US government collaborations protect and improve global health

Earlier this month, Reps. Albio Sires (D-NJ) and Mario Diaz-Balart (R-FL) introduced the 21st Century Global Health Technology Act, which would make several important and welcome changes to global health research and development (R&D) programs at the US Agency for International Development (USAID). Previous versions of this legislation were introduced in 2009 and again in 2011, but did not advance past the committee level. Compared with the previous versions, the bill introduced this month includes several key changes that take a more comprehensive approach to global health R&D at USAID. Key provisions in the bill include: Codifying into law the Health Technologies (Health Tech) program at USAID, which would help ensure that this important program is sustainable. In its first 25 years of operation, the Health Tech program has produced 85 new global health technologies with more than 100 different partners, all aimed at addressing the needs of low-resource settings around the world. Requiring that the USAID administration develop an action plan on global health R&D. The bill would require that these action plans incorporate global health R&D into each of USAID’s global health programs, and would require the agency to develop metrics to measure success. Recognizing the importance of USAID’s Center for Accelerating Innovation and Impact (CAII). CAII conducts market analysis and product introduction studies across USAID’s global health product development portfolio, in an effort to improve and speed scale-up of important new tools. Requesting that USAID continue its annual reports on health-related R&D. These reports would include information on: health R&D progress within each of the agency’s global health programs; how USAID coordinates translational and applied research with other US agencies; and USAID’s investments in science, technology, and innovation—an area that USAID Administrator Rajiv Shah has stated is a priority for the agency. Requesting that USAID work to align its health-related research strategy with similar strategies at other agencies, with the intent of creating a whole-of government strategy for global health R&D. Earlier this month, Reps. Albio Sires (D-NJ) and Mario Diaz-Balart (R-FL) introduced the 21st Global Health Technology Act, which would make several important and welcome changes to global health R&D programs at USAID. This new legislation—which was developed in close partnership with GHTC member PATH—supports global health R&D efforts across USAID. While it includes the Health Tech program, it also promotes research programming for every disease or health condition category that falls under USAID’s global health mission. This is an important sign of progress, as there are many health areas where new drugs, vaccines, diagnostic tools, and other technologies are sorely needed. This includes R&D for neglected tropical diseases and tuberculosis vaccines, which currently do not receive support from USAID. The legislation also looks across USAID’s spectrum of R&D work and takes into account introduction and scale-up needs, as well as harnessing the promise of science and technology—which Shah and President Obama have previously highlighted. Finally, the addition of strategy alignment with other US agencies is another welcome change. Because the United States is involved in the development of 200 of the 365 current technology candidates in the global pipeline, a strategy that aligns all US global health R&D would increase transparency and coordination among the major agencies that support this important work. It is unclear at this point how the bill will move forward, although there are several mechanisms available. For example, the bill could progress in Congress as a stand-alone bill, or as an amendment to a larger foreign affairs or global health package. At this point, there is no Senate version of the bill, although that may be a positive next step. If implemented, this legislation could provide promising improvements in US global health R&D transparency, coordination, and financing that would help new global health technologies reach those who need them most. You can find a press release from Rep. Sires here.

Wednesday, the White House released President Obama’s fiscal year (FY) 2014 budget request, which overall has mixed results for global health and research programs. Below, we provide specific details on funding levels at key agencies that support global health and research efforts, including the Centers for Disease Control and Prevention (CDC),the US Food and Drug Administration (FDA), the National Institutes of Health (NIH), and the US Agency for International Development (USAID). Details are still forthcoming about how global health research fared at the Department of Defense. It’s important to note that figures are compared to final FY2012 levels, since Congress is still working on finalizing FY2013 levels. The president's budget for FY2014 requests funding for key US agencies engaged in global health product development. Credit: PATH. CDC CDC’s overall budget took a hit in the president’s request—the president’s FY2014 budget requested $5.2 billion for the agency overall, compared with $5.65 billion in FY2012. However, CDC’s global health programs were slightly increased and were spared major cuts. CDC’s Center for Global Health would receive $393 million in FY2014 under the president’s budget, compared with $376.7 million in FY2012. FDA The FDA got a much-needed increase in the president’s budget request, although much of it is due to an expected uptick in user-fee income. The agency would receive $4.65 billion in FY2014 under the president’s budget, compared with $3.83 billion in FY2012. As noted above, user-fee income plays a large part in this increase in FDA’s budget. User fees would comprise $2.09 billion of the agency’s budget under the president’s request, compared with $1.32 billion in user fees in FY2012. In recent years, Congress has not adequately appropriated stable funding to FDA, instead relying on user fees to make up the difference. Critics have said that relying on user fees is unsustainable and creates a conflict of interest between FDA and the industries it regulates. NIH NIH funding was mostly flat-lined at FY2012 levels—the president’s budget requested $31.3 billion for the NIH in FY2014, compared with $30.8 billion that the agency received in FY2012. The National Institute of Allergy and Infectious Diseases (NIAID), as well as the National Center for Advancing Translational Science (NCATS), received increases that could hint at new programming in those areas. The president requested $4.6 billion for NIAID in FY2014, compared with $4.5 billion the center received in FY2012. NCATS would receive $666 million under the president’s FY2014 budget, compared with $574 million in FY2012. State Department and USAID At USAID, several key programs that fund global health research were cut dramatically—most notably the agency’s tuberculosis (TB) program. Most other programs at USAID were flat-funded or saw small increases. Under the president’s budget, USAID’s global health programs would receive $2.645 billion in FY2014, which is pretty much the same figure ($2.649 billion) for FY2012. Under USAID’s global health programs, several key initiatives saw disappointing funding cuts. The TB program would be reduced to $191 million in FY2014, compared with $236 million in FY2012. The HIV and AIDS program would be cut to $330 million, compared with $350 million in FY2012. The neglected tropical diseases program would be cut to $85 million in FY2014, compared with $89 million in FY2012. Fortunately, the malaria program would see an increase to $670 million in FY2014, compared with $650 million in FY2012. The State Department budget element getting the most buzz is the 5.3 percent cut to the President’s Emergency Plan for AIDS Relief, while the Global Fund to Fight AIDS, TB, and Malaria saw a robust request of $1.65 billion for FY2014. Federal agencies have also released their budget justifications, which detail policy and programmatic priorities for FY2014. We’ll provide a comprehensive update on these budget justifications and key policies that could impact global health research and product development. Usually, the President’s budget request sets a precedent that the advocacy community and Congress respond to—whether they agree or disagree with its content. However, with the request being released so late in the year, Congress has already acted, passing drastically different FY2014 budget resolutions in the House and Senate. House and Senate budget committee activity is moving quickly, with key leaders from US agencies that fund global health research and product development scheduled to testify at appropriations hearings as early as next week. Congress must act to avoid further cuts and fund global health research programs at the robust levels that ensure availability of new technologies to the millions who need them worldwide.