News: Advocacy action

123September 29, 2025   The Honorable Shelley Moore Capito  Chair Senate Committee on Appropriations  Subcommittee on Labor, Health and Human Services, and Education, and Related Agencies Washington, DC 20510  The Honorable Tammy Baldwin  Vice Chair Senate Committee on Appropriations  Subcommittee on Labor, Health and Human Services, and Education, and Related Agencies Washington, DC 20510   The Honorable Robert Aderholt Chair House Committee on Appropriations  Subcommittee on Labor, Health and Human Services, and Education, and Related Agencies Washington. DC 20515  The Honorable Rosa DeLauro  Ranking Member House Committee on Appropriations  Subcommittee on Labor, Health and Human Services, and Education, and Related Agencies Washington, DC 20515  Dear Chair Capito, Chair Aderholt, Ranking Member Baldwin, and Ranking Member DeLauro:  On behalf of the TB Roundtable, a group of organizations that advocates for robust domestic and global federal tuberculosis (TB) funding, legislation, and policies that support eradicating the disease, and the undersigned fourteen organizations, we thank you for your continued work on Fiscal Year (FY) 2026 appropriations and your commitment to fighting TB around the world, including efforts to fight the disease here in the United States.  As the House and Senate committees move to conference their FY 2026 Labor, Health and Human Services, and Education, and Related Agencies bills, we respectfully ask that you protect funding for the Global Tuberculosis CDC program. Additionally, we urge you to refrain from consolidating Sexually Transmitted Disease and Tuberculosis Prevention grants under the CDC’s Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention program in a final FY 2026 appropriations bill.  Globally, TB has resurged as the deadliest infectious disease, infecting 10.8 million people and killing 1.25 million people in 2023 alone. Since TB is the world’s leading infectious disease killer, the TB community of health experts, researchers, implementers, and advocates emphasizes the urgent need for increased resources to outpace this disease to decrease preventable deaths and infection rates. TB continues to disproportionately affect people in poor and vulnerable communities around the world and domestically in the U.S. Further, cuts to programs that help identify and treat TB alongside under-resourced programs over the past two decades have led to harder-to-treat and deadlier strains of drug-resistant TB (DR-TB), multi drug-resistant TB (MDR-TB), and in rare cases extensively drug resistant TB (XDR-TB). Drug-resistant forms of TB continue to drive rising rates of antimicrobial resistance globally.  Recent funding disruptions to global TB programs have resulted in people sick with TB going undiagnosed and, in some cases, losing access to lifesaving treatment. These disruptions are projected to lead to about a 30 percent increase in TB incidence, which includes new multi-drug resistant (MDR-TB) cases in the U.S. in the next year. Additionally, because of the failure to control the global TB epidemic, experts estimate that it will cost the U.S. health system an additional $40 million next year to treat and manage TB in the U.S. As cases continue to rise across the globe, it is imperative to continue the CDC’s Global Tuberculosis work to coordinate with countries to prevent, diagnose, and treat TB. The CDC’s Global TB program is uniquely positioned and skilled to strengthen laboratory networks and infection control measures. Their efforts enhance surveillance and response systems to prevent outbreaks and monitor TB trends globally, particularly for drug-resistant TB. If these cuts are enacted, a resurgence of TB globally is expected which will lead to additional domestic drug-resistant TB outbreaks despite decades of declining rates of diagnosis in the U.S. With a lean budget, CDC’s global TB program is focused on stretching U.S. investments further and supporting other governments to increase their own investments. CDC’s global TB program partners with countries like the Philippines and India, who invest tens of millions of dollars in their own domestic resources against TB every year, to strengthen their programs. TB programs continue to face historic strain as the frontline response against airborne infectious diseases, and as TB rates and deaths continue to rise.  The CDC’s domestic TB programming keeps Americans safer and healthier. TB continues to be detected in every U.S. state and territory and the highest number of TB cases in over ten years. The CDC estimates up to 13 million people in the U.S. live with latent TB infection–of which 1 in 10 will get sick with active TB. Recent large outbreaks in Kansas have highlighted the need for robust TB monitoring and funding to preserve core public health infrastructure. Our previous success in reducing TB numbers in the U.S. can be directly attributed to the dedicated funding provided to CDC's Division of TB Elimination.  