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Last week, a bipartisan group of legislators in both the House and Senate introduced the Foreign Aid Transparency and Accountability Act of 2013. Sens. Marco Rubio (R-FL) and Ben Cardin (D-MD) and Reps. Ted Poe (R-TX) and Gerry Connolly (D-VA) introduced the companion bills. Rep. Poe is co-chair of the Congressional Caucus for Effective Foreign Assistance. According to the Modernizing Foreign Assistance Network, the legislation puts in place guidelines on foreign aid that would apply to all relevant US federal agencies, along with metrics to measure progress. It would also require the president to maintain and expand the Foreign Assistance Dashboard, an online resource that allows users to examine, research, and track US government foreign assistance investments. Under the bill, the Dashboard would be broadened to include all US agencies that administer foreign aid programs. Currently, only five are represented: the State Department, the US Agency for International Development, the Millennium Challenge Corporation, the US Department of the Treasury, and the Department of Defense. Sens. Marco Rubio (R-FL) and Ben Cardin (D-MD) and Reps. Ted Poe (R-TX) and Gerry Connolly (D-VA) introduced companion bills that would reform several aspects of US foreign aid programs. A previous version of the bill came very close to becoming law during the last congress—the bill passed the House unanimously, but was held up at the last moment in the Senate. Supporters are hopeful that this new legislation won’t face the hurdles of previous versions, and already there are signs the bill could pass this year. Leaders from the global health and international development community have expressed broad support for the bill and have called on Congress to move it through the legislative process quickly. The reforms in the bill are welcome improvements in how the US government reports on its progress, as well as its challenges, with its foreign aid programs. As is the case with most global health research and development programs, hard data on how programs are funded, successes, and educational failures can be difficult to synthesize. Publicly available data that shows the effectiveness of the broad array of US foreign aid activities could boost support from US taxpayers and communities in target countries—ideally leading to a more adaptive, stronger foreign assistance platform.

In this guest post, Kari Stoever, vice president of External Affairs at Aeras, writes about a new film series that tells the story of the tuberculosis (TB) pandemic. TB kills 1.4 million people each year. Nearly 9 million people become sick with the disease annually. Controlling the global epidemic is anticipated to cost upwards of $24 billion through 2015 in low- and middle-income countries alone. If you’re like most people, this is where you start to tune out. While these numbers are staggering and should worry those of us who live in an interconnected world where contagious, airborne and deadly diseases thrive, most people remain unfazed by such statistics. We’re immune to the millions and billions. But by putting a face on these huge numbers—a story about a real person whom we can relate to—we can reach beyond the confusion and sterility of abstract statistics and motivate people to pay attention and act. Deborah Small, a Wharton marketing professor who has done groundbreaking research on how statistics can suppress giving, claims that it is far better to appeal to the heart than to the head. Feelings, not analytical thinking, drive donations. But how do we create a story that sticks and, hopefully, goes viral? In order for stories to grab a reader’s attention, they must be brief, relevant, and meaningful. They must have the element of surprise. And they must have enough power to make them worth repeating. Aeras produced a four-part film series called EXPOSED: The Race Against Tuberculosis. The series tells the stories of four different people whose lives have been affected by TB. Credit: Aeras. When I first joined Aeras, a global nonprofit biotech advancing TB vaccines, more than a year ago, I remember reading the comprehensive, high-quality report published by the World Health Organization on the status of the TB epidemic. Being a global health geek, I found the statistics astounding and frightening. I couldn’t imagine why so many people outside the global health space thought TB was a disease of the past or that we could be vaccinated and protected from it. These misconceptions inspired me and my team at Aeras to tell the untold story of TB. We decided to capture the stories of individuals who have been impacted by this disease and the front-line heroes working day in and day out to find better solutions to this increasingly challenging epidemic. With gifted filmmaker Mo Scarpelli, we produced a four-part film series called EXPOSED: The Race Against Tuberculosis. The series tells the stories of four different people whose lives have been affected by TB: A young American traveler who contracted multidrug-resistant TB while doing mission work in Africa. A physician in India who does his best to treat people with limited tools. A South African mother who enrolled in a clinical trial to help scientists someday find a vaccine to protect her children from TB. A researcher who dedicated 15 years of her life to finding a new, effective TB vaccine. With this film, we are trying to convey the urgent need for new TB vaccines. We’re doing it by showing how this epidemic is affecting people across all continents and all socioeconomic groups, from the patients and their families who must endure the disease and its onerous and outdated treatment, to the doctors and researchers who valiantly give their time and talent to alleviate the impact of this deadly epidemic. While scientists around the world are working to develop vaccines to protect our families, communities, and countries from this ancient scourge, we