Research Roundup: What we’re reading this week

Recent weeks have seen a flurry of activity for both the House and Senate appropriations committees. Congressional policymakers have approved several pieces of fiscal year (FY) 2014 budget legislation, including bills for accounts that fund global health research and development (R&D). However, with August recess looming and the end of FY 2013 only eight weeks away, it’s looking even more likely that we’re heading for another continuing resolution to keep the government running. Below, we provide highlights from recent Congressional budget activity that will determine funding levels for State and Foreign Operations, including global health and R&D programs at the State Department and the US Agency for International Development (USAID). Tomorrow, we’ll provide an update on budget activities that will impact R&D programs at other key federal agencies that support global health R&D. Congressional policymakers have approved several pieces of FY 2014 budget legislation, including bills for accounts that fund global health research and development. State and Foreign Operations As expected, the Senate version of this bill was much friendlier to several global health programs compared with the House version. The Senate bill would: Provide $8.455 billion for global health programs, which is $140 million above President Obama’s FY 2014 budget request level and $280 million above the House’s version. The difference between the House and Senate versions of the bill seems to be entirely contained in USAID’s Global Health Programs account and the State Department’s family planning programs, as funding for the Global Fund to Fight AIDS, Tuberculosis, and Malaria and the President’s Emergency Plan for AIDS Relief through the State Department were even between the House and Senate. One stark difference between the House and Senate bills is the family planning funding levels. The House version of the bill would prohibit funding to the United Nations Population Fund (UNFPA) and allocates a total of $461 million to all State and USAID family planning and reproductive health programs. The Senate bill, by contrast, includes $670 million for the same accounts, with $40 million of that money going to UNFPA. On a positive note, funding for tuberculosis programs was restored to $236 million, its FY 2012 level, in the House bill and to $225 million in the Senate version—much higher than the $191 million requested by the President. Funding levels aside, the policy language included in the Senate bill report contained several mentions of global health research, including key language on contraceptive R&D: “The Committee recognizes that there is a need to accelerate research and development of contraceptives that are more effective, affordable, and easier to deliver and may also prevent sexually transmitted diseases,” the bill reads, adding that USAID should increase funding to its Office of Population and Reproductive Health for such efforts. There is also some good news in the policy language in the House bill report. On neglected tropical diseases, the House bill “encourages USAID to support research into new drugs to address these diseases,” which is a step in the right direction. The bill also includes supportive language for malaria and HIV vaccines, microbicides, and pediatric HIV diagnostics and treatments. For the first time, it also includes a paragraph on USAID’s role in developing new health technologies: “The Committee continues to support USAID’s health technologies programs, including the development of technologies that maximize the limited resources available for global health and ensure that products and medicines developed for use in low-resource settings reach the people that need such products and medicines.” As with past years, global health programs fared better than other international development sectors in the State and Foreign Operations bills, particularly in the House version. However, as our next update will illustrate, we continue to see a clear pattern of flat-funding key programs across all federal agencies supporting global health and R&D. Combined with the threat of indiscriminate sequestration cuts, this is not an effective way to set long-term fiscal and programmatic goals. Furthermore, in both the short and long term, cuts to these programs undermine the immense progress made in global health research and threaten the future of the US global health mission. Tune in tomorrow for more details. Links to other helpful analyses: Kaiser Family Foundation Science Speaks blog InterAction

The House State and Foreign Operations (SFOPS) Appropriations Subcommittee on Friday held a hearing on its fiscal year (FY) 2014 budget legislation. The bill funds programs at the State Department and US Agency for International Development (USAID), including key global health research activities. Overall, global health programs fared relatively well under the bill, compared with other SFOPS accounts. That said, the Global Health Programs account, which includes activities at the State Department and USAID, was funded at $8.175 billion—a $140 million cut from the FY2014 request from President Obama but an increase of $200 million compared with the final FY2013 funding level. Under the bill: USAID would receive $2.505 billion in FY2014 for global health programs, which is a reduction of $140 million from Obama’s request. The State Department’s global health programs would receive $5.67 billion, which is equal to the FY2014 requested level. Therefore, it seems that spending cut to global health programs was taken from USAID and not the State Department. The House SFOPS bill would reduce funding for global health and research programs at the State Department and USAID. Photo: Evelyn Hockstein/PATH There’s not much detail offered on funding levels for specific diseases and sectors. There is language in the bill that implies full funding for the Global Fund to Fight AIDS, Tuberculosis, and Malaria within the State Department budget. However, no dollar amount is mentioned. One exception to this pattern is family planning. The legislation caps this funding at $461 million (equivalent to the FY2008 level) and contains language that would reinstate the Mexico City Policy. Accounts for international development banks, United Nations programs, and development assistance were slashed heavily. Development assistance programs would be funded at $2.0 billion under the bill, or a cut of $838 million from Obama’s FY2014 request of $2.837 billion. As we’ve seen in recent House versions of this legislation, all funding for the United Nations Population Fund (UNFPA) and the United Nations Educational, Scientific, and Cultural Organization (UNESCO) would be prohibited. Key umbrella funding mechanisms like the International Organizations and Programs (IOP) account were cut by more than 50 percent from FY2013 levels. This is important to note as some widely popular programs, such as the United Nations Children Fund (UNICEF), are included in the IOP category. Therefore, if programs like UNICEF are cut due to IOP reductions, allies may try to restore their funding by reducing support for other accounts, such as global health. The subcommittee hearing itself was short. Co-Chair Rep. Nita Lowey (D-NY) criticized the wide range of cuts included in the bill. The full Appropriations Committee plans to vote on this legislation later this week. As a result of sequestration, Congress is operating under tight budget caps for nearly every account. Even with these broad requirements, however, the House and Senate approaches to funding SFOPS programs are vastly different. The House version of the SFOPs bill is roughly 22 percent lower than the post-sequestration FY2013 level. It’s also 25 percent lower than the Senate version. The Senate SFOPs subcommittee will vote on its version on Tuesday. These two bills need to be reconciled on a funding and policy basis before any progress can be made. Funding delays and severe, indiscriminate budget cuts have a devastating impact on global health research and development programs, halting the creation of products that will save millions of lives. Congress should move quickly to protect these programs in upcoming Committee discussions and final budget negotiations later this year. Ashley Bennett is the GHTC’s policy officer.