A coalition of more than 100 leading global health and research organizations urged Congress to provide $250 million in new funding to the US Agency for International Development (USAID) to establish a fund to supercharge global health innovation.
The SIGHT Fund: A proposal to drive inclusive innovation at USAID
Science holds promise to ending the world’s deadliest diseases. But to deliver on that promise, we need forward-looking ways of developing new health technologies—and we need the world’s leading bilateral funder of global health, the US Agency for International Development (USAID), to lead the charge.
The Supporting Innovative Global Health Technologies Fund—or SIGHT Fund—is a proposal for a new flexible, catalytic fund to be housed at USAID that would infuse new funding into R&D efforts to close the biggest gaps in our global health toolkit and save more lives more quickly.
Despite tremendous gains in global health, today we are still without essential tools to combat many long-standing health challenges, and new threats are continuing to emerge.
For decades USAID has invested in the research and development (R&D) of new vaccines, drugs, diagnostics, and other tools as part of its broader mission to advance global health. With its deep international footprint, USAID is uniquely positioned to advance fit-for-purpose tools that will reach places where infrastructure is limited, electricity is unreliable, and trained health workers are scarce. Unfortunately, in recent years, USAID investments in R&D have shrunk as a proportion of its overall global health spending, squeezed by both stagnant budgets and growing needs. The SIGHT Fund is a solution that could supercharge USAID's innovation capacity.
The SIGHT Fund mission
The SIGHT Fund, proposed to be housed within USAID’s Global Health Bureau (GHB) and funded through a $250 million initial dedicated appropriation, would support investments toward R&D of new drugs, vaccines, diagnostics, and medical devices to address a range of global health challenges. It would be disease agnostic, focusing on priority areas of unmet need and promising scientific opportunity, and supplement—not supplant—existing pathways for USAID investments in innovation. In alignment with the agency’s goal of supporting inclusive development, it would be engineered to drive inclusive innovation, centering the perspectives and priorities of people in affected communities—the end users of innovations—in every stage of product development.
Why the SIGHT Fund is needed
USAID devotes only a small proportion of its global health funding to R&D activities. In 2006, this proportion peaked at 8 percent but has steadily declined to around 5 percent, as total funding for global health has grown but funding for R&D has slightly declined. This is despite the fact that wide innovation gaps persist.
A $250 million dedicated investment per year in the SIGHT Fund would bring USAID health R&D funding slightly above the level it was at in 2006, when it peaked as a proportion of GHB funding.
With limited resources, GHB program leads are forced to decide between funding health programs using today’s imperfect tools or developing new and improved tools that could dramatically accelerate the impact of programs in the future—lowering costs and multiplying impact. As a result, leaders often choose to prioritize immediate, short-term results over forward-looking bets on R&D.
By empowering GHB program leads to invest in innovation through additive resources, the SIGHT Fund would remove the burden of risk inherent in R&D, enabling them to make smart investments in game-changing innovations.
Funding for health R&D is primarily drawn from disease- and population-specific appropriations accounts, limiting the ability of USAID to fund products that address multiple health issues or to pivot as health emergencies arise.
The SIGHT Fund would be “disease agnostic,” enabling it to fund promising innovations that may cross health issue areas or to respond to R&D needs for emerging threats. As a centralized, additive source of innovation funding, the SIGHT Fund would also improve research coordination across the agency.
How the SIGHT Fund could sustainably grow R&D investments
Over the years, USAID’s investments in health-related R&D have declined as a proportion of total GHB spending. A $250 million annual commitment to the SIGHT Fund would raise total annual USAID investments in global health innovation to a healthy target of approximately 10 percent of overall bureau funding.
Health-related R&D funding as a proportion of GHB appropriations.
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Frequently asked questions about the SIGHT Fund
USAID is best positioned to house the SIGHT Fund because of 1) its unique mandate—as the only US agency with a primary mission to improve global health and development; and 2) its proven expertise in global health innovation. The agency has a decades-long track record of developing technologies to address unmet health needs of people in the world’s poorest places.
While other research agencies primarily focus on increasing scientific knowledge or advancing products for a US market, USAID is focused specifically on developing health technologies for global use. That means its specialty is creating products that are not only safe and effective, but also affordable and designed to work in places where infrastructure is limited, electricity is unreliable, and trained health workers are scarce.
Consider for a moment a new medicine or vaccine. If that product ends up costing hundreds or thousands of dollars or must be stored consistently at frozen or refrigerated temperatures, many low- and middle-income countries may struggle to make it broadly available and administer it to people in hard-to-reach, rural settings. When funding R&D, USAID considers these challenges from the beginning, so that the innovations it produces can ultimately be widely adopted and used around the world.
With its deep international footprint and strong relationships with health decision-makers in partner countries, USAID also has a keen understanding of what technologies are most needed to improve health programs—as a primary implementer of global health programs, the agency is able to see where current tools are falling short in real time. This enables it to prioritize investments in areas of highest need and potential impact.
