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Congress continues to debate how to keep the government running in the midst of a rollercoaster appropriations process, while at home and abroad global health research and development (R&D) programs struggle to continue their work and simultaneously juggle looming funding reductions. While the President's budget request for global health programs for fiscal year (FY) 2012 included funding increases in several areas, the outlook for global health funding in Congress is not as promising. Due to difficult economic times and conflicting priorities between the House of Representatives and the Senate, it seems unlikely that Congress will sustain the levels we saw in 2011 for additional years. The House of Representatives approves of deep cuts in nearly every government program. However, the Senate appropriation levels are much friendlier to global health and to foreign assistance overall, compared with the House levels. The two chambers must now reconcile the two different versions, while following the spending cap rules required by the new debt reduction law. In addition to the appropriations activities outlined above, the Congressional Debt Reduction Committee (the 'super committee') also must weigh in on funding levels for the next several fiscal years. It has until November 23 to make its recommendations to Congress for cutting at least $1.2 trillion over 10 years. To add yet another factor to this complicated equation, since Congress has (again) failed to complete the appropriations process by the end of the fiscal year, urgent continuing resolution legislation (CRs) have been required to keep the government open until the process is finalized. The CR currently up for debate enacts an across the board rescission of 1.5% from FY2011 levels to all government programs, but contains no other cuts targeted at international development or global health accounts. This is a temporary blessing for important programs that must continue its progress while funding levels are hammered out. It is likely that several CRs will be needed to buy enough time for Congress to negotiate the FY2012 budget. To read more details about specific global health programs and the appropriations activities in Congress read this piece.

This week, the GHTC is in Kenya, meeting with several GHTC members conducting ground-breaking work. Here are some photos from the field: Photo: Evelyn Hockstein/PATH Kombewa, Kenya - Martha Omondi puts her daughter Mercy Gloria, 3, under a mosquito net to take a nap. Photo: Evelyn Hockstein/PATH Siaya, Kenya - Fabian Oduor holds his sister Brittany's hand while she receives treatment for Malaria at the Siaya District Hospital in Western Kenya. Photo: Evelyn Hockstein/PATH Vihiga, Kenya - A mother vaccinates her child with pneumococcal vaccine at Vihiga District Hospital in Western Kenya. The free vaccine, manufactured as a result of donor support via an advance market commitment, is now administered to children under twelve months of age; protecting thousands of children across the country. Photo: Evelyn Hockstein/PATH Vihiga, Kenya - Festus Chabuga, who is HIV positive, receives ARV's at Vihiga District Hospital. "I feel fortunate I have the drugs. If the drugs were not available, I would have died by now." Photo: Evelyn Hockstein/PATH Vihiga, Kenya - Rister Kageha, 35, with her baby Sylvia Mboga, who is 14 months, at Vihiga District hospital. Rister learned she was HIV positive a month before she gave birth to her daughter Sylvia. She was put on ARV's in June 2010 and gave birth in July. Her baby was given Nevarapine after birth and is HIV negative. Photo: Evelyn Hockstein/PATH Kakamega, Kenya - Peter Owiti Motsi, a member of the Elwesero Men's Initiative Support Group, explains how ARV's have transformed his life from one of illness from HIV to health. His children are all negative, and now he is strong, able to farm, and lead a positive productive life. The men's support group helps educate, encourage, and support each other as they live life with HIV. Photo: Evelyn Hockstein/PATH Rawa, Kenya - Sharon Akinyi Ouma, 27, holds her daughter Winfrey Juma, 16mos, outside their rural home in Western Kenya. Sharon said she was happy to join the TB vaccine trial, because she would be helping children all over Africa. Photo: Evelyn Hockstein/PATH Kisian, Kenya - Wilfred Murithi, assistant research officer at KEMRI/CDC in Kisian, Kenya, prepares a sample to detect TB resistance to ritampicin, a TB drug.

