Breakthroughs Blog: US budget

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign up now to receive our weekly R&D News Roundup email. Recently published research found that vaccinating infants for measles earlier could help close a crucial gap in protection in those early months of life and warrants further study, especially as measles cases surge globally, underscoring the need for new and innovative approaches. The systematic review looked at 34 journal articles with data from 8,000 babies under nine months old in low- and middle-income countries, finding that maternal measles antibody rates were highest at birth before decreasing rapidly, leaving infants with low antibody rates for months before their first recommended measles vaccine dose at 9-12 months, followed by a second at 15-18 months. An earlier first dose, achieved either by giving the first dose sooner or adding a third dose before the routine two-dose schedule, could help close that critical gap in immunity.Last week, Roche announced that it is launching a Phase 3 trial of its novel antibiotic candidate, zosurabalpin, in patients with carbapenem-resistant Acinetobacter baumannii (CRAB) infections, considered one of the most dangerous and deadly antibiotic-resistant pathogens and a priority for antibiotic development. The study, expected to start at the end of 2025 or early 2026, will compare the safety and efficacy of zosurabalpin with standard-of-care antibiotics in around 400 patients with CRAB infections at sites across Europe, North and South America, and Asia. Zosurabalpin was previously shown to demonstrate high efficacy in lab tests against human clinical CRAB isolates and in mice with lung and thigh infections caused by pan–drug-resistant A baumannii.The Coalition for Epidemic Preparedness (CEPI) announced last week that it has signed a new agreement with the US Department of Defense’s Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defense to enable collaboration on several projects to boost global preparedness against future disease outbreaks, including through the development of medical countermeasures. The first project will support the development of a monoclonal antibody for the Nipah virus, a deadly zoonotic disease with no approved tools to defend against it. The department will transfer doses of a Nipah monoclonal antibody, which is currently undergoing Phase 1 testing in the United States, to CEPI for a Phase 1b/2a clinical trial in India and Bangladesh, two countries that see almost annual Nipah outbreaks. These trials aim to provide critical data that could enable access to the monoclonal antibody to protect vulnerable populations during an outbreak in Nipah-affected regions and the US joint forces in a potential emergency.

Earlier this month, GHTC obtained a copy of a report that the US Agency for International Development (USAID) submitted to Congress in November 2024 on its global health research and development (R&D) activities. This report—which was mandated by Congress but never released publicly—provides detailed information on the R&D investments made across health areas and the specific innovations supported by the agency in fiscal year (FY) 2023.Given USAID’s decades-long track record of advancing affordable, high-impact global health innovations, GHTC closely monitors these annual R&D reports to track shifts in the agency’s investments and innovation pipeline and to help ensure that taxpayer resources are strategically directed toward the greatest global health impact. While each year’s report is noteworthy and essential for accountability, this latest report is of particular significance, as it gives the clearest picture we have to date of what health R&D USAID was funding prior to recent funding shifts. It also offers a stark illustration of the scale of promising research that is now at risk.  Our analysis of the report along with circulating lists of active and canceled USAID awards suggest that the vast majority of R&D programs and partnerships highlighted in the report have since been terminated as the United States rapidly scales back its foreign assistance footprint and reorients its approach to foreign policy. What’s changed from FY 2022 to FY 2023?Before analyzing the potential impact of recent political shifts, we first examined what had changed in USAID’s funding approach from the prior reported year. Our analysis shows a slight decrease from FY 2022 to FY 2023 in products and projects supported by the agency but an overall increase in funding allocated to health R&D.The report appendix details 56 individual products or projects supported by USAID R&D investments in 2023, which is down slightly from the 63 listed in 2022. Overall, the agency’s portfolio in 2023 looked similar to 2022 in terms of the health areas and product types financed, with the addition of new investments in diagnostics for emerging infectious diseases. The report also revealed that in 2023, USAID budgeted $252.2 million in funding for global health R&D projects—an increase of $37.4 million, or roughly 17 percent, from 2022. This is noteworthy as it represents the highest non-inflation-adjusted baseline funding for R&D ever reported by the agency since 2006. This a welcome increase, and it also indicates that USAID was following a report language directive from Congress for the