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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. A group of researchers at the Peter Doherty Institute for Infection and Immunity in Melbourne, Australia have discovered a way to tackle a longstanding challenge that has eluded researchers trying to develop a cure for HIV for decades. HIV can hide in certain white blood cells, creating a reservoir in the body that can later reactivate and evade targeting by the immune system and drugs. The researchers found a way to make the virus visible using mRNA technology, an achievement previously thought impossible and a step closer toward being able to fully clear it from the body. Further research is needed to determine whether revealing the virus is enough to make it vulnerable to the immune system or whether the technology will need to be combined with other therapies, suggesting this technology is still years away from reaching humans.Recently published research examining an understudied group of coronaviruses called merbecoviruses (the same group that includes MERS) found that while most merbecoviruses are unlikely to pose a direct threat to humans, one subgroup is only one small mutation away from being able to spill over into human populations and cause a major outbreak. This subgroup of viruses, called HKU5, has been found across Asia, Europe, Africa, and the Middle East, but its natural host is in Asia: the Japanese house bat. Previous research has already found one HKU5 virus that has been documented to jump across animal species. This study and its methods, specifically the use of artificial intelligence, could be used to improve further research and support the development of new vaccines and treatments. A group of scientists in Burkina Faso have successfully completed the first phase of a clinical trial testing the PfSPZ-LARC2 vaccine for Plasmodium falciparum malaria in youths between 6 and 19 years old. The vaccine, which was previously found to be safe and effective in adults, is unique and innovative because it uses genetically engineered parasites that cannot cause disease but are potent enough to generate immunity. In fact, the vaccine has demonstrated an ability to achieve higher efficacy at a lower dose and for a longer duration than existing vaccines for malaria. If proven effective in further trials, it could represent a significant game changer in malaria control efforts, reducing the burden on health care systems and increasing convenience for people in malaria-endemic countries, as well as travelers and military personnel.

Jayanta “Jay” Bhattacharya, M.D., Ph.D. Director National Institutes of Health June 3, 2025 Dear Dr. Bhattacharya: As organizations representing researchers, clinicians, patients and other concerned stakeholders, we write to highlight the value and importance to Americans of the National Institutes of Health’s support of collaborative international biomedical research and to express concern about the unintended consequences of the current implementation of the updated NIH policy toward foreign subawards, which risk significantly disrupting research that benefits the American public. We also urge you to work with the scientific community toward our shared goals of improving transparency at NIH while minimizing disruptions to research that Americans depend upon to deliver life-saving medical advances and would appreciate the opportunity to meet with you. International Collaborative Research Benefits Americans For many health conditions that are more common in other countries, international collaborations are necessary to advance our knowledge of how to diagnose, treat, or cure these diseases, and the benefits of that knowledge for Americans living with those conditions can be enormous. Increased global travel can easily increase the prevalence of many of these diseases in the US, and conducting international research now boosts our readiness. Additionally, for many conditions, limiting research to the US will add significant costs to studies, slow recruitment and significantly delay the results and innovations. Consider these examples: • The Pediatric MATCH precision medicine trial which matched children and adolescents with advanced cancers to targeted therapies on genetic alterations. Patients were enrolled in the phase 2 trial from the U.S., Canada, Australia, New Zealand, Saudi Arabia, and other European countries. • The HIV Prevention Trials Network (HPTN) 052 study was an NIH-funded trial—conducted in 9 countries in Africa, Asia, Latin America, and North America—which proved that effective HIV antiretroviral therapy stops the sexual transmission of HIV. This finding has been foundational to public health strategies for the 1.2 million people with HIV in the U.S., informing the U=U (Undetectable=Untransmissible) campaign. More broadly, global HIV research has greatly informed chronic disease care delivery in the US, improving community-based care and retention in care for conditions including hypertension, diabetes and heart disease. • The Tuberculosis (TB) Trials Consortium Study 31 was an NIH and CDC-funded trial conducted in 13 countries, including the U.S. This study proved that a novel shorter 4- month TB treatment regimen could be as effective as the standard-of-care 6-month treatment regimen. Such research is critical, as TB affects nearly 10,000 Americans every year and TB rates have increased every year in the U.S. since 2020. Kansas is currently