News

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. The US Agency for International Development (USAID) and partners recently announced nominees for the Saving Lives at Birth: A Grand Challenge for Development initiative. In related news, plans are “taking shape to merge two offices” at USAID to create an institute that would test and scale up “technologies and innovations to spark major development breakthroughs,” Devex reports. The Treatment Action Group and HIV-iBase have released the 2013 Pipeline report, which calls on leaders in global health, government, and research to commit to and coordinate efforts that will expedite access to effective diagnostic, treatment, and prevention tools. The Infectious Disease Research Institute (IDRI) and Zydus, India’s fourth largest healthcare group, will partner to develop IDRI’s visceral leishmaniasis vaccine candidate. An op-ed in The Guardian by Dr. Anurag Mairal, global program leader of Technology Solutions at PATH, examines the importance of public-private partnerships for global health. “Our nation’s research ecosystem is now in a precarious state as a result of federal policies and proposals that continue to undermine medical innovation,” John Edward Porter, chair of Research!America’s Board of Directions, writes about sequestration in a new op-ed.

  As we discussed yesterday, lawmakers in the House and Senate have been busy with several pieces of legislation that would fund global health and research efforts across the federal government. Our first post yesterday detailed implications for global health research and development (R&D) activities at the US Department of State and US Agency for International Development. Today, we provide highlights for other key agencies involved in global health R&D. Labor-HHS The Senate Appropriations Committee has approved legislation to fund the Labor, Health, and Human Services (HHS) account, which includes support for the National Institutes of Health (NIH) and the US Centers for Disease Control and Prevention (CDC). Currently, there is no House version of this bill—a hearing scheduled for last week was canceled—so while we don’t have those figures to compare funding levels with, we do know that the House allocation for this account is drastically lower than the Senate version. Lawmakers in the House and Senate have been busy with several pieces of legislation that would fund global health and research efforts across the federal government. including the DoD, CDC, FDA, and NIH. The Senate bill would fund the NIH at $30.9 billion, which is a welcome but small increase of $307 million over FY 2013. Many key institutes and centers—including the National Institute of Allergy and Infectious Diseases, the National Institute of Child Health and Human Development, and the Fogarty International Center—were funded at levels higher than the final FY 2013 allocations but lower than the levels President Obama requested for FY 2014. One exception is the National Center for Advancing Translational Science, which received a total of $662.4 million under the bill—a boost in funding of $87 million over FY 2013. This includes a total of $50 million for the Cures Acceleration Network. The legislation would fund CDC at $6.9 billion, an increase of $681 million over FY 2013 and $300 million over the President’s request. This funding includes $391 million for the Center for Global Health, a significant increase of $46 million over FY 2013. The National Public Health Institutes received a $10 million allocation under the bill, which also included a large bump for polio eradication: $146 million versus the $131 million the President requested and the $116 million from FY 2013. The National Center for Emerging Zoonotic and Infectious Diseases was funded at $335 million, an increase of $44 million over FY 2013. FDA The House recently passed its appropriations legislation to fund the US Food and Drug Administration (FDA), providing the agency with $2.485 billion (not including income from user fees). This is roughly $20 million more than the agency received in FY 2013 and $40 million more than the President requested. Language was included in the bill that would ensure the FDA can review products for all neglected diseases, encourage the agency to “build stronger partnerships with global regulatory stakeholders, and strengthen its internal capacity to review products for neglected diseases.” Similar language was included in the Senate version of the legislation, which funds FDA at a higher level of $2.562 billion, or roughly $77 million more than the House version. Defense The full House passed a Department of Defense funding bill, in which the entire agency was provided with $513 billion. The bill would also provide $9.6 million for malaria vaccine development efforts, and welcome language is included in the bill report regarding the need for such a vaccine. The Senate Appropriations Defense subcommittee voted on its version of Defense funding yesterday, July 30th. We’re still waiting for the release of the accompanying bill report to determine any implications for global health R&D. As we pointed out yesterday, it’s clear that many global health R&D programs are being flat-funded year after year. If Congress is unable to reach a long-term budget deal, sequestration cuts will take effect again, further hampering efforts to develop urgently needed new technologies. Congressional policymakers could still reverse this trend by fully funding global health and health research programs through the FY 2014 budget conference later this year, as well as through negotiations around the impending debate on the US debt ceiling. However, with the difficult political climate, it’s unclear whether they will take advantage of this important opportunity. Links to other helpful analyses: American Association for the Advancement of Science Alliance for a Stronger FDA