agency to increase its annual health R&D spending (for which GHTC had advocated).The largest increases were seen in funding for global health security R&D, which grew by $41.96 million or 68 percent, and funding for “other public health threats,” which grew by $5.86 million or 114 percent from the prior year. The latter is a catchall that appears to include funding for neglected tropical diseases; water, sanitation, and hygiene; health system strengthening research; and anything else that falls outside the groupings of HIV/AIDS, tuberculosis (TB), global health security, maternal and child health, family planning and reproductive health, and nutrition.USAID funding for R&D for TB and nutrition also grew by 14 percent and 44 percent respectively. Meanwhile, funding for HIV/AIDS remained the same, while funding fell for family planning and reproductive health by 54 percent, for malaria by 26 percent, and for maternal and child health by 20 percent. It’s not entirely clear to what degree these changes reflect a shift in political prioritization versus the normal cyclical shifts that can occur in R&D costs as products advance through the R&D process. Other contributing factors may include increased private-sector investment, particularly in areas like HIV; strategic pivots toward later-stage implementation or procurement; and adjustments based on the anticipated regulatory or market readiness of specific technologies.While the $252.2 million budgeted funding for R&D in 2023 represents the highest ever reported by the agency, when R&D spending is calculated as a proportion of overall USAID global health spending, there is far more tempered cause for celebration.While proportional spending on R&D in FY 2023 rose slightly by 0.51 percent from FY 2022, bringing it to just over 6 percent, this is still below the 8 percent peak that the agency spent on R&D in 2006, representing a slight upward slope in an otherwise years-long trajectory of decline in the agency’s proportional R&D spending.A higher proportion investment helped ensure that the United States remained a leader in driving innovation for diseases disproportionately affecting low- and middle-income countries.What’s now at risk?While GHTC is pleased to see the increase in USAID’s FY 2023 global health R&D funding and the increased proportion of overall global health spending it represents, this report highlights the many promising research advancements now at risk and the valuable agency expertise that could be lost amid recent political shifts.It is challenging to determine with certainty which USAID-supported R&D efforts listed in the report have been ended under the US government’s foreign assistance overhaul, given 1) that there have been different and contradictory lists reported of which USAID awards remain active/terminated, and 2) the appendix of USAID-supported health products/projects included in the R&D report does not include associated award IDs, names, or prime recipients, making it difficult to definitively compare and match projects against the aforementioned lists.However, using the descriptions and partners listed and leveraging additional online research, our own sectoral knowledge, and self-reported information from our members and partners, GHTC has attempted to match this information. Based on our analysis, we believe at least 49 of the 56 products/projects listed are associated with USAID awards that have been terminated (six were identified as active and one was affiliated with an award that ended in 2024).Given the recent actions taken to minimize USAID’s footprint and fold its remaining programming into the Department of State, we are unlikely to see a report on R&D investments undertaken in FY 2024—possibly leaving us without a full accounting of what’s been lost and the R&D community without essential data needed to understand the progression of these promising investments.Among the USAID projects we know are canceled from our analysis include efforts to develop the world’s first HIV vaccine, new tools to combat drug-resistant TB, next-generation malaria vaccines, novel insecticides and other vector control products, point-of-care diagnostics for neglected tropical diseases, and new HIV prevention products, including those designed for women and girls who are at high risk of infection.These findings are worrisome on many fronts. First, these changes risk squandering past progress and investments, and jeopardizing the next generation of promising global health breakthroughs. Today, we are still without essential technologies needed to achieve a future where pandemics are prevented and health is within reach for everyone—underscoring the need for donors to sustainably increase, not reduce, their investments.Second, USAID has for decades brought unique value, vision, and capabilities to the global health innovation space by focusing on the late-state development of technologies that are affordable, appropriate for last-mile settings, and prime for widespread global adoption. Career staff at USAID also had very strong subject matter expertise. There is concern that these skills and capabilities could be lost as the US government’s foreign assistance structure is reimagined and rebuilt, meaning that terminations and the broader foreign aid overhaul will have an outsized impact on the R&D