struggling with one of the biggest TB outbreaks in the U.S. in decades. • A proposed histoplasmosis clinical trial that would collaborate with sites in Brazil to enroll more rapidly and cost effectively scored very well in study section such that funding would typically occur, but its current status is unclear. Histoplasmosis is a deadly fungal infection that occurs in people with transplants and autoimmune disorders as well as people with HIV. Americans will directly benefit from these results if the trial proceeds. • Similar to the examples above, whether one considers conditions as varied as Alzheimer’s disease, cancer, or stroke, NIH-supported international collaborations have been vital to enhancing the discovery and development of health technologies that have improved the health of millions of Americans. Concerns with the Current Approach to the Updated Foreign Subawards Policy While we are very supportive of the NIH’s goals of improving transparency in research, we have substantial concerns about the manner in which this policy is currently being implemented. Our concerns include: • A funding freeze for international scientific collaborations pending the new policy: Even though the implementation of the new award structure is pending, the NIH has stopped issuing any awards —including new, renewal, or non-competing continuation grants—that include foreign subawards. This includes new awards that have already undergone years of preparatory work, rigorous scientific review and been selected for funding. Additionally, existing multi-year awards will not be renewed if the “project is no longer viable without the foreign subaward.” Abruptly halting their funding undermines this long-term investment, wastes taxpayer dollars and jeopardizes high-impact research with direct relevance to public health in the U.S. and globally, including clinical trials. These interruptions could leave study participants in without access to life-preserving therapies and pose serious ethical concerns. Although the NIH notice indicates that steps will be taken to mitigate these impacts, emerging reports suggest that this may not be occurring consistently in practice. • Requiring researchers to “reapply” for awards that have already been selected for funding or that are in progress: This requirement would apply to awards that have been selected for funding and to awards for which research activities are already underway, with significant work completed. Awards have already undergone highly competitive scientific review. Full reapplication would result in a significant loss of the taxpayer dollars already invested in the planning, launching, and partial execution of these projects. This move increases waste and jeopardizes the continuity of high-impact research critical to public health in the U.S. • Loss of multi-country clinical trials: The current policy doesn’t appear to include any mechanism for NIH to continue participation in multi-country clinical trials. Multi-country country collaboration opens access to more patient populations and more efficient clinical trial enrollment for diseases affecting Americans from Alzheimer’s Disease, heart disease, and HIV to rare diseases with smaller patient populations. • Loss of US scientific workforce: Abrupt losses or unplanned delays or interruptions in funding can leave many researchers, particularly early-career researchers, unable to sustain their careers. Because so much US research includes an international component, a high number of researchers are at risk of leaving the field entirely, which would leave the US without the workforce we need to deliver needed breakthroughs. • Broader Implications for U.S. Public Health and Scientific Leadership: Beyond the direct impact on specific research projects, the current implementation of this policy may weaken the United States’ ability to prepare for and respond to global health threats. International collaborations enhance our early warning systems, accelerate the development of vaccines, treatments, and diagnostics for emerging diseases, and are often more costeffective than domestic-only studies. Stepping back from these partnerships could erode U.S. leadership in biomedical research. Recommendations Facilitate rapid restructuring of awards or streamlined reapplications with no termination or minimal interruption of research: We do not support termination of any research grants under the new policy but recognize that some grants have already been terminated and others may be terminated. Given this, and the fact that different foreign collaborations may have different needs based upon the type of research being conducted, structure of the project and specific partners involved, we recommend that NIH work with currently-funded researchers to develop and offer multiple options that provide sufficient transition time to allow researchers to meet the new financial reporting requirements with no or minimal disruption or delays to research. These options include: • Restructure awards in a manner that rapidly transitions foreign subawards to the linked foreign awards system, with no or minimal interruption of ongoing research and no or minimal delay for projects already selected for funding. • Enable researchers to maintain foreign partners in existing grants through consultancy and fee-for-service arrangements. • Provide a highly streamlined reapplication process for researchers to transition to the new linked grants system