Earlier today, the fourth annual G-FINDER report was released. This resource, developed by Policy Cures, is the only one of its kind that maps the global level of investment in developing new vaccines, drugs, diagnostics, and other tools that address 31 neglected diseases. This year’s report studies funding levels and trends in 2010. The G-FINDER report illustrates the first real evidence that the global financial crisis is impacting funders’ ability to support global health research and development (R&D). The report shows a drop of 3.5% among donors who were surveyed—including public donors in high- and low-income countries, private foundations, and the pharmaceutical industry. It is important to note that these findings merely report trends from one year to the next, and that it is essential to look at trends across multiple years to understand true patterns of change. In 2010 there were many reasons for decreased funding from some donors. For example, the Gates Foundation’s decreased funding can be largely attributed to a lower disbursement in 2010 for clinical trials of the RTS,S malaria vaccine because much of the significant funding for this research was provided up front, thus not disbursed in 2010. On the whole, funding levels in 2012 for global health R&D are higher than when the G-FINDER began tracking these numbers in 2007, which is a positive signal. That said, it is striking that in a year when the financial crisis hit its peak, public funding for global health research took an equally significant hit. The G-FINDER report also shows that globally, the public sector plays an important role in funding research and development for neglected diseases, providing nearly two-thirds of global funding. And in 2010, contributions from public funders fell by a stark 6%, or $125 million. At the GHTC, we’re paying special attention to trends related to the US government’s expenditures: The US remains the largest government funder of global health research, but even its funding for global health R&D dropped significantly: down by 5%, or $74.5 million. Drops in overall US funding are largely attributed to a decrease in funding from the National Institutes of Health (NIH) (down $44.8 million, or by 3.6%), as well as a significant decrease in funding by the Department of Defense (DoD) (down by $28.3 million, or nearly 30%). It is of interest to note that this drop in funding from the NIH came during a year when the agency received funding through the American Recovery and Reinvestment Act (ARRA). Even a modest increase in funding from the US Agency for International Development (USAID) (up $1.5 million, or roughly 1.8%) doesn’t come close to accounting for the drops by NIH and DoD. This decline in US government funding has real and significant consequences in the near- and long-term. Without sufficient funding, groups like product development partnerships, which are leading the development of global health products, are left without the immediate resources needed to complete the final phases of clinical research. And without the tools we need to combat the most severe global health challenges, people living around the world will continue to suffer and succumb to diseases that might have been otherwise prevented or treated. The scientific community is on the cusp of groundbreaking research that will yield powerful new tools to address global health, and now is not the time to turn back. An investment in science means an investment in the future, and policymakers in the US must keep their gaze forward as they make funding decisions today. Note: all funding amounts included in the G-FINDER report are adjusted for inflation and reported as 2007 dollars so that they may be compared to previous G-FINDER reports, which date back to 2007.

Yesterday, at an event hosted by ONE and (RED) to commemorate World AIDS Day, President Obama declared the beginning of the end of AIDS: “Today is a remarkable day. Today, we come together, as a global community, across continents, faiths and cultures, to renew our commitment to ending the AIDS pandemic –once and for all.” I was honored to join a group of distinguished guests to witness the President’s World AIDS Day address and to hear comments from former Presidents George W. Bush and Bill Clinton; the current President of Tanzania; and a powerful panel that included a few superstars—Bono and Alicia Keys—members of Congress, business leaders, and activists. The powerful panel that included a few superstars—Bono and Alicia Keys—members of Congress, business leaders, and activists.For thirty years, the US government has led the fight against HIV and AIDS, and has played an important role in advancing science to better understand HIV and how to prevent, treat, and diagnose infection. Over the last three decades, we’ve witnessed the fruits of that leadership and the longstanding investment US policymakers have pledged to research on HIV and AIDS: from the first AIDS treatment drugs, to this year’s news that medicines to treat HIV infection could actually help prevent it, too.Yesterday’s speakers reinforced the notion that our commitment to fighting AIDS must not waiver. President Bush declared that when budget constraints exist, we need to set priorities and focus on what works. He added that there is no greater priority than living out the mandate of “to whom much is given, of him much shall be required.” His perspective was reinforced by Alicia Keys, who said, “We have the opportunity to be a global community that leaves the legacy of an AIDS-free generation. If we have the power to, then we must.”Recent research results show that we have many of the tools we need to forever change the trajectory of the epidemic. But, as Obama said, now is not the time to be complacent. We still lack a vaccine, a microbicide gel, and other tools that could help us win the war against AIDS.I’m encouraged to see the continued commitment by the Obama Administration to fighting this disease coupled with bipartisan support from congressional leaders like Congresswoman Barbara Lee and Senator Marco Rubio. My hope is that this commitment translates to continued support for research that will lead us to the next generation of tools to fight HIV and AIDS. As Sanjay Gupta, moderator of the event, said, eradicating AIDS is a goal that “allows us to stand at that most perfect union of audacity and achievability.” Will our government rise to the challenge?

