Film series highlights need for new TB vaccines worldwide

Earlier this week, both the House and Senate passed a budget package to fund the government through the remainder of fiscal year (FY) 2013, thereby averting a government shutdown when current funding expires on March 27. The new compromise funds most accounts roughly at FY2012 levels, with an across the board cut of 0.092 percent. As a reference, the Centers for Disease Control and Prevention's Center for Global Health budget was $349 million in FY2012, while the National Institutes of Health was funded at $30.69 billion. In addition, global health programs at the State Department and US Agency for International Development (USAID) were funded at $8.167 billion. The budget package also makes some key changes to certain programs. For instance, global health programs at the State Department and at USAID, including those that fund global health research and development (R&D) initiatives, are increased over FY2012 levels by roughly 5 percent—potentially to counteract the effects of sequestration. The bill also gives greater flexibility to the Department of Defense to manage sequester cuts to its budget. It also leaves the sequester largely in place, instead of replacing it with balanced budget cuts, as many advocates in the global health community were hoping lawmakers would do. The bill now goes to President Obama’s desk, and he is expected to sign it. Budget negotiations in Congress will have far-reaching effects on global health R&D efforts at agencies such as CDC, DoD, NIH, and USAID. Photo credit: PATH/Evelyn Hockstein. If and when Obama signs the final FY2013 budget package into law, the funding levels will still be subject to sequestration—meaning that the final levels are really anywhere from 5 percent to 9 percent lower. For instance, USAID’s global health programs would see an overall cut of $193 million. While this is better than the $428 million cut it was facing before the Senate stepped in, it could still have a large impact on global health and R&D programs that fall under USAID. The House also passed its version of an FY 2014 budget resolution, which would replace sequestration with budget caps for the next decade. The House resolution would move most of the budget cuts away from the Department of Defense and onto non-defense accounts, including most global health R&D programs, and would balance the budget over the long term. The Senate has introduced its own budget resolution, which could pass today or tomorrow. The Senate version is very different from the House version, as it would make balanced cuts to both defense and non-defense programs and protect non-defense programs from the drastic cuts seen in the House budget. The Senate version does not include a plan to balance the budget in the short- or long-term, but contains a significant reduction in spending over the next decade. Although replacing sequestration with an actual budget plan is widely approved of, advocates for both domestic and global health programs believe that the House budget resolution would be devastating for key health and humanitarian programs. Therefore, as Congress makes decisions on FY2014 spending bills, lawmakers should use a balanced approach when allocating budget cuts (as seen in the Senate version), and increase support for global health and R&D when possible. Additionally, as agencies receive their final FY2013 budgets, they should ensure that global health and R&D programs are protected.

Earlier this week, the GHTC and other global health and international development advocates called on the House Appropriations State and Foreign Operations subcommittee to fully fund key programs in the foreign affairs budget. Advocates presented testimony regarding the fiscal year (FY) 2014 budget for State and Foreign Operations, which includes funding for the US Agency for International Development (USAID) and many other global health and research programs. Subcommittee Chair Rep. Kay Granger (R-TX) and Ranking Member Rep. Nita Lowey (D-NY) ran the proceedings, and Reps. Barbara Lee (D-CA) and Henry Cuellar (D-TX) also attended. Granger and Lowey kicked off the hearing with statements in support of continued US leadership in global health and foreign aid programs. Lowey stated that she is “proud of the progress that US government funding has made against diseases like tuberculosis, malaria and HIV and AIDS.” Global health research and development (R&D) efforts funded by agencies like USAID play an inextricable role in this progress, through innovations such as new HIV drugs, tuberculosis (TB) diagnostics, and advanced insecticides to bolster the use of mosquito nets to prevent malaria. Rep. Kay Granger (R-TX) (right) and Rep. Nita Lowey (D-NY) (left) ran the hearing, which focused on the FY 2014 budget for USAID. Photo credit: PATH. The GHTC and many of its members were invited to testify at the hearing, and spoke about the value of global health research in terms of saving lives, improving health outcomes, furthering American innovation, and increasing cost-savings in public health over the long term. According to the GHTC’s written testimony, every day “more than 35,000 people die from AIDS, TB, malaria, and other neglected diseases around the world. … These issues highlight the urgent need for sustained investment in global health research to deliver new tools to combat these devastating diseases.” Fortunately, previous “US investment in global health R&D has generated great success in treating devastating diseases and improving the lives of millions through new technologies.” And there are “several very promising technology candidates in the R&D pipeline; however, these tools will never be available if the support needed to continue R&D is not supported and sustained.” Other GHTC members stressed the importance of sustained support from USAID and other US agencies for global health research initiatives. For example: Jennifer Katz, policy director for the North America office of the Drugs for Neglected Diseases initiative (DNDi), highlighted the need for USAID to expand its neglected tropical disease (NTD) program to include research and product development through the story of William, a boy stricken with sleeping sickness in Uganda a few years ago. William was treated with the only medicine available at the time—an arsenic-based drug called melarsoprol. Michael died not from sleeping sickness but from the side effects of the toxic medication. Katz then explained that if William were treated today, he would receive a non-toxic and effective drug developed by DNDi. Katz stressed that support from USAID to develop new and improved NTD treatments would mean that more lives could be saved worldwide. International AIDS Vaccine Initiative (IAVI) CEO Margaret McGlynn described how even a 70 percent efficacious HIV vaccine distributed to 40 percent of the population in low- and middle-income countries would avert 8.9 million new infectious over 10 years. This impact would be a groundbreaking step forward in public health. USAID is a leading funder of IAVI’s efforts to develop a safe and effective HIV and AIDS vaccine, and McGlynn emphasized that Congress should continue to support USAID’s HIV vaccine research programs so this research can continue. Sabin Global Network for Neglected Tropical Diseases Managing Director Dr. Neeraj Mistry described the success that USAID’s NTD control program has had in delivering more than 587 million treatments and training hundreds of thousands of community health workers. Mistry also noted that USAID should increase its support for NTD research and product development efforts. Indeed, USAID can repeat its success in delivering existing treatments by also funding NTD research and product development, as new and improved drugs and other tools are desperately needed. PATH’s Senior Director of Policy and Advocacy Rachel Wilson described how a New Jersey company, in partnership with PATH and USAID, developed and produced a vaccine vial monitor that is now used to ensure the quality of every vaccine that UNICEF and other global agencies deliver worldwide. This is just one example of the economic benefit global health research holds for the United States. For example, 64 cents of every dollar invested in global health R&D goes directly to US researchers, many of which conduct research with domestic universities and academic centers—thereby providing jobs and jumpstarting new economic activity. Other global health community members such as the Non-Communicable Disease Roundtable, Bread for the World, and the GAVI Alliance also testified in support of global health and development programs. Witnesses at the hearing strongly demonstrated that even in this extremely challenging fiscal climate, when difficult decisions must be made in the face of budget cuts, is it essential that Congress prioritize effective programs that save lives at home and abroad. Global health research and product development programs at USAID save millions of lives, spur economic activity in the United States, and save money in the long run. These programs must be protected, and the US leadership in this area must not falter. To achieve this goal, Congress must ensure that global health research programs at USAID and across the government are robustly funded in FY 2014.