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GHTC held a Game changers in global health game night on Capitol Hill to educate Congressional staffers about the impact of US leadership in global health research and development (R&D). Our guests ate, drank, played games, and learned a thing or two about how investing in global health R&D saves lives around the world, creates US jobs and economic growth, and protects Americans from disease threats. Here are some of our favorite photos: Playing "ROI: Return on Innovation" claw game to see the impressive rate of return generated by US investments in global health R&D.  I wonder what return this person will get for his dollar.     Discovering that global health R&D is a smart investment. It saves lives around the world, spurs US economic growth, generates cost savings, and protects Americans from disease threats.      Pulling a block from "Agency Jenga" to learn a fun fact about the important and unique contributions made by each US government agency involved in global health R&D.     Each US agency is vital to a strong and stable global health R&D ecosystem. If too many blocks are removed, the system could topple!     Playing "Striking out Disease" bowling to experience how changing funding levels for global health R&D impacts our ability to strike out the world's deadliest diseases. This player experienced funding cuts so was stuck bowling with a tiny tennis ball!       This player received an R&D funding increase, so she was able to bowl with the jumbo ball.       Attendees visit the "Gallery of Game Changers" booth to see, touch, and taste how American investment is generating game-changing global health technologies.     The International Partnership for Microbicides demonstrates how its dapivirine vaginal ring is inserted and can help women protect themselves against HIV and AIDS. The ring, which slowly releases the antiretroviral drug dapivirine, was shown to be effective in late stage clinical trials.     PATH shows off the Nifty Cup. This low-cost device, developed with support from USAID, helps babies born prematurely who struggle to breastfeed.     HarvestPlus shows off its naturally-bred, biofortified Vitamin-A orange corn, allowing attendees a chance to taste orange corn cookies and popcorn. This innovation is a sustainable, cost-effective way to combat malnutrition.     Jhpiego demonstrates how to put on a new Ebola personal protective suit it developed with support from USAID's Ebola Grand Challenges for Development.     This guest agrees. Investing in global health R&D should be an important priority for the US government.     Playing "Race for a Cure" to learn about the global health R&D process. It takes an average of 12-15 years to develop a vaccine. This player is racing to see if she can get her vaccine through all the stages of the product development process before the clock runs out.     Developing treatments, cures, and vaccines for the world’s most devastating diseases is not easy. Many challenges arise along the path from scientific discovery to lifesaving technology. That's just a part of the global health R&D process.     GHTC Director Jamie Bay Nishi talks about GHTC's mission and the critical role of global health R&D in addressing the world's most pressing health challenges.     Jamie Bay Nishi introduces Congressman Albio Sires (D-NJ), a longtime global health R&D champion and lead co-sponsor of the Global Health Innovation Act.     Congressman Albio Sires highlights how US leadership in global health R&D not only saves lives around the world, but also protects Americans from disease threats and generates US jobs and economic growth.     Congressman Albio Sires (D-NJ) checks out Jhpiego's Ebola personal protective suit.     Guests visit the "Does It Exist?" booth with a scenario card they received at registration to discover whether the vaccine, drug, or other health technologies needed to address the scenario exists. Despite tremendous progress in global health, we still don’t have the tools needed to diagnose, prevent, and treat many longstanding and emerging health challenges.     A guest spins the "Wheel of Progress" to receive a trivia question about a US agency involved in global health R&D.     Guests enjoy GHTC's signature color-changing cocktail "The Cure." It takes a drop of American ingenuity, a dash of investment, and a dose of partnership to discover the cure.     Attendees check out Jhpiego's Ebola personal protective suit.     Everyone agrees, game night was a hit!

