Emily Conron

From August 17–24, GHTC—in partnership with our member the International AIDS Vaccine Initiative (IAVI)—hosted six US Congressional staff on a learning trip to Uganda. The staff represent Senate offices serving on key committees of jurisdiction over global health research and development (R&D) policy and funding. Uganda is a hub for cutting-edge scientific research and is a critical partner of the United States on shared global health research objectives. Long-standing partnerships between universities in the United States and Uganda have produced lifesaving global health tools and trained a new generation of researchers and clinicians, building the capacity of Uganda and neighboring countries in the region to discover solutions to mitigate their most pressing health challenges. Clinical research sites in Uganda have hosted trials that have resulted in new drugs, vaccines, and diagnostics for disease threats that affect populations in both countries, such as HIV and AIDS, and informed global treatment and prevention guidelines. Continued scientific partnership, nourished by US investments through the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), US Agency for International Development (USAID), Department of Defense, and other agencies, is critical to advance progress against long-standing health threats and prepare for the unknown pathogens of the future.Check out a tweet-by-tweet recap of the week:Day 1: The US-Uganda Research Partnership Our first stop on the @GHTCoalition/@IAVI congressional staff learning tour was the US Embassy, where we learned how US investments through USAID, CDC, NIH, DoD, and more have helped Uganda become a leader in global health R&D—saving lives and building scientific capacity. 🔬🌍— Emily Conron (@thatNTDgirl) August 19, 2019 Next, we visited the Ugandan Public Health Emergency Operations Center, which—with critical support from partners like @CDCgov—has responded to more than 70 outbreaks and public health events since it was founded, modeled on the EOC at CDC HQ in Atlanta. pic.twitter.com/oEMiVfG9CB— Emily Conron (@thatNTDgirl) August 19, 2019 We were grateful to meet with officials from the Ugandan Ministry of Health to hear their perspective on the US-Uganda partnership and how R&D can strengthen health systems, advance sustainability, and accelerate the journey to self-reliance. 🇺🇸🇺🇬— Emily Conron (@thatNTDgirl) August 19, 2019 Day 1 of the @ghtcoalition/@IAVI congressional staff learning trip ended with a reception hosted by @USAmbUganda to celebrate all that has been achieved by the US-Uganda partnership on global health R&D and all the future holds! 🇺🇸🇺🇬 pic.twitter.com/Kvn7QQJbps— Emily Conron (@thatNTDgirl) August 19, 2019 Day 2: Global Health R&D in Action We learned about the continuous cycle of global health research—from defining the problem to implementing and scaling up a new solution, informed at every step by robust community and stakeholder engagement. A site like MUJHU is often running several studies simultaneously. pic.twitter.com/T9fZgEQb8k— Emily Conron (@thatNTDgirl) August 20, 2019 Over 10,000 women have been enrolled in HIV prevention trials at MUJHU. Results from these studies, supported by NIH and CDC, have directly informed WHO policies and made an incredible global impact. Our congressional staff guests learned so much about the impact of R&D at MUJHU!— Emily Conron (@thatNTDgirl) August 20, 2019 Over 25,000 people have participated in clinical trials and field studies at the clinic, including phase I, II, and III clinical trials of new treatments and vaccines for TB and HIV-TB. The clinic has been a major site for the CDC-sponsored TB Trials Consortium for 15 years. pic.twitter.com/ujbNVEam27— Emily Conron (@thatNTDgirl) August 21, 2019 We heard directly from a former research participant about the impact of TB R&D and how her experience at UCRC made her an advocate and educator in her community. She encourages everyone experiencing symptoms of TB to seek care at the clinic. pic.twitter.com/E4FNYf529o— Emily Conron (@thatNTDgirl) August 21, 2019 Our last site visit of the day was @IDIMakerere, a powerhouse for infectious disease research, training, and treatment in Uganda. The Institute has over 100 current research projects ongoing and 1,000 full-time staff whose work is supported by a variety of USG partners.— Emily Conron (@thatNTDgirl) August 21, 2019 We heard short presentations from several young investigators—rising research stars whose work is shaping the understanding and response to leading infectious disease threats. pic.twitter.com/zAilpSSvo7— Emily Conron (@thatNTDgirl) August 21, 2019 Our congressional staff guests had a blast testing out this cutting-edge technology and imagining the possibilities of how VR can contribute to global health R&D. pic.twitter.com/s0iMWZh8cs— Emily Conron (@thatNTDgirl) August 21, 2019 Day 3: African-led Science Driving Innovation @UVRIug is one of the oldest research institutions in the region and had made many important discoveries in global health, including isolating the Zika virus as well as viruses including Chikungunya, West Nile, and many more—recently, close to one virus a year!