The SIGHT Fund:A proposal to drive inclusive innovation at USAID
Science holds promise to ending the world’s deadliest diseases. But to deliver on that promise, we need forward-looking ways of developing new health technologies—and we need the world’s leading bilateral funder of global health, the US Agency for International Development (USAID), to lead the charge.
The Supporting Innovative Global Health Technologies Fund—or SIGHT Fund—is a proposal for a new flexible, catalytic fund to be housed at USAID that would infuse new funding into R&D efforts to close the biggest gaps in our global health toolkit and save more lives more quickly. Recently, a bill known as the SIGHT Act, which would lay the foundation for the creation of the fund, was introduced in the US Congress.
Despite tremendous gains in global health, today we are still without essential tools to combat many long-standing health challenges, and new threats are continuing to emerge.
For decades USAID has invested in the research and development (R&D) of new vaccines, drugs, diagnostics, and other tools as part of its broader mission to advance global health. With its deep international footprint, USAID is uniquely positioned to advance fit-for-purpose tools that will reach places where infrastructure is limited, electricity is unreliable, and trained health workers are scarce. Unfortunately, in recent years, USAID investments in R&D have shrunk as a proportion of its overall global health spending, squeezed by both stagnant budgets and growing needs. The SIGHT Fund is a solution that could supercharge USAID's innovation capacity.
The SIGHT Fund mission
The SIGHT Fund, proposed to be housed within USAID’s Global Health Bureau (GHB) and funded through a $250 million initial dedicated appropriation, would support investments toward R&D of new drugs, vaccines, diagnostics, and medical devices to address a range of global health challenges. It would be disease agnostic, focusing on priority areas of unmet need and promising scientific opportunity, and supplement—not supplant—existing pathways for USAID investments in innovation. In alignment with the agency’s goal of supporting inclusive development, it would be engineered to drive inclusive innovation, centering the perspectives and priorities of people in affected communities—the end users of innovations—in every stage of product development.
The SIGHT Act
The SIGHT Act is legislation that has been introduced in the US Congress that would put in place the structure and authorities for USAID to operationalize a SIGHT Fund once Congress provides funding for it. The bill would create a distinct program and budget line for health R&D at USAID, establish a new leadership role and advisory council to guide investments, grant the agency authority to provide research awards, and mandate annual reporting on health R&D investments and results. Securing passage of this legislation would be an important step forward in turning the SIGHT Fund from vision to reality.
USAID funding for health-related R&D has declined as a proportion of overall global health spending—despite continued innovation needs.
USAID devotes only a small proportion of its global health funding to R&D activities. In 2006, this proportion peaked at 8 percent but has steadily declined to around 5 percent, as total funding for global health has grown but funding for R&D has slightly declined. This is despite the fact that wide innovation gaps persist.
The SIGHT Fund would reverse this decline and bring health R&D funding better in line with need.
A $250 million dedicated investment per year in the SIGHT Fund would bring USAID health R&D funding slightly above the level it was at in 2006, when it peaked as a proportion of GHB funding.
Constrained budgets force GHB leaders to prioritize immediate impact over innovation and long-term progress.
With limited resources, GHB program leads are forced to decide between funding health programs using today’s imperfect tools or developing new and improved tools that could dramatically accelerate the impact of programs in the future—lowering costs and multiplying impact. As a result, leaders often choose to prioritize immediate, short-term results over forward-looking bets on R&D.
The SIGHT Fund would enable staff to make bolder investments in innovation, by reducing risk and perceived trade-offs.
By empowering GHB program leads to invest in innovation through additive resources, the SIGHT Fund would remove the burden of risk inherent in R&D, enabling them to make smart investments in game-changing innovations.
Innovation at USAID is siloed by health area, limiting opportunities for multipurpose products and responsive research.
Funding for health R&D is primarily drawn from disease- and population-specific appropriations accounts, limiting the ability of USAID to fund products that address multiple health issues or to pivot as health emergencies arise.
The SIGHT Fund would provide flexibility to respond to evolving needs and address multipurpose innovations, while improving coordination.
The SIGHT Fund would be “disease agnostic,” enabling it to fund promising innovations that may cross health issue areas or to respond to R&D needs for emerging threats. As a centralized, additive source of innovation funding, the SIGHT Fund would also improve research coordination across the agency.
How the SIGHT Fund could sustainably grow R&D investments
Over the years, USAID’s investments in health-related R&D have declined as a proportion of total GHB spending. A $250 million annual commitment to the SIGHT Fund would raise total annual USAID investments in global health innovation to a healthy target of approximately 10 percent of overall bureau funding.
