Breakthroughs Blog: DoD

This post, written by John Donnelly, originally appeared in the GlobalPost. Donnelly is a Washington, DC based writer. For those in the global health world—and there are many in the nation’s capital—one common question is why in tight budgetary times should Congress support spending on research and development (R&D) to fight diseases around the world. At a congressional briefing today put on by the Global Health Technologies Coalition (GHTC), a group that represents 40 global health research and advocacy organizations, several experts gave a variety of answers to that question. Katherine “Kemy” Monahan, deputy executive director of the Obama administration’s Global Health Initiative, said, “These global health programs are literally saving lives, and not just a few lives, lots of lives … We are [also] protecting Americans at home and traveling abroad from infectious diseases.” Col. Peter J. Weina, deputy commander of Walter Reed Army Institute of Research, said, “We protect soldiers’ lives … Infectious diseases have ravaged military forces operating worldwide. … It also ravages populations we’ve worked with.” From 2003 to 2008, for instance, US troops in Iraq and Afghanistan had roughly 2,000 confirmed cases of leishmaniasis, a disease transmitted by the bite of a tiny sandfly. The disease causes a broad range of outcomes, some of them fatal. Then US Sen. John Boozman, a Republican from Arkansas, took the microphone from the back of the Kennedy Caucus Room at the Russell Senate Office Building, and gave his case for ongoing global health research. “It’s achievable stuff,” he said. “It represents real calamity. These are difficult problems, but they are very, very solvable. … You have a lot of support on Capitol Hill. We can be very, very proud of what has been accomplished so far.” A GHTC analysis of the Obama administration’s global health budget found a large number of decreases in funding compared to the previous year’s budget. Funding cuts were most glaring in the President’s Emergency Plan for AIDS Relief (PEPFAR), neglected tropical disease programs, and several other programs at the US Agency for International Development (USAID). But the budget also included increases to The Global Fund to Fight AIDS, Tuberculosis, and Malaria and the GAVI Alliance. The National Institutes of Health and the Centers for Disease Control and Prevention (CDC) were funded at the same level. “It’s a time of fiscal austerity,” Kevin De Cock, the director of CDC’s Center for Global Health, said in an interview after the briefing. “The cuts for global health programs might have been less than many people feared. There’s a need now for everyone in government to strive for greater efficiency and to find savings wherever they can in their budgets.” Karen A. Goraleski, the executive director of the American Society of Tropical Medicine and Hygiene who was the moderator at the event, said global health R&D also has economic benefits at home, including the creation of thousands of jobs. “It’s fueling our economy,” she said. For Marc LaForce, director of the Meningitis Vaccine Project, the importance of research could be seen in the story of the fight against meningitis. He said last year’s results were enough to show how US research can have a major impact in saving lives. In West Africa, the often-fatal disease has been so prevalent that the area is referred to by the name of the disease. It’s the Meningitis Belt. His project, a partnership between the World Health Organization and PATH, which included earlier research done by the Walter Reed Army Institute of Research, produced a vaccine that cost less than 50 cents a dose. It was administered to 19 million people last fall in three West African countries. Usually, the countries report thousands of cases of meningitis. Last year, the countries reported fewer than a dozen—all from children who were not vaccinated. “The coverage rates with the vaccine have been extremely good,” LaForce said. “We are probably at the beginning of the end. With sufficient funding, this epidemic is likely to be pretty much over in the next 10 years.”