— Emily Conron (@thatNTDgirl) August 21, 2019 We ended our @UVRIug tour at the brand-new Anthropod Containment Level 2 insectary where research will be conducted to develop new tools to tackle malaria. We suited up according to the highest biosafety standards! 🦟 pic.twitter.com/bxtwReRYue— Emily Conron (@thatNTDgirl) August 21, 2019 The ongoing HPTN-084 trial @UVRI_IAVI is conducting in fishing communities around Entebbe—the first large-scale clinical trial of a long-acting injectable medication for HIV pre-exposure prophylaxis in women—would be a game-changer for HIV prevention.— Emily Conron (@thatNTDgirl) August 24, 2019 After the presentation, our delegation was honored to receive a plaque recognizing the support of the American people for global health research & development in Uganda. pic.twitter.com/QIYpMYgd99— Emily Conron (@thatNTDgirl) August 24, 2019 Day 4: Community Partnerships Driving Research Progress We spent Day 4 of the @GHTCoalition/@IAVI congressional learning trip visiting fishing communities on Lake Victoria where @UVRI_IAVI leads clinical programs and conducts incredible research on HIV prevention.— Emily Conron (@thatNTDgirl) August 29, 2019 Onboard, @UVRI_IAVI’s community engagement officer oriented us to the lake and the islands we would be visiting—Kimi and Nsadzi. pic.twitter.com/hpfMlqqJkm— Emily Conron (@thatNTDgirl) August 29, 2019 We then met with members of the local Community Advisory Board in a small church (to escape a ferocious rainstorm!) to learn more about how community members are engaged in research efforts. pic.twitter.com/LB1bNTSGgc— Emily Conron (@thatNTDgirl) August 29, 2019 In our tour of Nsadzi, we learned more about ongoing research projects as well as the integrated HIV treatment and care at the health clinic. The visit helped us understand the linkages between R&D for new tools and implementation of existing tools through partners like @PEPFAR. pic.twitter.com/OjMfqNb0Qo— Emily Conron (@thatNTDgirl) August 29, 2019 Such collaborations increase access to HIV services for a population that otherwise would have limited access to care. This is one critical reason global health R&D is so important!— Emily Conron (@thatNTDgirl) August 29, 2019 Day 5: A Birds’ Eye View of the Impact of Global Health R&D We started with a visit to the Zika Forest—a protected field research station of @UVRIug. Home to more than 40 types of mosquitoes 🦟, the RNA of Zika Virus was isolated by researchers at the site in 1947, hence its name. pic.twitter.com/u1998vHebt— Emily Conron (@thatNTDgirl) August 29, 2019 Inside the forest, we peered up at the 120-foot observation and mosquito-baiting tower and learned about all of ground-breaking arbovirus research enabled by the structure over the decades. pic.twitter.com/L2H11LabSD— Emily Conron (@thatNTDgirl) August 29, 2019 We toured an HPTN 084 satellite clinic to learn how trial participants are enrolled in the study and better understand all of the partnerships that enable @UVRI_IAVI to positively impact the health of the communities where they work. pic.twitter.com/K5c1w8b52g— Emily Conron (@thatNTDgirl) August 29, 2019 Inside the clinic, I got to take a very “That NTD Girl” photo in front of a praziquantel dosing pole—a key tool in the fight against the NTD schistosomiasis (locally known as bilharzia), a major health challenge in communities around Lake Victoria. 💊💊💊 pic.twitter.com/4v1X6V8En3— Emily Conron (@thatNTDgirl) August 29, 2019 The other incredibly powerful part of our week—meeting researchers! Often, we talk about research and development like a noun—a thing that just happens. It’s very much a verb: a process, a series of steps that build to the discovery, refinement, and delivery of life-saving tools.— Emily Conron (@thatNTDgirl) August 29, 2019 Thanks to:@USAmbUganda Makerere University-Johns Hopkins University Research CollaborationUganda-Case Western Reserve University Research Collaboration@IDIMakerere & @AceUganda @UVRIug @UVRI_IAVI and of course, the congressional staff who spent a week learning with us!!— Emily Conron (@thatNTDgirl) August 29, 2019 The learning trip was an incredible experience that we hope will be a resource for our Congressional staff guests as they consider the US government’s role in improving global health, in particular through investments in R&D for new tools like drugs, vaccines, and diagnostics for use in low-resource settings. 