with strong assurances of funding for researchers whose grants had already scored well or been approved. Technical assistance: While we recognize the goal of improved transparency and tracking of funds, we are concerned that some important foreign research partners who provide significant benefits to Americans may not currently have the capacity to directly implement the upcoming NIH policy for linked awards. We request that NIH provide technical assistance to foreign research partners to help ensure successful implementation. Limited exemptions: We recommend NIH consider granting foreign subawards that meet certain thresholds. For example, if a US prime grantee affirms they cannot identify a different partner that could provide the same benefit as this foreign partner, and the foreign partner’s budget or staff size is below a certain threshold, such that it may be unable to comply with the foreign prime requirements or the new linked grants requirements, it could be considered for a foreign subaward. In addition, we recommend that multi-country clinical trials be exempt or otherwise permitted under the new policy. In these instances, we believe the benefits of enabling foreign collaborative research far outweigh the risks. The above requests are consistent with the NIH goal of improving transparency. Implementation of these recommendations will help ensure that innovative scientific research that benefits Americans can proceed and that critical international collaborations developed in good faith following prior NIH guidance are not arbitrarily harmed. Without changes such as these, the updated NIH policy is likely to undermine U.S. taxpayer investments and harm the health of Americans. Thank you for your consideration of our perspectives and recommendations. We share your commitment to accountability and strong stewardship of federal research funds and stand ready to work together to ensure international research continues to deliver for the American people. We would welcome the opportunity for dialogue with you to help ensure sufficient policies, processes and resources that will enable international research collaboration that provides significant health benefits to Americans. Sincerely, American Society for Microbiology American Society of Tropical Medicine and Hygiene DNDi North America Global Health Technologies Coalition HIV Medicine Association Infectious Diseases Society of America

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.

For decades, strong US government investment in biomedical innovation has fueled the development of new vaccines, treatments, and other breakthrough global health technologies that have saved and improved millions of lives around the world and here at home. Unfortunately, in recent months, we have seen these investments decline significantly, as the US government has shrunk its foreign assistance footprint and ended hundreds of medical research grants. With the majority of global health research programs at the US Agency for International Development (USAID) and many other key US agency programs facing an uncertain future, past progress and future gains in global health innovation are now at risk. These disruptions threaten to undermine the United States’ longstanding role as a global leader in biomedical innovation, compromise the return on previous investments, and heighten health risks for people in the United States and around the world.The current US administration has signaled its priority to make America safer, stronger, and more prosperous—a goal which is directly aligned with the outcomes of global health research and development (R&D). By embracing ongoing commitments and continuing to invest in global health R&D, US policymakers can safeguard the well-being, resilience, and economic prosperity of the American people—advancing the agenda of the US administration while simultaneously saving and improving lives around the world. Global health R&D protects Americans from disease threats and promotes international stabilityDisease threats know no borders. Americans are increasingly at risk of emerging and neglected diseases, as underscored by the recent domestic outbreaks of H5N1, measles, mpox, and tuberculosis. Right now, health technologies developed with US funding are protecting Americans and ensuring that the United States is equipped with the proper tools to mitigate disease threats. The 2025 outbreak of Sudan virus, which can cause Ebola disease in humans, in Uganda was the latest Ebola outbreak that endangered the well-being of citizens worldwide. In addition to providing critical monetary and technical assistance contributions to Uganda to combat this outbreak, the US government also donated courses of an experimental monoclonal antibody treatment that was developed with US funding and 500 rapid detection test kits to support ongoing surveillance and prevention of future outbreaks. Additionally, other global partners launched two major clinical trials testing an experimental vaccine and therapeutics, including the monoclonal antibody therapy and an antiviral treatment, all of which were developed with past US government support. Collectively, these interventions and the rapid response effort helped stop the virus from spreading beyond Ugandan borders, ultimately protecting lives around the world and quelling the potential threat to Americans. Thanks to sustained US investment in Ebola research and outbreak response since 2011, the United