Breakthroughs Blog: USAID

This week, months of tense negotiation between leaders in the Democratically-controlled US House of Representatives, the Republican-held Senate, and the White House concluded with the congressional passage of two massive spending packages encompassing all federal government spending for fiscal year (FY) 2020 —nearly three months behind schedule. Two continuing resolutions, passed by Congress to allow additional time for the process to play out after the start of the new fiscal year on October 1, have kept the government operating at FY19 levels, while from week to week, it was anyone’s guess whether the stalemate over funding levels and contentious items like border wall funding could be broken to avoid another government shutdown.A long process to produce two very long billsIn November, the appropriations “cardinals”—chairs and ranking members of both chambers’ Appropriation Committees—announced they had reached a deal on overall spending for each of the 12 appropriations bills, figures known as 302(b)s. This marked a critical step in the negotiations, given that at the time the House and Senate passed a two-year budget deal over the summer, each chamber had been working off of different overall blueprint funding envelopes: The House had already passed its appropriations bills assuming much higher funding levels than were ultimately included in the deal, while the Senate was developing its bills under the more modest final caps.Once the gulf was bridged and the 302(b)s were set, the leaders and their staff worked quickly to develop final compromise appropriations bills, which they grouped into two “minibus” funding packages released on December 16: a “national security appropriations” minibus and a “domestic priorities and international assistance appropriations” minibus, which included the bills for Labor, Health and Human Services, and Education (LHHS) and State and Foreign Operations (SFOPS).Funding increases included for several key accounts The later minibus encompassing LHHS and SFOPS was a mixed bag for accounts that support global health research and development (R&D). In the LHHS division of the minibus, overall funding for the National Institutes of Health (NIH) was boosted 6.7 percent from FY19 enacted levels—including increases of 6.7 percent for the National Institute of Allergy and Infectious Diseases, 3.3 percent for the National Center for Advancing Translational Sciences, 3.4 percent for the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and 3.4 percent for the Fogarty International Center. The joint explanatory statement accompanying the division also notes “an increase of no less than $25,000,000 over the fiscal year 2019 level for HIV and AIDS research” at NIH.The Centers for Disease Control (CDC) saw even greater overall growth than NIH, with an increase of 8.7 percent; however, GHTC-priority accounts that finance global health R&D were mostly flat-funded. While the Center for Global Health (CGH) received a 16.8 percent bump, the entirety of the increase went to Global Public Health Protection—which funds global health security activities—and a new Global Tuberculosis line—which represents level funding of an amount previously transferred annually from a domestic tuberculosis (TB) line to support global TB activities. All other CGH lines were flat-funded. The National Center for Emerging and Zoonotic Infectious Diseases got a modest 1.6 percent bump. The final GHTC priority account in the LHHS bill, the Biomedical Advanced Research and Development Authority (BARDA), was flat-funded.The SFOPS division of the minibus increased overall funding for Global Health Programs at the State Department and US Agency for International Development (USAID) by 2.9 percent. This is slightly lower than what had been proposed in the Senate SFOPS bill earlier this fall and significantly lower than the House proposal to increase by 5.2 percent, but overall still a positive trend reflecting strong support for global health among appropriators, who were working under the constraints of a modest overall SFOPS allocation in the final agreement. At USAID, most health area-specific allocations were flat-funded or increased by about two to four percent—the big exception being the Global Fund for AIDS, Tuberculosis, and Malaria, which was increased by 15.6 percent to reflect the higher pledge made by the US government at the Global Fund’s international pledging conference in October.Report language signals policy support for global health R&DGHTC successfully advocated for the inclusion of several sections of report language, included in the original House and Senate SFOPS bill reports, that will hold under the final agreement. Report language serves as guidance from Congress to US agencies on how it would like to see funding implemented. Language that will hold for FY20 includes GHTC-supported language on USAID’s important role in and reporting on health-related R&D and inter-agency collaboration and coordination on global health product development, as well as support for “CDC’s continued and enhanced work in research and development aimed at creating new tools to respond to health threats at home and abroad” and BARDA’s contributions to emerging infectious disease outbreaks and other naturally occurring threats.The “domestic priorities and international assistance minibus” not only included some positive funding increases and report language, but also advanced a bill supported by GHTC—the End Neglected Tropical Diseases (NTD) Act, which supports R&D activities by USAID to control and eliminate NTDs.The House passed both packages Tuesday afternoon, with the Senate following suit Thursday and now the bills are awaiting signature by the President. GHTC applauds Congress for their strong continued support for global health R&D evidenced by the final deal and looks forward to building on this foundation for our advocacy as we enter a new decade full of opportunities for global health innovation.

