On Monday the White House turned heads by releasing, for the first time since 2010, an on-time budget. Overall the White House presented a mixed outlook for global health research and development (R&D). At US$4 trillion, the President’s budget ignores the current budget caps and makes a clear case for Congress to do away with sequestration. While the overall federal budget request would provide a 6 percent increase in OVERALL funding for R&D—with a broader focus than global health—overall implications for global health R&D were mixed. State Department and US Agency for International Development (USAID) Although the White House’s overall request for the State, Foreign Operations, and Related Programs account—which funds activities at State and USAID—would increase by 8 percent, global health programs would see a slight 3 percent decrease compared to fiscal year (FY) 2015 levels. While this is a disappointing trend, not all accounts were treated equally. One significant cut was to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which compared to FY2015 levels would drop from $1.35 billion to $1.1 billion. While disappointing, this cut was expected and continues to meet the US commitment to provide $1 for every $2 pledged by other donors for the FY2014 – FY2016 replenishment. We were very disappointed to see the White House continue to low ball the funding for tuberculosis (TB) and neglected tropical diseases, which would see a 19 percent and 14 percent cut, respectively. It will once again be up to our champions in Congress to protect funding for these already underfunded accounts. Nutrition, vulnerable children, and global health security (formerly listed under the line item “pandemic influenza and other emerging threats”) also would see significant decreases. Funding for malaria, HIV and AIDS, the President’s Emergency Plan for AIDS Relief (PEPFAR), and family planning would be essentially flat funded. As mentioned earlier, not all accounts were treated equally, and GHTC is glad to see the President recognize the US commitment to ending preventable maternal and child deaths within a generation through an 8 percent increase to the maternal and child health budget line and an 18 percent increase to GAVI, the Vaccine Alliance. Something new in this year’s budget was a request for $300 million for a new PEPFAR Impact Fund to help countries re-align their national HIV and AIDS programs to focus on high burden areas. Also included was $94 million for the Commodity Fund, one function of which is to fund HIV vaccine development and research for microbicides. The congressional budget justification (CBJ) showed strong continued support for the Global Development Lab, specifically highlighting the lab’s role in battling the Ebola outbreak. The budget also continues to list the promotion of research, development, and innovation as a top focus of the Administration’s Global Health Initiative. It’s great to see strong commitments in language for global health R&D, but for long-term change to occur, we’ll need to see the Administration continue to back up its recognized priorities with the necessary investments. US National Institutes of Health (NIH) The NIH would receive 4 percent increase under President's plan. Photo: PATH/Will Boase Under the President’s plan, the NIH would be funded at $31.3 billion, a 4 percent increase from FY2015 funding. According to an accompanying US Department of Health and Human Services (HHS) factsheet, NIH estimates that in FY2016 the agency can support a total of 35,447 research grants, including over 10,000 new awards. GHTC is glad to see this budget line continue to increase, albeit slower than we’d like. Within NIH, the National Institute for of Allergy and Infectious Diseases would receive an almost 6 percent increase. Within this account, funding for emerging and infectious diseases, infectious and immunologic diseases, HIV and AIDS research, and research project grants would all receive significant increases. These accounts are critical for developing new tools in the fight against AIDS/HIV, TB, and malaria. Funding for the National Center for Advancing Translational Sciences, the National Institute of Child Health and Human Development, and the Fogarty International Center would all see modest increases of 4 percent, 2 percent, and 3 percent, respectively. One of the major implications for the NIH budget is the President’s new Precision Medicine Initiative, which split across multiple agencies adds up to a request of $215 million ($130 million for the NIH). The National Center for Emerging and Zoonotic Infectious Diseases would see a 70 percent increase in funding. Photo: CDC/ Dr. Scott Smith US Centers for Disease Control and Prevention (CDC) Under the President’s plan, the overall budget at the CDC would remain relatively the same with a slight (almost 2 percent) increase. Global health funding would fare quite well, particularly in a few of the areas GHTC tracks. At $448 million, funding for global health programs at the CDC would be $32 million above the FY2015 enacted level (which does not include the $30 million CDC received in additional Ebola funding for FY2015). We’re glad to see that the Administration’s request does not seem to penalize important programs based on additional emergency funding received last year. Within the CDC’s global health programs, the President included a $12 million increase to expand the Global Health Security Agenda, a $10 million increase to support global health capacity building, and a $10 million increase for the US commitment to polio eradication. The largest increase for global health R&D at the CDC was for the National Center for