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Over the past few weeks—as Congress worked on a budget deal to keep the federal government running through the end of March 2013—several global health and international development groups released new reports about what looming, across-the-board cuts would do to these programs worldwide. Groups are worried about the likely devastating impact of sequestration on US-funded global health, research, science, and development programs. Sequestration would require a reduction in government spending of $109 billion per year for nine years, beginning in January 2013. It’s expected that the resulting indiscriminate, across-the-board cuts would result in a 9.4 percent cut for most defense programs relevant to global health—including global health research and development (R&D) programs at the Department of Defense (DoD). Non-defense programs—including most programs at the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), the US Food and Drug Administration (FDA), the State Department, and the US Agency for International Development (USAID)—that are not exempt from cuts would receive an 8.2 percent cut. Some groups are worried about the likely devastating impact of sequestration on US-funded global health, research, science, and development programs. Below, we provide a round-up of some of these new analysis pieces, detailing the human impact of these sweeping cuts. In an updated analysis, amfAR, the Foundation for AIDS Research, recalculated its estimates on the human impact of budget sequestration on global health. The analysis finds that as the result of sequestration, HIV and AIDS treatment for 276,500 people worldwide will not be available, potentially leading to 63,000 more AIDS-related deaths and 124,000 more children becoming orphans. In addition, 112,500 fewer HIV-positive pregnant women will receive services to prevent transmission to their children, leading to more than 21,000 infants being infected with HIV. The analysis finds that 2.2 million fewer insecticide-treated nets will be procured, leading to nearly 6,000 deaths due to malaria, and that 60,000 fewer people with tuberculosis will receive treatment, leading to 7,000 more deaths from the disease. A new analysis from the American Association for the Advancement of Science (AAAS) finds that sequestration would “no doubt have significant impacts on federal funding of science, research, and innovation.” The analysis aims to provide a complete picture of the size of these potential cuts by estimating budget impacts for most key R&D agencies, and the funding ramifications by state, over the next five years. It found that the NIH could receive a cut of $11.3 billion over five years, averaging $2.3 billion less per year for research. The DoD could average $6.7 billion less for R&D per year, while the National Science Foundation could receive $2.1 billion less over five years. Total cuts through fiscal year 2017 would amount to $57.5 billion. “The resulting R&D budgets at most agencies would be lower than they've been in several years,” according to AAAS. Bread for the World has released a document that details the impact of sequestration on the international affairs budget. It finds that sequestration would result in reductions to international affairs funding that would entail about $1.7 billion in cuts to poverty-focused development accounts, including a $670 million cut to global health programs. These cuts would mean “[m]ore lives would be needlessly lost due to infectious disease and more children would be born HIV-positive,” according to the analysis. Research!America has also released an updated analysis on how sequestration would affect health research and science at key US agencies. Based on fiscal year 2012 numbers, the report finds that the NIH could lose $2.5 billion, the CDC could lose $479 million, and the FDA could lose $318 million for their R&D efforts. Sequestration would ultimately put health research “at the breaking point,” according to the report. With most members of Congress gearing up for the November elections, we hope that they’re paying attention to these reports and listening to the chorus of voices calling for a real, long-term solution to the budget. Both Mitt Romneyand Barack Obama have been taking about foreign assistance lately, and the issue will stay on the candidates’ minds as they participate in an upcoming debate focused on international issues. Preventing sequestration needs to be a priority in these conversations.

In this guest post, Kirsten Thompson, MPH, and J. Joseph Speidel, MD, MPH, of the University of California, San Francisco, write about the need for new and improved contraceptive options worldwide. Today marks World Contraception Day, and there is much to celebrate about the successes of modern family planning. Women all over the world are having smaller, healthier, and more prosperous families, thanks in part to increased access to safe and effective contraception. As Melinda Gates points out, there is no controversy in empowering women to decide if and when to have a child. But the contraceptive revolution is far from finished. An estimated 222 million women in developing countries want to delay their next child or limit the size of their family, but are not using a contraceptive. As we near the deadlines for the Millennium Development Goals and the Every Woman, Every Child campaign, improving contraceptive access is one of the most cost effective solutions to reduce maternal and infant mortality, and prevent mother-to-child transmission of HIV. Voluntary use of contraceptives already prevents 218 million accidental pregnancies, 118,000 maternal deaths, and 1.8 million infant deaths each year—we could prevent millions more accidental pregnancies, and maternal and infant deaths with expanded access. Voluntary use of contraceptives already prevents 218 million accidental pregnancies, 118,000 maternal deaths, and 1.8 million infant deaths each year—we could prevent millions more with expanded access and increased R&D. Photo credit: PATH. Global leaders have committed to help expand access to family planning services, particularly in nations with underdeveloped health systems. While expanding access is critical to reaching global health and development goals, we also need to reinvigorate contraceptive research and development (R&D). Do we need new contraceptives? We’ve learned a lot about how women and men use family planning over the last 50 years, including what they like and don’t like about various contraceptives. In developing countries, the most common reasons for not using contraception—cited by 20 percent to 50 percent of married women at risk of an accidental pregnancy—were side effects, health concerns, and inconvenience. Up to half of women had stopped using a method because they experienced or feared side effects. It’s clear that some women find hormonal side effects unacceptable. We’ve also learned that humans find it almost universally difficult to take daily medication. Over half of people taking daily medicine regularly fail to