Office of Management and BudgetLast Thursday, the Trump Administration released an outline of its budget proposal for fiscal year (FY) 2018, proposing dramatic cuts to US agencies involved in global health research and development (R&D) including the State Department (State) and US Agency for International Development (USAID) and the Department of Health and Human Services (HHS), including the National Institutes of Health (NIH). If enacted, these cuts would have significant impact on programs that advance global health innovation and protect the world and Americans from global disease threats. As an introduction to the Trump Administration’s budget priorities, this short and “skinny” budget outline lays out only high-level issues and proposes spending levels for top-line accounts. A more detailed funding proposal is expected in May that will include funding levels for individual agencies and programs. Still, while short on detail, the proposal is clear on targets for proposed reductions: the budget calls for nearly a one-third reduction in funding to State and USAID (cuts of $10.1 billion) and an 18 percent reduction in overall funding for HHS (cuts of $15.1 billion). Within HHS, a one-fifth reduction in funding (cuts of $5.8 billion) is proposed for NIH. The only US agency involved in global health R&D to receive a proposed increase in funding is the Department of Defense (DoD)—which is proposed to receive a 9 percent ($54 billion) boost. It remains unclear whether any of this increased funding would be directed to medical and infectious disease research. Reading between the lines, the President’s “skinny” budget foretells a challenging funding climate for global health R&D at State, USAID, and HHS: State Department and US Agency for International DevelopmentFunding for State and USAID was among the hardest hit in the President’s proposed budget. The blueprint calls for a 28 percent cut to State and USAID base funding, which grows to 30 percent when reductions to overseas contingency funds are included. USAID is a critical component of the US government’s support for global health R&D: In 2015, USAID provided nearly US$80 million in funding to support global health R&D. Cuts to USAID funding could stall promising innovations under development and halt efforts to roll out new technologies in USAID programs. While the President’s proposal does express support for US global health initiatives including the President’s Emergency Plan for AIDS Relief (PEFPAR); the Global Fund for AIDS, Tuberculosis and Malaria; Gavi, the Vaccine Alliance; and US malaria programs; the level of support proposed for these programs remains unclear. Language in the blueprint does not indicate if these programs would continue robust or expanded activities, or indicate whether these programs would be supported at current funding levels. It is also important to note that not all global health programs were called out in the budget, leaving uncertainties about how critical programs supporting maternal and child health, nutrition, tuberculosis, and neglected tropical diseases will be prioritized by the Administration. The budget also articulates a dramatic overall shift in America’s approach to diplomacy and development assistance with specific proposals calling for consolidation of State and USAID activities, linking aid and assistance to strategic interests, and reducing funding for the United Nations and affiliated agencies. It will be important to continue to monitor the impact of these proposals. Department of Health and Human Services The Administration’s budget proposes an 18 percent reduction to HHS funding across the board—cuts that if enacted would bring HHS to its lowest level of funding in nearly two decades. This would significantly reduce funding for HHS agencies engaged in global health R&D, including NIH, the US Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the Biomedical Advanced Research and Development Authority. Not only would cuts of this level have real impact on ongoing and future research needs, they could also undermine America’s leadership in global health R&D and diminish our ability to prevent, detect, and respond to emerging health threats. A full picture of the President’s proposal for HHS is not yet available, but limited details follow below: National Institutes of Health The President’s budget proposes a 19 percent cut to the NIH budget. NIH leads the world in financial support and technical expertise for global health R&D—so cuts of this magnitude would have a detrimental and lasting global impact on ongoing and future research projects. The budget also proposes a reorganization of NIH Institutes and Centers and calls for the elimination of the Fogarty International Center. Fogarty plays an important role in global health R&D. Its programs build partnerships between US and international researchers and strengthen the capacity of scientists in low-income countries to address critical global threats like