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GHTC submitted written testimony to the Senate State, Foreign Operations, and Related Programs (SFOPS) appropriations subcommittee urging them to sustain and protect global health research and development (R&D) funding at the US Agency for International Development (USAID) in the fiscal year 2024 (FY24) budget. Global Health Technologies Coalition Outside Witness Testimony for the RecordSubcommittee on State, Foreign Operations, and Related ProgramsJamie Bay Nishi, Executive Director, Global Health Technologies CoalitionOn behalf of the Global Health Technologies Coalition (GHTC), a group of 45 nonprofit organizations, academic institutions, and aligned businesses advancing policies to accelerate the creation of new drugs, vaccines, diagnostics, and other tools that bring healthy lives within reach for all people, I am providing testimony on fiscal year 2024 (FY24) appropriations for global health programs at the US Agency for International Development (USAID). These recommendations reflect the needs expressed by our members working around the globe to develop new and improved technologies for the world’s most pressing health issues. We appreciate the Committee’s support for global health, particularly for continued research and development (R&D) to advance new drugs, vaccines, diagnostics, and other tools for long-standing and emerging health challenges.I am testifying today because we still do not have the technologies that we need to achieve a future where pandemics are prevented, and health is within reach for everyone. In 2019, at least 1.27 million people were killed by antibacterial resistance. In 2021, 1.6 million people were killed by tuberculosis, 1.5 million people were newly diagnosed with HIV, and 247 million people were infected by malaria. Today, more than 1 billion people worldwide are still affected by neglected tropical diseases. Unfortunately, it is women and children who are often the most vulnerable. And as we look toward the future, we cannot afford to sit idly and wait for future pandemic threats with the potential to match or exceed the disruption of COVID-19.To develop the technologies that we need to defeat these diseases and to prevent future pandemics, the US government needs to sustainably increase its investments in global health research programs. Public funding is critical for this sector because companies have little commercial incentive to invest in health areas that impact people in poverty. As the world’s leader in biomedical research, the United States has both a responsibility and an opportunity: with relatively small public investments, we have the power to save and improve millions of lives.To continue our progress toward developing lifesaving tools, we respectfully request:Increased or sustained funding levels for every global health program under the US Department of State and USAID.Creation of a new, additive Supporting Innovative Global Health Technologies (SIGHT) Fund under USAID for global health innovation at $250 million in FY24.Inclusion of report language directing USAID to increase global health innovation spending.Inclusion of report language requesting that USAID produce an annual report on its global health research programs.USAID has provided unparalleled support for the late-stage development of global health technologies for decades. It is the only US agency with a mandate to improve global health that supports the development of global health products from early-stage concepts to delivery around the world. USAID identifies innovation gaps, sponsors clinical trials, and scales new technologies to communities in need. Additionally, USAID uses novel financing models, builds interagency and multisectoral partnerships, and applies a business mindset to stretch the US government dollar for maximum impact. The agency’s value-add is driving late-stage research and scale-up of global health products that offer significant public health benefit but are not supported by other public or private funders.Still, USAID’s global health innovation mandate is increasingly constrained by three challenges: USAID funding for R&D has not kept pace with total global health spending. In 2006, USAID spent 8 percent of its global health budget on R&D. Today, USAID spends 5 percent, and this spending is projected to decline further without a course correction. USAID funding for R&D is siloed by health area, limiting funding opportunities for products that are novel or needed for emergencies. Funding for innovation today is drawn from disease- and population-specific appropriations accounts, limiting the ability of USAID to fund products that address multiple health issues or emerging challenges.Constrained budgets force leaders in the Global Health Bureau to prioritize immediate impact over innovation. With limited resources, leaders must make difficult decisions between funding programs and funding innovation that could drive greater impact in the future. To this end, sustained or increased funding for every global health line and a new, additive approach to funding global health innovation is needed at the agency. With an initial appropriation of $250 million, the SIGHT Fund would raise total annual USAID investments in global health innovation to approximately 10 percent of overall Global Health Bureau funding, slightly above the previous peak of 8 percent set in 2006. Filling the cracks, the SIGHT Fund could be tapped for different health challenges as R&D opportunities emerge, especially products currently without a funding source, such as for antimicrobial resistance, malnutrition, and population-specific tools. The SIGHT Fund would improve health research coordination within USAID and with health research agencies across the US government. USAID has long-standing partnerships with many innovators, and the SIGHT Fund would supplement, not supplant, these existing programs and partnerships—expanding the global health pie rather than slicing it further. It would enable USAID to make bolder investments in new technologies while reducing the trade-off between programming and innovation. In addition, we urge Congress to renew its request for an annual R&D investments report. At the request of Congress, USAID releases an annual report on its health-related R&D investments and programs. These reports provide Congress and the global health community insight into how USAID is investing in global health research and progressing toward its health-related R&D strategy. The strategy is an important articulation of USAID’s health innovation mission and (together with the reports) is an essential accountability tool to ensure that USAID is on track to meet its health R&D goals. This request is critical to ensuring that US investments in global health research are efficient, coordinated, and maximally effective. Global health R&D is unique as a foreign policy goal in that it also supports researchers in the United States. From 2007 to 2020, more than $18 billion in federal funding went to US-based institutions for research on neglected diseases, supporting estimated hundreds of thousands of jobs and generating billions more in economic growth. In addition, many of the tools and technologies developed from this funding benefit people living in the United States either directly or indirectly by strengthening national health security and global prosperity. As we emerge from a global pandemic subdued by publicly supported science, it is clearer than ever what we can achieve with sustained funding and attention. With increased public funding for global health research, we can achieve a world that is healthier and safer for everyone.GHTC urges the Committee to continue to direct USAID to prioritize science, technology, and innovation to advance its global health and development mission; allocate sufficient resources to support this work; and continue producing detailed, public annual reports on USAID’s 2023-2028 health R&D strategy.We urge the Committee to maintain strong support for the Global Health Programs account under the State Department and USAID—supporting, at minimum, sustained funding at fiscal year 2023 levels for each disease- or population-specific program and supporting increases where possible—and creating a new SIGHT Fund for global health innovation with a new $250 million investment. Global health innovation and implementation must not be seen as competing priorities, but rather part and parcel of the US commitment to improving global health. Global health research that improves the lives of people around the world—while at the same time supporting US interests, creating jobs, and spurring economic growth at home—is a win-win investment.

