resistance (AR) is a growing challenge around the world. Antibiotic-resistant germs—bacteria that no longer respond to the drugs designed to kill them—cause more than 2 million illnesses and 23,000 deaths each year in the United States alone. It is critical for scientists and researchers to be equipped with the right tools and the best information available to combat antibiotic resistance and improve antibiotic use. Better diagnostic tests are needed to help us characterize and identify resistant pathogens—an important component of diagnosing an infection early and accurately, and preventing spread of resistant infections. And new antibiotics are needed to more effectively treat infections with bacteria that have already developed resistance. One of the new resources available to researchers is the Antimicrobial Resistance Isolate Bank (AR Isolate Bank), which was launched in 2015 by the US Centers for Disease Control and Prevention (CDC). An AR isolate panel is removed from the freezer. Photo: CDC A collaboration between CDC and the US Food and Drug Administration (FDA), the AR Isolate Bank is a curated repository of nearly 400 unique AR pathogens pulled from CDC’s collection of more than 450,000 AR isolates and more than 18,000 characterized genomes. These curated isolate collections—called panels—provide researchers with well-characterized, resistant bacteria that can be used to develop effective and accurate next-generation diagnostics and accelerate research for new antibiotics. E.coli. Photo: CDC A timely example of the value of the AR Isolate Bank panels is its collection of E.coli isolates with the mcr-1 gene. Increasing reports of bacteria carrying mcr-1 genes have put public health experts across the globe on high alert. These genes can make bacteria containing them resistant to the crucial antibiotic colistin—a last resort drug being used to treat “nightmare bacteria” carbapenem-resistant Enterobacteriaceae. Within three weeks of identification of E.coli with the mcr-1 gene in the United States, the CDC assembled appropriate panels for the bank. Public health, industry, academic, and private labs can use these panels to calibrate their diagnostic tests so that they can ensure that bacteria carrying the mcr-1 gene are quickly and accurately identified and characterized. Findings from these calibrated tests will help public health partners ramp up targeted detection and response. The sample isolates can also help researchers build new tests to detect these types of resistance in the future—all to more quickly slow the spread of resistance.Since the launch of the AR Isolate Bank, more than 140 customers—including academic, commercial, federal, hospital and clinic, and public health laboratories—have requested panels. CDC is collaborating with FDA to support and expand use of this resource. At this time, the isolates are only available for shipment to recognized US laboratories with confirmed biosafety officers.The AR Isolate Bank is one small piece of CDC’s wide-ranging work to reduce the spread and impact of antibiotic resistant infections. CDC’s Antibiotic Resistance Solutions Initiative supports implementation of the surveillance, prevention, and stewardship activities outlined in the National Action Plan for Combating Antibiotic-Resistant Bacteria, which identifies critical actions to be taken by federal agencies to combat the emergence of resistant bacteria.

The delegation checks out the mosquitoes that CDC is studying at its lab in Atlanta. Photo: Courtney Carson/GHTCLast month, Global Health Council (GHC) and PATH led a delegation of global health advocates to the US Centers for Disease Control and Prevention (CDC) headquarters in Atlanta.Since the founding of CDC more than 70 years ago, this US federal agency has played a vital role in global health. Its laboratories routinely work with some of the most deadly germs in the world.While many Americans tend to only hear about CDC during the flu season or epidemics like Ebola and Zika, the agency leads an impressive array of efforts that are vital to protecting the lives of US citizens and promoting the health and security of communities around the world.The delegation of advocates met with leaders across the agency’s divisions, including Dr. Tom Frieden, Director of CDC, and Dr. Rebecca Martin, Director of the Center for Global Health, to learn more about CDC’s work and to share their perspectives from Capitol Hill. They gained new insight into the agency’s science, policy, partnerships, and evidence-based public health programs, and learned more about the agency’s work in immunization, health research and development (R&D), global health security, HIV and AIDS, tuberculosis, and malaria. The delegation also had the opportunity to tour the CDC’s Emergency Operations Center and the Insectary and Parasitic Diseases Laboratory. They ended their trip with a presentation to CDC staff on how their global health advocacy efforts in Washington, DC support the CDC.We asked the delegation of global health advocates to share what they learned from the trip. Here’s what they had to say:“CDC’s Global Disease Detection program detects 30–40 outbreaks a day. The reason we don’t hear about those outbreaks—and why they don’t transform into epidemics and pandemics—is due to CDC’s swift response and ongoing capacity building programs that train local epidemiologist to detect, prevent, and respond to new and emerging disease threats.” — Bob Noziglia, Lutheran World Relief “Every CDC center is involved with Zika. It’s the most complicated response they’ve ever mounted, particularly because this is the first mosquito-borne