Breakthroughs Blog: USAID

President Obama officially began his second term in office this week, and will have a host of new faces to work with in Congress and his own administration. Below, we provide a roundup of some of the most critical leadership changes that could affect funding and policies for global health and international development programs. Secretary of State: The Senate Foreign Relations Committee will hold a hearing on the nomination of Sen. John Kerry (D-MA) to be the next secretary of state today. Sen. Bob Menendez (D-NJ) will oversee the hearing, as Kerry is the current chair of the Foreign Relations Committee. The Rethinking Foreign Assistance blog offers four questions to look for during Kerry’s confirmation hearing, including how he would work to ensure that the US Agency for International Development (USAID) is the premier development agency in the world, and what the new Office of Global Health Diplomacy would focus on during his tenure. President Obama officially began his second term in office this week, and will have a host of new faces to work with in Congress and his own administration. House Foreign Affairs Committee: Rep. Ed Royce (R-CA) is the new chair of the House Foreign Affairs Committee, and Rep. Eliot Engel (D-NY) is the new ranking member. The committee oversees legislation that impacts international development and global health efforts, including bills that affect funding and policy priorities at USAID. According to Science Speaks, Engel is a “global health champion” who succeeds former ranking member Howard Berman (D-CA), who lost his re-election bid in November. Royce “brings a mixed record on global health support to the post, having voted yes to the original Leadership Act that authorized the $15 billion President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, but then voting against reauthorization of PEPFAR in 2008, as the global AIDS response prepared for a transition from emergency to sustainable humanitarian response.” Following a closed-door meeting last week, Engel said, "The Democratic members of the Foreign Affairs Committee represent a wide range of views and experiences, and we will work together to help ensure that US foreign policy best serves our national interests." Other Democrats new to the committee include Rep. Karen Bass (D-CA) for the subcommittee on Africa, global health, global human rights, and international organizations; Rep. William Keating (D-MA) for the subcommittee on Europe, Eurasia, and emerging threats; Rep. Eni F.H. Faleomavaega (D-Samoa) for the subcommittee on Asia and the Pacific; and Rep. Albio Sires (D-NJ) for the subcommittee on the Western Hemisphere. Senate Appropriations and Budget Committees: Several new leaders have joined the Senate Appropriations Committee and the Senate Budget Committee, which are tasked with overseeing a “likely dwindling pool of federal dollars” across the US government. According to Science Speaks, both committees are now chaired by senators who hail “from two states that serve as headquarters to global health agenda setters.” Sen. Barbara Mikulski (D-MD) is the first woman to head the Senate Appropriations Committee. She represents Maryland, the home to the National Institutes of Health, and has been “lauded for her strong support for medical research and public health.” Sen. Richard Shelby (R- AL) is the new lead Republican on the committee. Shelby was one of eight senators to vote against the “fiscal cliff” deal, but has steadily supported PEPFAR. Sen. Patty Murray (D-WA)—whose state is home to global health groups such as the Bill & Melinda Gates Foundation, the Global Alliance to Prevent Prematurity and Stillbirth, the Infectious Disease Research Institute, PATH, Seattle BioMed, and the Washington Global Health Alliance—now heads the Senate Budget Committee. She has been recognized for her support of issues that include health and women’s equity. As co-chair of the Joint Select Committee on Deficit Reduction, Murray called on organizations to submit letters in support of the International Affairs budget.

Ahead of World AIDS Day, Secretary of State Hillary Rodham Clinton launched a new State Department blueprint to reach an “AIDS-free generation” within five years. “An AIDS-free generation will be within our sight,” Clinton said as she described the blueprint, which outlines key strategies the US will undertake to fight the HIV and AIDS pandemic. She also warned: “Now we have to deliver. … The history of global health is littered with grand plans that never panned out.” According to Clinton, an AIDS-free generation means that the world “can reach a point where virtually no children are born with the virus, and as these children become teenagers and adults, they are at a far lower risk of becoming infected than they are today. And if they do acquire HIV, they have access to treatment that helps prevent them from not only from developing AIDS, but from and passing the virus on to others.” The blueprint outlines several key actions to reach this goal, including: Scaling up the most effective prevention and treatment interventions. Targeting the populations at the greatest risk of contracting HIV, including people who inject drugs, sex workers, those trafficked into prostitution, and men who have sex with men. This also includes ensuring that HIV and AIDS programs recognize the particular needs of women and girls. Promoting sustainability, efficiency, and effectiveness. Promoting a global effort to achieve an AIDS-free generation. There have been several notable breakthroughs in HIV and AIDS science and research in recent years, and it’s critical that the US government prioritizes the development of new tools in any HIV and AIDS strategies and goals it creates. Photo credit: PATH. According to Clinton, science and research are key principles that must underlie each aspect of the AIDS-free generation blueprint. This includes US support for research to develop the next generation of “innovative technologies for prevention and treatment, such as microbicides and approaches that stave off opportunistic infections” like tuberculosis. It’s commendable that the US government is continuing its legacy as a leader in the fight against HIV and AIDS, as this blueprint indicates. It’s also encouraging that the blueprint focuses on developing new scientific breakthroughs in the fight against the disease. As Mitchell Warren from AVAC said in response to Clinton’s speech, “Powerful new HIV prevention options could together lead to dramatic reductions in HIV infections, but we don’t have all the information we need to scale them up in the right combinations for various communities. Urgent questions about the real-world use of new prevention tools in combination have been clear for months or even years, yet the work to answer them is barely under way. That’s as unconscionable as it is unnecessary.” There have been several notable breakthroughs in HIV and AIDS science and research in recent years, and it’s critical that the US government prioritizes the development of new tools in any HIV and AIDS strategies and goals it creates. But as Clinton stressed, it’s vital that the United States and its partners deliver on the promises outlined in the blueprint. According to the International AIDS Vaccine Initiative, the “realization of all this promise depends on sustained funding for HIV prevention research. Political will, too, must be sustained to secure the progress already made in the campaign against HIV. We must remember that any call to bring about the ‘end of AIDS’ will only be fulfilled if HIV prevention remains high on the list of global health priorities.” As the Obama Administration enters its second term in the new year, leaders across the Administration must ensure that the priorities outlined in this blueprint are fulfilled, particularly the US commitment to research and new HIV and AIDS tools. We cannot reach an AIDS-free generation otherwise.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. The latest G-FINDER report finds that annual investment in neglected disease research and development (R&D) from donors worldwide has been in the decline in recent years. And while the report finds that the United States has maintained its position as the top funder of neglected disease R&D, US funding still decreased in 2011 by $30.6 million. A treatment for sleeping sickness has entered clinical trials in the Democratic Republic of the Congo, and trials will start soon in Central African Republic. The study was initiated by the Drugs for Neglected Diseases initiative (DNDi) and its partners. A new opinion piece argues that sequestration “would significantly delay new, life-saving medical treatments. But what many people don’t realize is that the massive cuts also would put a chokehold on the creation of high-tech jobs and threaten US global competitiveness.” The US Food and Drug Administration approved 35 new medicines in its fiscal year 2012, which ended in September, according to a new report. That number is one of the highest levels in years. Senators Patrick Leahy (D-VT) and Christopher Coons (D-DE) have introduced legislation that aims to bolster the US Patent and Trademark Office’s Patents for Humanity initiative by making certificates awarded through the program transferable to third parties.