USAID would have the opportunity to leverage the SIGHT Fund to build upon and strengthen its ongoing collaborations and coordination with other US agencies sponsoring health research.
USAID already has a strong tradition of partnering with other agencies like the National Institutes of Health (NIH), Centers for Disease Control and Prevention, and Department of Defense on health research. Sometimes this occurs through formal interagency initiatives, like the President’s Emergency Plan for AIDS Relief (PEPFAR), or through specific joint projects. In other cases, USAID informally consults and shares information with other agencies, involving their staff in decisions on research strategy and investments. This continual coordination helps ensure USAID’s R&D investments are additive and complementary, rather than duplicative of other agency investments.
Given that USAID focuses on late-stage clinical development—translating scientific discoveries into proven products—greater interagency coordination enabled by the SIGHT Fund would help ensure promising products move successfully through the research pipeline, from early-stage research supported by NIH to later-stage research and market introduction supported by USAID.
The SIGHT Fund would be a flexible, disease-agnostic fund designed to support R&D of drugs, vaccines, diagnostics, and other medical devices across a range of global health areas. That could include HIV/AIDS, tuberculosis (TB), malaria, neglected tropical diseases (NTDs), maternal and child health, emerging infectious diseases, antimicrobial drug resistance, and more.
The fund could be used to advance discrete disease- or health-area specific innovations currently missing from our toolbox—such as more effective vaccines against TB or treatments and vaccines for NTDs. It could also be used to develop multipurpose tools that address multiple health areas simultaneously. The latter includes products like insecticides and other vector control tools, which reduce the burden of multiple diseases carried by mosquitoes, or combination HIV-prevention/contraception innovations, like vaginal rings or injectable therapies.What projects the fund ultimately chooses to finance would be determined by its leadership, in consultation with scientific experts and affected communities. For a comprehensive table of the types of technologies the fund could support, view page 8 of our policy brief.
To establish the SIGHT Fund, the US Congress would need to provide dedicated funding to USAID. Congress would do this by creating a new funding line for global health innovation under Global Health Programs within the State, Foreign Operations, and Relations Programs appropriations bill—the annual legislation that funds USAID.
Once it receives this funding from Congress, USAID would then have the resources and directive to establish and run the fund.
Congress could additionally choose to pass separate authorizing legislation for the SIGHT Fund, creating it as a formal entity through US law. This pathway would allow Congress to be more prescriptive in dictating how the fund should operate and make the fund more permanent by enshrining it in law and authorizing multiple years of funding. This step, however, is not required to launch the SIGHT Fund: the key is that Congress provides new dedicated funding to USAID for the specific purpose of funding global health innovation. This dedicated funding would have to be included annually in subsequent appropriations bills for the SIGHT Fund to continue providing dedicated resources for innovation in future years.
While USAID already specializes in advancing health technologies that are responsive to the needs of people living in low-resource settings, the establishment of a SIGHT Fund would provide opportunities for USAID to engage impacted communities more intentionally in setting and carrying out its research agenda.
GHTC recommends USAID, in establishing the fund, create a governance structure that includes representatives from affected communities in low- and middle-income countries. This would give these stakeholders a greater voice in setting priorities for the fund and in determining which research projects it supports. This would also represent a shift from USAID’s current approach, in which research investment decisions are made primarily by US-based leadership of disease- and health-area offices.
In making research awards via the SIGHT Fund, USAID would also have opportunities to build upon its track record of advancing user-centered design approaches and making investments that not only produce new tools, but also strengthen local scientific capacity. All these actions would serve to support USAID’s broader commitment to inclusive development, which seeks to ensure that every person, no matter their identity, is instrumental in transforming their societies
Despite tremendous progress achieved in global health over the last few decades, we are still without essential tools to combat many global health challenges.
No matter what global health area you work in, innovation gaps persist. Take malaria, for example. While past research successes like insecticide-treated bednets and antimalarial drugs have driven huge gains, growing drug and insecticide resistance is undermining the effectiveness of our current tools, leading to stalled progress. To eradicate this disease, next-generation treatments, vaccines, diagnostics, and vector control tools are urgently needed.
Or look at tuberculosis, the world’s second leading infectious disease killer after COVID-19. It is clear our current tools are insufficient to end this epidemic. The one vaccine we have, which is over 100 years old, does not work consistently in adults, and existing treatments, particularly for drug-resistant strains, can require taking thousands of pills and painful injections for six months to nearly two years. To turn this tide, we need new and improved innovations.
Even for HIV/AIDS programming, where our existing toolbox is relatively strong, it is common for patients to struggle to adhere to daily antiretroviral therapies (ARVs) taken as treatment or prevention. In the medium term, new technologies like longer-acting injectable ARVs or innovations that combine ARVs with contraception could help more people reliably use treatment and prevention products. Longer term, the development of an effective HIV/AIDS vaccine and cure would have a transformative impact toward ending this crisis.