HIV and AIDS, Ebola, and other emerging infectious diseases. Calls to eliminate this center are concerning. Cutting the Fogarty Center—a small center with a $70 million budget—would save little in the overall federal budget, while increasing our vulnerability to global disease threats. The President’s blueprint also calls for a “rebalance” of federal contributions to NIH research funding, which warrants careful consideration and further monitoring. If NIH research priorities are shifted to align only with disease burden in the United States—as is sometimes proposed—important research on neglected diseases and conditions will be jeopardized, ceding US leadership in this arena and potentially leaving Americans more vulnerable to infectious and emerging disease threats. Centers for Disease Control and Prevention and health preparedness The President’s budget proposal does not include overall funding levels for CDC, nor does it call out specific CDC programs for support or reductions. However, given the magnitude of cuts in the overall HHS budget, it is clear CDC funding is also at risk. The only CDC mention in the blueprint is a proposal to shift $500 million in CDC funding to block grants to be administered by the states. While details on this proposal are scarce, it’s likely these funds would be repurposed from within CDC’s budget, rather than represent new funding. CDC leads the United States’ public health defense system against infectious diseases, so robust funding for the agency is a global health and national security imperative. The agency plays a unique and important role in global health R&D by developing new tools and techniques for disease surveillance, training researchers and health workers overseas, and developing new health tools to advance disease detection, prevention, and response efforts. The budget also proposes the creation of a new Federal Emergency Respond Fund to enable rapid response to public health threats like Zika or Ebola. Such a dedicated fund has been championed by many public health leaders, including former CDC Director Tom Frieden. However, in the President’s request, there are few details regarding the fund’s approach or operations. It remains unclear how large the fund would be, whether it would support preventative R&D, or whether funding for the program would come at the expense of current US government emergency response and preparedness initiatives. As the budget proposal also call for reforms to “key public health, emergency preparedness, and prevention programs” under HHS—which could include CDC and other global health security programs—there remains more questions than answers. Food and Drug Administration The FDA also plays an important role in global health R&D by facilitating the review of new global health products to ensure they are safe and effective before entering the market. While the President acknowledged the need to direct more funding to the FDA, the budget blueprint does not propose increased government support for the agency, but rather calls for doubling user fees paid by healthcare companies for the regulatory review of their products—from $1 billion to $2 billion. Noting the constrained budget environment, the proposal says that companies benefiting from FDA approval “can and should pay for their share.” In addition to user fee increases, the Administration also proposes to take new, unspecified actions to speed the development and approval process for drugs and other medical products. Patient advocate groups and the private sector alike have stressed their belief that current review procedures appropriately balance thorough review of safety and efficacy with efforts to expedite products through the review process. Department of Defense The Presidential budget proposes a 9 percent ($54 billion) increase to discretionary funding for DoD. DoD plays a critical role in R&D for infectious diseases; however, the budget blueprint does not address DoD’s medical research activities and provides little information about what increased defense funding may be targeted. Congressional response and next steps The President’s budget proposal is the first official declaration of policy and spending priorities for the Administration and marks the beginning of months of discussions within Congress and the Administration on how best to allocate funds. Congress ultimately controls government spending, and many members on both sides of the aisle have expressed skepticism or criticism about the Administration’s budget blueprint, including its proposed cuts to foreign assistance and medical research. While there are calls in Congress to reduce government spending, and we may see cuts to US agencies engaged in global health R&D, the spending bills passed by Congress will likely look much different than the President’s proposal. GHTC will continue to monitor the FY18 budget and appropriations process and advocate for robust funding for all programs that support global health R&D.

