Breakthroughs Blog: State Department

As more detailed information about the President’s fiscal year (FY) 2015 budget requests to Congress is released, the results continue to be a mixed bag for global health research and development (R&D). The Congressional Budget Justifications—annual presentations to Congress to justify requests for funding—help shed a light into the administration’s priorities for FY 2015. National Institutes of Health (NIH) While the President made a modest request for overall NIH funding, the release of the NIH congressional budget justifications gives us a better sense of how the President hopes to fund specific institutes and programs at the agency. The National Institute of Infectious Diseases (NIAID) did include increases of $5.76 million for Biodefense and Emerging Infectious Diseases, $6.95 million for infectious and immunologic diseases, and $23.4 million for HIV and AIDS research compared with funding for FY 2014. The President’s request for the Office of AIDS Research—which covers all HIV and AIDS activities within all of the centers at NIH—was $3.004 billion. While this is nearly a $20 million increase from 2014 enacted levels, this number is still below enacted numbers for 2011 and 2012. Within this request was a decrease of 0.4 percent from 2014 funding for microbicides, an increase of 0.8 percent for vaccine research and a decrease of 1.4 percent for therapeutics research. Centers for Disease Control and Prevention (CDC) Historically, research at the CDC has led to major advances against devastating diseases, including the eradication of smallpox and advances in AIDS research. With a disappointing funding request for NIH, we were glad to see a much stronger request for the global health budget within the CDC. The President’s request included $445.29 million for Emerging and Zoonotic Infectious diseases, a $54.85 million increase from FY 2014 levels. Included in this was the $30 million requested for the Advanced Molecular Detection Initiative. The $30 million will go towards investments in advanced molecular detection technologies to help speed up outbreak detection and increase response efficacy. We’re glad to see the Administration acknowledging the need for the CDC to be cutting-edge in an increasingly global arena. US Food and Drug Administration (FDA) Amongst the government agencies involved in various stages of the development pipeline, the FDA has a vital role to play in accelerating the review of new global health products and strengthening the global regulatory system. Despite the tough budgetary times we currently face, Congress has been asking the FDA to do more with less. That said, we were pleased to see the President acknowledge that increased authority should also mean increased funding, with a robust request of $4.7 billion for the FDA, an 8.1 percent increase from Congress’ appropriation for 2014. The FDA’s Congressional Budget Justification acknowledged the unique role of the agency as an important international collaborator for global health through research and information sharing. The language specifically highlights the Biologics Program and its work to promote research and information sharing to facilitate access to vaccines and other products, harmonize regulatory standards, and establish and maintain standards for biologics. Another highlight is the news that FDA is in the process of drafting a proposed rule to add to their current list of neglected diseases for which they can allow accelerated reviews, and is specifically considering adding Chagas disease. US Agency for International Development (USAID) As we reported in our first blog post, while funding for global health at USAID and the Department of State was fairly disappointing, we were pleased to see an increase in the President’s request for malaria. Notable in this request was acknowledgement of the need for continued funding for R&D to support “the development of new malaria vaccine candidates, antimalarial drugs, new insecticides, and other malaria related research with multilateral donors.” Also in the USAID request was $153 million in central funding to accelerate science, technology innovation, and partnership. USAID describes this aim to “develop and scale breakthrough solutions and accelerate the transformation of the United States’ development enterprise by leveraging outside resources and improving the sustainability of development programs by attracting private-sector, market driven resources.” Department of Defense (DoD) DoD is the only US agency that funds global health research and product development from discovery to introduction. While we’re still sifting through all of the details in the Defense budget justifications, R&D at the agency—including health R&D—increased overall by 1.7 percent over FY 2014 enacted levels. Much of the global health research at DoD is funded through the Army’s Research, Development Testing and Evaluation (RDT&E) division as well as the Defense Health Program—including research on HIV and AIDS, malaria, and leishmaniasis. While we’re grateful the administration is continuing to recognize the need for sustained, robust support for global health R&D across several agencies, the decline of global health research funding in some key accounts remains concerning. We’ll look to Congress to equip these agencies with the necessary resources to carry out their essential role in developing new global health tools.

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.

Last week, a bipartisan group of legislators in both the House and Senate introduced the Foreign Aid Transparency and Accountability Act of 2013. Sens. Marco Rubio (R-FL) and Ben Cardin (D-MD) and Reps. Ted Poe (R-TX) and Gerry Connolly (D-VA) introduced the companion bills. Rep. Poe is co-chair of the Congressional Caucus for Effective Foreign Assistance. According to the Modernizing Foreign Assistance Network, the legislation puts in place guidelines on foreign aid that would apply to all relevant US federal agencies, along with metrics to measure progress. It would also require the president to maintain and expand the Foreign Assistance Dashboard, an online resource that allows users to examine, research, and track US government foreign assistance investments. Under the bill, the Dashboard would be broadened to include all US agencies that administer foreign aid programs. Currently, only five are represented: the State Department, the US Agency for International Development, the Millennium Challenge Corporation, the US Department of the Treasury, and the Department of Defense. Sens. Marco Rubio (R-FL) and Ben Cardin (D-MD) and Reps. Ted Poe (R-TX) and Gerry Connolly (D-VA) introduced companion bills that would reform several aspects of US foreign aid programs. A previous version of the bill came very close to becoming law during the last congress—the bill passed the House unanimously, but was held up at the last moment in the Senate. Supporters are hopeful that this new legislation won’t face the hurdles of previous versions, and already there are signs the bill could pass this year. Leaders from the global health and international development community have expressed broad support for the bill and have called on Congress to move it through the legislative process quickly. The reforms in the bill are welcome improvements in how the US government reports on its progress, as well as its challenges, with its foreign aid programs. As is the case with most global health research and development programs, hard data on how programs are funded, successes, and educational failures can be difficult to synthesize. Publicly available data that shows the effectiveness of the broad array of US foreign aid activities could boost support from US taxpayers and communities in target countries—ideally leading to a more adaptive, stronger foreign assistance platform.