Recent weeks have seen a flurry of activity for both the House and Senate appropriations committees. Congressional policymakers have approved several pieces of fiscal year (FY) 2014 budget legislation, including bills for accounts that fund global health research and development (R&D). However, with August recess looming and the end of FY 2013 only eight weeks away, it’s looking even more likely that we’re heading for another continuing resolution to keep the government running. Below, we provide highlights from recent Congressional budget activity that will determine funding levels for State and Foreign Operations, including global health and R&D programs at the State Department and the US Agency for International Development (USAID). Tomorrow, we’ll provide an update on budget activities that will impact R&D programs at other key federal agencies that support global health R&D. Congressional policymakers have approved several pieces of FY 2014 budget legislation, including bills for accounts that fund global health research and development. State and Foreign Operations As expected, the Senate version of this bill was much friendlier to several global health programs compared with the House version. The Senate bill would: Provide $8.455 billion for global health programs, which is $140 million above President Obama’s FY 2014 budget request level and $280 million above the House’s version. The difference between the House and Senate versions of the bill seems to be entirely contained in USAID’s Global Health Programs account and the State Department’s family planning programs, as funding for the Global Fund to Fight AIDS, Tuberculosis, and Malaria and the President’s Emergency Plan for AIDS Relief through the State Department were even between the House and Senate. One stark difference between the House and Senate bills is the family planning funding levels. The House version of the bill would prohibit funding to the United Nations Population Fund (UNFPA) and allocates a total of $461 million to all State and USAID family planning and reproductive health programs. The Senate bill, by contrast, includes $670 million for the same accounts, with $40 million of that money going to UNFPA. On a positive note, funding for tuberculosis programs was restored to $236 million, its FY 2012 level, in the House bill and to $225 million in the Senate version—much higher than the $191 million requested by the President. Funding levels aside, the policy language included in the Senate bill report contained several mentions of global health research, including key language on contraceptive R&D: “The Committee recognizes that there is a need to accelerate research and development of contraceptives that are more effective, affordable, and easier to deliver and may also prevent sexually transmitted diseases,” the bill reads, adding that USAID should increase funding to its Office of Population and Reproductive Health for such efforts. There is also some good news in the policy language in the House bill report. On neglected tropical diseases, the House bill “encourages USAID to support research into new drugs to address these diseases,” which is a step in the right direction. The bill also includes supportive language for malaria and HIV vaccines, microbicides, and pediatric HIV diagnostics and treatments. For the first time, it also includes a paragraph on USAID’s role in developing new health technologies: “The Committee continues to support USAID’s health technologies programs, including the development of technologies that maximize the limited resources available for global health and ensure that products and medicines developed for use in low-resource settings reach the people that need such products and medicines.” As with past years, global health programs fared better than other international development sectors in the State and Foreign Operations bills, particularly in the House version. However, as our next update will illustrate, we continue to see a clear pattern of flat-funding key programs across all federal agencies supporting global health and R&D. Combined with the threat of indiscriminate sequestration cuts, this is not an effective way to set long-term fiscal and programmatic goals. Furthermore, in both the short and long term, cuts to these programs undermine the immense progress made in global health research and threaten the future of the US global health mission. Tune in tomorrow for more details. Links to other helpful analyses: Kaiser Family Foundation Science Speaks blog InterAction