In a recent guest post for the ONE blog, GHTC director Kaitlin Christenson highlighted four game-changing HIV and AIDS interventions under development and the leadership from the US government that has helped foster these critical research breakthroughs. The fight against HIV and AIDS is not over, and a concerted effort must be made to prioritize research to develop new tools Photo: Robin Biellik/PATH The past three years have been historic in the number of breakthroughs in research to prevent, diagnose, and treat HIV and AIDS. For the first time, researchers proved that an HIV vaccine could prevent infection; an HIV prevention gel called a microbicide was shown to prevent infection among women; studies showed that a once-daily pill could reduce the risk of infection in high-risk individuals; and antiretroviral treatment among HIV-positive individuals was proven to reduce the risk of infecting their partners. "The fight against HIV and AIDS is not over, and a concerted effort must be made to prioritize research to develop new tools." Photo: Robin Biellik/PATHIt’s been incredible to see such progress over the past three years. But to be clear: these breakthroughs are a result of a long-standing commitment by international donors to boost research for HIV and AIDS. Innovations like these come as a result of years of work conducted by a variety of players—the private sector, NGOs, academic institutions and product development partnerships. In many cases, they are a direct result of the support provided by the US government. This commitment to research will continue to result in tools that change the way we approach the epidemic. Some impressive work is currently underway and promises to yield new interventions: Microbicides. Last year, a clinical trial in South Africa provided the first-ever proof that a vaginal microbicide could safely and effectively reduce the risk of HIV transmission to women. The trial was supported by the US Agency for International Development and two GHTC members, FHI360 and CONRAD. It provided new hope that an HIV-prevention tool designed for women could work. Additional research is needed on this product, though, and over the next two years, a follow-on trial will seek to confirm these results. Treatment as prevention. This summer, research supported by NIH demonstrated an astounding 96 percent reduction in transmission of HIV to an uninfected partner when his or her HIV-infected partner begins an antiretroviral regimen. Some questions remain about how this intervention might be implemented, and additional research is needed to understand how treatment as prevention will be operationalized. Oral pre-exposure prophylaxis (PrEP). Recent studies funded by the US National Institutes of Health (NIH) and others have confirmed that a daily dose of oral antiretrovirals can reduce the threat of HIV infection in high-risk groups. While additional research is needed to understand the implications of PrEP, many government agencies are considering adapting their HIV prevention guidelines to account for this new intervention. HIV vaccines. Two years ago, a clinical trial conducted in Thailand and funded by the US Department of Defense provided the first demonstration that a vaccine can prevent HIV infection in humans. While the results from this trial were too modest to support licensing this particular vaccine, trial data will help to inform the development of what researchers hope will be a more effective vaccine. On a recent trip to Kenya, my colleagues and I had the opportunity to meet with some of the research heroes who are leading the way in studying these and other interventions. The excitement they felt about the promise these new tools might provide was palpable. Lisa Mills, an American based with the CDC in Kenya, co-led a clinical trial which provided evidence for treatment as prevention. She told us that this intervention will have a “huge impact on communities. It will make HIV-positive people in these communities non-contagious. It’s also more cost-effective to do treatment as prevention, since you’re only treating HIV-positive people.” In speaking about research for microbicides, another of the individuals we met, Elizabeth Bukusi, deputy director at the Kenya Medical Research Institute (KEMRI), told us, “I think this is one of the tools that gives us the opportunity that we could actually end the epidemic. I think we can move towards a complete AIDS-free generation that will completely stop the epidemic in its track using microbicides as part of the armament.” She added that the “US has been a critical partner in providing catalystic funds and also in funding a large number of the trials that have looked at microbicides. So US funding is absolutely critical to moving this agenda forward.” Today, it is in our hands to decide the fate of future generations. The fight against HIV and AIDS is not over, and a concerted effort must be made to prioritize research to develop new tools — both those that are within arm’s reach, and those which still require much more study. Research is a long-term investment, and we must not give up on the commitments which have taken us this far. The US government is a leading supporter for research that has yielded many of the innovations we have today, and this support must not waiver even in the midst of today’s constrained budget environment. Will our leaders continue to set the stage? Imagine the breakthroughs that would be possible if so.

