Breakthroughs Blog: US budget

Now that Labor Day has passed and Washington, DC, is starting to cool down, members of Congress are filtering back into town from their August recess travels. Some were conducting district work, others were on vacation, and still others traveled to some of the hotspots for global health programming and research. With just nine working days left in the congressional calendar before the beginning of fiscal year 2014, the only thing most in Washington can agree on is that there won’t be a long-term budget deal by October 1. This means that we’re looking at another continuing resolution to keep the government open for the rest of the calendar year. Even beyond October, there are not very many days that Congress—particularly the House of Representatives—will be in session between now and the end of the year. What should Congress do with the limited working time it does have? Here are a few priorities. With the limited time Congress has between now and the end of the year, lawmakers should focus on avoiding a government shutdown, passing a budget agreement, and supporting global health R&D programs. 1. Avoid a government shutdown. First and foremost, Congress needs to pass legislation to keep the government open past September 30. Preferably, this legislation would support programs at least at their current levels. It should also include an expiration date far enough away to avoid yet more political battles related to the debt ceiling. 2. Pass a smart budget agreement that dodges sequestration while protecting key programs. Francis Collins, director of the National Institutes of Health (NIH), must be exhausted from explaining over and over the dire consequences of budget sequestration at his agency. NIH’s purchasing power has been reduced by 25 percent compared with fiscal year 2003. At least 700 NIH grants that would have been funded in the absence of sequestration have been denied support. Collins has stated that key vaccine research programs that are near fruition are at risk because of sequestration funding cuts. The case is similar at other US agencies that fund global health research and development (R&D). Congress must get past its political arguments and pass a budget that supports programs focused on saving lives and producing efficiencies and cost savings—thereby helping to avoid another round of sequestration cuts. Which leads us to… 3. Move legislation forward that creates efficiencies in global health and international development. One priority that the Obama Administration and Congress agree on is using efficiencies gained by technology and innovation to create cost-savings and promote US interests. The 21st Century Global Health Technology Act and the Foreign Aid Transparency and Accountability Act both achieve those goals. Congress should move to see them through committee approval and toward full House and Senate consideration. 4. Sustain global health programs, including global health R&D. Global health programs are recognized as effective and necessary by political champions of all stripes—particularly R&D for new global health technologies. Not only do these programs save lives at home and abroad, they also have a positive impact on local and global economic prosperity and save money in the long run. However, none of these positive effects is felt if budgets are indiscriminately slashed or if research is relegated to the back burner in order to save a few dollars upfront. Government shutdowns and sequestration cuts that slow R&D here in the United States impact populations far beyond our national borders—effects that reverberate back to the US. In addition to economic and political consequences, there is a growing burden of neglected diseases in the United States. For instance, there are an estimated five million impoverished Americans who live with neglected tropical diseases, including a previously hidden burden of neglected diseases among the poor in the southern United States. Supporting research to develop new health tools will help fight these diseases both at home and abroad. No one expects large budget increases this year, but Congress can halve the negative effects that even small decreases have by sustaining funding for global health and health research programs. 5. Act on the good stuff. Let’s end on a positive note. Recently at the US Agency for International Development’s Saving Lives at Birth Development XChange, author Dan Heath gave a TED-talk-like presentation on a model of thinking that does not get nearly enough emphasis: Instead of focusing on the problems, find the successes. As Heath put it, "Find a bright spot, and clone it." Congress appears to be at a standstill due to disagreements over budget levels, immigration programs, national security, and a host of other issues. However, members of Congress have the opportunity and the means to shake their obstructionist reputation and make progress on items they agree on—including supporting innovative global health research. There are lots of areas that Congress by and large agrees on, but which rarely make headlines. Members need to start acting on such unifying issues such as global health R&D and advance legislation that can have a positive impact on people’s health around the world.