The fruits of R&D—new and improved technologies—can help make all global health programming and services more effective and efficient, as well as help close access gaps to reach everyone, everywhere with quality care. That’s why it is vitally important that investing in R&D and investing in global health service delivery be viewed as two sides of the same coin in achieving health equity.
For a more detailed look at key missing tools across global health areas, view our fact sheet series.
SIGHT Fund supporters
A diverse group of global health organizations have joined the call for the SIGHT Fund:
- 1,000 Days
- 3rd Stone Design
- Advancing Synergy
- American Academy of Pediatrics
- American Society of Tropical Medicine and Hygiene
- Bay Area Global Health Alliance
- BEMPU Health
- Better World Campaign
- Bilimetrix s.r.l.
- BIO Ventures for Global Health
- Boston University Social Innovation on Drug Resistance Program
- Bridges to Development
- Burnet Institute
- Catalysts for Change
- Center for Global Health Innovation
- Center for Innovation in Global Health, Georgetown University
- Christian Connections for International Health
- Coalition for Epidemic Preparedness Innovations
- Coalition for Health Research and Development
- Consortium of Universities for Global Health
- CORE Group
- Deutsche Stiftung Weltbevoelkerung
- Dr Marri Channa Reddy Foundation
- Drugs for Neglected Diseases initiative
- Elizabeth Glaser Pediatric AIDS Foundation
- Emory University
- Equalize Health
- FREO2 Foundation
- Friends of the Global Fight Against AIDS, Tuberculosis and Malaria
- Global Antibiotic Research and Development Partnership
- Global Health Council
- Global Health Innovative Technology Fund
- Global Health Strategies
- Global Health Technologies Coalition
- Global Impact
- Hemex Health
- Infectious Diseases Society of America
- Innovative Vector Control Consortium
- International Business & Technical Consultants, Inc.
- International Partnership for Microbicides
- International Union Against Tuberculosis and Lung Disease
- International Vaccine Institute
- Johns Hopkins Center for Health Security
- KNCV Tuberculosis Foundation
- Linux Foundation Public Health
- Little Sparrow Technologies, Inc.
- Lucky Iron Fish
- Makerere University School of Public Health
- Management Sciences for Health
- Mbarara University of Science and Technology
- Medical IMPACT
- Medicines for Malaria Venture
- Modula S Inc.
- ONE Campaign
- Pandemic Action Network
- Panorama Global
- Partners In Health
- Pathfinder International
- Policy Cures Research
- Population Council
- Population Services International
- Rice University Institute for Global Health Technologies
- Sabin Vaccine Institute
- Sanaria Inc.
- Seed Global Health
- Sinapi Biomedical
- Smile Train
- Society for Children Orphaned By AIDS Inc.
- South Africa Health Technologies Advocacy Coalition
- Speak Up Africa
- TB Alliance
- Texas Children's Hospital
- The BroadReach Group
- The END Fund
- The Task Force for Global Health
- Treatment Action Group
- UCSF Institute for Global Health Sciences
- United to Beat Malaria
- Unlock Aid
- Vanderbilt Institute for Global Health
- Washington Global Health Alliance
- WCG Cares
- What To Expect Project
- White Ribbon Alliance
- Women in Global Health
Take action: Become a SIGHT Fund supporter
If you would like to add your organization to our list of SIGHT Fund supporters and join this advocacy effort, please fill out the form below.
Share your support: Use the suggested tweets below
We can't fight #globalhealth threats without the right tools. That’s why we’re calling on policymakers to create a new research fund at @USAIDGH to catalyze development of new and improved health technologies. bit.ly/36la2rw
We are still without essential tools to defeat many #globalhealth challenges. Join us in pushing for a new dedicated fund at @USAIDGH to drive inclusive innovation of vaccines, drugs, and other health tools. → bit.ly/36la2rw
Despite @USAIDGH’s long history of developing #globalhealth innovations, in recent years its R&D investments have shrunk as a proportion of health spending. A new proposed fund would reverse this decline and bolster our global health toolbox. → bit.ly/36la2rw
New funding is needed to stock the #globalhealth toolbox of the future and accelerate progress in global health. Join us in calling for a new dedicated fund at @USAID to supercharge innovation → bit.ly/36la2rw
When it comes to fighting #globalhealth threats, we must center the perspectives and priorities of people in affected communities in investment decisions. A new proposed fund would help drive inclusive innovation at @USAIDGH bit.ly/36la2rw
@USAIDGH has unique capabilities and proven experience in advancing scalable #globalhealth products—but its R&D funding has stagnated. Join us in calling for Congress to supercharge inclusive innovation with a new dedicated fund. → bit.ly/36la2rw
#COVID19 has shown the importance of #innovation in fighting epidemics. Yet, we are still missing critical tools to combat enduring threats like #HIV, #malaria & #TB. That's why we're calling for a new research fund at @USAID to supercharge R&D. bit.ly/36la2rw