On February 15, President Trump signed into law a bipartisan spending bill—averting another partial government shutdown and ensuring full-year funding for the government for the remainder of fiscal year (FY) 2019. The move followed several days of speculation about whether discord between Congress and the President on funding for a border wall would imperil the spending measure passed by Congress to fund the remaining one-quarter of the federal government.The months-long saga ended with some great news for global health and research and development (R&D)—a roughly US$150 million funding increase for global health programs in the State and Foreign Operations (SFOPs) bill, as well as a significant boost to the Food and Drug Administration (FDA) under the Agriculture bill included in the package.The bill included some welcome increases to global health accounts which have been flat-funded for five years running, including a $50 million (1.16 percent) increase to the President’s Emergency Plan for AIDS Relief (PEPFAR) and a $2.5 million (2.5 percent) increase to the US Agency for International Development’s (USAID) Neglected Tropical Disease Program compared to FY 2018. Nutrition saw a $20 million (16 percent) increase and Maternal and Child Health got a $5.5 million (0.66 percent) boost. But perhaps the most notable win in the bill was a long-sought increase to USAID’s tuberculosis (TB) program. After TB was in the spotlight at the United Nations High-Level Meeting on TB in September, the United States backed up its pledge of additional support for the global fight against TB by including a $41 million (15.71 percent) increase to the program in the final spending package for FY 2019—the largest increase to the program in more than five years. All other global health accounts were level-funded compared to FY 2018, resulting in an overall increase of 3.23 percent for USAID Global Health—a stark difference from the 36 percent cut proposed in the President’s budget.While most accounts of relevance to global health R&D within the Department of Health and Human Services were funded for the entire fiscal year in a spending package passed in September, the FDA was one agency whose funding was still in limbo. The FDA’s unique funding structure—divided between budget authority, or discretionary funding (appropriated by Congress), and fees (paid by FDA users) —shielded the agency from some of the worst impacts of the partial government shutdown in December and January as it drew down on user fees to continue most operations. But the final FY 2019 funding package included a welcome $460 million (9 percent) increase for the agency, including a $269 million (9 percent) increase in budget authority.As the FY 2019 appropriations process lurched across the finish line, advocates were already gearing up for another budget battle for FY 2020. Check back for regular updates as appropriations hearings begin and GHTC continues monitoring the prospects for global health R&D accounts in the coming year.  For reference, the text of the Conference Report to accompany H.J. Res. 31, the Consolidated Appropriations Act, 2019, is available here, the text of the Joint Explanatory Statement is here (with the Global Health Program breakdown on page 454 of the PDF), and a division-by-division summary is available here.