  As we discussed yesterday, lawmakers in the House and Senate have been busy with several pieces of legislation that would fund global health and research efforts across the federal government. Our first post yesterday detailed implications for global health research and development (R&D) activities at the US Department of State and US Agency for International Development. Today, we provide highlights for other key agencies involved in global health R&D. Labor-HHS The Senate Appropriations Committee has approved legislation to fund the Labor, Health, and Human Services (HHS) account, which includes support for the National Institutes of Health (NIH) and the US Centers for Disease Control and Prevention (CDC). Currently, there is no House version of this bill—a hearing scheduled for last week was canceled—so while we don’t have those figures to compare funding levels with, we do know that the House allocation for this account is drastically lower than the Senate version. Lawmakers in the House and Senate have been busy with several pieces of legislation that would fund global health and research efforts across the federal government. including the DoD, CDC, FDA, and NIH. The Senate bill would fund the NIH at $30.9 billion, which is a welcome but small increase of $307 million over FY 2013. Many key institutes and centers—including the National Institute of Allergy and Infectious Diseases, the National Institute of Child Health and Human Development, and the Fogarty International Center—were funded at levels higher than the final FY 2013 allocations but lower than the levels President Obama requested for FY 2014. One exception is the National Center for Advancing Translational Science, which received a total of $662.4 million under the bill—a boost in funding of $87 million over FY 2013. This includes a total of $50 million for the Cures Acceleration Network. The legislation would fund CDC at $6.9 billion, an increase of $681 million over FY 2013 and $300 million over the President’s request. This funding includes $391 million for the Center for Global Health, a significant increase of $46 million over FY 2013. The National Public Health Institutes received a $10 million allocation under the bill, which also included a large bump for polio eradication: $146 million versus the $131 million the President requested and the $116 million from FY 2013. The National Center for Emerging Zoonotic and Infectious Diseases was funded at $335 million, an increase of $44 million over FY 2013. FDA The House recently passed its appropriations legislation to fund the US Food and Drug Administration (FDA), providing the agency with $2.485 billion (not including income from user fees). This is roughly $20 million more than the agency received in FY 2013 and $40 million more than the President requested. Language was included in the bill that would ensure the FDA can review products for all neglected diseases, encourage the agency to “build stronger partnerships with global regulatory stakeholders, and strengthen its internal capacity to review products for neglected diseases.” Similar language was included in the Senate version of the legislation, which funds FDA at a higher level of $2.562 billion, or roughly $77 million more than the House version. Defense The full House passed a Department of Defense funding bill, in which the entire agency was provided with $513 billion. The bill would also provide $9.6 million for malaria vaccine development efforts, and welcome language is included in the bill report regarding the need for such a vaccine. The Senate Appropriations Defense subcommittee voted on its version of Defense funding yesterday, July 30th. We’re still waiting for the release of the accompanying bill report to determine any implications for global health R&D. As we pointed out yesterday, it’s clear that many global health R&D programs are being flat-funded year after year. If Congress is unable to reach a long-term budget deal, sequestration cuts will take effect again, further hampering efforts to develop urgently needed new technologies. Congressional policymakers could still reverse this trend by fully funding global health and health research programs through the FY 2014 budget conference later this year, as well as through negotiations around the impending debate on the US debt ceiling. However, with the difficult political climate, it’s unclear whether they will take advantage of this important opportunity. Links to other helpful analyses: American Association for the Advancement of Science Alliance for a Stronger FDA

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.

Today, the Senate appropriations committee approved a fiscal year (FY) 2014 appropriations bill that outlines funding levels for the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC). The Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) Appropriations Bill would take the positive step of restoring sequestration cuts to CDC and NIH, although there is mixed news for global health programs at the agencies. NIH The bill would fund the NIH at a total of $30.9 billion in FY 2014, restoring this year’s five percent sequestration cut and providing a small increase over last year’s budget. Science Insider reports that the NIH had “strong support” from Senate Appropriations Committee Chair Barbara Mikulski (D-MD), who recently said that she is determined to reverse "reckless cuts to American biomedical research." In her opening remarks earlier today, Sen. Mikulski said, “Because of the investments we have made in NIH over the past decades, … HIV and AIDS is no longer a death sentence, and polio and small pox are essentially eradicated in this country. These medical breakthroughs didn’t just happen, they occurred because this Committee supported NIH, and the NIH supported dedicated scientists who sought knowledge and medical breakthroughs. We must keep up this support.” The bill includes $50 million, five times the FY 2013 level, for NIH’s Cures Acceleration Network, which aims to speed the translation of medical research discoveries in the laboratory that have not advanced far enough to attract significant investments from the private sector. According to Nature, in order to approve a new NIH budget—as opposed to passing yet another continuing resolution for FY 2014—the House and Senate must agree on a common figure for the agency. As a comparison, the House FY 2014 Labor-HHS bill would provide $8 million less for NIH compared with the Senate version. The Senate Labor-HHS appropriations bill for FY2014 would fund the NIH at $30.9 billion and the CDC at $7.022 billion. Credit: PATH/Evelyn Hockstein CDC The Senate bill would provide CDC with $7.022 billion in funding for FY 2014. The bill would restore the $800 million cut from CDC’s budget by sequestration and add a $22 million funding increase. The bill would provide $391.9 million for CDC’s Center for Global Health. This would include $116.9 million for CDC’s Global AIDS Program, which is equivalent to the FY 2013 level, but $15 million below President Obama’s FY 2014 request. The bill would provide $19.3 million for CDC’s Parasitic Diseases and Malaria program, which is comparable to FY 2013 levels, but less than the $22.2 million requested by Obama. CDC’s Division of Tuberculosis Elimination would receive flat funding at the FY 2013 funding level of $140 million. No additional funding for the division’s research programs was allocated. Finally, the bill also contains a total of $19.2 million for Global Public Health Capacity Development. These funds are for a new initiative to support public health capacity building in at least five developing countries over a two-year period to be overseen by CDC. The fate of the Labor-HHS appropriations bill is unclear from this point on. There is a $91 billion funding gap between the House and Senate overall budgets for FY 2014. And while the House Labor-HHS subcommittee has its overall budget, the subcommittee has not announced a date for consideration of a bill. Whatever happens, both the House and Senate must work to protect funding levels at the NIH, CDC, and all federal agencies that support global health and research programs.