Breakthroughs Blog: USAID

Since our last update on the latest budget action on the Hill, two significant events happened late last week in Congress and at the White House. First, the White House’s Office of Management and Budget (OMB) released a report on the potential impact of sequestration on federal agencies. Sequestration would require a reduction in government spending of $109 billion per year for nine years, beginning in January 2013. According to the report, most defense programs relevant to global health—including global health research and development (R&D) programs at the Department of Defense—would receive a 9.4 percent cut under sequestration. Non-defense programs—including most programs at the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), the US Food and Drug Administration (FDA), the State Department, and the US Agency for International Development (USAID)—that are not exempt from cuts would receive an 8.2 percent cut. It’s important to note that some parts of these programs’ funds are exempt from cuts. For instance, out of a total budget of $34.249 billion for the NIH in fiscal year (FY) 2013, the sequestration applies to $30.861 billion. The rest is exempt. As for the primary agencies that fund global health and R&D programming, the report finds that: The total cut to NIH would equal $2.529 billion. This would put NIH’s total funding for FY 2013 at $31.720 billion. At USAID, the Global Health Programs account—the account responsible for all of USAID’s global health R&D work—would be cut by $670 million, leaving the final global health program’s funding level at $7.498 billion. The FDA, which plays a key role in regulating global health products, would see a cut of $318 million, with a final funding level of $3.624 billion (not including funding from user fees). The CDC would see a cut of $470 million from its overall funding, with $464 million coming from non-defense activities funding. This leaves CDC with a final funding level of $6.861 billion. These predictions are based on current FY 2012 funding levels. Many of these agency programs are already dealing with looming cuts to their funding levels for next year under various congressional budget proposals. If FY 2013 appropriations bills in Congress reduce agencies’ funding even further, the sequestration cuts would be even steeper than what’s outlined in the OMB report. Second, the House of Representatives late last week approved a Continuing Resolution (CR) for FY 2013, in order to keep the government running through the end of March 2013. The House approved the measure by a vote of 329-91, with 70 Republicans and 21 Democrats in opposition. The bill now moves to the Senate and is expected to pass this week. The CR funds the government at $1.047 trillion, consistent with the Budget Control Act. It also includes a slight 0.6 percent increase across the board for all federal programs, essentially maintaining spending at current levels. The CR provides a total of $55.2 billion for International Affairs, slightly higher than the $54.9 billion current level and higher than either the House or Senate FY 2013 appropriations recommendations. House Appropriations Committee Chair Hal Rogers (R-KY) said that lawmakers will aim to finalize appropriations bills when they return to work after the November elections. “We intend to use the lame-duck session to the fullest extent,” he said, adding, “Just because this CR will last until March 27 of next year, we will not rest on our laurels until that time.”

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. GHTC member the American Foundation for AIDS Research has issued a brief analyzing the human impact that widespread budget cuts, or sequestration, would have on US-funded global health programs. The brief concludes that a “proportionate cut in US Global Health Initiative funding through sequestration would have minimal impact on deficit reduction … The human impact of such cuts in US investments, however, would be devastating.” The director of the National Institutes of Health (NIH), Francis Collins, also discussed the effect of sequestration on biomedical research. He testified before the Health Subcommittee of the Energy and Commerce Committee, saying that sequestration “could do serious damage to the progress that we now see in medical research [at the NIH].” The European Medicines Agency has issued a recommendation that the Hexaxim childhood vaccine is safe for use outside of the European Union. Developed by Sanofi, the vaccine offers protection against six World Health Organization priority diseases. A recent article in USA Today looks at the potential of a widely used HIV/AIDS drug, Truvada, as a possible tool to prevent HIV transmission. In an effort to make foreign assistance more transparent, the US Agency for International Development has made its foreign assistance obligation and expenditure data available online on the Foreign Assistance Dashboard. An experimental four-in-one HIV and AIDS drug called Quad is found to be safe and effective after going through a three-phase clinical process. The Lancet published the research following a recommendation in May by a US Food and Drug Administration (FDA) advisory panel to approve Quad for previously untreated adults infected with HIV-1. A final decision is expected from the FDA by August.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. A recent article in VOA News reveals that a research team at Monash University has discovered a viral protein that may be used to develop an alternative to antibiotics. In a recent study in Nature Genetics, researchers say they have unraveled the genetic codes of four parasite strains responsible for the bulk of malaria cases outside Africa. The findings could have implications for malaria vaccine research and development. The military’s Defense Advanced Research Projects Agency has announced a new program to speed the development of a tool that integrates 10 human “organs-on-a-chip” to study complex human physiology outside the body. The international development network site Devex provides a sneak peek at the plans for the International AIDS Conference scheduled for 2014 in Melbourne, Australia. Researchers and policymakers recently gathered in London to champion affordable, innovative solutions to the world’s biggest health issues, such as maternal health.The meeting stemmed from a new partnership between the Qatar Foundation and Imperial College London.