ecosystem.Finally, these investments also deliver substantial returns to the United States by strengthening our economy, creating American jobs, and keeping Americans safe from deadly diseases—benefits that could now be lost as the United States draws back its support. Between 2007 and 2002, $46 billion in US government investment in global health R&D led to $104 billion in direct economic activity and the creation of more than 600,000 jobs nationwide. The follow-on effects from US-backed global health research are projected to generate $255 billion for the US economy.As the US government overhauls and reimagines what the future of US foreign assistance will look like, we believe it is critical that science, technology and innovation remain a cornerstone of its global health mission. These are strategic, win-win investments that bring benefits to the world and to Americans.See the below links to past USAID health R&D reports and strategies, which are no longer available on government websites.20082009201020122013201420152016Strategy (2017-2022)20172018201920202022Strategy (2023-2028)20232024

In many ways, 2024 has been a year marked by change—the first new year since the official end of the COVID-19 pandemic and a record number of elections ushering in political transitions around the world. With the global spotlight shifting to antimicrobial resistance (AMR) and tuberculosis (TB) reclaiming the designation as the top infectious disease killer from COVID-19, it may seem, at first glance, that the world has moved on from the pandemic that dominated every aspect of life for the better part of four years. However, with a deeper look, it’s clear that the global community is still reacting to and learning from the pandemic—for better or worse.As the year comes to an end, GHTC is reflecting on the global health innovation news and policies that shaped 2024.1. New disease outbreaks arise around the world, spurring need for and progress in R&D.In 2024, disease outbreaks continued to dominate the headlines—from the first reports of avian flu in the United States in March to the rapid global spread of the clade 1b mpox strain over the summer to the outbreak of the deadly Marburg virus in Rwanda beginning in September. Each of these incidents exposed devastating gaps in our prevention and response toolkit and spurred important steps forward on research and development (R&D) and access.For example, in response to the worrisome spread of avian flu, both the World Health Organization (WHO) and the US government launched efforts to accelerate the development of mRNA vaccines that could be deployed in case of human-to-human transmission of the currently spreading strain of avian flu or redirected to target another form of pandemic influenza if needed. Additionally, following declarations from the Africa Centres for Disease Control and Prevention and WHO designating mpox a public health emergency this past August, WHO prequalified the first vaccine against mpox and approved the first mpox test for emergency use, with the goal of accelerating global access to these critically needed tools. The outbreak also provoked new research to develop improved vaccines against mpox and the broader range of orthopox viruses, with early studies of mRNA mpox vaccines in macaques and mice demonstrating promising results.This fall, as cases of Marburg were on the rise in Rwanda, and with no currently approved vaccines or treatments available, researchers fast-tracked efforts to evaluate tools to stem the current outbreak and curb future ones. Rwandan health authorities initiated an open label vaccine trial in health workers and others at heightened risk, and there has since been a randomized clinical trial arm launched, which will offer critical efficacy data. Additionally, scientists launched the first-ever clinical trial for a Marburg treatment this year.Beyond accelerating innovation against these outbreaks, 2024 also brought exciting research advancements targeting other pathogens scientists believe are most likely to cause the next pandemic, including trials that could lead to the first-ever approved vaccines for Sudan ebolavirus and Lassa fever, as well as further efforts to improve coronavirus vaccines and simplify and speed up vaccine development and manufacturing.2. Pandemic preparedness policy reforms march forward while post-COVID political backlash in United States grows.Multilateral efforts to strengthen the world’s pandemic preparedness and response architecture moved incrementally forward this year. At the World Health Assembly (WHA) in May, member states adopted several amendments to the International Health Regulations—an existing framework codifying international responsibilities during a pandemic—, including new commitments to solidarity and equity on financing and ensuring access to medical products. The World Bank-hosted Pandemic Fund, a financing mechanism launched in 2022 to help low- and middle-income countries strengthen their preparedness and response capacities, also raised $982 million in new contributions and an additional $1.8 billion in co-financing this year, as well as awarded $500 million in grants to countries to strengthen surveillance, laboratory, and workforce capacities and fast-tracked an additional $129 million for the mpox response. Under the Brazilian presidency, G20 