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In this feature on Breakthroughs, we provide an update on what’s currently happening with global health in Congress and an outlook for future legislative activity. Following the August recess and Labor Day Holiday, Congress is now back for a very brief time before it takes another break to focus intensely on campaigning ahead of the November elections. We don’t expect much action on legislation specific to global health or research programs. Instead, Congress will focus on passing a Continuing Resolution (CR) for fiscal year 2013 in order to keep the government running through the end of March 2013, as members juggle the remaining legislative tasks on their plate. The CR actually includes a tiny 0.6 percent increase across the board for all federal programs, including those that fund global health research. However, the resolution will expire long after the looming budget sequestration goes into effect in January 2013 and will also run into the fiscal year 2014 budget process, effectively creating a budgeting perfect storm. Advocates for a wide range of federal programs are in high gear to convince Congress to delay sequestration or to pass a balanced budget in its place. Some of those advocates have found congressional allies willing to take on their cause. Also this week, we’re looking for a report from the Obama Administration on the potential impact of sequestration on federal agencies. As we outlined in our last update, sequestration could result in cuts ranging from 8.5 percent to 14 percent to most federal programs, depending on the outcome of the budget negotiations in Congress and the November elections. Sequestration would undoubtedly have a significant impact on global health and research programs at agencies like the Centers for Disease Control and Prevention, the Department of Defense, the US Food and Drug Administration, the National Institutes of Health, and the US Agency for International Development. We’re eager to see this report and learn more about how sequestration might impact efforts supported by these agencies to develop new lifesaving global health tools. Global health research and development (R&D) programs span the breadth of the US budget. Congress needs to work to protect these essential R&D programs from disproportionate cuts and ensure that funding is sustained—and increased if possible—for the coming years. Although the elections may be on the top of everyone’s to-do list for now, temporary budget fixes that leave these activities vulnerable to indiscriminate cuts and similar actions will not work forever. We need a plan that protects global health R&D and other key programs for the long-term, and right now, that job starts with Congress.

Rachel Wilson is the senior director of policy and advocacy at PATH, a GHTC member. She wrote this guest post in reaction to last week’s conference on child health in Washington, DC. The Child Survival Call to Action that took place last week in Washington, DC, was a unique opportunity for 700 stakeholders working in the government, the private sector, faith-based organizations, and civil society to come together to kick off a long-term, focused effort to save children's lives. While the goal of the Call to Action— to decrease annual preventable childhood deaths to two million by 2035—may seem daunting, we ought to remind ourselves that we already have many of the tools at our disposal to achieve success. Existing health commodities like oral rehydration solution and zinc effectively treat life-threatening dehydration caused by severe diarrhea, one of the leading killers of kids. Insecticide-treated bednets can prevent malaria—another deadly disease for children—and help save half a million lives per year. Solutions like these are simple and affordable, and ought to be expanded so that all children, no matter where they live, can access them. However, to fully answer the call to end preventable child deaths, we also need to determine where there are gaps or where alternatives may need to be added to the portfolio of solutions that are currently available. So, in addition to ensuring access to current interventions, new tools are needed to address the leading killers of kids. To that end, PATH is working in partnership with private-sector partners to develop vaccines to prevent diarrhea, pneumonia, and malaria and better diagnostics to detect diarrhea and malaria. Finally, we are working with our new drug development affiliate OneWorld Health on new formulations for oral rehydration salts and new malaria drugs to treat diarrhea and malaria, respectively. In a similar vein, it is imperative that we invest in innovations that enable us to deliver products—like vaccines—in a safe and cost-effective way. PATH is developing an innovative technique to fully immunize children using less vaccine—a cutting-edge way of spending less money to save more lives. Our new president and CEO, Steve Davis, spoke on a panel around innovation on the second day of the conference where he discussed how collaboration, which the Call to Action exemplifies, is an essential element of innovation. The US Government has been an incredible champion of innovation over the years. According to a recent report put out by the Global Health Technologies Coalition and Policy Cures, the United States is the world’s leader in investments in global health research and development, which have led to some game-changing innovations. These discoveries have contributed to the remarkable progress in the area of child survival. In the last 50 years, child deaths have dropped by 70 percent worldwide, and in the past two decades alone, child deaths have plummeted from 12 million in 1990 to 7.6 million in 2010. This rapid progress is largely due to high-impact solutions, notably new and low-cost vaccines and improved health services. However, without US ingenuity and the foresight to invest in the science that gave rise to these solutions, these gains would have been far less dramatic. The goal of the Call to Action ought to be commended. We have the simple solutions available today to make that happen. And we can save even more lives if we also focus on the health tools and technologies on the horizon. Let’s be sure to answer the call.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. The Food and Drug Administration has approved the use of a new diagnostic test developed by the Centers for Disease Control and Prevention for earlier detection of dengue fever in the United States. Research!America has launched a new ad campaign that promotes US federal investments in driving research for new global health tools. A recent article in the Journal of Medical Microbiology discusses some of the scientific, financial, and ethical challenges in vaccine development. A new report by BIO Ventures for Global Health and the Biotechnology Industry Organization found that small- and medium-sized biotechnology companies are tackling the development of treatments, diagnostics, and other tools for neglected diseases. Congressman Edward Markey (D-Mass.) calls for a “detailed understanding of the harm” that mandatory cuts in the US federal budget to agencies such as the National Institutes of Health “pose to vital health programs upon which millions of Americans around the nation rely.”