also need support from political leaders and the public. Our hope is that this film series educates, inspires, and motivates people to act—to galvanize organizations and governments across the world to make a greater investment in research and development for new vaccines, drugs, and diagnostics. As a global community, we should have righteous indignation that we have allowed this epidemic to come back with a vengeance. Without adequate protection through vaccination, we remain exposed. EXPOSED is a four-part series of short films that tells the story of the deadly global epidemic of TB. The series focuses on current efforts to halt this airborne disease, which is growing more difficult to address, as well as the urgent movement to develop new tools to prevent it. By telling the stories of four inspiring individuals, interspersed with expert commentary from some of the world’s top TB physicians, scientists, advocates, and policymakers, EXPOSED brings viewers to the forefront of the race against TB. We need your help to spread the word. Watch and share at www.aeras.org/exposed . For more information or to organize a screening, email film@aeras.org.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. A new analysis by amfAR, The Foundation for AIDS Research, finds that global health funding accounts for about one quarter of one percent of the total US federal budget. These programs help fight diseases like HIV and AIDS, tuberculosis (TB), malaria, and neglected tropical diseases. As a result sequestration, TB research at federal agencies such as the National Institutes of Health, the Centers for Disease Control and Prevention, and the US Agency for International Development has been reduced significantly. The number of approvals for drug treatments targeting neglected diseases such as HIV and AIDS and malaria has increased in recent years, but research and development spending has leveled off, according to a report from the Tufts Center for the Study of Drug Development. Trevor Mundel, president of the Global Health Division at the Bill & Melinda Gates Foundation, examines how innovative financing can help spur global health research and product development. Reps. Ted Poe (R-TX) and Gerry Connolly (D-VA)—along with Sens. Marco Rubio (R-FL) and Ben Cardin (D-MD)—have introduced companion bills that aim to improve the accountability and transparency of US foreign assistance programs.

Today, the Senate appropriations committee approved a fiscal year (FY) 2014 appropriations bill that outlines funding levels for the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC). The Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) Appropriations Bill would take the positive step of restoring sequestration cuts to CDC and NIH, although there is mixed news for global health programs at the agencies. NIH The bill would fund the NIH at a total of $30.9 billion in FY 2014, restoring this year’s five percent sequestration cut and providing a small increase over last year’s budget. Science Insider reports that the NIH had “strong support” from Senate Appropriations Committee Chair Barbara Mikulski (D-MD), who recently said that she is determined to reverse "reckless cuts to American biomedical research." In her opening remarks earlier today, Sen. Mikulski said, “Because of the investments we have made in NIH over the past decades, … HIV and AIDS is no longer a death sentence, and polio and small pox are essentially eradicated in this country. These medical breakthroughs didn’t just happen, they occurred because this Committee supported NIH, and the NIH supported dedicated scientists who sought knowledge and medical breakthroughs. We must keep up this support.” The bill includes $50 million, five times the FY 2013 level, for NIH’s Cures Acceleration Network, which aims to speed the translation of medical research discoveries in the laboratory that have not advanced far enough to attract significant investments from the private sector. According to Nature, in order to approve a new NIH budget—as opposed to passing yet another continuing resolution for FY 2014—the House and Senate must agree on a common figure for the agency. As a comparison, the House FY 2014 Labor-HHS bill would provide $8 million less for NIH compared with the Senate version. The Senate Labor-HHS appropriations bill for FY2014 would fund the NIH at $30.9 billion and the CDC at $7.022 billion. Credit: PATH/Evelyn Hockstein CDC The Senate bill would provide CDC with $7.022 billion in funding for FY 2014. The bill would restore the $800 million cut from CDC’s budget by sequestration and add a $22 million funding increase. The bill would provide $391.9 million for CDC’s Center for Global Health. This would include $116.9 million for CDC’s Global AIDS Program, which is equivalent to the FY 2013 level, but $15 million below President Obama’s FY 2014 request. The bill would provide $19.3 million for CDC’s Parasitic Diseases and Malaria program, which is comparable to FY 2013 levels, but less than the $22.2 million requested by Obama. CDC’s Division of Tuberculosis Elimination would receive flat funding at the FY 2013 funding level of $140 million. No additional funding for the division’s research programs was allocated. Finally, the bill also contains a total of $19.2 million for Global Public Health Capacity Development. These funds are for a new initiative to support public health capacity building in at least five developing countries over a two-year period to be overseen by CDC. The fate of the Labor-HHS appropriations bill is unclear from this point on. There is a $91 billion funding gap between the House and Senate overall budgets for FY 2014. And while the House Labor-HHS subcommittee has its overall budget, the subcommittee has not announced a date for consideration of a bill. Whatever happens, both the House and Senate must work to protect funding levels at the NIH, CDC, and all federal agencies that support global health and research programs.