States had the knowledge, infrastructure, and tools needed to respond quickly and effectively to the recent outbreak—minimizing the threat to regional stability and American public health.Beyond Ebola, the US government has also advanced other global health breakthroughs that have directly benefited Americans, including new drug-resistant tuberculosis treatments, long-acting HIV prevention and treatment options, and vaccines for mpox.Global health R&D strengthens US global influence, while also protecting military personnelGlobal health R&D has historically been a powerful diplomatic tool for the United States in strengthening its partnerships and ties around the world. By drawing back its investments, the United States risks ceding leadership in the foreign policy and medical research space to other countries—including its geopolitical rivals—who could step up to fill part of the vacuum left behind. Take China for example: in recent years, it has continued to grow its R&D investments, diminishing the gap between American and Chinese investments. Additionally, at the 2024 Forum on China Africa Cooperation, the Chinese government announced plans to encourage Chinese businesses to invest in the production of medicines and vaccines in Africa as part of its 2025-2027 action plan. As other global actors expand their influence in global health, including through increased investment in medical innovation and manufacturing, the United States must remain engaged to preserve its leadership, uphold its values, and continue delivering lifesaving impact around the world. Diminished leadership in global health innovation could also increase the vulnerability of US military personnel stationed around the world. Infectious diseases are the single largest cause of hospitalizations of US servicemembers during conflicts, representing an average of nearly 60 percent of casualties in recent conflicts. Global health technologies advanced through foreign assistance dollars and non-defense spending have helped keep US warfighters healthy and safe. For example, the US Centers for Disease Control and Prevention helped create a test to ensure US military uniforms treated with malaria-targeting insecticides remain effective, and USAID supported the development of tafenoquine, a single-dose medicine used to treat Plasmodium vivax malaria, as well as the only US Food and Drug Administration-approved treatment for leishmaniasis, a parasitic disease common in the Middle East. Without continued investments in research, challenges like growing antibiotic resistance could put the US military in an increasingly vulnerable position.Global health R&D drives American innovation and prosperityBetween 2007 and 2022, the US government invested just under $46 billion in R&D for neglected diseases, emerging infectious diseases, and sexual and reproductive health issues (To put this amount in context, in 2022 alone, the US government spent $751 billion on defense and $1.34 trillion on Medicare and Medicaid). This relatively modest investment helped contribute to the development of 67 new technologies approved since 1999 for neglected and emerging diseases (excluding COVID-19) and fueled a burgeoning pipeline of 261 promising products in late-stage development, which could further reduce the human and economic toll of these diseases.Beyond its health impact, this investment has also delivered substantial economic benefits to the US economy. Between 2007 and 2022, at least 86 percent of all funding that the US government directed to global health R&D was reinvested in American companies and institutions. This investment has created an estimated 600,000 new American jobs, spurred $104 billion in direct economic activity, and yielded scientific knowledge to inspire further innovations, which will ultimately generate $255 billion in long-term benefits to the American economy.These investments have also proven their potential to create cost savings, by driving down health care costs or preventing costly care down the line. For example, switching all patients with drug-resistant tuberculosis to regimens incorporating a new drug, pretomanid, which was developed with support from USAID and the National Institutes of Health, could generate global cost savings of $740 million annually. Even modest investments in scientific research can yield significant economic returns for the United States. The good we do makes us great Investment in global health R&D makes up just a small portion of the federal budget—around 0.8 percent in fiscal year 2022—but it has a priceless impact on the lives and livelihoods of Americans and people in need around the world. When the United States invests in global health research, we create opportunities and benefit the health of people in our nation and around the world. We fuel innovation at home. We create jobs. We make friends and allies. We make the world safer, and we make our world safer too. It’s the good we do, in part, that makes us great. As the US government reimagines its foreign assistance architecture and makes future research funding decisions, global health R&D efforts must be prioritized to preserve the progress we’ve made and deliver the bold breakthroughs of tomorrow. Sustaining the US government’s commitment to global health R&D will yield strategic and cost-effective benefits, bringing us closer to a safer, stronger, and more prosperous America and world—but only if we are able to meet the moment we are in.