Emily Halnon

Congress continues to debate how to keep the government running in the midst of a rollercoaster appropriations process, while at home and abroad global health research and development (R&D) programs struggle to continue their work and simultaneously juggle looming funding reductions. While the President's budget request for global health programs for fiscal year (FY) 2012 included funding increases in several areas, the outlook for global health funding in Congress is not as promising. Due to difficult economic times and conflicting priorities between the House of Representatives and the Senate, it seems unlikely that Congress will sustain the levels we saw in 2011 for additional years. The House of Representatives approves of deep cuts in nearly every government program. However, the Senate appropriation levels are much friendlier to global health and to foreign assistance overall, compared with the House levels. The two chambers must now reconcile the two different versions, while following the spending cap rules required by the new debt reduction law. In addition to the appropriations activities outlined above, the Congressional Debt Reduction Committee (the 'super committee') also must weigh in on funding levels for the next several fiscal years. It has until November 23 to make its recommendations to Congress for cutting at least $1.2 trillion over 10 years. To add yet another factor to this complicated equation, since Congress has (again) failed to complete the appropriations process by the end of the fiscal year, urgent continuing resolution legislation (CRs) have been required to keep the government open until the process is finalized. The CR currently up for debate enacts an across the board rescission of 1.5% from FY2011 levels to all government programs, but contains no other cuts targeted at international development or global health accounts. This is a temporary blessing for important programs that must continue its progress while funding levels are hammered out. It is likely that several CRs will be needed to buy enough time for Congress to negotiate the FY2012 budget. To read more details about specific global health programs and the appropriations activities in Congress read this piece.

This week, the GHTC is in Kenya, meeting with several GHTC members conducting ground-breaking work. Here are some photos from the field: Photo: Evelyn Hockstein/PATH Kombewa, Kenya - Martha Omondi puts her daughter Mercy Gloria, 3, under a mosquito net to take a nap. Photo: Evelyn Hockstein/PATH Siaya, Kenya - Fabian Oduor holds his sister Brittany's hand while she receives treatment for Malaria at the Siaya District Hospital in Western Kenya. Photo: Evelyn Hockstein/PATH Vihiga, Kenya - A mother vaccinates her child with pneumococcal vaccine at Vihiga District Hospital in Western Kenya. The free vaccine, manufactured as a result of donor support via an advance market commitment, is now administered to children under twelve months of age; protecting thousands of children across the country. Photo: Evelyn Hockstein/PATH Vihiga, Kenya - Festus Chabuga, who is HIV positive, receives ARV's at Vihiga District Hospital. "I feel fortunate I have the drugs. If the drugs were not available, I would have died by now." Photo: Evelyn Hockstein/PATH Vihiga, Kenya - Rister Kageha, 35, with her baby Sylvia Mboga, who is 14 months, at Vihiga District hospital. Rister learned she was HIV positive a month before she gave birth to her daughter Sylvia. She was put on ARV's in June 2010 and gave birth in July. Her baby was given Nevarapine after birth and is HIV negative. Photo: Evelyn Hockstein/PATH Kakamega, Kenya - Peter Owiti Motsi, a member of the Elwesero Men's Initiative Support Group, explains how ARV's have transformed his life from one of illness from HIV to health. His children are all negative, and now he is strong, able to farm, and lead a positive productive life. The men's support group helps educate, encourage, and support each other as they live life with HIV. Photo: Evelyn Hockstein/PATH Rawa, Kenya - Sharon Akinyi Ouma, 27, holds her daughter Winfrey Juma, 16mos, outside their rural home in Western Kenya. Sharon said she was happy to join the TB vaccine trial, because she would be helping children all over Africa. Photo: Evelyn Hockstein/PATH Kisian, Kenya - Wilfred Murithi, assistant research officer at KEMRI/CDC in Kisian, Kenya, prepares a sample to detect TB resistance to ritampicin, a TB drug.