disease with fetal birth defects since Rubella. But CDC is coordinating its response with other agencies, including a CDC-designed diagnostic that has been distributed to more than 100 countries around the world alongside lab training to use it.” — Lissy Moskowitz, Gavi, the Vaccine Alliance “The world is on the verge of one of the greatest public health achievements in human history: the eradication of polio. CDC has played a key role in these efforts, helping to develop a global network of polio surveillance, health workers, and laboratories that have become the backbone of many developing countries’ health system. This infrastructure goes beyond polio to support a wide range of essential health services, including providing vitamin A supplements, measles vaccinations, and surveillance of other diseases, like neonatal tetanus, and CDC continues to play a key role in ensuring health services continue.” — Brian Massa, United Nations Foundation/Shot@Life “CDC’s greatest resource is their people. Staff have an incredible career longevity—spending decades with the agency—which results in a depth of expertise across global health issues, tight coordination across teams, and development of unique skill sets. For instance, CDC has two staff that can identify unknown pathogens within an hour—morning, noon, and night—while others help countries with surveillance, lab capacity, and training, or serve as key health advisors across multilaterals. This is one reason CDC is internationally recognized as “the world’s 9-1-1,” serving as the first line of defense for health departments and ministries globally.” — Brandon Ball, PATH “Unless Congress acts, funding for global health security at CDC will reach a fiscal cliff in FY19. To truly build and sustain the global networks to prevent, detect, and respond to disease threats, predictable long-term funding is needed; while emergency supplemental funds are valuable, they often come too late. Targeted, but flexible funding is needed so that local experts are resourced to act quickly to stop threats in their tracks.” — Erin Fry Sosne, PATH The delegation checks out the mosquitoes that CDC is studying at its lab in Atlanta. Photo: Courtney Carson/GHTC“CDC's malaria and parasitic disease program not only conducts research to advance new diagnostics, vaccines, and countermeasures for malaria, but also works to make sure we are using existing malaria interventions effectively. In their insectary, CDC tests bednets to determine how many, and where tears and holes can exist before the nets are rendered ineffective. This work is vital to leveraging US investments in the Presidents Malaria Program and ensuring we are using US global health funds responsibly and productively.” — Erin Will Morton, Global Health Technologies Coalition “CDC’s Center for Malaria and Parasitic Diseases works every day to improve treatment and develop new tools to address diseases that kill an estimated 534,000 people worldwide, but many Americans never see up close—neglected tropical diseases (NTDs). Not only does CDC leverage donations from pharmaceutical companies to administer drugs for treatable NTDs at less than fifty cents per person per year, but they also conduct research to develop new diagnostics and treatment regimens to more effectively combat hard or expensive-to-treat NTDs. For example, CDC is working to transform a laboratory diagnostic for NTD schistosomiasis to a point-of-care urine test that is both more cost effective and more appropriate for use in low-income, rural settings where the disease is most prevalent.” — Courtney Carson, Global Health Technologies Coalition “Through the CDC Foundation, CDC is able expand the reach of its work through partnerships with corporations and individuals. Established by Congress as an independent nonprofit organization, since 1995 the CDC Foundation has raised over US$680 million, launched 800 programs around the world, and interacted with over 200 private sector entities. Most recently, through its Global Disaster Fund, the foundation raised $56 million from donors to assist with the response to the Ebola outbreak.” — Lanice Williams, Global Health Council “Although CDC had been working on the global response to HIV and AIDS since 1999, PEPFAR changed how CDC worked globally. With the inception of PEPFAR in 2003, CDC expanded its global work by opening more country offices and working closely with ministries of health. Today, through its regional offices, CDC continues to monitor Ebola in West Africa, trains epidemiologists through its Field Epidemiologists Training Program, and work on the Zika response. And its work in PEPFAR continues: providing over 7 million men, women, and children with antiretroviral treatment (ART) and care, as well as support for 5 million orphans and vulnerable children and the training of over 140,000 health care workers.” — Danielle Heiberg, Global Health Council “Through the use of lab technology advancement, CDC has significantly driven down the cost of genome sequencing testing. CDC’s Advancing Molecular Detection (AMD) initiative focuses on using the latest technology advances in pathogen identification to protect Americans from infectious disease outbreaks. This initiative is fundamentally changing how CDC scientists conduct lab work and diagnostics on diseases such as tuberculosis, malaria, Zika, and tropical diseases such as leishmaniasis, and by providing a thousand times more information in a shorter time frame.” — Karen Goraleski, American Society for Tropical Medicine and Hygiene This blog was originally published on The Collective Voice, the blog of the Global Health Council.