Prior to receiving directly appropriated funding, states and local health departments received funding for TB control in communicable disease block grants. As TB cases declined after a surge of the disease in the early 20th century, categorical federal funding ended and local funding was shifted to other priorities. However, this de-prioritization resulted in a deadly resurgence of the disease in the 1990s, with over 25,000 TB cases being reported per year. Following a significant federal investment in TB control activities in 1993, with a return to designated funding for TB control activities, TB cases began to decline nationwide. Currently, the House FY 2026 LHHS report proposes taking the country back to the block grant structure we know will lead to higher TB cases and consolidating funding for the CDC’s Sexually Transmitted Disease and Tuberculosis Prevention grants. In order to continue our current success, Congress must not block grant STD and TB funding, but rather should maintain currently dedicated funding for TB prevention and control programs that have been vital to keeping domestic TB cases in check.  TB is a national health security issue—but one that can be course corrected with adequate resources. Robust funding both globally and domestically is needed to recover momentum against the disease and save lives. The current proposals in the House FY 2026 LHHS report to cut vital TB elimination programs put progress achieved over the last few years at risk. Any program cuts or efforts to create block grants will create more room for this disease to spread and the development of drug resistance, which we cannot afford to risk. We therefore urge you to protect the CDC’s Global Tuberculosis program funding and refrain from consolidating Sexually Transmitted Disease and Tuberculosis Prevention grants under the CDC’s Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention program in a final appropriations bill.  Sincerely,   American Thoracic Society Association of Asian Pacific Community Health Organizations (AAPCHO) AVAC Georgia AIDS Coalition Global Health Technologies Coalition National Tuberculosis Coalition of America (NTCA) North East Medical Services (NEMS) Partners in Health RESULTS Scene Health Stop TB USA TB Alliance TB Elimination Alliance Treatment Action Group (TAG)   CC: The Honorable Tom Cole, The Honorable Susan Collins, The Honorable Patty Murray

GHTC delivered the below statement at the second official meeting of the negotiators of the Intergovernmental Working Group on the Pathogen Access and Benefit Sharing system annex to the Pandemic Agreement.We welcome the start of negotiations for a Pathogen Access and Benefit Sharing (PABS) system. Your work together in the months to come will be essential to making the world safer for everyone. Given the short timeline for finalizing negotiations, we propose the following actions to ensure successful deliberations: First, we call for a process that systematically and meaningfully engages civil society and relevant stakeholders as experts to reflect an inclusive, whole-of-society approach. We welcome the strategy of hosting informal sessions with experts, member states, and civil society ahead of each meeting of the Intergovernmental Working Group to help advance shared understanding and agreement.  We also call on member states to work with all relevant stakeholders to define the scope of "materials and sequence information on pathogens with pandemic potential." Negotiations to date have focused on human samples and information, even though the majority of emerging infectious diseases are zoonoses.Lastly, greater clarity is also still needed about how the World Health Organization will distribute benefits. The current draft agreement states that "the distribution of these vaccines, therapeutics, and diagnostics shall be on the basis of public health risk and need, with particular attention to the needs of developing countries."  But "public health risk and need" is a subjective categorization and could necessarily be affected by political imperatives. We therefore urge member states to outline decision-making criteria and make these publicly available for scrutiny. We know the coming months will present a challenging test for member states to find breakthroughs, and we encourage all parties to underscore their political commitment to the process. Success can only be achieved through a strong emphasis on equity and transparency, enshrined through robust and meaningful provisions in the PABS framework. We look forward to our continued participation in these forums to advance a meaningful outcome.

GHTC sent public written testimony to the Senate Appropriations Subcommittees on State, Foreign Operations, and Related Programs (SFOPS) and Labor, Health and Human Services, Education, and Related Agencies (LHHS), urging policymakers to increase funding and include supportive policy directives for global health research and development in fiscal year 2026 (FY26) spending bills. Among other priorities, the testimony urges Congress to continue to direct the US Agency for International Development and the Department of State to prioritize science, technology, and innovation as core pillars of its global health mission and to appropriate robust funding for emerging infectious diseases and additional funding for antimicrobial resistance at the Biomedical Advanced Research and Development Authority.

