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As is always the case with the approach of summer, the global health community is gearing up for another session of the World Health Assembly (WHA), which will be held in Geneva from May 21–26. WHA brings together the World Health Organization’s (WHO) 194 member states, civil society, and the United Nations system to review WHO’s progress against previous commitments and chart the course for the next 12 months. This 71st session of WHA will see a number of debates on topics affecting global health research and development (R&D). 13th General Program of Work Perhaps most significantly, this year’s WHA will see the approval of the next General Program of Work (GPW 13), which will set WHO’s strategic objectives and activities for 2019–2023. Reflecting Director-General (DG) Dr. Tedros Adhanom Ghebreyesus’ first real opportunity to legislate a course change for WHO and put his stamp on the organization, the draft GPW 13 is framed around an ambitious “triple billion” set of targets, aiming to: Cover 1 billion more people with universal health care, Better protect 1 billion more people from health emergencies, and Ensure that 1 billion more people enjoy better health and well-being. Encouragingly, the current draft of the GPW 13 includes a concrete cross-cutting workstream across these three broad targets to support R&D by strengthening coordination and collaboration, stepping up WHO’s normative work to encourage uptake of new innovations, and by using WHO’s convening authority to ensure best practices and the latest techniques to support R&D are shared across geographies. The three ambitious targets will require significant additional investment by member states, as well as a significant reprioritization of WHO’s existing staff and resources—both of which are heavy political lifts for the DG and his team. The extent to which WHO succeeds in mobilizing additional resources will largely determine whether GPW 13 achieves its ambitious vision to fundamentally change the way WHO does business. Access to Medicines The debate on how WHO should engage in activities to address concerns around access to medicines continues unabated. The January Executive Board (EB) meeting saw intensely heated debate, with the Brazilian delegate challenging the United States representative by stating, “We have been debating this for five years. You say everything ‘poses implementation issues.” To move past this stalemate, the EB ultimately recommended a compromise solution calling for WHO to undertake a strategic consultation and strategy development process over the course of 2018 and to present the resulting strategic roadmap to the EB in January 2019. Notably, the current draft resolution specifically calls out the need for WHO to consult with member states, but excludes mention of non-state actors in official relations with WHO. GHTC will work to ensure that the final resolution includes a provision for civil society to be consulted. Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property Following the spirited discussion at the EB meeting regarding the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property (GSPOA-IP) and the appropriate role of WHO in advancing policies around intellectual property for health products, the EB proposed a compromise resolution. It calls on member states and WHO to implement those recommendations from the Expert Review Panel that align with the existing elements of the Strategy and Plan of Action, while continuing to discuss those recommendations that fall outside the current scope. Having led the charge for an expansive view of the GSPOA-IP mandate at the EB, Brazil will almost certainly take a very active role on this item at WHA as well. Much like the EB debate, the focus for WHA will be on the more aggressive recommendations proposed by the Expert Review Panel that some countries argue fall outside the scope of the original GSPOA-IP. Key recommendations include: The WHO Secretariat to identify mechanisms to increase health technology transfer in the context of the Technology Facilitation Mechanism established by the Sustainable Development Goals The WHO Secretariat, in collaboration with other international organizations working in intellectual property, to advocate for the development of national legislation to fully reflect the flexibilities provided in the Agreement on Trade-Related Aspects of Intellectual Property Rights and Public Health and the Doha Declaration          Member States to commit to dedicating at least 0.01 percent of their gross domestic product to basic and applied research relevant to the health needs of developing countries Member States to encourage the implementation of schemes which partially or wholly delink product prices from research and development costs As a result, this agenda item will likely require a drafting group to convene to litigate line-by-line language changes given the profound disagreement among member states on whether recommendations that fall outside of the GSPOA-IP’s current scope should be implemented or not. GHTC will follow these negotiations closely given that the recommendations currently viewed as out of scope include provisions on a percentage of GDP target funding level for R&D, initiatives on price transparency, and local R&D capacity building.