John Donnelly, a writer working with the GHTC, is blogging following our trip to visit global health research projects in Kenya. This is his third post from the field. KISUMU, Kenya – The shortcomings in the tools to fight tuberculosis (TB) are stunning. There is no effective TB vaccine beyond childhood. The most common TB diagnostic tool was developed in the 1880s and fails to detect the bacterium in half of the cases. And the drugs needed to treat TB are also ancient – the most recent ones were developed more than 40 years ago. As a result, resistance to TB drugs has run wild in parts of the world. There are an estimated 440,000 cases of multi-drug resistant TB globally, and at least 58 countries have reported cases of extensively drug resistant TB, which can be incurable. “TB is an example of what happens if you fail to invest in research,” said Kevin Cain, TB Branch Chief at the KEMRI/CDC Research and Public Health Collaboration in Kisumu. The Kenya Medical Research Institute (KEMRI) and the US Centers for Disease Control and Prevention (CDC) have been partnering together in the country for more than 30 years. “It means you end up with a diagnostic tool that is over a century old, you are using drugs from the 1960s and older. And you end up with the situation we are in: many cases of extensively drug-resistant TB, which can be untreatable.” But in western Kenya, and in several other research sites around the world, clinical trials are ongoing for a new vaccine, drugs, and diagnostics. On GHTC’s trip to Kenya, we were able to see participants of a Phase II trial of a TB candidate sponsored by Aeras, a GHTC member and non-profit product development partnership (PDP) dedicated to the development of an effective and affordable TB vaccine for all age groups. Currently, the Bacille Calmette-Guérin (BCG) vaccine, which is over 80 years old, is only partially effective; it provides some protection against severe forms of pediatric TB, but is unreliable against adult pulmonary TB. The trial in western Kenya involves giving two doses to children: one on the initial visit and a second 28 days later. Dr. Samuel Ouma, a physician working on the TB trial, said that 144 children have enrolled at his clinic in Boro. The trial offers free health care to the babies enrolled in the study. We met with one of the mothers of the children in the study. Sharon Akinyi Olunga, 27, said she asked many questions before enrolling her baby, Winfrey Atieno Juma, now 13 months old. She said she was very happy she had enrolled her daughter. “It’s good for our babies,” she said. “I loved that my child should go into this research project first because if anything happened to her, whether she was sick with a cold or pneumonia, she would immediately receive free medical care. Here, funding for medical care is really difficult to get. So it put me at ease.” Olunga said there was another reason she wanted her daughter to be part of the trial: it served a greater good for children around the world. “I think of so many babies, so many children in Africa and around the world, have been helped by vaccines,” she said. “If this vaccine works, that means all those children will be helped by my baby’s participation. That makes me feel very good.” Watching Olunga was her grandmother, Hilda Auma Juma, who was in her 70s. Juma also said she was glad to see medical research in her village and in neighboring villages. “I am happy because it helps the health of all babies,” said Juma, who had nine children. She said health care has dramatically improved for mothers and children compared to the situation a half-century ago. “In my time, when I gave birth, mothers only had the faith of God to take care of the babies,” Juma said. “Now mothers have all these vaccines. Babies and children are living. We hope we may soon have more vaccines. It’s wonderful.”

John Donnelly, a writer working with the GHTC, will be blogging this week from our trip to visit global health research projects in Kenya. This is his second post from the field.ELWESERO, Kenya -- In the year 2000, Kenya had just a handful of HIV-positive people taking antiretroviral drugs.Today, just 11 years later, the country has a half-million people on these drugs, which have saved many from an early death.While much of the focus of this feat has gone to the extraordinary efforts to expand the access to treatment—the government of Kenya, the US President’s Emergency Plan for AIDS Relief (PEPFAR), and the Global Fund to Fight AIDS, Tuberculosis, and Malaria take much of the credit—little acknowledgment has been given to the research that made it possible.On GHTC’s trip through Kenya this week, the impact from research of years ago is being felt throughout the country. And the promise of today’s research is being eagerly talked about among health workers, as well as mothers and fathers who are hopeful for more lifesaving innovations.At the Elwesero Men Initiative Support Group on Thursday in western Kenya, about 10 members came to meet us. A few stood to tell stories of nearly dying from AIDS and then recovering rapidly because of the medication.Photo: Evelyn Hockstein/PATHPeter Owiti Omotsi, 39, father of five, was a former bus driver in Nairobi. He said he began to feel sick. At first, he said, it felt like malaria, with fevers and chills. “Then I felt I was bewitched,” he said. “My body was wasted.” He dropped from 175 pounds to 125 pounds.In 2008, he tested positive for HIV. His wife tested negative. His CD4 count was 95; anyone under a 200 count at the time was put on antiretroviral drugs. He started treatment, and he improved dramatically.“I carry these drugs with me everywhere I go,” he said, holding up a packet of the medicine. “The rest of my life is because of these drugs. My life has changed. I used to drink a lot and smoke. Now I do none of that. I eat nutritious foods. With God and these drugs, my life can be prolonged.”Another member of the support group, Peter Lumumba, 49, thanked researchers for saving his life.Lumumba, a father of six, was first diagnosed with HIV in 1987 and started antiretroviral treatment in 2006.“I am now well,” he said. “People are totally astonished. I helped start this support group, and when we are telling people we are (HIV) positive, they will say, ‘No, you are lying." Without the research that led to this lifesaving medicine, he said, “I would have already died. “ Photo: Evelyn Hockstein/PATH Later in the day, Omotsi took us to his home on a hillside in a village named Ematsayi. He showed off his garden of spinach, maize, onions, kelp, watermelon, peppers, bananas, papayas, and a local vegetable called managu.“Everything in the garden has high nutritious value,” he said as he waited for his children to return home from school.He said if he could talk with the researchers who produced the various antiretroviral medicines, “I would tell them that they can see right here the benefits of what they created. They can see my life. These drugs work. I believe before I die, I will see my grandchildren. Without these drugs, that probably wouldn’t happen. But I have some years to live now. I can at least be proud of my grandchildren.”