Health-related R&D funding as a proportion of GHB appropriations.
The Supporting Innovative Global Health Technologies (SIGHT) Act, a bill spearheaded and endorsed by GHTC that would create a disease-agnostic fund for research and development at the US Agency for International Development, was introduced in the Senate by Senator Cory Booker (D-NJ) today after being introduced in the House of Representatives last fall.
Congressman Brian Fitzpatrick (PA-01), Congresswoman María Elvira Salazar (FL-27), and Congresswoman Chrissy Houlahan (PA-06) introduced the Supporting Innovative Global Health Technologies (SIGHT) Act of 2023, which would establish a disease-agnostic research and development program at the US Agency for International Development, in the House of Representatives.
The Saporta Report featured a blog written by the GHTC team on our organization and our proposed Supporting Innovative Global Health Technologies (SIGHT) Fund, which would create a designated, separate funding line for global health R&D at the US Agency for International Development.
GHTC submitted a letter to the White House Office of Management and Budget OMB highlighting the critical role of US programs that support global health research and development (R&D) and encouraging continued support for this important work in the fiscal year 2024 (FY24) budget request, including the creation of a new Supporting Innovative Global Health Technologies Fund at the US Agency for International Development.
Devex featured an op-ed from Management Sciences for Health President and CEO Marian Wentworth making the case for why a new dedicated R&D fund proposed by GHTC—called the Supporting Innovative Global Health Technologies (SIGHT) Fund—is needed at the US Agency for International Development to supercharge health research and bolster the agency’s ability to deliver accessible innovations to stock the global health toolbox of tomorrow.
Frequently asked questions about the SIGHT Fund and Act
USAID is best positioned to house the SIGHT Fund because of 1) its unique mandate—as the only US agency with a primary mission to improve global health and development; and 2) its proven expertise in global health innovation. The agency has a decades-long track record of developing technologies to address unmet health needs of people in the world’s poorest places.
While other research agencies primarily focus on increasing scientific knowledge or advancing products for a US market, USAID is focused specifically on developing health technologies for global use. That means its specialty is creating products that are not only safe and effective, but also affordable and designed to work in places where infrastructure is limited, electricity is unreliable, and trained health workers are scarce.
Consider for a moment a new medicine or vaccine. If that product ends up costing hundreds or thousands of dollars or must be stored consistently at frozen or refrigerated temperatures, many low- and middle-income countries may struggle to make it broadly available and administer it to people in hard-to-reach, rural settings. When funding R&D, USAID considers these challenges from the beginning, so that the innovations it produces can ultimately be widely adopted and used around the world.
With its deep international footprint and strong relationships with health decision-makers in partner countries, USAID also has a keen understanding of what technologies are most needed to improve health programs—as a primary implementer of global health programs, the agency is able to see where current tools are falling short in real time. This enables it to prioritize investments in areas of highest need and potential impact.
USAID would have the opportunity to leverage the SIGHT Fund to build upon and strengthen its ongoing collaborations and coordination with other US agencies sponsoring health research.
USAID already has a strong tradition of partnering with other agencies like the National Institutes of Health (NIH), Centers for Disease Control and Prevention, and Department of Defense on health research. Sometimes this occurs through formal interagency initiatives, like the President’s Emergency Plan for AIDS Relief (PEPFAR), or through specific joint projects. In other cases, USAID informally consults and shares information with other agencies, involving their staff in decisions on research strategy and investments. This continual coordination helps ensure USAID’s R&D investments are additive and complementary, rather than duplicative of other agency investments.
Given that USAID focuses on late-stage clinical development—translating scientific discoveries into proven products—greater interagency coordination enabled by the SIGHT Fund would help ensure promising products move successfully through the research pipeline, from early-stage research supported by NIH to later-stage research and market introduction supported by USAID.
The SIGHT Fund would be a flexible, disease-agnostic fund designed to support R&D of drugs, vaccines, diagnostics, and other medical devices across a range of global health areas. That could include HIV/AIDS, tuberculosis (TB), malaria, neglected tropical diseases (NTDs), maternal and child health, emerging infectious diseases, antimicrobial drug resistance, and more.
The fund could be used to advance discrete disease- or health-area specific innovations currently missing from our toolbox—such as more effective vaccines against TB or treatments and vaccines for NTDs. It could also be used to develop multipurpose tools that address multiple health areas simultaneously. The latter includes products like insecticides and other vector control tools, which reduce the burden of multiple diseases carried by mosquitoes, or combination HIV-prevention/contraception innovations, like vaginal rings or injectable therapies.
