Breakthroughs Blog: USAID

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.

Research!America, a GHTC member, recently hosted an event on global health research and development (R&D) in New York. In this guest post, Mandy Goldberg, MPH, shares highlights from the event. Research!America, in partnership with the AIDS Vaccine Advocacy Coalition (AVAC), Drugs for Neglected Diseases initiative North America (DNDi), Global Alliance for TB Drug Development (TB Alliance), International AIDS Vaccine Initiative (IAVI), SUNY Downstate Medical Center, and Treatment Action Group (TAG), hosted a forum, Global Health Research and Development in New York: Fueling Innovation and Saving Lives, on Monday, April 9, at the New York Academy of Sciences. Mary Woolley, president and CEO of Research!America, opened the forum by acknowledging the remarkable progress made in the growing field of global health research in New York in the past decade. She also released the results of a new state poll commissioned by Research!America that shows that 64 percent of New Yorkers are concerned about global health, and 63 percent believe that global health research is important to New York’s economy. Congresswoman Nita Lowey (D-NY-18) then took the stage and explained the significance of global health R&D as an economic driver that creates jobs for New Yorkers. She stated that “despite the critical importance and significant economic impact of these programs, funding for global health is threatened again this year” in regard to the proposed fiscal year (FY) 2013 budget, and pledged to continue fighting for “robust funding for all our global health programs, including critical research and development.” Renowned global health commentator Laurie Garrett, senior fellow for global health at the Council on Foreign Relations, moderated a discussion between panelists Rachel Cohen, regional executive director, DNDi North America; Jack DeHovitz, MD, MPH, distinguished service professor and director, SUNY Downstate AIDS International Training and Research Program; Margaret McGlynn, president and CEO, IAVI; Mel Spigelman, MD, president and CEO, TB Alliance; and Pol Vandenbroucke, MD, vice president of development, emerging markets, Pfizer. In her opening remarks, Garrett emphasized the importance of the US commitment to global health funding, especially after the 2008 financial crisis, when “the United States stepped up to the plate” after the community saw “a huge number of players disappear” from the field. She stated that “if we cannot protect the US commitment to global heath spending, every single program in global health is going to have to chop, chop, chop its budget.” Laurie Garrett moderated a panel including Mel Spigelman, Pol Vanderbroucke, Rachel Cohen, Margaret McGlynn, and Jack DeHovitz. Panelists then discussed how innovative partnerships among public, private, and academic sectors are transforming the way that research is conducted and yielding promising developments for the future of global health. Spigelman highlighted that the TB Alliance is “on the verge” of technological breakthroughs, which require an increased commitment to research due to the costly final stages of testing and clinical trials. Partnerships in global health R&D are cost-effective, he argued, citing the TB Alliance’s NC-002 clinical trial conducted in partnership with the US Agency for International Development, Bayer, and Novartis. This trial has the potential to produce a drug regimen that could reduce the TB treatment to 4 months, potentially saving as much as 90 percent of current costs. Vandenbroucke emphasized that the private sector has unique resources and capabilities to contribute to partnerships that are essential for the development of health technologies. He stated that cuts to the federal budget would affect the work of the pharmaceutical industry “in the long term, as less funds are available to do the basic groundwork to study diseases” that Pfizer then applies during its advanced drug development process. Cohen expressed concern over the fact that neglected tropical diseases (NTDs) received the single largest percentage funding cut of the global health programs in the President’s FY 2013 budget request and the impact this would have on DNDi’s work. She noted that there is currently no federal funding available for late-stage product development for NTDs, and the current FY 2013 budget request “totally eviscerates the possibility of future investments, at least for the coming 2 years,” if passed, which threatens the continued progress of DNDi’s efforts. McGlynn spoke about the evolution of IAVI from an advocacy organization to a product development partnership, with the support of Mayor Bloomberg and New York City. IAVI’s Vaccine Design and Development Laboratory, established in Brooklyn in 2006, plays a pivotal role in the Mayor’s New York City Bioscience Initiative and is a key component of IAVI’s global AIDS vaccine R&D network. McGlynn stressed that the scientific expertise of New York City’s “globally educated and raised” workforce has been essential to IAVI’s work, and to the growth of global health R&D in the area. DeHovitz reinforced that multisectoral collaborations have yielded major advancements in the field of HIV and AIDS. He cited the federal contribution to international HIV and AIDS through the work of the Fogarty International Center at the National Institutes of Health, which funds advanced research training in public health at five New York City universities. He also spoke of “the huge upsurge of interest among our health care students in global health,” stating that 45 percent of medical school entrants are interested in global health and 30 percent of medical school graduates have had a global health experience in school. “They’re committed, they’re interested and they want to help,” he said, noting the potential impact of this group to the future of global health. New York—home to seven of the top 50 US research universities, the largest bioscience workforce and second-largest life sciences workforce of any US city, and three global health product development partnerships (PDPs)—is clearly a world leader in global health R&D, and this growing industry is a promising economic engine for the state. There was a general consensus in the room that the community needs to work together to ensure that global health R&D remains a priority. Great progress has been made in the development of new technologies to fight TB, HIV and AIDS, and NTDs, and increased funding is needed to sustain this momentum and build upon previous successes. Spigelman noted that the current “slash and burn” Congress could have a devastating effect on global health efforts, and argued that the US will get “the most bang for that buck” by investing in global health technologies that will reduce the foreign aid budget in the long term. Woolley concluded the forum with a call to action, asking the global health community to share with others, including their members of Congress, the importance of the work that they do. A video of the event is available here. For more information on global health R&D in New York, check out the New York edition of Research!America’s economic impact state fact sheet and public opinion poll series.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. The Consultative Expert Working Group on Research and Development: Financing and Coordination (CEWG) has released its final report. The report offers recommendations to close the funding gap in global health research and development. The Fogarty International Center and other programs at the National Institutes of Health are awarding about $20.3 million over the next five years to train the next generation of global health researchers and scientists. The US Agency for International Development (USAID) has released a new policy that aims to ensure the quality and integrity of the agency's scientific activities. The report recognizes that USAID is the US Government’s “lead international development agency, for which science and technology are critical means for improving the quality of peoples’ lives around the world.” A new study offers insight into promising new targets for future HIV vaccine efforts.