Dr. Bríd Devlin is the executive vice president of product development of the International Partnership for Microbicides (IPM), a GHTC member. In this guest post, she writes about a new study IPM launched last week that will look at a new HIV prevention option for women. Last week, IPM announced The Ring Study, a Phase III efficacy trial to determine whether a monthly antiretroviral (ARV)-containing vaginal ring can safely and effectively help prevent HIV infection in women. This product could provide women with discreet, long-acting, and easy-to-use protection. In my role, I oversee IPM’s drug development projects. After working on a variety of drug delivery technologies for over 18 years, I cannot overstate how excited I am about a ring for prevention of HIV—this could be a real game-changer. The ring is a platform technology that has been used successfully for other medical purposes for decades. IPM has adapted the ring to potentially stem the spread of HIV to women in sub-Saharan Africa, the epicenter of the epidemic and where our studies show high acceptability for such a product. While highly effective, current HIV prevention options often cannot be used by women who are disproportionately vulnerable to infection. The ring is a promising way to expand women’s prevention options on multiple levels. First, several studies have shown that the same types of ARV drugs that successfully treat HIV may also protect against infection before it has a chance to take hold. In addition, by offering women sustained, monthly protection, it could overcome the burden of adherence, which is crucial to achieving the protective benefit offered by ARV-based prevention. As Sarah Boseley of The Guardian wrote in her recent blog, it’s a tool that “women can wear and forget about—at least for a month at a time.” The ring is also female-initiated and discreet. This means women can control their own HIV prevention without having to rely on a male partner’s cooperation or action. IPM has announced The Ring Study, a Phase III efficacy trial to determine whether a monthly antiretroviral (ARV)-containing vaginal ring can safely and effectively help prevent HIV infection in women. Additional studies in the field are looking at other approaches to female-initiated prevention, such as gels used around the time of sex and daily pills. It is important for women to have a range of options so that they can choose a product that best meets their needs and preferences. This year, IPM celebrates its 10th anniversary and a decade of progress in helping to advance HIV prevention for women. We have not arrived at this milestone alone. Partnership is at the core of our business model and mission. By working with partners across the public and private sectors, we amplify our individual resources and scientific ingenuity to help meet the health needs of women everywhere. For instance, the National Institutes of Health-funded Microbicide Trials Network will begin a larger Phase III “sister” study of the ring called ASPIRE in the coming months. Given its promise as a delivery mechanism, IPM is adapting the ring to meet the unique needs of women. With funding from the US Agency for International Development, we are developing a dual-purpose prevention ring designed to provide both HIV protection and contraception in a single product. We are bringing together global leaders to talk about the urgent need for multipurpose prevention technologies at Advancing the Integration of HIV and Sexual and Reproductive Health, a satellite session IPM is cohosting with Women Deliver at the upcoming International AIDS Society (IAS) conference. In late July, thousands of HIV scientists, policymakers, and activists will descend on Washington, DC, for the IAS conference. The theme is “turning the tide together” and one topic that will be highlighted is promising developments in HIV prevention. IPM looks forward to the ring being part of that conversation.