New details emerging about sequestration that indicate an uncertain future for global health R&D

  In this guest post, Margie McGlynn, president and CEO of the International AIDS Vaccine Initiative (IAVI), Zeda Rosenberg, chief executive officer of the International Partnership for Microbicides (IPM), and Renate Baehr, executive director of DSW (Deutsche Stiftung Weltbevoelkerung) mark International Women’s Day with a call for continued research to develop new women’s health tools. On this day honoring the political, social, and economic contributions women have made worldwide, nearly 2,000 women will die of AIDS and 790 will perish in pregnancy or childbirth. If we wish to truly advance the health and rights of women globally, we must give them the tools they need to protect their own health. Yet, while the benefits of investing in women—and their health in particular—are well-established and far-reaching, less progress has been made over the past decade toward attaining Millennium Development Goals that address women’s health and gender equality than virtually every other goal.   HIV is a case in point. In the regions hardest hit by the AIDS pandemic, such as sub-Saharan Africa, women bear a disproportionate burden of HIV, accounting for six out of every 10 new infections. A unique combination of factors, having as much to do with biology as with gender inequality, contribute to women’s increased vulnerability. Researchers have made remarkable progress toward developing tools for HIV prevention that could empower women to protect themselves from the virus. Photo credit: PATH/Evelyn Hockstein Fortunately, researchers have in recent years made remarkable progress toward developing tools for HIV prevention that could empower women to protect themselves from the virus. A number of such products and strategies are under development today, including microbicides, AIDS vaccines, multi-purpose prevention technologies (MPTs) and the use of antiretroviral drugs (ARVs) as pre-exposure prophylaxis (PrEP). Take, for example, IPM’s monthly vaginal ring that is currently in the late stages of clinical evaluation. The device slowly releases the ARV dapivirine to prevent HIV. Another product that has already been shown to be partially effective, a microbicide gel containing the ARV tenofovir that is used around the time of sex, is now being tested in a confirmatory trial. And though the latest results from the VOICE trial found that PrEP did not work in that study due to low adherence, a number of other studies have demonstrated that if used consistently, ARVs can do much to prevent HIV. Further, long-acting preventive tools like the dapivirine ring could help address the challenge of adherence for women. IPM and others are also developing MPTs that slowly release ARVs along with a contraceptive to prevent HIV and unintended pregnancy—both leading causes of death for women worldwide. Researchers have also made significant strides toward the development of preventive HIV vaccines. A trial conducted in Thailand four years ago establishes hope that HIV can be prevented by vaccination. Vaccine design too is advancing apace. Scientists around the world have isolated scores of broadly neutralizing antibodies to HIV, uncovering clues to the design of broadly effective vaccines against the highly variable virus. Recent modeling by IAVI suggests that even a partially effective HIV vaccine could significantly reduce the number of new infections among women, if it were deployed in the context of expanded prevention and treatment programs. These models suggest that a vaccine with 50 percent efficacy given to 30 percent of the adult population in low- and middle-income countries would prevent 2.8 million infections in women over 10 years. Vaccines, microbicides and other new preventive technologies could empower women to protect their own health because they could be used discreetly, without the need for negotiation with their sexual partners. Taken together, these new tools and measures could—if deployed with existing methods of HIV prevention—eventually end the AIDS pandemic. Until then, preventing HIV and supporting family planning would improve the health and economic well-being of entire families and advance key development goals. When women are healthy, they have more opportunities for education and employment, which in turn strengthens communities. A paper commissioned by DSW recently reported, for example, that the promotion of HIV prevention and sexual and reproductive health research can help countries make gains toward poverty reduction. This International Women’s Day, we call on the global community to recommit to investing in new preventive tools and health technologies for women. The health of women is, after all, essential to the well-being and economic stability of not only the women themselves and their families—but of entire nations.

  “I’d be careful not to break something that would be hard to put back together,” Alan Magill—director of Malaria at the Bill & Melinda Gates Foundation—said this week at the GHTC’s annual congressional briefing. Sequestration, just days away, was a primary concern for Magill and others at the event, which focused on how US policymakers can protect the nation’s investments in global health research in upcoming budget discussions. As Magill and others stressed, sequestration and federal budget cuts would severely hamper research taking place across the US government to develop new vaccines, drugs, and other tools for global public health. According to moderator Lisa Cohen, executive director of the Washington Global Health Alliance, more than 350 health innovations are in the research pipeline. She added that 200 of these are supported by the US government through agencies such as the Centers for Disease Control and Prevention (CDC), the Department of Defense (DoD), the US Food and Drug Administration (FDA), the National Institutes of Health (NIH), and the US Agency for International Development (USAID). (from right to left) Lee Hall from the National Institute of Allergy and Infectious Diseases, Caroline Ryan from the President's Emergency Plan for AIDS Relief, and Alan Magill from the Bill & Melinda Gates Foundation. Photo credit: PATH. Widespread budget cuts would stop scientific progress in its tracks—progress that cannot be seamlessly picked up again if funding were to resume in the future. “Many biomedical studies cannot survive cuts in funding in the middle of their work. It would be an irreversible mistake to halt these ongoing global health research efforts,” Cohen said, adding, “Halting funding would mean that the world may never benefit from these tools that are so close to development and delivery.” As the panelists stressed, there are several compelling humanitarian reasons to protect US investments in global health research. “Scientific advancements have brought us to a tipping point in the fight against HIV and AIDS,” Caroline Ryan, deputy coordinator for Technical Leadership at the President’s Emergency Plan for AIDS Relief (PEPFAR) said. She added that “science has set us on a new path—a path to achieving an HIV-free generation.” Lee Hall, chief of the Parasitology and International Programs Branch at the National Institute of Allergy and Infectious Diseases, said that the NIH is supporting research for an array of new, lifesaving health tools—including drugs, diagnostics, and vaccines for malaria, Chagas disease, and tuberculosis. “We’re standing at a very promising moment,” Hall said. “Looking at what’s on the horizon, it’s clear that a lot will come out of our support for global health research. We need new tools if we are to realize the benefits of US support for global health.” Speakers also emphasized that there are countless domestic benefits that come with US investments in global health research. “We live in a globalized world, whether we like it or not,” Magill said. “This presents us with the choice to exert America’s leadership role and shape the world how we’d like to see it—or let someone else do it for us.” Magill added that with the ease and speed of airline travel, “what’s happening in the middle of Africa today could be happening at Dulles tomorrow.” Hall also highlighted that many areas in the United States are vulnerable to tropical infections, and that diseases like Chagas are appearing throughout some Southwestern states. Lee Hall (left) and Alan Magill (right) at the GHTC's annual congressional briefing. Throughout the event, all three panelists underscored the importance of partnerships to advancing research and science for new health tools. According to Ryan, PEPFAR “gets more bang for our buck” by working in partnerships with other US agencies, such as the NIH and FDA, as well as philanthropic groups like the Gates Foundation. As an example, Ryan cited that PEPFAR and USAID are supporting the development of microbicides with a research infrastructure established by the NIH. Hall also cited NIH’s numerous partnerships with US academic institutions, nonprofit groups, and other federal agencies like the CDC and DoD. Magill stressed that from the Gates Foundation’s perspective, the US government is a critical partner in global health. “The Bill & Melinda Gates Foundation can only provide a small fraction of what the US can bring to the table,” he said, adding that investments in global health research should not only be seen as humanitarian aid—they are investments in science that provide “a lot bang for a little buck. We should save programs that are investments in the future.”