Research!America, a member of the GHTC, recently conducted analyses in target states to measure the health and economic impact of global health research and development (R&D), highlighting its benefits for states across the nation and strengthening the evidence base for Congress’ support of federal investments in global health R&D. Danielle Doughman, program manager for global health R&D advocacy, shares the organization’s findings in Maryland. This is the third post in a series. If it’s true that health is wealth, Maryland has both in abundance. Maryland is home to two federal health powerhouses, the Food and Drug Administration and the National Institutes of Health (NIH), the world’s largest medical research institute. Together, they employ 25,000 people. Silver Spring’s Walter Reed Army Institute of Research is engaged in global health research to protect our military personnel from infectious threats they may encounter in the field. And Marylanders see the direct benefits of that research: 82 percent recognize that American civilians benefit from the health research conducted by the military, according to a poll commissioned by Research!America. Maryland is home to two federal health powerhouses, the Food and Drug Administration and the National Institutes of Health (NIH), the world’s largest medical research institute. Photo credit:PATH What’s more, Maryland’s life sciences sector supported 71,600 jobs in 2010. Workers in the life sciences industry earned, on average, more than $91,000 annually—76 percent more than the state average. Of the nearly $52.7 million in extramural funding that flowed to Maryland from NIH in fiscal year 2012, over 70 percent, or $37.8 million, was awarded through contracts and grants to Johns Hopkins University. Hopkins is among Maryland’s largest employers, with 47,000 employees across the university and affiliated health system, and it contributes more than $10 billion per year to the state’s economy. Nonprofit global health “product development partnerships” use a unique business model to work across sectors to accelerate the creation of low-cost drugs, vaccines, and diagnostics to advance health for the most vulnerable populations. Two such nonprofits are headquartered in Maryland. Rockville’s Aeras, another GHTC member, engages in the development of new tuberculosis (TB) vaccines and other prevention technologies, capitalizing on the expertise of its partners to accelerate the development of the six vaccines in its R&D pipeline. Aeras’ 135 Maryland-based employees understand that the sooner effective products are available, the closer we are to dramatically reducing the 1.4 million lives lost to TB every year. Just last week, Aeras announced its partnership with NIH’s National Institute of Allergy and Infectious Diseases for a Phase II clinical trial of a TB vaccine. With the first cases of totally drug-resistant TB coming to international attention earlier this year, aggressive pursuit of vastly improved TB drugs, vaccines, and diagnostics has never been more crucial than it is now. With support from the US Agency for International Development and NIH, Maryland’s International Partnership for Microbicides (IPM) is helping to lead the charge to design products to protect women from HIV and AIDS, the leading cause of death for women ages 15-44 worldwide. In addition to the support of the US government, IPM works with partners around the world to develop antiretroviral-based microbicides to safely and effectively protect women against HIV. Later this year, IPM and the NIH-funded Microbicide Trials Network will move a promising product into late-stage clinical trials. The robust federal investment and presence in Maryland reflects the fact that more than three-quarters of Marylanders say Americans should be concerned about global diseases like malaria, cholera, and other infectious diseases that mostly affect poorer countries. More than ever before, America’s health—in both economic and medical terms—is global health.

Nelson L. Michael, M.D., Ph.D is the Director of the U.S. Military HIV Research Program (MHRP) at the Walter Reed Army Institute of Research (WRAIR), an international HIV vaccine research program that successfully integrates HIV and AIDS prevention, care and treatment. In this post, Col. Michael reflects on the progress being made in HIV prevention science. December 1 marks the commemoration of World AIDS Day—a day to reflect on an epidemic that has affected millions of lives worldwide for three decades now and how far we’ve come towards an end. This year’s focus and theme is a right on target: “Leading with Science, United for Action.” Recent scientific achievements have brought us closer to eliminating AIDS than we have ever been. Results from the landmark RV144 trial, an international collaboration that involved more than 16,000 Thai volunteers, were announced in 2009. While it took a quarter of the century from the discovery of HIV to show that a vaccine is possible, the results of RV144—which showed the first scientific evidence of vaccine efficacy—have propelled the HIV vaccine research field forward. Earlier this year, we announced the results of extensive follow-up laboratory studies that provide new clues about the types of immune responses that may have played a role in the protection seen in RV144. These new advances were the result of nearly two years of work by more than 100 researchers at 25 institutions worldwide. We now have a better understanding of how the vaccine may have prevented infection and a renewed scientific direction to help guide future vaccine development. We are united in our efforts to end AIDS; no one organization can do it alone. As we move forward, MHRP’s collaborators are leading a tremendous effort to identify correlates of protection. Additionally, a new collaboration—a public-private partnership called P5 that comprises MHRP, the Division of AIDS/NIAID, the Bill and Melinda Gates Foundation, Sanofi Pasteur, Novartis, and the HIV Vaccine Trials Network—is planning the next set of Phase IIb trials to build on the results of RV144 and bring us closer to a vaccine product with a public health impact. MHRP’s commitment to ending AIDS extends beyond developing an efficacious vaccine to creating innovative programs to prevent and treat HIV through the President’s Emergency Plan for AIDS Relief (PEPFAR). In 2011, our site in Uganda, the Makerere University Walter Reed Program launched the first ever mobile circumcision clinic with the ambitious goal to circumcise 6,000 men by year’s end, Kenya has become a leader in the prevention of mother-to-child transmission (PMTCT) due in large part to the efforts of the Walter Reed Project, and the number of patients currently receiving antiretroviral therapy at all of MHRP’s African sites—Kenya, Nigeria, Tanzania and Uganda—exceeded 100,000. A world without AIDS seems more achievable now than any other time in history. However, one prevention strategy alone will not be the end all to this pandemic. We must maintain the momentum and commitment to both scaling up currently available and evidence-based prevention strategies and finding a long-term solution to eliminate AIDS. In the meantime, MHRP is uniquely positioned to move HIV vaccine science forward and to inform HIV prevention, care and treatment with scientific data to develop best practices and to ensure the best, most efficient practices are provided around the globe.