Emerging and Zoonotic Infectious Diseases, which would see an increase of over 70 percent (going from $405 million to $699 million). Nearly all of this additional funding would go towards the implementation of the National Strategy to Combat Antibiotic-Resistant Bacteria, which among other priorities, is working to accelerate basic research for new antibiotics, therapeutics, and vaccines. US Food and Drug Administration (FDA) The CBJ recognized the important role of FDA in global health R&D. Photo: FDA/ Michael J. Ermarth Under the President’s budget, the FDA’s budget authority would grow by 6 percent, an increase of $147 million. GHTC is pleased to see the CBJ recognize the important role the FDA plays in global health R&D by highlighting the agency’s accomplishments in improving global health through international collaboration, research, and information sharing. Also highlighted was FDA’s role in the International Conference on Harmonization and the International Conference of Drug Regulatory Authorities. GHTC is glad to see the Administration starting to build back up many of the basic research structures and baseline funds that were hit especially hard during sequestration. However, the development of life-saving new tools and technologies for vulnerable populations requires a whole-of-government approach which necessitates robust funding across all accounts involved in R&D. We’re pleased to see funding for many of these programs at the NIH, CDC, and FDA moving in the right direction, but are disappointed to see more of the status quo for USAID’s global health programs which play a vital role in ensuring new tools are developed and delivered to those who need them. We’ll now be looking to Congress to finish what the President started.

Congress passed an omnibus spending bill which largely flat funds global health R&D programs. Photo: Tim Evanson Working over a rare weekend session and racing against the clock to keep the government open, Congress finally came to an agreement on a year-long spending plan to fund the government through September 30, 2015 (with the exception of the Department of Homeland Security, which only goes through February 27). The package sustains budgets for global health research and development (R&D) and includes policies which we hope will improve coordination across the government to ultimately strengthen the impact of US investments. State, foreign operations, and related programs (SFOPS) For the most part, global health programs funded through the State Department and the US Agency for International Development (USAID) were essentially flat funded. Total fiscal year (FY) 2015 funding for USAID and State was US$8.44 billion, slightly above FY2014’s $8.454 billion. While most programs remained the same, Gavi, the vaccine alliance received a boost of $25 million, and malaria was increased by $4.5 million. While there was a $300 million decline in US contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria, bilateral funding for HIV and AIDS received a $300 million increase. One thing we were watching closely was how the bill would handle the White House’s proposed cut to tuberculosis funding—thankfully appropriators rejected the proposed cut and went with the higher House number of $236 million—which was the same as last year. In addition to tracking final funding levels, we were anxiously watching to see how appropriators would handle report language. The SFOPS explanatory statement noted that unless specifically stated, all report language put in the FY2015 House and Senate report still stands. As noted in our previous blog on report language, we are thrilled to see the Committee direct USAID to coordinate across the government with other agencies involved with global health R&D to ensure efforts are efficient and coordinated. Health and human services (HHS) The FDA received a 2 percent increase in FY 2015 funding over FY 2014 funding. Photo: FDA/Michael J. Ermarth At just over $30 billion, funding for the US National Institutes of Health (NIH) increased by $150 million in base funding from 2014, but still came in below both the White House and Senate request. Within the NIH, the National Institute of Allergy and Infectious Diseases, the Fogarty International Center, and the National Center for Accelerating Translational Science (NCATS) were essentially flat funded with NCATS receiving a slight increase of $2 million. Overall funding for global health at the US Centers for Disease Control and Prevention (CDC) remained the same. Within the CDC’s global health programs, the global immunization program overall, and specifically polio, saw slight increases of 3.8 percent and 5.8 percent respectively. Finally, the US Food and Drug Administration (FDA) was funded at $4.43 billion, which reflected the higher Senate request and was just over a 2 percent increase from FY2014 (note this number includes user fees). We were pleased to see appropriators include strong HHS report language around the need for coordination among agencies. Included in the joint explanatory statement was a request for a global health strategy that would direct the CDC, FDA, and NIH to “jointly develop, coordinate, plan, and prioritize global health research activities.” Defense The peer reviewed medical research program at the US Department of Defense (DoD)received funding at $247.5 million—$47.5 million more than FY 14 levels. This program funds important research for dengue and malaria. We were pleased to see that the final omnibus also includes language submitted by the GHTC affirming the DoD contributions to global health R&D, and asking the agency to improve upon current reporting on its work in