On February 5, President Trump delivered his second State of the Union address. Among the long list of policy proposals and pledges in the speech was one of great interest to the global health research community—an announcement of a new whole-of-government plan to eliminate HIV transmission in the United States by 2030. Though just a few sentences long, this announcement hinted at a much-anticipated budget increase for HIV and AIDS efforts and linked the feasibility of this goal to “scientific breakthroughs”—many driven directly by US government investments in research for new tools to diagnose, treat, and prevent HIV and AIDS. As the President put it, “In recent years we have made remarkable progress in the fight against HIV and AIDS. Scientific breakthroughs have brought a once-distant dream within reach. My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years. We have made incredible strides. Incredible. Together, we will defeat AIDS in America. And beyond.”Though the announcement and the associated plan released shortly thereafter by the Department of Health and Human Services (HHS) is squarely focused on eliminating HIV transmission within the US, the wording of the statement and a subsequent editorial published in the Journal of the American Medical Association penned by key agency officials both connect to international efforts and reference advances in HIV research and product development supported by the US government.At this moment of excitement—a “once-in-a-generation opportunity,” as Alex Azar, HHS Secretary, put it in the release of the plan—it is worth noting how our “chance to end the HIV epidemic for the next generation” is based on decades of patient, bipartisan commitment by the US government to advancing our understanding of HIV and AIDS and our ability to diagnose, treat, and prevent it through the development of cutting-edge tools.As the AIDS crisis was growing in the 1980s, NIH research led to the development of the first screening tests to detect the virus in the blood supply and the first antiretroviral treatment, AZT. Later, NIH research led to strategies to prevent maternal-to-child transmission, improved combination therapies, and the discovery that antiretroviral therapies could be used to prevent and treat the disease—research that was foundational to the development of pre-exposure prophylaxis (PrEP). CDC research has expanded our understanding of the epidemiology of the disease, improved prevention and treatment programs, and supported the development of a novel diagnostic that can, for the first time, identify whether an infection is recent or longstanding to improve contact tracing.While many don’t associate the Defense Department with health research, the US Military HIV Research Program has been on the forefront of the battle against HIV to both protect US troops and reduce the global impact of the disease. The program supported a large-scale HIV and AIDS vaccine trial in Thailand that was the first to show that a safe and effective HIV vaccine is possible and continues to advance HIV vaccine research. The US Agency for International Development (USAID), in addition to funding the implementation of the President’s Emergency Plan for AIDS Relief (PEPFAR) programs in nearly 100 countries, has also supported HIV vaccine research, as well as the development of microbicides to reduce transmission among women—including a microbicide-based vaginal ring. The US Food and Drug Administration has also played a crucial role in ensuring the availability of HIV treatment and prevention tools for those in need globally. The agency operates a program to facilitate the “tentative approval” of antiretroviral drugs for purchase by PEFPAR programs and recently launched a pilot program with the World Health Organization (WHO) to expedite the review of HIV drug applications through WHO’s prequalification program.The progress we have achieved through sustained whole-of-government investment in HIV research is astounding, but a need for new and improved HIV and AIDS prevention and treatment tools, including a vaccine, remains. As President Trump said, we can end the HIV epidemic—through both the scale-up of existing interventions and continued investment in the development of new tools. Even a cursory glance at the history of HIV and AIDS shows that every new product developed for treatment or prevention has both increased our ambition to end the epidemic and fundamentally altered our approach. We cannot know for certain that the tools we have in hand today are the most effective we will ever have, so our continued commitment to discover the next game-changer must ramp up in tandem with our efforts to expand access to existing interventions.While the President’s pledge to end HIV and AIDS in the US and his acknowledgement of the importance of scientific breakthroughs is encouraging, his past actions have failed to match this rhetoric. In 2017 and 2018, the administration proposed the elimination of HIV and AIDS vaccine and microbicides funding at USAID and deep cuts to NIH and CDC programs that fund HIV research. As the President prepares to release his fiscal year 2020 budget request, we hope it will include the resources necessary to realize the goals of this welcome pledge, including strong funding for the programs which develop and deliver the tools needed to end AIDS domestically and globally. This is an area of historically bipartisan consensus that offers a rare but important chance at this moment of divided government for Congress and the administration to work together to achieve a bold vision: defeating AIDS in America—and beyond.