Jayanta “Jay” Bhattacharya, M.D., Ph.D. Director National Institutes of Health June 3, 2025 Dear Dr. Bhattacharya: As organizations representing researchers, clinicians, patients and other concerned stakeholders, we write to highlight the value and importance to Americans of the National Institutes of Health’s support of collaborative international biomedical research and to express concern about the unintended consequences of the current implementation of the updated NIH policy toward foreign subawards, which risk significantly disrupting research that benefits the American public. We also urge you to work with the scientific community toward our shared goals of improving transparency at NIH while minimizing disruptions to research that Americans depend upon to deliver life-saving medical advances and would appreciate the opportunity to meet with you. International Collaborative Research Benefits Americans For many health conditions that are more common in other countries, international collaborations are necessary to advance our knowledge of how to diagnose, treat, or cure these diseases, and the benefits of that knowledge for Americans living with those conditions can be enormous. Increased global travel can easily increase the prevalence of many of these diseases in the US, and conducting international research now boosts our readiness. Additionally, for many conditions, limiting research to the US will add significant costs to studies, slow recruitment and significantly delay the results and innovations. Consider these examples: • The Pediatric MATCH precision medicine trial which matched children and adolescents with advanced cancers to targeted therapies on genetic alterations. Patients were enrolled in the phase 2 trial from the U.S., Canada, Australia, New Zealand, Saudi Arabia, and other European countries. • The HIV Prevention Trials Network (HPTN) 052 study was an NIH-funded trial—conducted in 9 countries in Africa, Asia, Latin America, and North America—which proved that effective HIV antiretroviral therapy stops the sexual transmission of HIV. This finding has been foundational to public health strategies for the 1.2 million people with HIV in the U.S., informing the U=U (Undetectable=Untransmissible) campaign. More broadly, global HIV research has greatly informed chronic disease care delivery in the US, improving community-based care and retention in care for conditions including hypertension, diabetes and heart disease. • The Tuberculosis (TB) Trials Consortium Study 31 was an NIH and CDC-funded trial conducted in 13 countries, including the U.S. This study proved that a novel shorter 4- month TB treatment regimen could be as effective as the standard-of-care 6-month treatment regimen. Such research is critical, as TB affects nearly 10,000 Americans every year and TB rates have increased every year in the U.S. since 2020. Kansas is currently struggling with one of the biggest TB outbreaks in the U.S. in decades. • A proposed histoplasmosis clinical trial that would collaborate with sites in Brazil to enroll more rapidly and cost effectively scored very well in study section such that funding would typically occur, but its current status is unclear. Histoplasmosis is a deadly fungal infection that occurs in people with transplants and autoimmune disorders as well as people with HIV. Americans will directly benefit from these results if the trial proceeds. • Similar to the examples above, whether one considers conditions as varied as Alzheimer’s disease, cancer, or stroke, NIH-supported international collaborations have been vital to enhancing the discovery and development of health technologies that have improved the health of millions of Americans. Concerns with the Current Approach to the Updated Foreign Subawards Policy While we are very supportive of the NIH’s goals of improving transparency in research, we have substantial concerns about the manner in which this policy is currently being implemented. Our concerns include: • A funding freeze for international scientific collaborations pending the new policy: Even though the implementation of the new award structure is pending, the NIH has stopped issuing any awards —including new, renewal, or non-competing continuation grants—that include foreign subawards. This includes new awards that have already undergone years of preparatory work, rigorous scientific review and been selected for funding. Additionally, existing multi-year awards will not be renewed if the “project is no longer viable without the foreign subaward.” Abruptly halting their funding undermines this long-term investment, wastes taxpayer dollars and jeopardizes high-impact research with direct relevance to public health in the U.S. and globally, including clinical trials. These interruptions could leave study participants in without access to life-preserving therapies and pose serious ethical concerns. Although the NIH notice indicates that steps will be taken to mitigate these impacts, emerging reports suggest that this may not be occurring consistently in practice. • Requiring researchers to “reapply” for awards that have already been selected for funding or that are in progress: This requirement would apply to awards that have been selected for funding and to awards for which research activities are already underway, with significant work completed. Awards have already undergone