infectious disease research. The report language also noted the importance of DoD’s research around malaria, dengue and Chikungunya and encouraged continued research and partnerships with other federal agencies and non-profit organizations. Ebola emergency funding Congress provided $5.4 billion in additional funding for US agencies to tackle Ebola. Photo: CDC/Sally Ezra Included in the $1.1 trillion omnibus agreement was $5.4 billion in additional funding for Ebola response at home and abroad (as a reminder, the president requested $6.2 billion). Out of that $5.4 billion, $2.5 billion is for the Department of State, $2.7 billion for HHS, which includes $1.78 billion for the CDC’s work in the US and around the world (including $597 million for the CDC to set up and strengthen National Public Health Institutes), $238 million for NIAID’s research (including its work on Ebola vaccines), and $157 million for research through the Biomedical Advanced Research and Development Authority (BARDA) at HHS. This funding for Ebola is on top of previously noted funding levels. We’re glad to see that appropriators heard our call that funds to meet the Ebola crisis must be made in addition to other global health funds and not at the expense of other spending. While we would have liked to see higher increases overall, we’re glad funding for global health R&D has been sustained and that important policy shifts are taking place to ensure increased efficiency and coordination, and ultimately making sure that we are seeing maximum bang for our buck.

The voters spoke, and Republicans extended their majority in the House and took majority control of the Senate. Photo: VOX Efx Election night saw an historic shift in Congress, with Republicans extending their majority in the House of Representatives and capturing the Senate for the first time since 2006. President Barack Obama now faces a united Republican Congress for the last two years of his term, and the key question will be whether he can work with Speaker John Boehner and new Senate Majority Leader Mitch McConnell or whether the gridlock will continue. Another key story is the number of neck-in-neck races, with several races still too close to call. Let’s take a look at how this big November shake-up might impact global health research and development (R&D): House of Representatives We rightly predicated that Republicans would keep control of the House and gain seats in the Senate. However, not only did Republicans pick up seats in both chambers, they did so on a large scale, the 114th Congress will be the most dominant Republican controlled Congress since 1929. While leadership in the House committees with jurisdiction over global health R&D issues won’t be changing too much, there were a couple of key races we were paying attention to, including those of Congressmen Brad Schneider (D-IL) and Ami Bera (D-CA), who serve on the House Foreign Affairs Committee. Schneider lost to Republican Robert Dold. Bera—who has been a strong advocate for global health issues—is currently trailing by a few thousand votes to Republican Doug Ose. With more ballots to count, final results won’t likely be known until this weekend. Last week, we mentioned other potential changes to the make-up of House committees, most of which we still won’t know until early next year when committee assignments are made. With a number of retiring members, we’ll be watching to see who gets tapped to fill roles in the House Appropriations Committee, as well as who is chosen as Ranking Member of the House Energy and Commerce Committee. Senate Republicans gained control of the Senate, which means there will be a complete switch up in Committee leadership. Photo: Greg Willis As we predicted, the Senate is where things are really being shaken up. Republicans gained a total of 10 Senate seats, putting them over the 51 needed to gain control of the Senate. The all-powerful Senate Appropriations Committee, which has jurisdiction over deciding funding allotments across the US government, will look particularly different in the 114th Congress. Senator Mark Pryor (D-AR)—current chairman of the Agriculture Appropriations Subcommittee, which has funding jurisdiction over the FDA—lost in a close race to Republican Tom Cotton. Current incumbent Senator Mary Landrieu (D-LA) will be facing a tough run-off election with Republican Bill Cassidy, and Senator Mark Begich (D-AK) is currently losing to Republican Dan Sullivan (although votes are still too close to make a final call). One bright spot for Democrats came in the reelection of Senator Jeanne Shaheen (D-NH), who will likely continue to serve on both the Senate Appropriations and Foreign Relations Committees. A Republican-controlled Senate means there will be a complete switch up in Committee leadership–with all chairmen roles in the 114th Congress being filled by the majority party—in this case Republicans. Committees also reflect the general ratio of Republicans and Democrats in each chamber; thus, we will also see members switching between committees to retain proper committee ratios. We will likely see current ranking members of both full and subcommittees—like Senators Jerry Moran (R-KS), Lindsey Graham (R-SC), Thad Cochran (R-MS), Richard Shelby (R-AL), Lamar Alexander (R-TN), and Bob Corker (R-TN) step into chairman roles. What does it all mean? Leading both chambers for the first time in years, Republicans will be anxious to show they can lead and are able to unify their party. Whatever the final outcomes of recounts and runoffs, we've got to start educating new members of both the House and the Senate on the critical role the US government plays in global health R&D.