On February 20, Jamie Bay Nishi joined GHTC as its new coalition director. Marissa Chmiola, GHTC’s communications officer, sat down with Jamie during her third week on the job to find out more about her background, what inspires her, what challenges and opportunities she sees in advocacy for global health research and development (R&D), and what lies ahead for the coalition. What first got you interested in the field of global health and development, and what inspires you about this line of work? Jamie Bay Nishi. Photo: DevexI grew up as overseas as a “diplobrat,” so I consider an interest in international affairs and global development to be in my DNA. As the child of diplomats, I lived in Saudi Arabia, Egypt, France, and Germany, and had the chance to see firsthand the impact of US engagement in diplomacy and global development.I really fell into health as an area of interest after graduating college. I wanted to work overseas, but most of the opportunities available at the time were contractor positions in Iraq as part of the war effort. Because that wasn’t an interest area of mine, I took a job working at the Advisory Board Company where I helped launch their Technology Insights product, advising hospitals in the United States on their clinical technology purchasing needs. While I found the work interesting, I ultimately recognized that domestic health wasn’t my passion, so I pivoted my career trajectory toward the global development field. I earned a Master’s degree in Conflict Resolution and ultimately took a job at then startup-mode Devex, a membership organization and media platform for the development community (basically a Bloomberg for international development). Over a decade later, I am delighted to have landed at an organization that focuses on both health and development, marrying these two interests! What attracted you to the director role at GHTC, and what excites you most about leading this coalition? I joined GHTC after spending nearly nine years growing Devex’s membership, as well as building unique partnerships. When considering the GHTC director position, I was excited about the possibility of diving deeper into a technical area within the global development field, and exploring how my membership-building and media partnership development skills could be applied in the advocacy space. It’s also exciting to take helm of a coalition that has a decade-long track record of effectively mobilizing support for global health R&D. This gives me a strong foundation to build upon, while at the same time offering me the opportunity to consider new approaches to amplify our advocacy for even greater impact.You’ve been on the job for three weeks now. What are your first impressions?In my first few weeks on the job it has been my priority to meet with each of our coalition members. I have been continually impressed by the incredible and impactful work each organization is doing to advance innovation to save and improve lives around the world. It’s truly inspiring.It’s also clear I’ve come into this role at a pivotal time in American political history. The United States has long lead the world in global health and medical innovation, and now more than ever, there is a need for coalitions like GHTC to engage with policymakers to maintain this support and champion continued US leadership in improving health and well-being worldwide. This is especially the case for protecting investments in global heath R&D—forward-looking investments that can sometimes fly under the radar.Your professional background is in stakeholder engagement, strategic partnerships building, and marketing. How does this experience shape your thinking about advocacy and translate into this new role at GHTC? While I am relatively new to the policy and advocacy field, I feel my previous experience in member engagement and communications will be a useful skill set to bring into the advocacy space. I hope to bring a fresh set of eyes to the advocacy challenges we face today and drive forward innovative approaches to build momentum within the coalition and to achieve impact with policymakers.What do you see as some of the biggest opportunities and challenges right now in advocacy for global health R&D? This year has brought dramatic shifts in the US political landscape, which could alter the US government’s historic leadership role in global health R&D. As a coalition and community, we have a lot of work ahead to support continued US, as well as multilateral leadership, and prioritization of global health R&D, which includes efforts to maintain or increase funding. Maintaining bipartisan political support and buy-in will be our biggest priority—and to do this we will have to make sure that as a coalition we articulate both the need for and promise of new global health innovations, in the United States and around the world. Due to the highly nuanced and technical nature of R&D, this can sometimes be challenging to communicate.On the other hand, I am really looking forward to digging-in to expand and deepen GHTC’s relationships with key policymakers and thought leaders in the United States and multilateral space. To really drive the global health R&D agenda forward, it will be critical to broaden GHTC’s constituency to enlist new supporters, and elevate visibility both for the coalition’s advocacy work and the pivotal role R&D plays in the future of global health.Tell us about your vision for GHTC and what you will be focusing on in your first year as director. I look forward to bringing our members together this spring for GHTC’s first ever member summit, where together we will strategize the future of GHTC. I also look forward to adding to GHTC’s core competencies to complement the incredible efforts and activities of my team. I personally want to look at new ways to augment the visibility of the coalition and its members, engage new stakeholders without diluting the core mission and purpose of GHTC, and strategize new communications efforts that will resonate with policymakers.My team as a whole will also be doubling down on engagement with policymakers in Congress, federal agencies, and multilateral entities to promote continued and expanded engagement in global health R&D.What do you enjoy doing in your spare time? I have a lot of hobbies outside of work including being a Zumba instructor, salsa dancer, stand-up paddle boarder and beer/kombucha homebrewer.