Katherine E. “Kemy” Monahan, a career foreign service officer steeped in development issues and an economist and lawyer by training, was appointed as deputy executive director of the Global Health Initiative (GHI) in July. She had been the Brussels-based Counselor for International Development and the US Agency for International Development (USAID) Representative to the European Union. She took up her new post in late September and just three weeks into her job traveled to Kenya. On Tuesday, after seeing a Centers for Disease Control and Prevention (CDC) research site in the Kibera slum, she talked to GHTC’s Breakthroughs blog on site about her impressions of the US global health work in Kenya, the importance of research, and the critical need now to make the case to Congress for investing in global health. Katherine E. “Kemy” Monahan, a career foreign service officer Photo: Evelyn Hockstein/PATH Q: What was most memorable about your visit to Kibera? A: There is such a contrast. You see this very poor slum that is far from an ideal environment and then you see very healthy mothers and children inside their homes. That’s a real tribute to the work that CDC and Carolina for Kibera are doing here. When people do get sick, they can go to a clinic here, thanks to these organizations. I met a grandmother who was part of a CDC study. The CDC worker found out that the child had a very high fever, and the grandmother didn’t know about it. They took him to the clinic, gave him medicine, and the grandmother said he was better immediately. She was very happy. Q: What is the benefit of the CDC research in Kibera? A: The grandmother said it well. We asked her what the project was about. She said that the CDC was trying to find more out about the diseases that are most dangerous, that they would tell the Ministry of Health their results, and that would be used to help the neighborhood and the whole country. She was exactly right. CDC really has educated people well about the study. Q: Where does research fit into the priorities of the Global Health Initiative (GHI)? A: GHI is very focused on efficiencies, on all the agencies working well together, and working with other stakeholders such as the host government, other donors, and NGOs. If I think of the one thing that has been most important in cost savings and advancements in global health, it would be research and development (R&D). Research and development can create whole new paradigms. It can cut costs dramatically with one new vaccine, or one new drug, or one new test. R&D is expensive on the front end but very cost effective once you start implementing it. It’s so important that we remember this is a long-term investment. There are examples all over PEPFAR (the President’s Emergency Plan for AIDS Relief), with the pneumococcal vaccine, and the many new innovations now being tested, such as microbicides research. Q: Like many programs in the US federal budget, global health funds are under threat. A House bill would cut $700 million from the administration’s request. How do you make the case for global health in these times? A: There are so many reasons why GHI is good for Americans. It’s not just a moral imperative. It’s not just a reflection of American values—although it is both of those. It’s also about national security, making sure we know how to fight epidemics, helping keep other countries strong. It’s really value for our money. It’s a small percentage of the budget that really is making a difference. Q: If $700 million is cut, what is lost? A: We would not be able to do so many of the things that Americans support. We may not be able to do all the work in preventing malaria, for instance, or we may have to cut back on pre-natal care that is so vital for the health of pregnant women. The choices would be very hard. The United States takes its commitments very seriously. The world respects us for meeting our commitments. America’s word is a bond, something to be proud of. We don’t want to lose that pride when it comes to meeting our commitments in global health, especially when they are so meaningful to people around the world.

Alex Dehgan, science and technology advisor to the admistrator of USAID, talks global health R&D with GHTC Dr. Alex Dehgan is the science and technology adviser to the administrator of the US Agency for International Development (USAID), where he helps employ science, technology, and creativity to help solve traditional and persistent development challenges. Previously, he worked in the Department of State on science diplomacy issues with the Muslim world, including Iraq, Afghanistan, and Pakistan. He talked with GHTC’s Breakthroughs blog on a number of issues, including a NASA-USAID innovation for remote areas and the promise of several products in the pipeline that could save many lives. Q: During USAID’s 50th year, there’s a lot of talk about helping women in the developing world. How are you doing this with scientific research? A: Microbicide research is a good example. It would empower women to protect themselves against HIV. In areas where there are economic disparities, where the relationship involves older men and younger and poorer women, and men refuse to use condoms, a microbicide might be the only way for a woman to protect herself. Another example is research and development with mobile phones. It helps women capitalize on the benefits of microfinance. It allows children to have access to educational materials. It allows for easy cash dispersal. And in health care situations in remote locations, NASA and USAID have an incubator program called LAUNCH. One of the innovations is essentially a lab-in-a-box, a handheld device that takes a drop of blood and analyzes it for quick diagnosis of a variety of diseases. This could have exceptional uses, including for regular checkups for women who are pregnant. Q: You’ve just had a large gathering in Washington, DC, of researchers at the Saving Lives at Birth event, part of USAID’s Grand Challenges initiative. Why was this important to you? A: We focused on three constraints: How to improve the capacity of caregiver, how to deliver new tools, and how to ensure demand generation by women. What we need to do now is provide women in remote settings with new tools. For instance, we’ve now have these simulation models that allow health care workers to simulate doing a C-section surgery. That kind of innovation is very important. Q: So what innovation jumped out at you at this gathering? A: One that caught my attention was a nominee from Australia on stopping post-partum bleeding, which is a major cause of death after childbirth. Now, there’s a drug that stops the bleeding, but you need cold chain – refrigeration – which can be difficult in remote areas. What the inventor did was turn the drug into an aerosol, which doesn’t need refrigeration. It’s a great example of how we use innovation to create easier ways to get the products people need out in the communities. Q: What about challenges in research? What happens after you get unexpected results from a trial? A: Microbicides is a good example. It’s one of the challenges that exist and it involves a great deal of trial and error research. It requires incremental knowledge, and it requires building upon the failures of other people, so that we can get to a product that works. We all tend to celebrate breakthroughs, but we don’t often look at how many combinations we had to try in order to get to the point itself. You have to try a variety of combinations. We are frequently expecting results very quickly and come up with answers on timelines, but it doesn’t always work out that way. That said, we need to recognize that failure is actually an opportunity to learn and move forward; we need to not be afraid to take risks.