GHTC Director Kaitlin Christenson attended Secretary of State Hillary Clinton’s speech at the National Institutes for Health (NIH) yesterday and blogged her reaction to the address for Breakthroughs. To a room full of dignitaries, US policymakers, members of Congress, research leaders, and global health advocates at NIH yesterday, Secretary of State Hillary Clinton declared that in the midst of difficult budget times, “investing in our future is the smartest investment we can make.” The Secretary spoke with pride and hope about the historic leadership that the US government has played in advancing progress to combat HIV and AIDS, and the need to stay the course—even as Congress considers budget cuts which may affect global health and HIV and AIDS funding—as we work toward the previously unimaginable goal of an AIDS-free generation. "An AIDS-free generation would be one of the greatest gifts the United States could give to our collective future." -Secretary of State Hillary Clinton at speech on Tuesday. Photo: Wendy Stone/PATH During her speech, Clinton highlighted the numerous advances made possible through an investment in science by the US government: American scientists were the first to report the AIDS epidemic; NIH research provided proof that HIV causes AIDS; the US government supported the development of the first drugs to treat AIDS; and continued US investments are supporting the search for a vaccine, microbicides, and other tools. But she could have added even more successes to this list. In the past two years, US-funded research has: Led to the first-ever proof of concept that both an HIV vaccine and a vaginal microbicide could work. Provided evidence that treatment of individuals who are HIV positive can actually help prevent new infections--potentially reducing the risk of transmission up to 96%. Shown that once-daily pills can work to reduce the risk of HIV in high-risk groups. It is scientific advances like these that will lead us to a new era in the AIDS epidemic, and US policymakers must do all that they can to protect our investment in the research that will yield the new tools that are so critically needed. In Washington, she joked, some would prefer that we operate in an “evidence-free zone.” But she called on all of us to stand up for science and evidence, and keep our focus on the future, urging us to consider what the world would look like if we succeeded in our goal of an AIDS-free generation. “That is the world that has always been at the core of American belief, and we have worked toward it in our own history. It’s the world I think we all would like to live in. An AIDS-free generation would be one of the greatest gifts the United States could give to our collective future.” Thanks to the scientific advances in recent years, the global community is finally positioned to end the AIDS epidemic. The US government must answer Secretary Clinton’s call to keep the momentum going and seize this historic opportunity.