Combating preventable child deaths worldwide is an “investment that will pay dividends for years to come,” Deputy National Security Advisor Dennis McDonough said last week at a major conference at Georgetown University. At the conference, representatives from over 80 countries met to pledge their support for an exciting new global campaign for child survival. Hosted by the United States, UNICEF, and the governments of Ethiopia and India, the summit convened high-ranking government officials, members of the faith community, advocates, and private sector representatives. Over the last 50 years, child mortality rates have dropped by 70 percent. However, 7.6 million children under age five still die each year—far too many. In 2010, 57 out of every 1,000 children died before age five. The goal of the new program is to reduce that global rate to 15 deaths per 1,000 children by 2035. Under the program, UNICEF will house a small secretariat that will coordinate global activities to increase access to existing technologies and improve treatment guidelines, while partner countries like the United States will implement five strategic shifts to accelerate progress. As US agencies work with their partners to implement a new child health program, they must invest in R&D for new global health technologies. It’s critical that the program include a dedicated and distinct focus on global investments in research and development (R&D) for new tools to combat global child deaths, we still lack the vaccines, drugs, and other technologies needed to save children’s lives around the world. Indeed, research and innovation for new tools have been a huge factor in the success made against child mortality in the past 20 years, and must be prioritized by the new program. Several speakers at the summit praised the impact that technologies like the polio vaccine, oral rehydration solution to treat diarrhea, the MenAfriVac™ meningitis vaccine, and others have made in saving the lives of millions of children. Imagine if we had never invented a polio vaccine, or malaria drugs for children, or diagnostic tools for tuberculosis—what would global child mortality rates be today? A historic commitment to child health R&D helped create the tools that have already made a huge dent in global childhood deaths. For this reason, we should not only increase access to these existing technologies—the US Government and global partners must also continue to support R&D for the next generation of health products for children. If they don’t, the world will never reach the goals set by the new program. Fortunately, several US officials stressed the role of R&D in this effort last week. Secretary of State Hillary Clinton emphasized the commitment of the US Government to the development of new tools, saying, “We will support innovative research into new life-saving cost-effective measures.” Health and Human Services Secretary Kathleen Sebelius echoed the US role in basic research to support global health programs. Additionally, health officials from countries such as Bangladesh, Pakistan, and Nigeria highlighted the immense impact of global health technologies on their national child health programs. These achievements can be furthered by R&D-focused programs supported by the US Government, such as the second round of the Saving Lives at Birth program at the US Agency for International Development (USAID) and a joint USAID/National Institutes of Health initiative (NIH) that will provide grants to researchers in developing countries. As USAID and other agencies work with their partners to implement this important new program, they must invest in R&D for new global health technologies and plan for their delivery. USAID, NIH, and several other US agencies have a history of investment in innovation and are experts in catalyzing new research for huge impact. If we truly want to make the amazing progress we are promising to the next generation, the US must continue to expand its investment in global health R&D.