The Trump Administration’s proposal to slash funding to fight global health threats like malaria, Ebola, and HIV/AIDS could cost states thousands of jobs and millions of dollars in economic investment and put the health of residents at risk, according to a new state-by-state analysis released today on Capitol Hill by the Global Health Technologies Coalition (GHTC). This first-of-its-kind analysis quantifies how federal funding to create vaccines and treatments to combat deadly global diseases also benefits American states. “While the Administration claims cuts to global health research are putting America first, the data suggest otherwise,” said GHTC Director Jamie Bay Nishi. “US funding for global health research is not only saving lives worldwide, it’s also paying significant economic and health dividends across American states.” According to the analysis, US investments in global health research and development (R&D) from 2007 to 2015 generated considerable economic benefits for individual states—creating jobs and injecting millions of dollars into local economies. For example, in Maryland alone, US-funded global health research contributed US$2.5 billion to the state’s economy and created more than 30,700 jobs for its residents. Similarly, Georgia has these investments to thank for 5,800 local jobs and $349 million to its economy. The analysis also underscores the dangers of ignoring neglected diseases in an increasingly interconnected world by enumerating how these diseases—assumed by many to only afflict the world’s poorest—also affect individuals across every state. The state-by-state analysis includes data on well-known diseases such as HIV/AIDS, tuberculosis, malaria, and Zika; but also lesser-known threats like dengue and chikungunya, which many do not realize have been locally transmitted in the United States. For example, Florida has seen 779 cases of dengue since 2010, including a local outbreak in 2009–2010 that sickened 88 people, as well as 1,216 cases of Zika since 2015, including 220 cases from local mosquito transmission. In addition to reporting the overall economic impact to each state of federal funding for global health R&D, the new analysis also documents how local universities and research institutions are benefiting from these investments and identifies private-sector companies within each state that are working to advance new innovations to combat long-standing and emerging global health challenges. Global and national benefits of global health R&D This state-by-state analysis builds upon a report released last year by GHTC and the health-oriented think tank, Policy Cures Research. The report, Return on innovation: Why global health R&D is a smart investment for the United States, examined the national and global impact of US spending on global health R&D. It found that from 2007 to 2015 alone, $14 billion in US government investments in global health innovations contributed to the advancement of numerous new technologies to combat dangerous global diseases, while also creating 200,000 new American jobs and generating $33 billion in US economic growth. The Return on innovation report revealed that while this spending may be directed at solving global health challenges, most of the money—89 cents of every dollar—stays in the United States, funding researchers and stimulating industry investments. Public funding for global health R&D under increased threat Despite the increase of health threats and the strong returns both at home and abroad from these investments, US government spending for global health R&D has been unreliable. According to the G-FINDER report, which tracks global funding for R&D for neglected diseases, outside the emergency allocation for the Ebola response, US public investment has been on the decline since 2012. While 2016 saw a modest uptick, investment remained $178 million below 2012 levels. Now, President Trump is proposing further deep cuts across the government’s global health and medical research portfolio for fiscal year (FY) 2019 and exploring ways to roll back prior years’ spending through presidential rescissions, which could target these same programs, though details remain unclear. Specifically, in its FY19 budget proposal, the Administration has called for a 36 percent cut, over FY18 enacted levels, to global health programs at the US Agency for International Development, which fund vital research to develop new health innovations for vulnerable communities worldwide. The Centers for Disease Control could see a 17 percent cut to the National Center for Emerging and Zoonotic Infectious Diseases, which develops tools to detect and fight deadly diseases abroad before they reach American shores, as well as a 16 percent cut in funding for its global health programs responsible for conducting critical disease surveillance and immunization activities. The budget also includes a 9 percent decrease to the National Institutes of Health’s National Institute for Allergy and Infectious Diseases, which funds important research on infectious disease threats like malaria, HIV/AIDS, and Zika. “We hope Congressional policymakers will see the wisdom to reject these dangerous cuts,” said Nishi. “Slashing funding for global health research will not only mark a retreat from America’s humanitarian and moral leadership in the world; it will also put the health of US citizens at risk and harm the economies of states.” Top 10 states benefiting from global health R&D investments Based on federal funding for global health R&D invested in state from 2007 to 2015 and jobs created as a result. Maryland: $2.5 billion | 30,700+ jobs New York: $916 million | 9,600+ jobs California: $876.4 million | 11,800+ jobs Virginia: $874.5 million | 9,700+ jobs Washington: $783.9 million | 9,700+ jobs Massachusetts: $731.1 million | 8,400+ jobs North Carolina: $410 million| 5,900+ jobs Pennsylvania: $352.8 million | 4,300+ jobs Georgia: $349.1 million | 5,800+ jobs Texas: $201.6 million | 3,100+ jobs  View data for all states on GHTC’s online data tool: http://www.ghtcoalition.org/in-your-state About the Global Health Technologies Coalition The Global Health Technologies Coalition (GHTC) works to save and improve lives by encouraging the research and development of essential health technologies. We bring together 30 nonprofit organizations, academic institutions, and aligned businesses to advance policies to accelerate the creation of new drugs, vaccines, diagnostics, and other tools that bring healthy lives within reach for all people.