Today, the US Agency for International Development (USAID) celebrates 50 years of leadership and expertise in addressing development challenges to improve lives across the globe. Since it launched, USAID has had a rich history of supporting global health, including research and development (R&D). Some of the major breakthroughs in global health that USAID has supported include: Oral rehydration therapy (ORT). ORT, a treatment for diarrhea, is credited with saving tens of millions of children’s lives. USAID began supporting this effort in the 1960s. In 1979, USAID made the largest donor investment in the establishment of the International Centre for Diarrhoeal Disease Research, where scientists continue to conduct important R&D to improve ORT. Eradicating smallpox. In 1966, USAID joined the global effort to eradicate smallpox, a contagious disease that killed more than 300 million people in the 20th century. In the same decade that USAID began to fight the disease, 10 million to 15 million people contracted the disease a year, and more than 2 million people died from it. Through investing in research that adapted the mechanics of US military jet injectors for application of the smallpox vaccine, USAID played a critical role in achieving global eradication of the disease. Funding research for tools to help women. USAID funded research to develop the Uniject™ injection system, a tool that delivers the drug oxytocin to help reduce excessive bleeding during the third stage of childbirth. More recently, USAID has ramped up efforts to combat HIV by funding research for microbicide gels, a tool that has the potential to help women protect themselves from the virus. Through investing in a groundbreaking trial held at the Centre for the AIDS Programme Research in South Africa (CAPRISA), USAID played a critical role in supporting the first proof-of-concept trial that showed a microbicide can protect women against HIV and herpes. USAID has helped save lives across the world through its strong support for global health R&D Photo: Wendy Stone/PATH USAID’s commitment to global health R&D remains strong today. In fact, USAID is a vital partner to many GHTC members. USAID and the International AIDS Vaccine Initiative (IAVI) have been in a cooperative agreement since 2006 to accelerate the discovery of an AIDS vaccine. USAID also supports the Global Alliance for TB Drug Development (TB Alliance) in its effort to develop better drugs to treat tuberculosis (TB). The agency also contributed significant funding to the Meningitis Vaccine Project (MVP)—a partnership between PATH and the World Health Organization—for its efforts to discover and deliver a new meningitis vaccine. USAID supported a comprehensive analysis of the economic costs of meningitis epidemics, aided efforts to improve meningitis surveillance, and helped to address regulatory issues. With this strong commitment from USAID, the future of global health R&D will undoubtedly hold many breakthroughs that have the potential to save millions of lives worldwide.

This is an exciting week for the GHTC. Not only are we launching our “Breakthroughs” blog, but we’re also taking off on an amazing trip to Kenya to discover how global health research is changing people’s lives on the ground. We can’t wait to share live updates on our blog from the trip, and give you a sense for the incredible progress taking place in Kenya. We’re very fortunate to be meeting with several GHTC members conducting ground-breaking work in Kenya. In Nairobi, we have plans to meet with local researchers from the Drugs for Neglected Diseases initiative (DNDi), the International AIDS Vaccine Initiative (IAVI), and the International Partnership for Microbicides (IPM). DNDi is leading an incredible effort to create new treatments for visceral leishmaniasis, or VL, a painful and deadly disease that affects half a million people worldwide each year. IPM and IAVI are leading work to develop new HIV prevention methods in the form a vaccine (IAVI), as well as gels, rings and other products women can use to protect themselves against HIV (IPM). Also while we’re in Nairobi, the GHTC is meeting with several dedicated American officials working on global health research in Kenya. These committed US citizens work with agencies such as the State Department, the US Embassy, and the Centers for Disease Control and Prevention (CDC). They’ll share with us why the US Government thinks research for new global health tools is so critical to American interests at home and abroad. After Nairobi, we’ll visit Kisumu in Western Kenya. Kisumu is home to some of the most exciting health research going on in Kenya, including an incredible partnership several US agencies have with the Kenya Medical Research Institute (KEMRI). The CDC has been working with KEMRI for 30 years, and we’ll be visiting some exciting research projects the CDC/KEMRI partnership is working on with GHTC members. For example, there’s some remarkable vaccine research going on in and around Kisumu—GHTC member Aeras is conducting research for a new tuberculosis (TB) vaccine among infants in the region. And we’ll get the chance to hear about a ground-breaking study, called HPTN 052, on using antiretroviral drugs for HIV prevention in couples. The Department of Defense (DoD) also has a long history of medical research in Kisumu that we’ll get the hear more about during our visit. Finally, we’ll be visiting a great program in western Kenya run by our secretariat PATH. The program, called APHIA II, provides comprehensive health care and prevention services for diseases such as HIV and AIDS, TB, and links these services to others that improve maternal and child health. APHIA shows the impact of lifesaving tools - such as drugs, vaccines, bed nets, and other treatments – that only exist as a result of the research investments that helped to develop them. We hope you’re as excited about the GHTC’s trip as we are. We’re thrilled to share these stories with you, and hope you follow us throughout the week.