highly competitive scientific review. Full reapplication would result in a significant loss of the taxpayer dollars already invested in the planning, launching, and partial execution of these projects. This move increases waste and jeopardizes the continuity of high-impact research critical to public health in the U.S. • Loss of multi-country clinical trials: The current policy doesn’t appear to include any mechanism for NIH to continue participation in multi-country clinical trials. Multi-country country collaboration opens access to more patient populations and more efficient clinical trial enrollment for diseases affecting Americans from Alzheimer’s Disease, heart disease, and HIV to rare diseases with smaller patient populations. • Loss of US scientific workforce: Abrupt losses or unplanned delays or interruptions in funding can leave many researchers, particularly early-career researchers, unable to sustain their careers. Because so much US research includes an international component, a high number of researchers are at risk of leaving the field entirely, which would leave the US without the workforce we need to deliver needed breakthroughs. • Broader Implications for U.S. Public Health and Scientific Leadership: Beyond the direct impact on specific research projects, the current implementation of this policy may weaken the United States’ ability to prepare for and respond to global health threats. International collaborations enhance our early warning systems, accelerate the development of vaccines, treatments, and diagnostics for emerging diseases, and are often more costeffective than domestic-only studies. Stepping back from these partnerships could erode U.S. leadership in biomedical research. Recommendations Facilitate rapid restructuring of awards or streamlined reapplications with no termination or minimal interruption of research: We do not support termination of any research grants under the new policy but recognize that some grants have already been terminated and others may be terminated. Given this, and the fact that different foreign collaborations may have different needs based upon the type of research being conducted, structure of the project and specific partners involved, we recommend that NIH work with currently-funded researchers to develop and offer multiple options that provide sufficient transition time to allow researchers to meet the new financial reporting requirements with no or minimal disruption or delays to research. These options include: • Restructure awards in a manner that rapidly transitions foreign subawards to the linked foreign awards system, with no or minimal interruption of ongoing research and no or minimal delay for projects already selected for funding. • Enable researchers to maintain foreign partners in existing grants through consultancy and fee-for-service arrangements. • Provide a highly streamlined reapplication process for researchers to transition to the new linked grants system with strong assurances of funding for researchers whose grants had already scored well or been approved. Technical assistance: While we recognize the goal of improved transparency and tracking of funds, we are concerned that some important foreign research partners who provide significant benefits to Americans may not currently have the capacity to directly implement the upcoming NIH policy for linked awards. We request that NIH provide technical assistance to foreign research partners to help ensure successful implementation. Limited exemptions: We recommend NIH consider granting foreign subawards that meet certain thresholds. For example, if a US prime grantee affirms they cannot identify a different partner that could provide the same benefit as this foreign partner, and the foreign partner’s budget or staff size is below a certain threshold, such that it may be unable to comply with the foreign prime requirements or the new linked grants requirements, it could be considered for a foreign subaward. In addition, we recommend that multi-country clinical trials be exempt or otherwise permitted under the new policy. In these instances, we believe the benefits of enabling foreign collaborative research far outweigh the risks. The above requests are consistent with the NIH goal of improving transparency. Implementation of these recommendations will help ensure that innovative scientific research that benefits Americans can proceed and that critical international collaborations developed in good faith following prior NIH guidance are not arbitrarily harmed. Without changes such as these, the updated NIH policy is likely to undermine U.S. taxpayer investments and harm the health of Americans. Thank you for your consideration of our perspectives and recommendations. We share your commitment to accountability and strong stewardship of federal research funds and stand ready to work together to ensure international research continues to deliver for the American people. We would welcome the opportunity for dialogue with you to help ensure sufficient policies, processes and resources that will enable international research collaboration that provides significant health benefits to Americans. Sincerely, American Society for Microbiology American Society of Tropical Medicine and Hygiene DNDi North America Global Health Technologies Coalition HIV Medicine Association Infectious Diseases Society of America