nations established a voluntary coalition to strengthen local and regional production of health products, which, while focused foremost on neglected diseases, could also strengthen capacities critical for pandemic preparedness and response. Unfortunately, despite some progress on negotiations toward a new pandemic accord, countries failed to reach sufficient consensus before the end of this year, and negotiators are now pushing to wrap up by the next WHA in May of 2025.At the same time as some progress was achieved on the international front, in the United States, post-COVID political backlash has deepened and become more entrenched through congressional scrutiny and reform agendas targeting the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC). Though the fiscal year 2025 budget is not expected to be finalized until next year, the health-related spending bill introduced by the House proposes spending cuts to CDC and a reorganization of NIH, which mirrors that put forward by House Republicans over the summer and could have serious implications for the agency’s core global health R&D capacities. Beyond appropriations, we also continued to see a plethora of congressional hearings targeting NIH and CDC on the origins of COVID-19, gain-of-function research, China’s influence, and the perception that these agencies are overstepping their mandates. The scrutiny and reform efforts we saw this year are expected to intensify in 2025, as Republicans gain control of both chambers of Congress and the White House.3. AMR captures the world’s attention as the global threat continues to grow.2024 was informally dubbed “the year of AMR,” with AMR elevated on the global agenda at several key moments. In May, a WHA resolution was adopted to accelerate national and global responses to AMR by advancing R&D, strengthening surveillance systems, and forging international partnerships. Later in September, a landmark report found that without further policy interventions, the death toll from AMR is expected to reach 39 million between 2025 and 2050—the equivalent of three deaths per minute.This shocking report set the scene for the United Nations High-Level Meeting on AMR in September, which led to the adoption of a political declaration that set the goal to reduce AMR deaths by 10 percent by 2030 and committed countries to promote the R&D of and equitable access to antimicrobials, vaccines, diagnostics, and other products. Global leaders also adopted an action plan in November, built off of the declaration, to provide actionable objectives and additional check-ins to monitor progress.This political momentum on AMR was also matched by exciting research breakthroughs that made the news this year. Researchers discovered a new compound that could potentially treat a resistant bacterial pathogen that can cause lethal hospital infections. Additionally, Phase 3 trials yielded promising results for both a therapeutic option for patients with serious bacterial infections and limited treatment options, as well as a new antibiotic that could cure uncomplicated gonorrhea infections, which could be approved sometime next year.4. TB reclaims title of deadliest infectious disease, but promising trials offer hope. This past year, TB surpassed COVID-19 to reclaim the spot as the world’s leading infectious disease killer, according to WHO’s Global Tuberculosis Report 2024. While this sobering news underscored major gaps in the tools needed to prevent, diagnose, and treat TB, especially drug-resistant TB, 2024 also brought exciting news on the research front that will hopefully help fill them.In March, a Phase 3 trial launched in South Africa, which is testing a TB vaccine candidate that could eventually become the first vaccine to prevent pulmonary TB in adolescents and adults. The only approved TB vaccine on the market, which was developed more than 100 years ago, is effective at preventing some types of TB in infants, but it offers inconsistent protection in adults against pulmonary TB. Additionally in November, the endTB consortium announced the completion of the first Phase 3 randomized controlled trial to exclusively enroll people with pre-extensively drug-resistant TB, a very hard-to-treat form of TB. Preliminary results demonstrated that a shorter, less toxic treatment strategy achieved high cure rates. Earlier in the year, WHO also recommended three new regimens for multidrug- or rifampicin-resistant TB, offering a much-needed variety of therapeutic alternatives for those with multidrug-resistant TB. 5. A major HIV breakthrough, but work remains on access. In what has been hailed as a breakthrough in HIV prevention, in 2024, exciting results were reported from a series of clinical trials for Gilead’s long-acting HIV prevention drug, lenacapavir, which found that the drug was 100 percent effective in preventing HIV in cisgender women and adolescent girls and 96 percent effective among cisgender men, transgender men and women, and gender nonbinary individuals who have sex with men. Both trials were so successful that they were unblinded early to offer the drug to all participants. Lenacapavir, which is administered via a twice-yearly injection, is currently approved as a treatment for multidrug-resistant HIV, but, if approved as a preventative regimen, the drug could be a game-changer for the HIV