Faces of Innovation—a new GHTC project that features scientists on the front lines of research and development on new global health tools and technologies—profiles Dr. Rohit Ramchandani, who we met at the American Society of Tropical Medicine and Hygiene Annual Conferenc. Dr. Ramchandani does research to innovate global treatment options for childhood diarrhea at the Johns Hopkins School of Public Health in Baltimore, Maryland and the University of Waterloo. My name: Rohit Ramchandani, DrPHWhere I work: Johns Hopkins School of Public Health in Baltimore, Maryland and the University of WaterlooI’m funded by: US Agency for International DevelopmentMy research: My research focuses on diarrhea in children…the second-leading cause of death in children under five globally…These are close to 500,000 deaths that are happening every year, most of which are preventable, and treatable. They’re treatable with medicines, oral rehydration salts [ORS] and zinc. That’s the globally recommended treatment for diarrhea. But the problem is, in many low- and middle-income countries, access to these medicines is not where it should be, particularly in rural communities. So we looked at that issue of access. We did it by leveraging human-centered design approach. And we really focused on the details and the challenges that mothers face treating their children with diarrhea…Our research showed that 40% of the time, mothers are preparing ORS in the wrong concentration: either too diluted, or too concentrated. That can lead to hypernatremia, that can make the diarrhea even worse, or the efficacy gets reduced if it’s too diluted. So we actually worked with a local pharmaceutical company in Zambia to shrink down then size of the ORS sachets—the standard all over the world is a one-liter sachet—we shrunk those down to make 200-mililiter sachets, and then we made the packaging double as a measurement vessel for the right amount of water…One of our key funders during our scale-up phase was USAID—their Discover Health Program. They played a fundamental role in some of the social marketing we were doing as we were scaling up the development of our diarrhea treatment kit.Motivation: There’s just a fundamental issue of justice in the world…We often think of innovation being new product development, high technology, but things like ORS and zinc—innovation can happen really in the delivery side of things. And that’s really where our innovation focused.Why federal support is critical: I think this is low-hanging fruit. Diarrhea, as one of the leading causes of death in the world for children—we have the solutions, we know what to do, and these kinds of innovations can really make a huge difference in saving lives.…[And] there’s a health security argument [to do this work]. The world is getting smaller and smaller every day. We are inextricably linked to one another. When I’m not in the lab: I’m a dad! I’m a dad of two amazing young girls. They inspire me every day. It makes my work in child health that much more meaningful—the inspiration I get from them. I want all parents to have that.

Faces of Innovation—a new GHTC project that features scientists on the front lines of research and development on new global health tools and technologies—profiles Dr. Mohammad Nuhu Amin, who we met at the American Society of Tropical Medicine and Hygiene Annual Conference. Dr. Amin researches sanitation and diarrheal diseases with support from the United States Agency for International Development.My name: Nuhu Amin BDS, MPH, HSCWhere I work: International Centre for Diarrhoeal Disease Research in Bangladesh (icddr,b) I’m funded by: US Agency for International Development My research: My primary goal is to do interventions to reduce diarrhea and cholera in low- and middle-income countries, particularly in the urban communities of Dhaka. I’ve worked at icddr,b for the last ten years, and I’ve had the opportunity to work with lots of US universities. Currently I’m working with Stanford University with Professor of Medicine Dr. Stephen Luby on a Rohingya distribution impact assessment. I’m also working on another project with Emory University on a fecal pathogen exposure assessment. And our team is doing a different project with Emory University in collaboration with the University of Sydney to track the sanitation chain to detect pathogens, like norovirus, salmonella, shigella, and cholera, that cause diarrhea. We have previously also collaborated with Johns Hopkins University and we have lots of colleagues who work with Oregon University and other state universities in the United States.Motivation: I am a medical graduate, and I’ve had lots of patients with different problems including diarrhea and other infectious diseases. Bangladesh is a tropical country, so infectious disease rates are really high. This motivates me to not only focus on treatment, but to do the research to remove and prevent these diseases.Why US federal support is critical: USAID is one of our four core donors. They have been funding us for more than 50 years to support the research of our institute. I think the contribution of the US government is important for this research and development. When I’m not in the lab: I’m also a dental surgeon, so I have a clinic. Every day, for two or three hours, I treat patients and particularly patients who are poor. Dental health treatment is expensive, so I aim to serve my patients at a low-price. I have two kids as well, so I spend my time with them—they’re very inspiring for me. In addition, I love to travel to different countries. This year I traveled to almost four countries including Swaziland, South Africa, and India. I love to meet with other people around the world—that’s my hobby. 

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign-up now to receive our weekly R&D News Roundup email. On World Polio Day last week, the World Health Organization officially declared that type three poliovirus has been eradicated—making it the second of the three strains of the virus to be wiped out. Naturally-occurring cases of the last remaining virus strain, type one, are now limited to Afghanistan and Pakistan with a total of just 33 new cases last year. Though much progress has been made toward eradicating this disease, the number of confirmed cases this year has risen to 88 in those two countries as violence and mistrust have hindered vaccination campaigns. Cases caused by the vaccine itself have also thwarted eradication efforts. The National Institutes of Health and the Bill and Melinda Gates Foundation will jointly invest US$200 million over the next four years to develop genetic-based cures for sickle cell disease and HIV. Both partners have vowed that the cures will be both affordable and available in low-resource countries hit hardest by the two diseases, particularly in Africa. This partnership reflects growing concerns that scientific advances such as gene therapies and genome-editing are prohibitively expensive and therefore out of reach to most patients. This collaboration aims to move gene-based therapies into clinical trials in the United States and countries in sub-Saharan Africa within the next seven to ten years and eventually make treatments for sickle cell disease and HIV available in the hardest hit areas. After a two-day meeting in Okayama, Japan, health ministers of the world’s twenty largest economies issued a declaration endorsing the rapid achievement of universal health coverage (UHC), more effective support of healthy ageing, increased attention to health emergencies and their causes, and more forceful action on antimicrobial resistance. The G20 Health Ministers Declaration goes well beyond the general commitments made by G20 leaders to advance global health goals after their two-day meeting back in June. As part of the commitment to UHC, the health ministers recognized the importance of access to medicines and vaccination and reaffirmed pledges to end HIV, tuberculosis, and malaria, among other measures.