Breakthroughs Blog: State Department

In this feature on Breakthroughs, we provide an update on what’s currently happening with global health in Congress and an outlook for future legislative activity. Following the August recess and Labor Day Holiday, Congress is now back for a very brief time before it takes another break to focus intensely on campaigning ahead of the November elections. We don’t expect much action on legislation specific to global health or research programs. Instead, Congress will focus on passing a Continuing Resolution (CR) for fiscal year 2013 in order to keep the government running through the end of March 2013, as members juggle the remaining legislative tasks on their plate. The CR actually includes a tiny 0.6 percent increase across the board for all federal programs, including those that fund global health research. However, the resolution will expire long after the looming budget sequestration goes into effect in January 2013 and will also run into the fiscal year 2014 budget process, effectively creating a budgeting perfect storm. Advocates for a wide range of federal programs are in high gear to convince Congress to delay sequestration or to pass a balanced budget in its place. Some of those advocates have found congressional allies willing to take on their cause. Also this week, we’re looking for a report from the Obama Administration on the potential impact of sequestration on federal agencies. As we outlined in our last update, sequestration could result in cuts ranging from 8.5 percent to 14 percent to most federal programs, depending on the outcome of the budget negotiations in Congress and the November elections. Sequestration would undoubtedly have a significant impact on global health and research programs at agencies like the Centers for Disease Control and Prevention, the Department of Defense, the US Food and Drug Administration, the National Institutes of Health, and the US Agency for International Development. We’re eager to see this report and learn more about how sequestration might impact efforts supported by these agencies to develop new lifesaving global health tools. Global health research and development (R&D) programs span the breadth of the US budget. Congress needs to work to protect these essential R&D programs from disproportionate cuts and ensure that funding is sustained—and increased if possible—for the coming years. Although the elections may be on the top of everyone’s to-do list for now, temporary budget fixes that leave these activities vulnerable to indiscriminate cuts and similar actions will not work forever. We need a plan that protects global health R&D and other key programs for the long-term, and right now, that job starts with Congress.

Mitchell Warren, the executive director of AVAC and a founding member of GHTC, wrote the following op-ed in reaction to Secretary of State Hillary Clinton’s speech at the National Institutes of Health and her announcement to prioritize achieving an AIDS-free generation. This op-ed originally appeared in The Hill’s “Congress Blog” this week. Last week at the National Institutes of Health (NIH), Secretary of State Hillary Clinton laid out an ambitious vision to end the HIV and AIDS pandemic. In a statement that no US leader has made before, Clinton said that it is possible to achieve an AIDS-free generation. The goal Secretary Clinton lays out is indeed possible, and we welcome her announcement of an additional $60 million for implementation of a combination of prevention strategies in four sub-Saharan African countries and evaluation of their impact. But this funding can only be viewed as a down payment on the work that needs to be done. In order to get there, the Obama administration, along with developed and developing country governments around the world, need to add specific commitments, milestones, and strategies to the vision. And they need to commit to the long haul. It is 16 days to World AIDS Day, and we expect to hear additional commitments and see leadership from President Obama, with an eye to both the international and domestic epidemics. The good news is that, as Secretary Clinton emphasized, there is a strong foundation on which to build. Thanks in large part to prior US support for HIV research and implementation, particularly via the NIH, we have today three key tools to help end the epidemic: voluntary medical male circumcision, effective treatment for people living with HIV, and prevention of mother-to-child transmission. If taken to scale, the number of new infections will plummet. But Secretary Clinton also noted the need to continue developing new tools for tomorrow. The commitment to both research and implementation must be unwavering. There are three critical research priorities that require long-term investment to truly close the door on AIDS. First, we need real-world research to understand how best to use additional HIV prevention tools that were recently found effective in clinical trials, including topical microbicides and pre-exposure prophylaxis, or PrEP. Second, we need to sustain the search for a vaccine to prevent HIV, especially now that the vaccine field is being re-energized by promising new scientific advances. Third, we need to pursue the increasingly real possibility of developing a functional cure for HIV infection. It is critical to sustain investments in research and development for additional powerful prevention tools. On World AIDS Day, we will be listening for a strong, specific commitment to scaling up the tools we have at our disposal immediately, with a focus on combination prevention and an emphasis on HIV testing and counseling, which is the gateway to male circumcision, prevention of mother-to-child transmission, and treatment and care for HIV positive people. Now is the best possible moment to invest in research, when the possibilities for long-term success are greater than ever before. This is when we should double down on some of the amazing successes we’ve seen in the past few years. As Secretary Clinton said in her speech, it is possible to create an AIDS-free generation. Research has made this goal possible, and we must stay focused on the future. We cannot turn back now. Not when there is a potential end to this epidemic finally in sight.

After Secretary of State Hillary Clinton’s speech at the NIH earlier this week, GHTC asked our member organizations involved in HIV and AIDS why the US should continue to prioritize HIV and AIDS research. Here are answers from three of our members working on this issue: Elizabeth Glaser Pediatric AIDS Foundation: GHTC members stress the importance of prioritizing HIV and AIDS research in order to save lives around the world. Photo: Wendy Stone/PATH Discovering the medical interventions to prevent mother-to-child transmission of HIV (PMTCT) is one of the great success stories in the thirty-year fight against HIV and AIDS. But we cannot finish the job of eliminating pediatric AIDS worldwide without continued research. To implement the science that we do know, operations research is needed to address the global gaps in PMTCT coverage. Further clinical research is also needed to understand why approximately 60% of babies who are exposed to HIV from their mothers and receive no medical interventions still do not become infected. Answering this question could help in the development of an HIV vaccine that is safe and effective for children and adults, and provide lifetime immunity to the virus. International AIDS Vaccine Initiative: US support of HIV and AIDS research, including new HIV prevention tools, is vital to bringing an end to a pandemic that has taken and affected millions of lives in the US and worldwide, as well as cost the global economy billions of dollars. These investments also keep the US on the frontier of scientific innovation, as the lessons learned in trying to stop one most formidable foes ever encountered by scientists hold potential across many areas of medicine. Global Campaign for Microbicides/PATH: The generosity of the American people invested in HIV research can not only help to save the lives of poor people in other countries most greatly affected by HIV—but that same generosity can benefit the American people whose lives can also be saved by the same innovations. The world is a small place. As good global neighbors, prioritizing HIV research can help save the lives of poor people in not-so-distant lands. The same innovations in HIV treatment and prevention can save the lives of our neighbors much closer to home.

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.