As the partial government shutdown stretches into a fifth week – the longest in United States history – news of its impact on agencies essential to global health broadly, and research and development in particular, is taking clearer shape. While less visible than long lines at Transportation Security Administration (TSA) airport check-points, the consequences of shuttering the US Agency for International Development and furloughing broad swaths of the State Department and Food and Drug Administration workforce for more than a month will only become more obvious as the dispute between Congress and the administration over funding for a border wall continues.Here’s what we know now, based on news reports, anecdotal evidence, and intel from agency contacts:Food and Drug AdministrationThe Food and Drug Administration (FDA) has managed to continue many activities in the midst of the shutdown by drawing down on prescription drug user fees, with reviews of submissions filed and paid for ahead of the partial shutdown on December 22, but drug reviews will stop completely as that funding dwindles in the coming weeks. A sign-on letter sent this week on behalf of “millions of American patients, caregivers, healthcare providers, and researchers” raised alarm that the shutdown “has begun to put future scientific discovery and innovation in jeopardy” by forcing the FDA to “make difficult choices regarding to which essential functions its greatly reduced resources are directed,” and urging that “the health and safety of Americans today should never be weighed against the prospect of new life-saving therapies for patients.”State Department/PEPFAROn January 17, the State Department announced it would be “taking steps to make additional funds available to pay employee salaries” to resume most personnel operations and fund most salaries beginning this week and continuing through at least February 14. The announcement from Bill Todd, Deputy Under Secretary for Management, specified that “although most personnel operations can resume, bureaus and posts are expected to adhere to strict budget constraints with regard to new spending for contracts, travel, and other needs.” For the remainder of this interim fix, it appears most of the President’s Emergency Plan for AIDS Relief (PEPFAR), funded through the State Department, should be operating as usual.  US Agency for International DevelopmentIn advance of the shutdown, the US Agency for International Development (USAID) released guidance noting that about half of its 3,100 person staff would be furloughed, with the remainder exempt and expected to continue working, including “those who are funded through mechanisms other than annual appropriations; employees whose jobs are considered necessary for the protection of life and property or necessary to carry out the president’s constitutional duties; or those who are authorized because of their connection to operations that will continue.” While this allows many contract employees across the agency to continue working, only a handful of full-time agency staff within the Global Health Bureau are reported to be in the office.The development and global health community is slowly beginning to feel and communicate the impact of USAID’s staffing and funding shortages. Last week, Devex detailed one example of a USAID funding commitment delayed by the shutdown, though most development leaders they contacted for comment suggested that the shutdown has had limited effect thus far as USAID-funded programs continue operating on prior year funds, but could soon slow funding approvals and dry up grant funds if protracted. This week, we began to hear anecdotes from implementing nongovernmental organization partners to that end, detailing agency guidance to slow spending and even cease activities on some USAID-funded projects.The Washington Post reported this week that White House Acting Chief of Staff Mick Mulvaney has asked agency leaders to provide him with a list of high-impact programs at risk if the shutdown continues into March and April, which increased concern that a compromise is not imminent. On Thursday, two bills with the potential to end the shutdown failed in the Senate, and no immediate path to resolve this impasse and reopen the government has emerged. Of note, a spending package released by House Democrats last week – based on compromise bills drafted last year by House and Senate negotiators – which is expected to shape final funding outcomes, increased global health programs by US$147 million over fiscal year 2018 enacted levels, including boosts to HIV and AIDS, nutrition, tuberculosis, maternal, newborn and child health, and neglected tropical diseases, as well as positive language about USAID’s role in product development.GHTC continues to track reports of how the shutdown may be affecting global health research and development (R&D) activities. Please email Emily Conron (econron@ghtcoalition.org) to share details of any impacts your organization or partners are experiencing as a result of agency closures.