pandemic.Advocates applauded Gilead for its historic commitment to inclusion in these trials, while also urging that lenacapavir be made accessible and affordable as soon as possible to those that most need it. In October, Gilead announced a plan to allow generic versions of the drug to be sold in 120 countries, including all those with the highest HIV rates. However, the plan faced criticism for excluding most middle- and high-income countries that account for around 20 percent of new HIV infections. In these countries, the originator drug will only be available at higher prices, making it potentially inaccessible to at-risk populations.In other welcome HIV prevention news, in October, Population Council announced the results of a Phase 1 trial, which suggest that a three-month dapivirine vaginal ring for HIV prevention will be as effective as the currently approved one-month ring. The ring, which is self-inserted into the vagina and slowly releases an antiretroviral drug to prevent infection over three months, was found to deliver the drug at higher levels than the one-month ring. If the longer-acting ring continues to demonstrate success, it could offer a more cost-effective and convenient option for at-risk women. 6. Trump presidency and Republican trifecta portend changes to US leadership in global health.In the November election in the United States, former President Donald Trump won the presidency and Republicans gained control of both the US House of Representatives and the Senate. It was an across-the-board victory that will portend changes to US leadership on global health and medical research. If past is prologue, we’re likely to see President-elect Trump once again propose significant funding cuts to US global health programs and public health agencies like NIH and CDC, as well as withdraw the United States from WHO and other multilateral initiatives, the latter of which could derail efforts to finalize a pandemic accord. Given that the United States is the largest funder of global health programs and global health R&D efforts, these political changes could have a reverberating impact on health around the world.Since winning the presidency, President-elect Trump has also nominated several controversial picks to lead America’s public health agencies. These include Robert F. Kennedy Jr, a noted vaccine skeptic who has expressed a desire to cut the NIH workforce and refocus the agency on chronic diseases over infectious diseases, to lead the Department of Health and Human Services; Dr. Jay Bhattacharya, a health economist who criticized public health measures during the COVID-19 response and a vocal critic of NIH, to lead NIH; and Dr. Dave Weldon, a former Congressman who has questioned vaccine safety, to lead CDC.On the congressional front, with Republicans now in control of both chambers of the US Congress, as discussed, we’ll likely see continued scrutiny and reform efforts targeting NIH and CDC, as well as potential spending cuts to health and foreign assistance programs.7. New policies and innovative research approaches help reach underserved populations.Every person, everywhere, deserves to benefit from the fruits of science, and in this otherwise tumultuous year, there were several successful efforts to advance more inclusive clinical studies. In September, WHO released new guidance on clinical trial best practices outlining practical considerations for trials to include children and pregnant and lactating individuals, populations currently underrepresented in trials, leading to a lack of approved technologies for these groups. This guidance aligned with WHO’s living toolkit to facilitate the inclusion of pregnant and breastfeeding populations in clinical trials that was published earlier in the year. 2024 also brought the launch of two historic trials that aim to diversify research and thereby ensure that future technologies will serve the needs of underserved populations. This summer, a global consortium launched the first-ever Phase 3 clinical trial testing the efficacy and safety of antimalarials in women in their first trimester of pregnancy, which will hopefully not only lead to an urgently needed new treatment option for these women but also set a precedent for the inclusion of pregnant women in future clinical trials. Earlier this year, the US Administration for Strategic Preparedness and Response also announced funding to Walgreens to support a decentralized clinical trial testing COVID-19 vaccines. This unique approach will allow for a more diverse pool of study participants by bringing the study closer to where they live, ultimately ensuring that the resulting data reflects real-world use among a broader swath of the population. In the end, 2024 proved to be a complicated year, marked by both scientific and political steps forward and back. As new innovations and policies emerge in 2025 and beyond, GHTC will continue to work to ensure support for global health R&D remains a political priority and that the gains we have already made on neglected and emerging health challenges are not only sustained but also strengthened to combat an evolving health landscape.For other fascinating global health news delivered to your inbox weekly and to stay abreast of developments in 2025 and beyond, sign up now to receive GHTC’s R&D News Roundup newsletter.