In this guest post, Kirsten Thompson, MPH, and J. Joseph Speidel, MD, MPH, of the University of California, San Francisco, write about the need for new and improved contraceptive options worldwide. Today marks World Contraception Day, and there is much to celebrate about the successes of modern family planning. Women all over the world are having smaller, healthier, and more prosperous families, thanks in part to increased access to safe and effective contraception. As Melinda Gates points out, there is no controversy in empowering women to decide if and when to have a child. But the contraceptive revolution is far from finished. An estimated 222 million women in developing countries want to delay their next child or limit the size of their family, but are not using a contraceptive. As we near the deadlines for the Millennium Development Goals and the Every Woman, Every Child campaign, improving contraceptive access is one of the most cost effective solutions to reduce maternal and infant mortality, and prevent mother-to-child transmission of HIV. Voluntary use of contraceptives already prevents 218 million accidental pregnancies, 118,000 maternal deaths, and 1.8 million infant deaths each year—we could prevent millions more accidental pregnancies, and maternal and infant deaths with expanded access. Voluntary use of contraceptives already prevents 218 million accidental pregnancies, 118,000 maternal deaths, and 1.8 million infant deaths each year—we could prevent millions more with expanded access and increased R&D. Photo credit: PATH. Global leaders have committed to help expand access to family planning services, particularly in nations with underdeveloped health systems. While expanding access is critical to reaching global health and development goals, we also need to reinvigorate contraceptive research and development (R&D). Do we need new contraceptives? We’ve learned a lot about how women and men use family planning over the last 50 years, including what they like and don’t like about various contraceptives. In developing countries, the most common reasons for not using contraception—cited by 20 percent to 50 percent of married women at risk of an accidental pregnancy—were side effects, health concerns, and inconvenience. Up to half of women had stopped using a method because they experienced or feared side effects. It’s clear that some women find hormonal side effects unacceptable. We’ve also learned that humans find it almost universally difficult to take daily medication. Over half of people taking daily medicine regularly fail to take it, whether it’s a birth control pill, a medicine to treat high blood pressure, or an antibiotic to prevent a transplanted organ from being rejected. Taking any medication inconsistently means is doesn’t work as well. So in reality, we have only two highly effective and reversible contraceptives: the implant and the intrauterine device (IUD). Both of these require highly skilled healthcare providers for placement and removal, and for some women, they are prohibitively expensive. So we need to focus our efforts on creating, safe, effective, and innovative methods of family planning that can be used in low-resource settings. Research shows that there is demand for methods that don’t yet exist, such as: User-controlled methods that do not require daily action for effectiveness. Methods that prevent transmission of HIV and pregnancy simultaneously. Methods for women that do not require a male partner’s participation or knowledge. Methods that could be used once to prevent pregnancy around the time a woman has sex. Non-surgical methods of sterilization. No one contraceptive method works for everyone, and we know that offering a wide range of methods increases satisfaction with family planning services and increases the number of couples using contraception. Public funding for contraceptive R&D is critical and effective Of the contraceptives now available in the United States, the majority were developed with public funding at universities and nonprofit organizations, or with philanthropic support. The original birth control pill became available after support from philanthropists, and a new IUD under development by Medicines360 will follow suit. The Mirena and ParaGard IUDs, Ella emergency contraception, and the contraceptive vaginal ring were all developed with US public funding. The first implantable contraceptive Norplant, the female condom, and the new SILCS diaphragm were all developed with philanthropic and public funding. The injectable contraceptive Depo Provera was developed with private funding, but the studies that allowed it to be marketed in the US were carried out with public funding. The public sector—including the US Agency for International Development, the National Institutes of Health, and the World Health Organization—has a great track record for contraceptive R&D. The public sector is also able to conduct R&D at approximately one-tenth the cost of private pharmaceutical companies. With mergers and new management at large pharmaceutical companies in the last decade, none of these companies have active contraceptive R&D programs. The US public sector has been a global leader in past contraceptive R&D, but funding for this work has steadily declined in the last 30 years. The time is right for the US government to reinvigorate its commitment to leadership in this field, and reap the benefits in maternal and child health globally.