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The fiscal year 2023 (FY23) budget request released yesterday by the White House includes some much needed and welcome increases to several global health and research and development (R&D) priority accounts but does not meet the moment in terms of putting forth a comprehensive commitment to growing resources across all these essential programs. The Global Health Technologies Coalition (GHTC) is disappointed to see FY23 requests for some critical accounts fall below FY22 enacted levels. The administration has proposed incredibly ambitious multi-year, multi-agency mandatory—or automatic—funding to bolster pandemic preparedness but must lay out a path forward marrying these new visionary commitments with increases to discretionary—or annually determined—global health and R&D spending.Unprecedented global challenges demand unprecedented American leadership—including unprecedented investments in global health and R&D programs, both those newly proposed to respond to emerging challenges and those with decades of proven impact. These investments are not just numbers on a page: they directly translate into lives saved from the enduring epidemics of HIV/AIDS, tuberculosis, and malaria; ground gained against the COVID-19 pandemic still smoldering as 40 percent of the world’s population awaits a first vaccine dose and we live under constant threat of new variants; strengthened health systems worldwide to detect, prevent, and respond to the next health threat; and new and improved health tools designed for impact everywhere in the world they are needed. The International Affairs Division of the FY23 budget request released today includes some hopeful steps in that direction, including a significantly increased US contribution to the Global Fund for AIDS, Tuberculosis and Malaria; new global health security commitments, including the establishment of a financial intermediary fund for pandemic preparedness; and increases to malaria, neglected tropical diseases, and international family planning programming at the US Agency for International Development (USAID) and State Department. Other critical global health accounts, however, are flat funded or even cut relative to FY22 enacted levels in the request. GHTC is disappointed that the budget request does not include comprehensive funding increases across the entire State Department and USAID Global Health Programs account. This sends a mixed message from the White House and does not reflect the administration’s stated commitment to global leadership on a broad range of health challenges. Flat funding or cutting global health programs under more budgetary strain than ever due to the continued impact of COVID-19 does not meet the moment. The $6.5 billion in five-year funding requested for the State Department and USAID through a new mandatory funding pathway, which includes a strong US commitment to the Coalition for Epidemic Preparedness Innovations, is an exciting proposal. The White House must now work with congressional appropriators to ensure this and other mandatory spending for pandemic preparedness proposed in the budget request is realized alongside increases to discretionary spending accounts. Reaching our global health goals in the months and years to come requires robust investments in R&D today, and GHTC welcomes the increases proposed in the budget framework for the Biomedical Advanced Research and Development Authority, the Centers for Disease Control and Prevention’s Center for Global Health and National Center for Emerging and Zoonotic Infectious Diseases, and the transformative level of new mandatory spending proposed for pandemic preparedness through these and other agencies within the Department of Health and Human Services. However, of the $4.3 billion increase requested for the National Institutes of Health (NIH), $4 billion would be used to boost the new Advanced Research Projects Agency for Health, leaving very little room for increases to other NIH institutes and centers. GHTC welcomes the increase proposed for the Fogarty International Center but is disappointed that the FY23 request for other NIH institutes and centers vital to global health R&D, including the National Institute of Allergy and Infectious Diseases, National Center for Advancing Translational Sciences, and National Institute of Child Health and Human Development, fall below FY22 enacted levels. There are some bright spots and visionary proposals included in the White House’s FY23 budget request, and the proposed mandatory spending for pandemic preparedness across the US government would be transformative—if enacted by Congress. However, the administration missed a crucial opportunity to lay out a comprehensive approach to boosting our global health and R&D capabilities through increases to discretionary spending in this request. At this moment of intersecting global health crises—layered on top of so many other pressing international challenges—maintaining hard-won gains against enduring global health threats and preparing for new threats to come will require even bolder investments. GHTC looks forward to working with champions in Congress to ensure that the final FY23 budget rejects any cuts relative to FY22 and sustains a pathway toward funding commensurate with unprecedented global needs.

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. Moderna plans to ask the US Food and Drug Administration to authorize its COVID-19 vaccine for emergency use in children aged 6 months to 6 years, the company announced Wednesday. Interim data from two clinical trials among children under 6 showed the vaccine generated similar immune responses to those seen in adults aged 18 to 25 who received two doses of Moderna’s adult formulation. The two-dose vaccine was, however, less effective at preventing symptomatic infection in the young children than seen in previous trials for older age groups. The decreased efficacy was on par with what would be expected of a vaccine in adults against the omicron variant, which predominated during the trial, according to Moderna. There were no severe cases, hospitalizations, or deaths in the studies.Pfizer will supply nearly 4 million courses of its oral COVID-19 treatment, Paxlovid, to UNICEF for use in 95 low- and middle-income countries. The two-drug treatment, which has emergency use authorization in the United States and is currently under assessment by the World Health Organization, will be allocated among the target countries depending on demand, clinical recommendation, and necessary approvals. Paxlovid was shown to be 89 percent effective at reducing the risk of hospitalization or death due to COVID-19 in clinical trials, and early studies indicate the treatment has some efficacy against the newer BA.2 variant that has caused cases to increase across Europe and Asia. Pfizer expects to be able to begin supplying orders to UNICEF in April and continue throughout 2022.A new “mosquito-grounding” insecticide that causes mosquitos’ wings to spasm and wither could bolster the fight against malaria, according to trial results published in The Lancet last week. In a two-year trial in Tanzania, lacing bednets with a combination of the new substance—chlorfenapyr—and a widely used insecticide—pyrethroid—significantly reduced malaria prevalence, including in regions where insecticide resistance is widespread. Insecticide-treated bednets have been central in efforts to reduce the spread of malaria, but rising insecticide resistance among mosquitos has hampered progress. Chlorfenapyr is the first new insecticide to be deemed safe and effective in about 40 years, and an ongoing study in Benin will continue to evaluate whether the substance reduces malaria transmission.