Breakthroughs Blog: US budget

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. A group at the World Health Assembly this week announced that it will combine four different proposals that aim to fund research and development for neglected diseases of the developing world. The Senate Committee on Appropriations has approved its fiscal year 2013 State and Foreign Operations appropriations bill. The bill includes funding for global health programs at the US Agency for International Development and the State Department. Leaders from about 50 research agencies have announced the creation of the Global Research Council, a forum that will examine issues important to science agencies worldwide. Malaria stakeholders, donors, and partners recently launched the Global Plan for Insecticide Resistance Management, which will address growing mosquito resistance to at least one class of insecticides around the world.

Late last week, the House Appropriations Committee debated and approved Fiscal Year (FY) 2013 appropriations legislation for the State and Foreign Operations (SFOPS) account, which includes funding levels for the State Department and the US Agency for International Development (USAID). The bill that the SFOPs subcommittee previously approved—which we discussed here—went largely unchanged in the full appropriations committee vote. As we covered last week, global health funding under USAID was restored to FY 2012 levels for most accounts. However, USAID’s family planning and reproductive health efforts were capped at 25 percent below the FY 2012 level, and the United Nations Population Fund (UNFPA) was completely de-funded. Three separate efforts during the appropriations committee markup on Thursday to restore some funds to UNFPA failed. These cuts have been criticized by many in the global health community and on the Hill as harmful, short-sighted, and life-threatening to women worldwide. During the hearing, there were no amendments related to global health research and development (R&D) programs, although language in the report that accompanies the House bill highlights the need for research into health technologies appropriate for low-resource settings. Additional language in the accompanying report promotes R&D for microbicides, and HIV and malaria vaccines, among other health tools. The Senate will weigh in with its own (and likely very different) version of this legislation tomorrow, May 22nd. We hope that the Senate also recognizes the importance of USAID’s R&D efforts, and that it restores the agency’s family planning and reproductive health work. Congressional support for all areas of USAID’s global health programming—from R&D to women’s health—is critical to improve the health and well-being of people 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. On HIV Vaccine Awareness Day, GHTC members the International AIDS Vaccine Initiative and AVAC have released new materials and data on the search for and potential impact of this new prevention tool. The House Appropriations Committee voted on its fiscal year 2013 State and Foreign Operations Appropriations bill and released a report that clarifies its funding intentions for global health programs. The GHTC and Policy Cures stress that all stages of research—from early science to the later stages of product development—are critical to the successful creation of new global health tools. A Food and Drug Administration advisory panel has recommended that the agency approve the first over-the-counter HIV test, a kit that could return results for consumers in the privacy of their homes.

On Thursday, the House Appropriations Committee will vote on a State and Foreign Operations (SFOPS) appropriations bill for fiscal year (FY) 2013, which will include funding levels for global health and other programs at the State Department and US Agency for International Development (USAID). This vote follows last week’s markup of the bill by the House SFOPS appropriations subcommittee. Overall, the subcommittee’s bill had mixed results for global health and other programs at USAID: while some programs were sustained at FY 2012 levels, others saw significant budget cuts that will affect the agency’s efforts worldwide. Under the subcommittee’s bill, the entire State and Foreign Operations account was cut by nine percent. Many bipartisan programs like the President’s Emergency Program for AIDS Relief (PEPFAR) were flat-funded at FY 2012 levels. USAID’s global health funding, which contributes to global health research and development (R&D) projects, was cut by six percent, a decrease of roughly $150 million. USAID’s operating budget was also slashed by 5%, which will affect all of its programs. No funding levels were outlined for the many disease-specific programs at USAID. These disease-specific funding levels could be added to later versions of the bill, or could be left up to the Obama Administration once the entire appropriations process is completed. The only exception was family planning, which was slashed by one-quarter and given a new overall funding cap of $461 million—$149 million below the FY 2012 levels. It’s important to remember that the final SFOPS budget for FY 2013 will probably look different from the House bill being considered this week. The Senate is working on its own version of the appropriations bill, and both versions will eventually have to be negotiated if Congress follows a typical appropriations process (which it hasn’t done in the past few years). Whatever the final SFOPS budget looks like, it’s critical that Congress fully funds USAID so it can continue its work in all areas of global health, including the agency’s support of R&D to develop new health tools. And if it’s left to the Administration to make decisions about disease-specific program funding at USAID, funding for R&D and innovation for all disease areas needs to remain a top priority at the agency. USAID plays a huge role not just in funding product development to combat global health challenges, but also ensuring that new technologies are appropriate for the communities where they will be used. Some of the tools that have benefited from USAID funding and expertise include the RTS,S malaria vaccine candidate, the groundbreaking CAPRISA microbicide trials, and the Xpert TB diagnostic. USAID also works in partnership with many critical players in the global health R&D space, such as other US agencies, the private sector, nongovernmental organizations, and universities. It’s clear that USAID has seen major successes in its support for global health R&D. As the House Appropriations Committee votes on the SFOPS bill on Thursday and the budget process continues, Congress will have to decide whether it should boldly support USAID’s goal of developing new health tools—tools that are projected to save millions of lives—or withdraw this support and risk halting scientific advancement in its tracks.