Breakthroughs Blog: US budget

In this guest post, Regina McEnery—science writer for IAVI Report and VAX—writes about a rally held in Washington, DC, on April 8 to call on federal policymakers to support health research. This post originally appeared on the IAVI Report blog. Megan Kane never thought her first post-doc assignment would be a temporary job in science communications. The Virginia resident, who graduated from Johns Hopkins recently with a PhD in human genetics, had hoped to land a job with an academic or government lab focused on HIV and AIDS. She has a particular interest in long-term nonprogressors—HIV-infected individuals who are able to control HIV for up to a decade or more without ever taking ARVs. But after a 5 ½ month search and about a dozen applications, Kane found the hiring climate about as arid as the Sahara. It wasn’t that researchers weren’t impressed with her credentials or interested in hiring her, she said. They were just reluctant or unable to add new positions—which typically go to early career investigators—due to the rocky funding climate. The fear is that federal funding for basic science, which isn’t exactly exorbitant now, could get a whole lot worse in coming months, thanks to the sequester. That is the $85 billion in automatic and largely indiscriminate spending cuts took effect March 1, which could result in a 5 percent drop in the National Institute of Health’s annual budget of $31 billion. Kane said her friends are all having a hard time finding jobs. And, at least in her case, the frustration doesn’t end with her career. “My husband works for the federal government and so he’s looking at furlough days,” said Kane, who works for Research!America as a communications intern. “That’s another reason why I need a permanent job.” Advocates held a rally on April 8 to call on federal policymakers to stop sequestration from damaging health research efforts. I ran into Kane, dressed in her white coat and snapping pictures, at an April 8 rally championing support for medical research. Research!America was one of the organizers of the rally, held in Washington, DC, in front of the Carnegie Library, where etched in stone were the words: “Dedicated to the diffusion of knowledge.” The library is adjacent to the Walter E. Washington Convention Center, where an estimated 18,000 researchers, policymakers, and advocates had gathered for the annual American Association for Cancer Research (AACR) meeting. It was no coincidence that the rally was staged the same week as the AACR meeting: it is one of the largest scientific conferences in the world, and cancer commands the largest chunk of the NIH budget. People attending the AACR meeting were encouraged to attend the rally—and a few thousand obliged, grabbing free T-shirts with empty boxes printed on the back, so people could spell out why they were there. Many listed cancer, heart disease or stroke. There was a pancreatic cancer group, a diabetes group, and an endocrine disorders group. About half-dozen women wore hot-pink feather boas around their neck to show their support for breast cancer research. And one lone woman, who declined to give her name, said she was rallying for shigella, a bacterium that causes dysentery and which she has been studying for about eight years. The rally lasted about two hours and had a long list of speakers that included Regan Hofmann, former editor of POZ magazine and a long-term survivor of HIV. Hofmann said she has been grateful for the daily dose of combination antiretroviral therapy that has kept her alive since her diagnosis in 1996. “But these drugs have side effects and are not easy to take,” she said. “We need a lot more research and development to find preventive and therapeutic vaccines.” Hofmann said she is grateful for the “extra time on the planet” but “I never stop hoping that one day I won’t have to take the pills.” She is looking to research to help make that happen.

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.

Although we’re several days into sequestration, details about the full impact of funding cuts are still hazy. On Friday, the Office of Management and Budget (OMB) released a report to Congress, which details funding cuts required to offset $85 billion in the fiscal year (FY) 2013 budget. In order to reach this goal, the OMB report indicates that global health research and development (R&D) programs will be subjected to cuts of either 5 percent or 7.8 percent. But because the cuts must take place over a seven month period (instead of a full year) to fit within the fiscal year, OMB calculates that these cuts could actually be at a rate of 9 percent and 13 percent with the remaining funding for this year. OMB’s report provides some specific details on how the cuts are calculated. It also provides illustrative examples of what the sequestration cuts might look like if applied equally within federal agency budgets. However, because agency heads will have discretion over how specific cuts affect their agencies, the exact implications of sequestration will be determined in the coming weeks. Estimates are emerging regarding the widespread impact of sequestration on the agencies that support global health R&D. Photo credit: PATH While waiting for these details to come out, we are starting to see some estimates emerge regarding the impact of sequestration on the agencies that support global health R&D. For example: The National Institutes of Health’s discretionary budget will be reduced from $30,899,000 to $29,321,000 for FY13, a cut of over $1.5 billion. The sequester would equate to a $2.6 billion reduction to the State Department and US Agency for International Development (USAID) FY13 budget, translating to a $1.7 billion cut to foreign assistance programs. In particular, sequestration will cut over $400 million from global health initiatives at the State Department and USAID, including R&D initiatives. Global health programs at the Centers for Disease Control and Prevention are likely to be reduced by taking 5 percent from HIV and AIDS initiatives and then taking 5 percent from the remainder of the account. Discretionary spending for the Department of Defense (DoD) is subject to a 7.8 percent reduction, which would include any global health R&D initiatives embedded in DoD programs. Some reports indicate that the US Food and Drug Administration will lose about 9 percent of its budget for FY13. The Obama Administration is urging Congress to allow the agency to spend $41 billion-worth of user fees. In the meantime, the government is currently running on a Continuing Resolution, which expires on March 27. Congressional leaders and President Obama have expressed hopes about successfully negotiating a new spending bill by March 27, in order to avoid a government shut-down. These negotiations may also provide an opportunity to reverse the sequester, before the full impact of the cuts are felt across the government. The President’s budget request for FY14 is also on the horizon, with reports indicating that it might be released on March 25. The House and Senate will begin to take up FY14 budget resolutions, which each Chamber must pass by April 15. It’s becoming increasingly clear that sequestration is the wrong way to reduce the nation’s debt, especially when the impact would set back innovation and devastate global public health. Policymakers should use the upcoming budget negotiations as an opportunity to reverse sequestration and develop a long-term budget solution that protects and—where possible—increases funding for global health product development. Slashing funding will interrupt scientific progress and leave us without the urgent tools we need to address health needs now and in the future.