While the dust is still settling from the US midterm elections on November 6—with a handful of key races yet to be decided and others headed for run-offs—the major takeaways are set. Democrats have decisively retaken control of the House of Representatives with at least 228 of 435 seats declared in their favor (a 34-seat pickup likely to grow as the remaining races are called). Meanwhile, Republicans have solidified and likely expanded their hold on the Senate, with at least 51 of 100 seats called for Republicans and the still-too-close-to-call remaining races leaning in their favor. With Washington poised for at least two years of divided government, one commentator has predicted that “We may be looking at two years in which a Congress we already regard as pretty dysfunctional doesn’t really function much in the legislative sense.” He foresees a Congress that “functions as an investigative body in the House”—intent on investigating the Trump Administration and flexing oversight muscle— “and a judge-making machine in the Senate”—fulfilling Republicans’ promise to their voters to confirm conservative federal judges. What does all of this mean for US support of global health research and development (R&D)? Of top interest are potential changes to the leadership and makeup of key congressional committees. While these rosters will not be set until early 2019, one broad takeaway is that only a few members currently serving on such committees lost their races. No Senators on committees of interest lost, though Cindy Hyde-Smith (R-MS), currently serving on the Senate Appropriations Committee and its Labor, Health and Human Services and State and Foreign Operations Subcommittees, faces a run-off election on November 27. However, some already-announced retirements will still mean shake-ups for global health leadership in the Senate. Senator Bob Corker (R-TN), who currently chairs the Senate Foreign Relations Committee (SFRC), and fellow committee member Senator Jeff Flake (R-AZ), who chairs the Africa and Global Health Policy Subcommittee, announced their retirements earlier this year. This means we will see at least two new Republican faces on SFRC come 2019, with the potential for more to be added after the top Senate Republicans and Democrats negotiate committee ratios to account for Republicans adding seats to their majority in the chamber. While the House of Representatives overall will look quite different in the 116th Congress due to the change in party control, retirements, and flipped seats, only a few current members on key committees of interest to global health R&D will not be returning. In the House, John Culberson (R-TX), Kevin Yoder (R-KS), David Young (R-IA), and Scott Taylor (R-VA) of the House Appropriations Committee; Leonard Lance (R-NJ) on the Energy and Commerce Committee and its Subcommittee on Health; and Dana Rohrabacher (R-CA) and Dan Donovan (R-NY) on the House Foreign Affairs Committee lost their races. House Foreign Affairs Committee Chairman Ed Royce (R-CA) had already announced his retirement, and it is not yet clear who will succeed him. Donovan’s departure, in particular, will leave a leadership gap on global health among House Republicans. He served on the House Foreign Affairs Subcommittee on Africa, Global Health, Global Human Rights and International Organizations; several global health-related caucuses; and frequently led or signed Dear Colleague letters on global health appropriations. He is one of several moderate Republicans who have been frequently called upon by the global health community to serve on caucuses or sign Dear Colleague letters who will not be returning to Washington for the 116th Congress. Notably, two-thirds of House Republicans who signed a Dear Colleague letter on fiscal year 2019 maternal and child health funding lost their races or are retiring come January. Of course, a “glass half full” perspective also accounts for some exciting new members set to join the ranks of the 116th Congress who could be cultivated as champions for global health R&D. Of particular interest to global health R&D advocates, at least nine new “science-credentialed candidates” were elected on November 6—eight to the House and one to the Senate. These science-engaged members include a pediatrician (Kim Schrier, a Democrat elected to Washington’s 8th District), a dermatologist who began his career as a naval physician (John Joyce, a Republican elected to Pennsylvania’s 13th District), and a registered nurse with a Master of Public Health degree (Lauren Underwood, a Democrat elected to Illinois' 14th District who served in the Obama Administration as a senior adviser at the Department of Health and Human Services focused on bioterrorism threats and public health emergencies). On both sides of the aisle, many candidates with military or national security backgrounds won their races, which should expand the audience for advocacy on issues of international concern. A quick snapshot of some other freshmen with interesting backgrounds coming to town include: A son of Eritrean refugees (Joseph Neguse, D-CO-2) and a Somali refugee who has previously worked as a community nutrition educator (Ilhan Omar, D-MN-5). A former associate vice president of Florida International University’s Herbert Wertheim College of Medicine (Debbie Mucarsel-Powell, D-FL-26). A former Washington director of Human Rights Watch and Assistant Secretary of State for Democracy, Human Rights, and Labor with experience on the National Security Council (Tom Malinowski, D-NJ-7). A former Secretary of Health and Human Services, who was the longest-serving in history (Donna Shalala, D-FL-27).  There are real challenges to come in the new year. With Democrats taking the House having campaigned on big promises squarely focused on domestic priorities, getting the attention necessary to advance global health R&D will continue to require creative approaches. This is compounded by growing fiscal constraints, including looming budget caps and additional demands on non-defense discretionary funding across the board, which will make maintaining and growing the resources we need even more difficult. One thing is certain: between wins, losses, and retirements, Congress will look very different come January. Educating new members and continuing to cultivate the support of their returning colleagues on the value of US investments in global health R&D will be an exciting challenge.