GHTC responded to a request for information (RFI) on House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA)'s recently published framework that lays out the current challenges facing the National Institutes of Health (NIH) and makes recommendations for reform with the letter below, raising concerns that some of the recommendations could limit important and lifesaving work and urging that any reforms included in legislation to be thoroughly vetted to protect that work.Dear Chair McMorris Rodgers, As members of the global health advocacy community, thank you for your interest in optimizing the National Institutes of Health (NIH) and for the opportunity to provide input on the  Reforming the National Institutes of Health Framework for Discussion.We are pleased to share thoughts below on several specific proposals. However, given the significance of NIH to the health, security, and well-being of the American people and populations across the globe, it is critical to engage in a process that permits interactive discussion with and between different parties who can shed light on the day-to-day implications of these potential changes. Through this process, we can work together to identify opportunities to strengthen NIH in support of the goals and objectives of members of Congress from both sides of the aisle.    For this reason, we are deeply concerned that changes outlined in the framework have been incorporated into the Fiscal Year 2025 House Labor, Health and Human Services, Education, and Related Agencies (LHHS) appropriations bill even before the deadline for comments on the proposal. Our concern is not that the calls for reform and increased transparency are without merit but rather that any reform included in legislation be thoroughly vetted to ensure that the important and lifesaving work of NIH is allowed to thrive.In the spirit of such a process, the following text provides specific input from the global health research community and advocates on several proposals included in the framework. The community’s apprehension centers on bifurcating the National Institute of Allergy and Infectious Diseases (NIAID); collapsing several institutes and centers, including the Fogarty International Center, into a single institute; and incorporating the Advanced Research Projects Agency for Health (ARPA-H) into an NIH institute. These actions will impose barriers, both administrative and scientific, for global health research and development that will affect NIH’s reputation as the global leader in biomedical sciences, a legacy that enhances the United States’ image on the international stage as a champion of global health innovation and a steward of global health diplomacy. NIAID is the world leader in global health research and development because its basic research expands our fundamental knowledge of antimicrobial resistance, HIV/AIDS, malaria, tuberculosis, and neglected tropical diseases. As COVID-19 variants continue to arise, the complex interactions between immunity and infectious threats have reached the public’s attention as never before. Antimicrobial resistance is another example of how the intertwined nature of infectious diseases and immunity requires constant collaboration between professionals from these fields. We are concerned that NIAID will not cleanly split in two as the LHHS report and House Committee on Energy & Commerce’s proposed framework posit. Rather, the split will disrupt the research helping us defeat the most deadly infectious disease threats—past, present, and future—at home and abroad. We are also concerned that grouping the Fogarty International Center (FIC) with topically unrelated and domestic-facing institutes into the Institute on Health Sciences Research would minimize the key role FIC plays in maintaining the United States’ global health security leadership role and advancing medical progress that benefits the American people and populations across the globe. FIC is a lesser-known but hugely consequential branch of NIH responsible for training a vast network of approximately 8,500 professionals from 132 countries in public health threat response. These trainees have gone on to hold high-ranking academic and government positions and have moved the needle on neglected and emerging infectious diseases, such as HIV/AIDS, COVID-19, Zika, and Ebola.  Rather than embedding FIC in another institute, we believe an important opportunity exists to strengthen this center to play an even more impactful role in advancing the health and security of Americans. We would welcome the opportunity to discuss options such as expanding FIC’s role to encompass strengthening clinical trial capacity and strategic partnerships in countries where capacity gaps pose risks and create tragic missed opportunities for faster medical progress. Finally, we believe that maintaining ARPA-H’s independent status is important for preserving its unique approach to high-risk, high-reward innovation as initially envisioned by Congress, which does not duplicate NIH’s critical role in basic and translational research.  The agency, authorized in 2022, has not been in place long enough to evaluate federal investment in this new model. Its efforts to reverse blindness, dramatically increase the precision of tumor removal, and overcome challenges with broad significance should be given the time they need to succeed or fail. Had Congress abandoned the Defense Advanced Research Projects Agency in its first years of operation, GPS could be a matter of science fiction, not everyday use. ARPA-H has the potential to bring new scientific thought and processes to a field marked by tradition—minimizing its role risks the United States falling behind our geopolitical rivals in health innovation during an age of rapidly evolving technologies. We believe it is in the nation’s interests to put ARPA-H’s muscle toward addressing health threats within and (currently) outside our borders. Again, Chair McMorris Rodgers, we share your commitment to strengthening NIH and believe that thoughtful, bipartisan reforms, supported by thorough discussion and vetting, are key to achieving this goal. We write to advocate for robust funding and a structural, operational, and policy infrastructure that best supports fast-paced scientific, medical, and public health progress. NIH is an asset that serves US interests and contributes in profoundly important ways to the health and well-being of all around the world. We urge that congressional efforts to optimize NIH take place on a bipartisan and bicameral basis and that only changes that have been carefully vetted through a thorough, interactive, and cross-sector process are considered. Thank you for your consideration,Alex LongUS Policy & Advocacy OfficerGlobal Health Technologies Coalition (GHTC)E: along@ghtcoalition.org