Rachel M. Cohen, MPP, is the regional executive director of the Drugs for Neglected Diseases initiative (DNDi) North America. One billion people. That’s roughly how many people live in North America and Europe combined. And that’s also roughly how many people have at least one neglected tropical disease (NTD). NTDs, as defined by the World Health Organization, are a set of 17 infectious diseases that severely debilitate or kill people, most of whom are poor, marginalized, or in other ways vulnerable. NTDs such as sleeping sickness and kala azar are 100 percent fatal if left untreated. Parasitic-worm diseases like river blindness and elephantiasis can blind and deform people, young and old. Chagas disease almost exclusively infects those in Latin America, but kills more people in this region than malaria. The United States Government has played a major role in ensuring that patients with certain NTDs receive urgently needed treatments through the US Agency for International Development (USAID) NTD Program, while simultaneously being the largest funder of basic research for NTDs through the National Institutes of Health. This commitment has spanned several presidential administrations, receiving widespread support from both Democrats and Republicans alike in Congress. However, today US Government funding for NTDs is under threat. The recently announced US fiscal year (FY) 2013 budget request from the Obama Administration has slashed the USAID NTD Program budget, which was already miniscule at $89 million, by nearly 25 percent to $67 million. That is one of the single largest percentage cuts in global health. This isn’t trimming the fat—it’s cutting into muscle. While the USAID NTD Program has made an enormous impact for millions of people, the current initiative only focuses on five of the 17 NTDs. It does not fund diagnosis or treatment of the NTDs with the highest death rates —sleeping sickness, Chagas disease, and visceral leishmaniasis—and it does not fund any research into new health tools, unlike every other disease-specific program at USAID. USAID must urgently invest in research and late-stage product development for NTDs in order to bring new, life-saving health technologies to patients. Photo: PATH/Evelyn Hockstein. If the requested budget cuts go through, existing programs will have to be cut, and there will be no room for urgently needed program expansions. This will have direct consequences in terms of lives lost. The NTD Program budget line needs to be increased to President Obama’s FY 2012 request of $100 million. USAID must also urgently invest in a broader scope of diseases, including the aforementioned deadly NTDs, and in late-stage product development for NTDs in order to bring new, life-saving health technologies to patients. But why are new drugs needed? Can we not make do with the drugs already available to treat NTDs? In short, no. Here is just one reason. Today, filarial parasitic-worm diseases (onchocerciasis, also known as river blindness, and lymphatic filariasis, also known as elephantiasis) are treated with the drug ivermectin. But in people co-infected with another filarial disease, African eye worm (Loa loa, or loaisis), this treatment, alone or in combination with another called albendazole, can lead to brain damage—or even death. More than 14 million people are at high risk. For these patients, a new treatment is needed. My organization, the not-for-profit research and development organization Drugs for Neglected Diseases initiative (DNDi), is developing a drug called flubendazole that, if successful, would be safe and effective in these patients. Without such a drug, control and elimination of river blindness and elephantiasis will not be possible. USAID has publicly committed to contributing to the global goals of elimination and control of these and other NTDs, both through the US Global Health Initiative targets and, most recently, by signing on to the “London Declaration on NTDs” on January 30 at the high-level event “Uniting to Combat NTDs.” But rather than sustaining or expanding its commitment to NTDs, USAID appears to be retreating. For nearly all other communicable diseases, USAID funds late-stage product development (phase IIb or later), to bring needed innovations through the pipeline and, ultimately, to patients. This is the case for malaria, tuberculosis, and HIV and AIDS, for example. But not for NTDs. USAID must without delay begin investing into late-stage product development for NTDs. This approach would align NTDs with other disease-specific USAID programs that currently allocate a percentage of their funding for late-stage product development, and would be entirely consistent with USAID’s vision of promoting science and technology to advance international development. In order to bridge the gap between innovation and equitable access to the benefits of scientific research, late-stage product development is crucial. USAID must act now to prioritize the needs of the world’s most neglected patients who urgently need new drugs, diagnostics, and vaccines. Without new tools, these patients will fall through the cracks and die in silence.