With less than two weeks to go until one of the most anticipated midterm elections in recent memory, there are big questions occupying the minds of Washingtonians and politics junkies from coast to coast: Will the Democrats regain control of the House of Representatives for the first time in eight years? Do they have any chance of retaking the Senate, or might recent swings in the polls signal that Republicans could tighten their hold on the chamber? And, what will it all mean for US support for global health research and development (R&D)? While nothing can be taken for granted in the current political climate, here are our best modest bets on what to expect once the dust settles on November 6. Democrats will take back the House and focus on domestic priorities and oversight Predictions of a “blue wave” have tempered slightly with shifts in the polls in the past couple of weeks, but most expect that Democratic enthusiasm will carry the party far enough to retake the House for the first time since 2010. FiveThirtyEight’s House Forecast gives Democrats a five in six chance of winning control with their model currently predicting a 38-seat pick-up. (Democrats need a net gain of 23 seats to flip the House). Assuming these predictions hold—though we highly recommend refreshing their forecast a few times, as predictions seem to change by the hour—leadership of committees would shift to Democrats with new freshmen joining several committees of interest for global health R&D. Of note:   House Appropriations Committee: Current chairman Rodney Frelinghuysen (R-NJ) is retiring, along with fellow full committee member Tom Rooney (R-FL). And, with another nine Republican committee members in tight races, the make-up of the House Appropriations Committee has the potential to change dramatically in the next Congress. In contrast, only one Democrat currently on the committee, Matt Cartwright (D-PA), is considered vulnerable. If Republicans maintain control of the House, potential candidates to replace the retiring Frelinghuysen as full committee chairman include Representatives Robert Aderholt (R-AL), Kay Granger (R-TX), Mike Simpson (R-ID), Tom Cole R-OK), or Tom Graves (R-GA). Should the Democrats take the House, one of these names will likely fill the ranking member position on the full committee.   All but one member on both sides of the Subcommittee on Labor, Health and Human Services, and Education (LHHS)—which appropriates funds for the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the Food and Drug Administration (FDA)—are very likely to win re-election. However, with a Democratic take-over, we would still expect significant changes to the subcommittee make-up. On the State, Foreign Operations, and Related Programs (SFOPs) Subcommittee—which appropriates funds for the US Agency for International Development and major global health programs like the President’s Emergency Plan for AIDS Relief—one Republican retirement (Tom Rooney (R-FL)) and one tight race (Mario Diaz-Balart (R-FL)) could bring changes. Though again, a Democratic win would do so regardless.  Nita Lowey is the lead Democrat on both the full Appropriations Committee and the State, Foreign Operations, and Related Programs Subcommittee, and Rosa DeLauro (D-CT) serves as the ranking member of the Labor-HHS, and Education Subcommittee—both of whom are expected to win re-election easily. (Of note: Democrats do not determine chairs or ranking members of committees automatically by seniority, so it could take several months for the dust to fully settle from the election and new leadership for committees to be determined—particularly in the wake of a blue wave.) House Energy and Commerce Committee (E&C): E&C—with jurisdiction over leading agencies in global health R&D, including NIH, CDC, and FDA—will see bigger changes. Three Republican members are retiring—Joe Barton (R-TX), current Vice-Chairman Gregg Harper (R-MS), and Ryan Costello (R-PA)—another two members are in toss-up races, and another five are in competitive races. In contrast, just one Democrat, Gene Green (D-TX), the ranking Democrat on the Health Subcommittee, is retiring, and no Democrats currently on the committee are considered at risk of losing re-election. Congressman Frank Pallone (D-NJ) currently serves as the lead Democrat on the full Committee.  House Foreign Affairs Committee (HFAC): HFAC is where we will see the biggest changes of all in terms of Republican leadership on issues related to global health R&D. A staggering 13 of the 25 Republican committee seats are up for grabs due to retirements or competitive races, and there are no retirements or tight races on the Democrat’s side. HFAC Chairman Ed Royce (R-CA) and Chairman Emeritus Ileana Ros-Lehtinen (R-FL) are both retiring, along with several other long-serving members stepping down or in toss-up races. This will create space for new Republicans to lead on international development, global health, and diplomacy—alongside a potentially large group of freshman Democrats joining the committee. Representatives Michael McCaul (R-TX), Joe Wilson (R-SC), and Ted Yoho (R-FL) are