take it, whether it’s a birth control pill, a medicine to treat high blood pressure, or an antibiotic to prevent a transplanted organ from being rejected. Taking any medication inconsistently means is doesn’t work as well. So in reality, we have only two highly effective and reversible contraceptives: the implant and the intrauterine device (IUD). Both of these require highly skilled healthcare providers for placement and removal, and for some women, they are prohibitively expensive. So we need to focus our efforts on creating, safe, effective, and innovative methods of family planning that can be used in low-resource settings. Research shows that there is demand for methods that don’t yet exist, such as: User-controlled methods that do not require daily action for effectiveness. Methods that prevent transmission of HIV and pregnancy simultaneously. Methods for women that do not require a male partner’s participation or knowledge. Methods that could be used once to prevent pregnancy around the time a woman has sex. Non-surgical methods of sterilization. No one contraceptive method works for everyone, and we know that offering a wide range of methods increases satisfaction with family planning services and increases the number of couples using contraception. Public funding for contraceptive R&D is critical and effective Of the contraceptives now available in the United States, the majority were developed with public funding at universities and nonprofit organizations, or with philanthropic support. The original birth control pill became available after support from philanthropists, and a new IUD under development by Medicines360 will follow suit. The Mirena and ParaGard IUDs, Ella emergency contraception, and the contraceptive vaginal ring were all developed with US public funding. The first implantable contraceptive Norplant, the female condom, and the new SILCS diaphragm were all developed with philanthropic and public funding. The injectable contraceptive Depo Provera was developed with private funding, but the studies that allowed it to be marketed in the US were carried out with public funding. The public sector—including the US Agency for International Development, the National Institutes of Health, and the World Health Organization—has a great track record for contraceptive R&D. The public sector is also able to conduct R&D at approximately one-tenth the cost of private pharmaceutical companies. With mergers and new management at large pharmaceutical companies in the last decade, none of these companies have active contraceptive R&D programs. The US public sector has been a global leader in past contraceptive R&D, but funding for this work has steadily declined in the last 30 years. The time is right for the US government to reinvigorate its commitment to leadership in this field, and reap the benefits in maternal and child health globally.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. GHTC member Aeras has announced that it has signed an agreementwith GlaxoSmithKline Vaccines (GSK) to jointly advance the development of a tuberculosis (TB) vaccine candidate. A new series in the Financial Times looks at neglected tropical diseases, including their economic burden, the need for improved treatment methods, and the need for research and development funding. Genocea Biosciences, a company that advances vaccines for infectious diseases, has raised $30 million in new funding from groups like the Bill & Melinda Gates Foundation. An article examines how the priority review voucher program, an “innovative funding model for research into neglected diseases,” has “finally come of age.” GSK also announced this week that it plans to make clinical trial data available to other researchers, as well as open its TB compound library to help stimulate research.

In this guest post, Rachel Cohen—regional executive director of the Drugs for Neglected Diseases initiative (DNDi) North America—writes about the need for research to develop new health products for neglected tropical diseases (NTDs). This post originally appeared on the US Agency for International Development’s (USAID) Impact blog . The United States government and its country partners should be commended for the tremendous achievements in the fight against neglected tropical diseases (NTDs) as part of the USAID NTD Program. When it comes to research, the US government also plays a major role in NTDs: the National Institutes of Health is by far the largest funder of basic research for NTDs. The commitment to NTD implementation programs and research has spanned several presidential administrations, receiving widespread bipartisan support from both sides of the congressional aisle. However, not all NTD research is created equal. Beyond basic research, much more research and development (R&D), including late-stage product development, for new drugs, vaccines, and diagnostics is urgently needed for those NTDs where adequate tools do not exist. Without such new tools, disease control and elimination will not be possible for certain NTDs—greater investments in research are urgently needed. For example, when it comes to the filarial parasitic-worm diseases of river blindness (onchocerciasis) and elephantiasis (lymphatic filariasis), which together infect over 150 million people, the standard treatment of ivermectin, alone or in combination with albendazole, can lead to brain damage or death in people co-infected with loiasis (Loa loa, also called African eye worm). Also, current drugs kill only juvenile and not adult worms, which continue to infect, requiring repeated mass drug administrations. The Drugs for Neglected Diseases initiative (DNDi)—a nonprofit R&D organization—is looking to develop a new macrofilaricide (a drug targeting adult worms) to address this gap in NTD treatment. Of the 17 NTDs defined by the World Health Organization, DNDi focuses most of its attention on the three with the highest case fatality rates—African sleeping sickness, Chagas disease, and kala azar (visceral leishmaniasis, or black fever). These diseases are not yet included in the USAID NTD Program. Although cases of African sleeping sickness (human African trypanosomiasis) have dropped over recent years, this fatal disease continues to infect people in remote, conflict-ridden pockets of the Democratic Republic of Congo, among other hotspots. Diagnostic tools are inadequate—painful lumbar punctures must be performed—and the current treatment requires hospitalization and intravenous infusions, which are difficult in unstable, resource-poor settings. DNDi is therefore aiming to develop an easy-to-take oral pill for sleeping sickness, which can treat both stages of the disease and do away with the need for painful lumbar punctures. This would go a long way in helping eliminate the disease once and for all. While continuing to provide existing medicines for NTDs, greater commitment to developing new NTD treatments and other tools is sorely needed if disease control or elimination is to be achieved. Patients infected now with these neglected afflictions are anxiously waiting.