As candidates make their final pitches, volunteers canvas like crazy, and pollsters make their predictions, GHTC is taking a look at what the outcomes of next week’s election could mean for global health research and development (R&D). With every member of the House of Representatives and a third of the Senate up for re-election, there will undoubtedly be some big changes ahead. Here are the potential changes we’re tracking: The House will remain red, but changes expected in key committee membership While Republicans are expected to retain their House leadership, there will still be changes in membership on key committees. Photo: Slack12 There’s no question that Republicans will retain their leadership in the House. While the House will likely see less drastic changes than the Senate, there will be changes to membership and leadership of a number of the Committees that have jurisdiction over both policy and funding for global health R&D. Foreign Affairs Committee: Although the House Foreign Affairs Committee (HFAC) won’t see major changes in leadership, we already know that Representatives Tom Cotton (R-AR)—currently in a tight run with incumbent Senator Mark Pryor for a seat in the Senate—and Steve Stockman (R-TX)—who lost his primary in a bid to replace Senator Cornyn (R-TX)—won’t be returning. HFAC members facing tough races include Representatives Brad Schneider (D-IL) and Ami Bera (D-CA). Bera—who sits on the Subcommittee on Africa, Global Health, and Human Rights and is a trained physician—has been an outspoken advocate for global health. Appropriations Committee: Similar to the HFAC, the Appropriations Committee isn’t likely to see significant changes in leadership, although there will be some notable faces missing from the 2015 roster. Representative Jack Kingston (R-GA)—current chairman of the Subcommittee on Labor, Health and Human Services, and Education, 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)—gave up his seat in a failed bid for the Senate and will not be returning to the 115th Congress. Representatives Tom Womack (R-AZ)—current committee vice chair—or Tom Cole (R-OK) are rumored to be the top candidates to take over the chairmanship. Also missing due to retirement will be Representatives Frank Wolf (R-VA), Tom Latham (R-IA), Jim Moran (D-VA), Ed Pastor (D-AZ), and Bill Owens (D-NY). Energy and Commerce Committee: With jurisdiction over the NIH, CDC, and FDA, the Energy and Commerce Committee (E&C) plays an important role in issues relating to global health R&D, particularly as the Ebola crisis has thrust the CDC into the global spotlight. After twenty terms in Congress, E&C Ranking Member Henry Waxman (D-CA) will be retiring. Representatives Frank Pallone (D-NJ) and Anna Eshoo (D-CA) are both vying for the role, with the loser likely taking the role of ranking member on the Health Subcommittee—a position currently held by Rep. Pallone. Of course there’s no knowing until Election Day how things will actually shake-up in the House. After that, it’s up to members to make the case to House leadership for their desired and priority committee assignments. With a possibility for run-off races continuing after November 4, it’s likely that committee rosters won’t be finalized until February 2015. The Senate is leaning red; could mean major shift in key committee leadership Recent polls indicate the odds are in favor of a Republic-controlled Senate. Photo: Joe Shlabotnik The Senate is where things get interesting and where we’ll likely see the greatest change. Recent polls are consistent in their predictions that the odds are in favor of a Republican-controlled Senate; currently Democrats have 55 seats and Republicans have 45. If Republicans do take the majority, we will see a huge shift in committee leadership as Republicans take hold of coveted chairmanship positions. Senate Foreign Relations Committee: With six committee members up for reelection—one Republican and five Democrats—five are expected to hold on to their seats with the only toss-up race being Senator Jeanne Shaheen’s (D-NH) seat. If Republicans take the Senate, current Ranking Member Bob Corker (R-TN) will likely become the chairman. Otherwise, the chairmanship will likely be kept by Senator Bob Menendez (D-NJ). Senate Appropriations Committee: Of the 14 members of this committee that are up for re-election, 5 of them are currently toss-up races. An additional three—Senators Mike Johanns (R-NE), Tim Johnson (D-SD), and Tom Harkin (D-IA)—previously announced their retirement and won’t be returning for the new session of Congress. As the chairman of the Labor, Health, and Human Services Subcommittee, Senator Harkin’s departure is notable. His role will likely be filled by current Ranking Member Jerry Moran (R-KS), or if Democrats hold their seats, by Senator Patty Murray (D-WA)—a huge champion for global health R&D and the lead Senate sponsor of the 21st Century Global Health Technology Act. If Republicans win, other notable changes in leadership would likely include Senators Lindsay Graham (R-SC) chairing the Foreign Operations and Related Programs Subcommittee, Thad Cochran (R-MS) chairing the Defense Subcommittee, and Richard Shelby (R-AL) chairing the full committee. If there is a change in Senate leadership as expected, committee breakdowns will change to reflect the balance between Republicans and Democrats. For the Appropriations Committee, this could result in junior members—like staunch global health advocate Senator Chris Coons (D-DE)—losing their seats on the committee. Senate Health, Education, Labor, and Pensions Committee: With current committee Chairman Tom Harkin retiring, the Health, Education, Labor, and Pensions Committee will see new leadership regardless of the election outcome. Current Ranking Member Lamar Alexander (R-TN) is likely to take the role if Republicans gain critical mass. If not, Senator Murray is rumored to be the top choice for chairman—otherwise she will likely become ranking member. What’s next? What does all this mean for the future of global health R&D? While it’s impossible to fully predict election outcomes, the future will become much clearer in the coming days (unless of course run-offs or recounts keep us waiting). As the new Congress convenes in January, it will be critical for global health R&D advocates to educate new members and their staff on the importance of continued funding and strong polices to support the development of new health tools to meet the needs of the developing world. For real-time election analysis, check out Nate Silver’s FiveThirtyEightPolitics, Politico’s Election Central, or The Washington Post’s Election Lab.

With only a few weeks left in session, lawmakers must decide what to prioritize and what to push off. Photo: Photo Phiend After a five week recess, members of Congress returned to their Capitol Hill offices on Tuesday night. Staffers who had enjoyed the brief freedom of wearing jeans to work returned to their suits, and lobbyists and constituents alike returned to waiting in long security lines to enter Congressional offices. With only a few weeks left in session before they hit the campaign trail, lawmakers must decide what to prioritize and what to push off. Here is what we expect Congress may address before session end. Keeping the government open Passing legislation to keep the government funded past September 30th is a top priority for Congress. Given the wrath lawmakers faced following last year’s government shutdown and the looming mid-term elections, it seems almost certain that policy makers will come to a short-term solution to keep the government open. Earlier this week, Chairman Hal Rogers of the House Appropriations Committee offered a stop-gap spending bill that would fund the government through December 11th. Finding funds to fight Ebola Lawmakers appear to be coming together to support additional funding to meet the needs of the Ebola crisis. Last month, the President requested an additional $88 million to bring much needed drugs and supplies to the West African countries ravaged by this deadly disease, and Chairman Rodgers has indicated that the full $88 million will be included in the House version of the continuing resolution (CR). A summary of this CR put out by the House Appropriations Committee notes that this funding will be used to “accelerate [Department of Health and Human Services’] research on Ebola therapies, and additional funding for the [Center for Disease Control and Prevention’s (CDC)] response to the growing outbreak in Africa.” Chairman Rodger’s budget is in line with the current budget cap of $1.012 trillion and would maintain current spending levels. Also included in the GOP-backed bill is $85.1 billion for overseas contingency funding, an extension of the Export-Import Bank through June 2015, and an extension of the Internet Tax Freedom Act through the CR. Strong language supporting global health R&D was included in many of this year's appropriations report, but will it make it into a more long-term budget deal? Caption Photo: PATH/Gabe Bienczycki Dealing with uncertainty GHTC is hopeful that we will not face another government shutdown—we know that funding for research and development (R&D) is best leveraged when there is consistent and certain financial support. Another short-term CR will continue to undermine potential game-changing discoveries and, as detailed in GHTC’s 2014 Policy Report, make planning for the future nearly impossible. Congress bucking at the traditional appropriations process also means uncertainty around what, if any, committee report language will be included in a more long-term budget deal. In previous blogs, GHTC reported on the strong language in support of global health R&D that was included in many of this year’s appropriations bills, including those put out by the subcommittees on Labor, Health and Human Services, Department of Defense, and State and Foreign Operations. We hope this language will be included in whatever final agreement takes place. While House and Senate fiscal year (FY) 2015 appropriators showed only lukewarm support in their funding for global health R&D, some accounts—like those for the National Institutes of Health and CDC’s Center for Global Health—saw funding requests