considered leading contenders for chairman or ranking member with Royce’s departure—each with very different backgrounds and views of US engagement internationally. Congressman Elliott Engel (D-NY) new serves as the senior Democrat on the Foreign Affairs Committee   If Democrats take back the House, indications are strong that international issues will rank low on their overall priority list, with oversight of the Trump Administration and key domestic issues like healthcare likely to dominate the agenda. In a recent interview, likely Speaker Nancy Pelosi (D-CA) listed campaign finance reform, domestic drug prices, background checks for gun purchases, and protecting undocumented immigrants who were brought to the United States as children as the Democrats’ top priorities should they retake the chamber. Another interesting consideration in that scenario is how freshman Democrats—many of whom hewed to a populist message on the campaign trail that was light on America’s international leadership obligations—will engage on issues like global health and development once in Washington. Education of new members will be key for advocates as soon as races are called to ensure that the bipartisan consensus that has protected and grown US support for global health over the past fifteen years is maintained as political shifts continue to shake up Congress. Republicans will retain a narrow margin in the Senate—with no end to gridlock in sight As in any election year, roughly one-third of Senate seats are up for grabs, but analysts have called the 2018 electoral map one of the most Republican-friendly in a generation, with Democrats defending 26 of the 35 seats up for re-election—including 10 seats in states that voted for Trump in 2016. The enthusiasm of the Democratic base may not be enough to reverse the narrow 51 to 49 margin that Republicans currently hold in the Senate. Democratic pundits are confident incumbents can defend most of the seats in play but are increasingly pessimistic about picking up new seats in toss-up races in Arizona, Texas, Nevada, and Tennessee—once seen as serious possibilities. In a complete reversal of their House prediction, the FiveThirtyEight Forecast currently gives Republicans a five in six chance of holding on to the Senate. Assuming Republicans maintain a slight majority, the leadership and make-up of key committees are unlikely to change dramatically, though several key retirements will mean new faces are likely to join their ranks. In more detail: Senate Appropriations Committee: Chairman Richard Shelby (R-AL) and Vice Chairman Patrick Leahy (D-VT) are not up for re-election this year, so the leadership of the Senate Appropriations Committee is set; but five Democrats on the committee are up for re-election, with several in tight races. Leadership of the LHHS and SFOPs Subcommittees is also stable, with Chairman Roy Blunt (R-MO) and Ranking Member Patty Murray (D-WA) not up this cycle on the LHHS side and both SFOPs Chairman Lindsey Graham (R-SC) and Ranking Member Leahy hanging on. This is good news for global health R&D, as all four have championed such investments in the past in their leadership of these key subcommittees. Between the two subcommittees, just four members are up for re-election, likely ensuring a good bit of continuity for the next two years.   Senate Health, Education, Labor and Pensions Committee (HELP): The HELP Committee has a larger potential for shifts, with one Republican retiring and seven Democrats up for re-election, though most are expected to return. Chairman Lamar Alexander (R-TN) and Ranking Member Murray are not up for re-election in this cycle.    Senate Foreign Relations Committee: As in the House, the biggest potential changes among Senate committees of interest will be on Foreign Relations, where Chairman Bob Corker (R-TN) is retiring, and Ranking Member Bob Menendez (D-NJ) is in a tighter-than-expected re-election race. Committee member Jeff Flake (R-AZ) is retiring, and another Republican and three Democrats are up this cycle, though all are considered safe seats. Looking ahead Should the Republicans retain control of the Senate and Democrats take the House, as tentatively expected, gridlock in Washington is only expected to intensify, especially as moderates in both parties who have been more open to compromise have retired or been picked off in primaries. Even if Democrats wrestle control of both chambers, another two years of a Republican administration and the ramp-up of a presidential election that promises to be one of the most contentious in generations likely engenders new political challenges in every direction. Add to that the fact that the budget deal currently shaping annual appropriations will expire during the next session of Congress, and you’ve got a recipe for drama! Global health R&D advocates will have to think creatively about messages that could resonate in a divided government in a time of tightening budgets to ensure that critical investments and policies that support the creation of new health tools remain a priority no matter which wildly different midterm prediction comes to pass.