What projects the fund ultimately chooses to finance would be determined by its leadership, in consultation with scientific experts and affected communities. For a comprehensive table of the types of technologies the fund could support, view page 8 of our policy brief.
While USAID already specializes in advancing health technologies that are responsive to the needs of people living in low-resource settings, the establishment of a SIGHT Fund would provide opportunities for USAID to engage impacted communities more intentionally in setting and carrying out its research agenda.
GHTC recommends USAID, in establishing the fund, create a governance structure that includes representatives from affected communities in low- and middle-income countries. This would give these stakeholders a greater voice in setting priorities for the fund and in determining which research projects it supports. This would also represent a shift from USAID’s current approach, in which research investment decisions are made primarily by US-based leadership of disease- and health-area offices.
In making research awards via the SIGHT Fund, USAID would also have opportunities to build upon its track record of advancing user-centered design approaches and making investments that not only produce new tools, but also strengthen local scientific capacity. All these actions would serve to support USAID’s broader commitment to inclusive development, which seeks to ensure that every person, no matter their identity, is instrumental in transforming their societies
To establish the SIGHT Fund, the US Congress would need to provide dedicated funding to USAID. Congress would do this by creating a new funding line for global health innovation under Global Health Programs within the State, Foreign Operations, and Relations Programs appropriations bill—the annual legislation that funds USAID.
Once it receives this funding from Congress, USAID would then have the resources and directive to establish and operate the fund. For the fund to continue operations, Congress would also need to include this dedicated funding in each subsequent year’s appropriations bills.
Congress could additionally choose to pass separate authorizing legislation for the SIGHT Fund, creating it as a formal entity through US law. This pathway would allow Congress to be more prescriptive in dictating how the fund should operate. The SIGHT Act, which was introduced in 2023, is authorizing legislation that would establish the structure for the fund to be operationalized once funding is provided.
The SIGHT Fund is a proposal for a new flexible, disease-agnostic R&D fund at USAID.
The SIGHT Act is authorizing legislation that would create the structure and authorities for USAID to operationalize the fund. The SIGHT Act would:
Establish health R&D as a distinct program area and budget line within the GHB at USAID.
Establish a Chief Innovation Officer for Health (CIOH) position within USAID’s GHB to advise the Assistant Administrator for Global Health on R&D priorities and investments.
Establish a Global Health Research and Development Advisory Council comprised of external health R&D experts to advise the CIOH and Assistant Administrator.
Authorize the USAID Administrator and the CIOH to make Health Innovation Research and Development Awards.
Require an annual report to Congress on USAID’s global health R&D investments and results.
Importantly, while the act would put in place important structural changes that would allow USAID to stand up and operate the fund, it does not provide any new funding. Thus, even if the SIGHT Act becomes law, Congress would still need to appropriate new funding for the SIGHT Fund to become a reality.
The SIGHT Act was introduced on November 15, 2023, in the US House of Representatives by Rep. Brian Fitzpatrick (R-PA), Rep. María Elvira Salazar (R-FL), and Rep. Chrissy Houlahan (D-PA). A list of current co-sponsors is available here. Companion legislation was also introduced in the Senate on September 27, 2024 by Senator Cory Booker (D-NJ). A list of current co-sponsors is available here. Currently, GHTC is working to build support for the bills in both chambers, with the hopes of eventually securing passage of this legislation.
Despite tremendous progress achieved in global health over the last few decades, we are still without essential tools to combat many global health challenges.
No matter what global health area you work in, innovation gaps persist. Take malaria, for example. While past research successes like insecticide-treated bednets and antimalarial drugs have driven huge gains, growing drug and insecticide resistance is undermining the effectiveness of our current tools, leading to stalled progress. To eradicate this disease, next-generation treatments, vaccines, diagnostics, and vector control tools are urgently needed.
Or look at tuberculosis, the world’s second leading infectious disease killer after COVID-19. It is clear our current tools are insufficient to end this epidemic. The one vaccine we have, which is over 100 years old, does not work consistently in adults, and existing treatments, particularly for drug-resistant strains, can require taking thousands of pills and painful injections for six months to nearly two years. To turn this tide, we need new and improved innovations.
Even for HIV/AIDS programming, where our existing toolbox is relatively strong, it is common for patients to struggle to adhere to daily antiretroviral therapies (ARVs) taken as treatment or prevention. In the medium term, new technologies like longer-acting injectable ARVs or innovations that combine ARVs with contraception could help more people reliably use treatment and prevention products. Longer term, the development of an effective HIV/AIDS vaccine and cure would have a transformative impact toward ending this crisis.