The Global Health Technologies Coalition (GHTC) is greatly encouraged that yesterday’s G7 Nagasaki Health Ministers’ Communiqué contains strong support for investing in research and development (R&D) initiatives to strengthen pandemic preparedness, combat antimicrobial resistance, and address long-standing global health challenges.The COVID-19 pandemic underscored how vital the R&D of medical countermeasures (MCMs) is to addressing pandemic threats but also revealed systematic gaps in our ability to provide equitable access to the resulting tools. Thus, we applaud the G7’s support for developing an end-to-end MCM ecosystem and delivery partnership to coordinate the rapid development of and facilitate equitable, timely, and affordable global access to health tools during emergencies. We are also pleased to see the ministers voice continued commitment to the 100 Days Mission to reduce the impact of future pandemics by developing MCMs within 100 days and their recognition of the need to support regional bodies and low- and middle-income countries (LMICs) in strengthening R&D, clinical trial, and production capabilities. Additionally, we welcome the commitment to addressing the financing gaps of the World Bank Pandemic Fund, which has secured just US$1.6 billion in pledges against its $10.5 billion annual target, as it could prove a powerful new financial instrument to strengthen R&D and regulatory capacities in LMICs. Finally, we were encouraged to see leaders reaffirm the G7’s target of supporting at least 100 LMICs in implementing the core capacities required in the International Health Regulations for another five years until 2027, as committed in 2022, and underscore the need to strengthen existing institutions for capacity-building, including the Global Health Security Agenda.Given the COVID-19 pandemic has diverted critical resources and attention away from battles against other long-standing global health challenges, GHTC welcomes the G7’s support for investing in the development and adoption of innovative technologies for HIV/AIDS, tuberculosis, malaria, and neglected tropical diseases, as well as R&D for new antimicrobials, including contributing to existing global pooled efforts, such as the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator, the Global Antibiotic Research and Development Partnership, and SECURE. However, we are disappointed G7 leaders failed to acknowledge the importance of strengthening the end-to-end ecosystem for poverty-related and neglected diseases and recognize more explicit linkages for dual-use capacity-building for both pandemic preparedness and ongoing health threats. Through yesterday’s communiqué, the G7 Health Ministers are sending an important signal that R&D continues to be critical for driving solutions to enduring and emerging threats. We now look to G7 nations to match this rhetoric with tangible policies and financial commitments to truly deliver a more resilient and equitable R&D ecosystem.

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign up now to receive our weekly R&D News Roundup email.Last Thursday, the World Health Organization (WHO) declared the end of the global health emergency for mpox following a recommendation from WHO’s emergency committee on mpox, which also recommended continued management to prevent the virus from evolving. Bavarian Nordic’s vaccine for smallpox was deployed in the United States and Europe under emergency authorizations and recommended by WHO primarily for post-exposure during the mpox emergency, although the limited available stock that was already earmarked for wealthy countries created access challenges in low- and middle-income countries. Randomized control trials planned in endemic countries will provide more essential data about the efficacy of the vaccine against mpox. Additional data is also needed to fully understand how the strain of the virus evolved to sustain prolonged transmission between humans.Last week, the US$30 million Human Pangenome project, launched in 2019 and funded by the US National Human Genome Research Institute, published the first phase of the first human pangenome, which aims to be a genome that is more representative of the diversity of DNA in humans around the world. The genome could be an important guide for researchers building genetic tests and looking for new drug targets. This initiative addresses diversity gaps in the first reference genome, released in 2001, which have undermined the ability to develop tests that work across diverse populations.A new global research consortium organized by the Centres for Antimicrobial Optimisation Network aims to fight antimicrobial resistance by improving clinical use of antimicrobials and improving practices and guidelines for prescribers, users, and policymakers. Research hubs in Kampala, Cape Town, São Paulo, Liverpool, and London—where there is a high burden of drug-resistant infections and where there are communities highly affected by the burden of infectious disease—will generate essential data on the optimal use of antibiotics. Researchers hope this will in turn lead to more effective treatment and prevention of bacterial infections in the face of rising antimicrobial resistance worldwide.