Breakthroughs Blog: DoD

In this feature on Breakthroughs, we provide an update on what’s currently happening with global health in Congress and an outlook for future legislative activity. Following the August recess and Labor Day Holiday, Congress is now back for a very brief time before it takes another break to focus intensely on campaigning ahead of the November elections. We don’t expect much action on legislation specific to global health or research programs. Instead, Congress will focus on passing a Continuing Resolution (CR) for fiscal year 2013 in order to keep the government running through the end of March 2013, as members juggle the remaining legislative tasks on their plate. The CR actually includes a tiny 0.6 percent increase across the board for all federal programs, including those that fund global health research. However, the resolution will expire long after the looming budget sequestration goes into effect in January 2013 and will also run into the fiscal year 2014 budget process, effectively creating a budgeting perfect storm. Advocates for a wide range of federal programs are in high gear to convince Congress to delay sequestration or to pass a balanced budget in its place. Some of those advocates have found congressional allies willing to take on their cause. Also this week, we’re looking for a report from the Obama Administration on the potential impact of sequestration on federal agencies. As we outlined in our last update, sequestration could result in cuts ranging from 8.5 percent to 14 percent to most federal programs, depending on the outcome of the budget negotiations in Congress and the November elections. Sequestration would undoubtedly have a significant impact on global health and research programs at agencies like the Centers for Disease Control and Prevention, the Department of Defense, the US Food and Drug Administration, the National Institutes of Health, and the US Agency for International Development. We’re eager to see this report and learn more about how sequestration might impact efforts supported by these agencies to develop new lifesaving global health tools. Global health research and development (R&D) programs span the breadth of the US budget. Congress needs to work to protect these essential R&D programs from disproportionate cuts and ensure that funding is sustained—and increased if possible—for the coming years. Although the elections may be on the top of everyone’s to-do list for now, temporary budget fixes that leave these activities vulnerable to indiscriminate cuts and similar actions will not work forever. We need a plan that protects global health R&D and other key programs for the long-term, and right now, that job starts with Congress.

Did you know that Americans spend more money on ice cream in three weeks than the US Government spends on global health research and development (R&D) in a year? And despite this relatively modest investment in the creation of new global health tools, the United States is the worldwide leader in R&D for neglected diseases. When we at the GHTC tell US policymakers the story of how global health R&D has revolutionized people’s lives around the world, we highlight the prominent role that the US Government plays in funding and supporting the development of new global health tools. We’ve always believed that US leads the world in investment in global health R&D, and that this comparatively small investment has paid off many times over in lives and dollars saved. We’ve seen the effectiveness of US-funded technologies like the polio vaccine, oral rehydration solution, and HIV and AIDS drugs. We’ve known that tools in the pipeline would have similar game-changing effects. And now we have the evidence to prove it. A new report, released today by the GHTC and Policy Cures, provides important confirmation that the US is the largest global health R&D funder in the world, investing $12.7 billion over the last decade. A new report, released today by the GHTC and Policy Cures, provides important confirmation that the US is the largest global health R&D funder in the world, investing $12.7 billion over the last decade. In fact, the US government in the last decade more than doubled its annual commitment to developing new global health products, from $685 million in 2000 to $1.4 billion in 2010. These investments represent just 0.01 percent of US gross domestic product. Our report confirms the strong leadership role the US has played in the global health R&D landscape, and also includes new information on spending and support by key US federal agencies—the Centers for Disease Control and Prevention, Department of Defense, US Food and Drug Administration, National Institutes of Health, and US Agency for International Development. New information also details the public health impact of products already on the market, and new health and economic projections detail the possible impact for health tools still in development. There is an exciting pipeline of 365 new vaccines, drugs, diagnostic, and other products for global health, and the US Government is supporting 200 of them. These are just a few examples of the immense impact of global health R&D, and the incredible benefits it will continue to have if robust support continues. The US is not alone in this effort—many governments around the globe, philanthropic foundations, and private industry partners provide large amounts of funding, technical expertise, and key intellectual property to develop new global health tools. The global health R&D landscape would not be the same without these important allies. While the success of US investment in global health R&D is exceptional, the report makes clear that sustained and increased US support is essential to ensuring that the potential of global health research is not lost. The report provides recommendations for how the US Government can maximize its investments in new global health products. The recommendations are: The US Government should maintain its funding for global health R&D, and increase this funding where possible. The US Government needs to have a greater focus on the later stages of research and product development to fully leverage its global health R&D investments. The US Government should increase funding to partnering mechanisms that are focused on translation of global health research. With all of the amazing results of global health R&D we have seen—and with this new evidence that global health R&D is a worthwhile, cost-effective investment—it would be a shame to retreat now. With the US leadership role comes the responsibility to continue pushing the boundaries of science and leading the world in combating global health diseases.

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.