The fruits of R&D—new and improved technologies—can help make all global health programming and services more effective and efficient, as well as help close access gaps to reach everyone, everywhere with quality care. That’s why it is vitally important that investing in R&D and investing in global health service delivery be viewed as two sides of the same coin in achieving health equity.
For a more detailed look at key missing tools across global health areas, view our fact sheet series.
SIGHT supporters
A diverse group of global health organizations have voiced their support for the SIGHT Fund and SIGHT Act:
1,000 Days
3rd Stone Design
Advancing Synergy
American Academy of Pediatrics
American Society of Tropical Medicine and Hygiene
AVAC
Bay Area Global Health Alliance
BEMPU Health
Better World Campaign
Bilimetrix s.r.l.
BIO Ventures for Global Health
Biotechnology Innovation Organization (BIO)
Boston University Social Innovation on Drug Resistance Program
Bridges to Development
Bugworks
Burnet Institute
Catalysts for Change
Center for Global Health Innovation
Center for Innovation in Global Health, Georgetown University
Christian Connections for International Health
Coalition for Epidemic Preparedness Innovations
Coalition for Health Research and Development
CONRAD
Consortium of Universities for Global Health
CORE Group
COVIDPEDIA LABS
Deutsche Stiftung Weltbevoelkerung
Dr Marri Channa Reddy Foundation
Drugs for Neglected Diseases initiative
Elizabeth Glaser Pediatric AIDS Foundation
Emory University
EpiPointe
Equalize Health
FIND
FREO2 Foundation
Friends of the Global Fight Against AIDS, Tuberculosis and Malaria
Global Antibiotic Research and Development Partnership
Global Health Council
Global Health Innovative Technology Fund
Global Health Strategies
Global Health Technologies Coalition
Global Impact
HarvestPlus
Hemex Health
IAVI
Infectious Diseases Society of America
Innovative Vector Control Consortium
International Business & Technical Consultants, Inc.
International Partnership for Microbicides
International Union Against Tuberculosis and Lung Disease
International Vaccine Institute
Johns Hopkins Center for Health Security
KNCV Tuberculosis Foundation
Linux Foundation Public Health
Little Sparrow Technologies, Inc.
Lucky Iron Fish
Makerere University School of Public Health
Management Sciences for Health
Matchboxology
Mbarara University of Science and Technology
Medical IMPACT
Medicines for Malaria Venture
Modula S Inc.
MRIGlobal
MustER
ONE Campaign
PAI
PanAfricare
Pandemic Action Network
Panorama
Partners In Health
PATH
Pathfinder International
PHC Global
Policy Cures Research
Population Council
Population Services International
Research!America
RESULTS
Rice University Institute for Global Health Technologies
Sabin Vaccine Institute
Sanaria Inc.
Seed Global Health
Shift Labs
Shot@Life
Sightsavers
Sinapi Biomedical
Smile Train
Society for Children Orphaned By AIDS Inc.
South Africa Health Technologies Advocacy Coalition
Speak Up Africa
TB Alliance
Texas Children's Hospital
The BroadReach Group
The END Fund
The Task Force for Global Health
Treatment Action Group
UCSF Institute for Global Health Sciences
United to Beat Malaria
Unlock Aid
Vanderbilt Institute for Global Health
Washington Global Health Alliance
WCG Cares
What To Expect Project
White Ribbon Alliance
Women in Global Health
Zenysis
3rd Stone Design
Advancing Synergy
American Academy of Pediatrics
American Society of Tropical Medicine and Hygiene
AVAC
BEMPU Health
BIO Ventures for Global Health
Bugworks
Catalysts for Change
Center for Global Health Innovation
Coalition for Epidemic Preparedness Innovations
Coalition for Health Research and Development
CORE Group
Deutsche Stiftung Weltbevoelkerung
FHI360
FIND
FREO2 Foundation
Global Health Council
Global Health Strategies
Global Health Technologies Coalition
Global Impact
Hemex Health
IAVI
Innovative Vector Control Consortium
International Union Against Tuberculosis and Lung Disease
International Vaccine Institute
Makerere University School of Public Health
Management Sciences for Health
Mbarara University of Science and Technology
Medical IMPACT
Medicines for Malaria Venture
MRIGlobal
Pandemic Action Network
Panorama
PATH
Pathfinder International
Policy Cures Research
Population Council
Population Services International
Rice University Institute for Global Health Technologies
Sabin Vaccine Institute
Sightsavers
Sinapi Biomedical
Society for Children Orphaned By AIDS Inc.
