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In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. GHTC members the Global Alliance for TB Drug Development and the Foundation for Innovative New Diagnostics have announced a partnership that aims to coordinate the development of complementary new tools to fight tuberculosis (TB). In related news, GHTC member Aeras has released its annual report and a new infographic about the global burden of TB and the need to develop new products to control the disease. The Global Alliance to Prevent Prematurity and Stillbirth has announced five innovative research projects that aim to prevent premature birth worldwide. The initiative seeks to discover biological mechanisms that lead to preterm birth and develop innovative strategies for prevention, with particular focus on solutions relevant to low- and middle-income countries. A new study defines factors that can lead to successful open-source drug discovery for neglected diseases. GHTC member Research!America has released a list that details the top 10 reasons the United States should invest in global health research and development.

Over the past few weeks—as Congress worked on a budget deal to keep the federal government running through the end of March 2013—several global health and international development groups released new reports about what looming, across-the-board cuts would do to these programs worldwide. Groups are worried about the likely devastating impact of sequestration on US-funded global health, research, science, and development programs. Sequestration would require a reduction in government spending of $109 billion per year for nine years, beginning in January 2013. It’s expected that the resulting indiscriminate, across-the-board cuts would result in a 9.4 percent cut for most defense programs relevant to global health—including global health research and development (R&D) programs at the Department of Defense (DoD). 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. Some groups are worried about the likely devastating impact of sequestration on US-funded global health, research, science, and development programs. Below, we provide a round-up of some of these new analysis pieces, detailing the human impact of these sweeping cuts. In an updated analysis, amfAR, the Foundation for AIDS Research, recalculated its estimates on the human impact of budget sequestration on global health. The analysis finds that as the result of sequestration, HIV and AIDS treatment for 276,500 people worldwide will not be available, potentially leading to 63,000 more AIDS-related deaths and 124,000 more children becoming orphans. In addition, 112,500 fewer HIV-positive pregnant women will receive services to prevent transmission to their children, leading to more than 21,000 infants being infected with HIV. The analysis finds that 2.2 million fewer insecticide-treated nets will be procured, leading to nearly 6,000 deaths due to malaria, and that 60,000 fewer people with tuberculosis will receive treatment, leading to 7,000 more deaths from the disease. A new analysis from the American Association for the Advancement of Science (AAAS) finds that sequestration would “no doubt have significant impacts on federal funding of science, research, and innovation.” The analysis aims to provide a complete picture of the size of these potential cuts by estimating budget impacts for most key R&D agencies, and the funding ramifications by state, over the next five years. It found that the NIH could receive a cut of $11.3 billion over five years, averaging $2.3 billion less per year for research. The DoD could average $6.7 billion less for R&D per year, while the National Science Foundation could receive $2.1 billion less over five years. Total cuts through fiscal year 2017 would amount to $57.5 billion. “The resulting R&D budgets at most agencies would be lower than they've been in several years,” according to AAAS. Bread for the World has released a document that details the impact of sequestration on the international affairs budget. It finds that sequestration would result in reductions to international affairs funding that would entail about $1.7 billion in cuts to poverty-focused development accounts, including a $670 million cut to global health programs. These cuts would mean “[m]ore lives would be needlessly lost due to infectious disease and more children would be born HIV-positive,” according to the analysis. Research!America has also released an updated analysis on how sequestration would affect health research and science at key US agencies. Based on fiscal year 2012 numbers, the report finds that the NIH could lose $2.5 billion, the CDC could lose $479 million, and the FDA could lose $318 million for their R&D efforts. Sequestration would ultimately put health research “at the breaking point,” according to the report. With most members of Congress gearing up for the November elections, we hope that they’re paying attention to these reports and listening to the chorus of voices calling for a real, long-term solution to the budget. Both Mitt Romneyand Barack Obama have been taking about foreign assistance lately, and the issue will stay on the candidates’ minds as they participate in an upcoming debate focused on international issues. Preventing sequestration needs to be a priority in these conversations.

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.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. GHTC member Aeras has announced that it has signed an agreementwith GlaxoSmithKline Vaccines (GSK) to jointly advance the development of a tuberculosis (TB) vaccine candidate. A new series in the Financial Times looks at neglected tropical diseases, including their economic burden, the need for improved treatment methods, and the need for research and development funding. Genocea Biosciences, a company that advances vaccines for infectious diseases, has raised $30 million in new funding from groups like the Bill & Melinda Gates Foundation. An article examines how the priority review voucher program, an “innovative funding model for research into neglected diseases,” has “finally come of age.” GSK also announced this week that it plans to make clinical trial data available to other researchers, as well as open its TB compound library to help stimulate research.