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On Thursday, the House Appropriations Committee will vote on a State and Foreign Operations (SFOPS) appropriations bill for fiscal year (FY) 2013, which will include funding levels for global health and other programs at the State Department and US Agency for International Development (USAID). This vote follows last week’s markup of the bill by the House SFOPS appropriations subcommittee. Overall, the subcommittee’s bill had mixed results for global health and other programs at USAID: while some programs were sustained at FY 2012 levels, others saw significant budget cuts that will affect the agency’s efforts worldwide. Under the subcommittee’s bill, the entire State and Foreign Operations account was cut by nine percent. Many bipartisan programs like the President’s Emergency Program for AIDS Relief (PEPFAR) were flat-funded at FY 2012 levels. USAID’s global health funding, which contributes to global health research and development (R&D) projects, was cut by six percent, a decrease of roughly $150 million. USAID’s operating budget was also slashed by 5%, which will affect all of its programs. No funding levels were outlined for the many disease-specific programs at USAID. These disease-specific funding levels could be added to later versions of the bill, or could be left up to the Obama Administration once the entire appropriations process is completed. The only exception was family planning, which was slashed by one-quarter and given a new overall funding cap of $461 million—$149 million below the FY 2012 levels. It’s important to remember that the final SFOPS budget for FY 2013 will probably look different from the House bill being considered this week. The Senate is working on its own version of the appropriations bill, and both versions will eventually have to be negotiated if Congress follows a typical appropriations process (which it hasn’t done in the past few years). Whatever the final SFOPS budget looks like, it’s critical that Congress fully funds USAID so it can continue its work in all areas of global health, including the agency’s support of R&D to develop new health tools. And if it’s left to the Administration to make decisions about disease-specific program funding at USAID, funding for R&D and innovation for all disease areas needs to remain a top priority at the agency. USAID plays a huge role not just in funding product development to combat global health challenges, but also ensuring that new technologies are appropriate for the communities where they will be used. Some of the tools that have benefited from USAID funding and expertise include the RTS,S malaria vaccine candidate, the groundbreaking CAPRISA microbicide trials, and the Xpert TB diagnostic. USAID also works in partnership with many critical players in the global health R&D space, such as other US agencies, the private sector, nongovernmental organizations, and universities. It’s clear that USAID has seen major successes in its support for global health R&D. As the House Appropriations Committee votes on the SFOPS bill on Thursday and the budget process continues, Congress will have to decide whether it should boldly support USAID’s goal of developing new health tools—tools that are projected to save millions of lives—or withdraw this support and risk halting scientific advancement in its tracks.

Late last week, the National Center for Advancing Translational Science (NCATS) at the National Institutes of Health (NIH) unveiled a pilot program that aims to speed the creation of new drugs. Under the program, three pharmaceutical companies have agreed to make dozens of their failed compounds available to researchers, who will investigate if the compounds can be re-purposed into successful treatments for other diseases. The HIV and AIDS drug AZT, which was born out of an unsuccessful cancer treatment, has been cited as a prime example of the potential for this new program. At the launch event, NIH Director Francis Collins highlighted that the NIH needs to “speed the pace at which we are turning discoveries into better health outcomes.” He also emphasized the urgent need for new cures for patients suffering without any available treatment options. With NCATS, an exciting potential exists for new tools to combat neglected global health diseases. Photo credit: PATH The new program embodies the public-private partnership model. In 2013, $20 million in US Government grants from the NIH will fund researchers to work with compounds provided by private-sector pharmaceutical companies in pursuit of new treatments. As of now, over 20 compounds have been committed by the three companies. Kathy Hudson, acting deputy director of NCATS, hopes that many more will be available by the time the program releases its first Request for Applications (RFA) next month. No information is currently available from NCATS on what compounds will be available, or what diseases the program hopes to tackle. We won’t have that information until the RFA is public. In setting his goals for NIH at the beginning of his tenure, Collins stated that global health would be a top priority for NIH as an organization. Now that NCATS—which focuses on spurring drug development for neglected diseases of the developing world, as well as rare diseases—is established and this new program has been launched, an exciting potential exists for new tools to combat neglected global health diseases. Since its inception, NCATS has unfortunately been slow to take up initiatives that target global health diseases, as many of the NCATS programs announced thus far focus primarily on rare diseases that affect US populations. Rare diseases absolutely deserve funding, support, and targeted research—as do global health diseases. As shown in our recently released report, the United States leads the world in global health research and development. Under this leadership, who knows what groundbreaking cures for global health diseases could be created with the compounds included in the new program? At the press conference, patient advocate Michael Manganiello spoke enthusiastically about his experience as a patient saved by AZT. “Without partnerships between the NIH and industry, I would not be here to give this statement today,” he said. HIV and AIDS is just one example of the range of global health diseases that remain in urgent need of new tools. Think of how far we have advanced from a time when there were no treatments for HIV and AIDS, and think of what progress could be made in other neglected diseases under this new program. With this new therapeutics program, NIH and NCATS have created an exciting, innovative model for collaboration between the public and private sectors. They should be applauded for it. Now NCATS must ensure that research for neglected diseases is encouraged and supported through this initiative. NCATS has the opportunity to jump start innovation that will one day save lives and create better health outcomes—an opportunity that should be shared with patients around the world.