Obama’s FY 2013 budget request raises concerns for global health R&D

On Monday, President Obama released his Administration’s much-anticipated FY 2013 budget request to mixed reviews. In his introduction to the overall budget request, Obama emphasized that research and development (R&D) programs are essential to the US economy and the country’s future. He even highlighted the work of the National Institutes for Health (NIH) and the Food and Drug Administration (FDA) in this area. When looking at the budget numbers for global health, Obama’s emphasis on R&D in his introduction played out in various ways, with some good and bad news.

Overall, the President’s request was in line with the rumors that preceded its release. Global health numbers faced nearly across-the-board decreases when compared with FY 2012 levels, although the broader State and Foreign Operations account did receive an increase. Under the State and Foreign Operations account:

• The Global Fund To Fight AIDS, Tuberculosis and Malaria and the GAVI Alliance received major increases.
• The President’s Emergency Plan for AIDS Relief (PEPFAR) saw funding cuts.
• Most global health line items in the budget for the US Agency for International Development (USAID)—aside from family planning and reproductive health—received reductions in funding, some by as much as 25 percent. These funding cuts could drastically affect USAID’s ability to support global health R&D projects.

Global health R&D funding under the Department of Health and Human Services (HHS) account saw additional inconsistent results, with some good and bad news.

• The FDA received an $11 million increase. However, this increase relies on the collection of user fees, which has some constraints.
• Overall NIH funding remained at FY 2012 levels, with essential programs at National Institute of Allergy and Infectious Diseases and the Fogarty International Center receiving small, but welcome, increases. The Office of AIDS Research stayed the same as last year, as did the new National Center for Advancing Translational Science (NCATS).
• More flat-funding was seen at the Centers for Disease Control and Prevention (CDC). HIV and AIDS and polio stayed essentially the same as FY 2012, with malaria receiving a small increase. Otherwise, global health programs at CDC were requested at last year’s levels.
• Further drastic cuts at crucial Department of Defense research programs on malaria, HIV and AIDS, and neglected diseases add to the concerning budget slashing.

It is important to note that the President’s Budget Request is not the last word on global health R&D funding. Congress has the authority to change the funding levels as it sees fit. However, it could be difficult to justify spending above what the Administration views as appropriate, especially given the current fiscal crisis and the shortened election-year appropriations process.

Although some of the proposed reductions may appear to be minor, given the larger picture of the federal budget, they will certainly have serious effects on R&D projects—both for those now on the cusp of groundbreaking results, and for those in the future. The Administration has tried to soften the blow of these budget reductions by pointing out that cost-savings can be found in global health scientific advances like newer HIV drugs, inexpensive diagnostics, and streamlined vaccine delivery devices. It’s absolutely true that these new tools can save dollars while they save lives. The question is, if we cut US global health R&D funding now, will we have these urgently-needed advances to rely on five or ten years down the road?

More information on the President’s budget request can be found at the following links:

Kaiser Family Foundation Budget Tracker

White House Office of Management and Budget Website and blog post