G20 health ministers meet: The good, the bad, and the unknown for health R&D

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.

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. Major funders are betting that a new online platform for genetic sequencing will help health workers worldwide more easily identify mysterious infections and track disease outbreaks. The platform, IDseq, seeks to make metagenomics sequencing—the analysis of genetic material and the matching of those readouts to databases of known microbes—, which can be expensive and technically demanding, more accessible and affordable, particularly in low-resource settings. Free and based in the cloud, IDseq allows researchers to upload patient data, which is then “crunched” against existing databases, to determine what infection a patient has. The Chan Zuckerberg Initiative is supporting the platform’s development, and the Bill & Melinda Gates Foundation announced last week a new training program to support clinicians around the world in using the platform. In an early stage trial, a combination of two broadly neutralizing antibodies (bNAbs)—proteins that can bind to different strains of HIV and prevent the virus from entering human cells—suppressed blood levels of HIV for months after treatment in some people. Participants received up to three infusions of bNAbs over a six-week period with their viral load monitored every one to two weeks. Though further testing and refinement is required, long-acting bNAbs combinations may eventually become an alternative to daily anti-HIV drugs. Researchers hope to test whether engineering the antibodies to last longer in the blood can improve viral suppression and explore new combinations with additional antibodies or other drugs. The Global Antibiotic Research & Development Partnership (GARDP) and Novartis are joining forces to reduce child deaths from antimicrobial resistance (AMR) by accelerating the development of generic antibiotic treatments for children. The strategic partnership will focus on: 1) enhancing the availability of generic antibiotics and increasing access for children in low- and middle-income countries, 2) developing heat-stable pediatric formulations, and 3) leveraging the knowledge and shared expertise of both partners. The partnership between GARDP and Novartis is a response to the World Health Organization’s call for affordable, improved, and adapted antibiotics for this vulnerable population, for which treatment options are limited.