South Africa Health Technologies Advocacy Coalition
Speak Up Africa
TB Alliance
The BroadReach Group
The Task Force for Global Health
Treatment Action Group
Unlock Aid
White Ribbon Alliance
Former and current policymakers speak out on the need for the SIGHT Fund and Act:
While serving as Ambassador to Tanzania, I saw the need for new technologies to tackle tuberculosis, HIV, and poverty-related neglected diseases, particularly in places where with fewer healthcare resources. USAID has historically been a critical partner to global innovators who develop fit-for-purpose products to take on those diseases. The SIGHT Fund could strengthen this work by formalizing research and development as a priority within USAID's Bureau for Global Health—creating opportunities to strengthen research capacity as part of the journey to self-reliance and accelerating the achievement of our most ambitious global health targets.
Ambassador Mark Green, former USAID Administrator
For over 25 years, the U.S. Government through USAID, has led the global effort to increase access to TB, HIV, malaria and neglected tropical disease diagnosis, treatment and care, particularly among those who are most impoverished. With limited budgets, Global Health Bureau staff are forced to make tough calls between program implementation and supporting research for the tools that don’t yet exist to overcome global health challenges, and I’m concerned that R&D funding as a percentage of the overall budget of the Bureau has stagnated. Investment in R&D shouldn’t be something USAID does if there’s extra money in an annual budget, it should be an articulated priority with its own additional funding, and the SIGHT Fund, grounded in advancing inclusive innovation, is the right approach to make that happen.
Ariel Pablos Mendez, former USAID Assistant Administrator for Global Health
USAID should be synonymous with 'innovation,' because the Agency's success depends on finding, nurturing, and deploying the best new technologies and approaches. But innovation needs resources, and the current budget of the Global Health Bureau at USAID is siloed. We need a new mechanism to finance cross-cutting and disease-agnostic innovation that could help us develop the next generation of essential global health tools in cooperation with the private sector. A dedicated funding line to support that work, like the SIGHT Fund, is long overdue.
Dr. Bill Steiger, former USAID Chief of Staff
The United States must remain a leader in health technology innovation at home and abroad. Our bipartisan bill [the SIGHT Act] aims to address global health issues and provide further research and development in order to help save millions of lives on the world stage.
Rep. Brian Fitzpatrick (R-PA)
As an Air Force veteran and as a Member of the House Armed Services and Intelligence Committees, I am acutely aware of the need to support investments in America’s diplomatic and foreign assistance programs. In fact, I introduced the SIGHT Act with my colleague, Rep. Fitzpatrick to increase the US’s investment in global health research and development. As we face global challenges and crises on multiple fronts, it is more critical than ever that we strengthen US leadership and bolster our national security by investing in evidence-based, cost-effective and lifesaving foreign aid programs…By investing resources in USAID’s research and development of innovative health technologies, we can help ensure that the US remains a global leader in fighting disease and building resilient health systems around the world.
Rep. Chrissy Houlahan (D-PA)
Take action: Become a SIGHT Fund supporter
If you would like to add your organization to our list of SIGHT Fund supporters and join this advocacy effort, please fill out the form below.
Share your support: Use the suggested tweets below
We can't fight #globalhealth threats without the right tools. That’s why we’re calling on policymakers to create a new research fund at @USAIDGH to catalyze development of new and improved health technologies. bit.ly/36la2rw
We are still without essential tools to defeat many #globalhealth challenges. Join us in pushing for a new dedicated fund at @USAIDGH to drive inclusive innovation of vaccines, drugs, and other health tools. → bit.ly/36la2rw
Despite @USAIDGH’s long history of developing #globalhealth innovations, in recent years its R&D investments have shrunk as a proportion of health spending. A new proposed fund would reverse this decline and bolster our global health toolbox. → bit.ly/36la2rw
New funding is needed to stock the #globalhealth toolbox of the future and accelerate progress in global health. Join us in calling for a new dedicated fund at @USAID to supercharge innovation → bit.ly/36la2rw
When it comes to fighting #globalhealth threats, we must center the perspectives and priorities of people in affected communities in investment decisions. A new proposed fund would help drive inclusive innovation at @USAIDGHbit.ly/36la2rw
@USAIDGH has unique capabilities and proven experience in advancing scalable #globalhealth products—but its R&D funding has stagnated. Join us in calling for Congress to supercharge inclusive innovation with a new dedicated fund. → bit.ly/36la2rw
#COVID19 has shown the importance of #innovation in fighting epidemics. Yet, we are still missing critical tools to combat enduring threats like #HIV, #malaria & #TB. That's why we're calling for a new research fund at @USAID to supercharge R&D. bit.ly/36la2rw