from the Senate that were above both FY 2014 funding and White House requests. A CR means these recommendations for funding increases will continue to be put off. Preventing “the lamest lame-duck” With pending mid-term elections, it’s difficult to predict what this lame-duck session will bring. While Politico is already predicting that this will be the “lamest lame-duck session,” there are a number of common-sense, no-cost bills that Congress could and should pass before the end of the 113th session. The 21st Century Global Health Technology Act, a bill which establishes the US Agency for International Development’s mandate for global health R&D, as well as improves agency coordination, transparency, and reporting would be an easy way for Congress to leverage existing funds and programs without creating any additional spending. Additionally, the Patents for Humanity Program Improvement Act of 2013 would make it easier for American researchers to develop solutions to the world’s most pressing health issues and incentivize first-time researchers to apply their work towards addressing humanitarian needs. While preventing another government shutdown is a step in the right direction, we hope lawmakers will take seriously the need for longer-term solutions. With three months left in the 113th Congress, it’s time to get down to business.

While lawmakers battled it out on the field last week during the annual Congressional Baseball Game (Democrats won for the sixth year in a row!), they found something they could join together on as the House Appropriations Committee easily approved the State and Foreign Operations Subcommittee’s (SFOPS) appropriations bill on Tuesday afternoon. Since GHTC reported two weeks ago on initial funding levels between the bills, both chambers have also released their accompanying reports which provide policy language that gives further clarity on the policymakers’ thinking and intent. What’s new? House and Senate appropriation reports included language supporting global health R&D. Photo: PATH/Patrick McKern We think the House Committee hit a home run in their inclusion of language submitted by the GHTC on the need for coordination across the US government on global health research and development (R&D). The language in the report directs the US Agency for International Development (USAID) to coordinate across the government with the other agencies involved in global health R&D. As it currently stands, there is no cross-US government global health R&D strategy, which leads to gaps in research, inefficiencies, and missed opportunities. This is a no-cost fix which will help leverage taxpayer dollars, fill gaps, and ensure that the ball is not dropped when valuable research needs to be shared across agencies. We’re glad to see policymakers are recognizing the need for improved coordination, and we are hopeful this language will be included in whatever final legislation is passed—whether in a continuing resolution, conference, or omnibus bill.   New to this year’s Senate report was the inclusion of a ‘Research and Development’ line within the Global Health section of the report which noted “the Committee supports investments in new global health technologies to address ongoing global health challenges.” This is another score for R&D advocates and one we hope will be included in final law. Also new for both chambers’ reports was the inclusion of language supporting the Global Development Lab. Both versions express support for the lab, as well as instructions to keep Congress informed on its progress. Continued support for R&D Similar to last year’s report, the House included language encouraging USAID to continue supporting research around the need for new drugs to address neglected tropical diseases (NTDs). Also like last year, the Senate language was a bit more enigmatic—noting the contributions of the private sector in R&D for NTDs, but not specifically mentioning USAID’s role in the process. Again, we’re hoping the House language will be included in the final bill. Similarly, the House provides strong language around continued support for microbicide development. R&D for malaria continued to have strong support, particularly from the Senate bill, which, similar to previous years, included language about the need for new insecticides, diagnostic, and vector control tools, alternatives to arteminisin combination therapies and counter resistance, and pediatric formulations. While this isn’t new, it’s encouraging to see this remains a priority for policymakers. As in previous years, the Senate bill provides strong support for the acceleration of research for contraceptives that are “effective, affordable, and easier to deliver.” Both reports included language about efforts to develop a malaria vaccine and language around the need for continued research for a vaccine to combat AIDS. Next steps Now that both chambers’ appropriations committees have approved their respective SFOPS bills, it will be up to policymakers to work out the differences, both in funding levels and policy. We’re hoping lawmakers can figure out a way to keep the ball rolling, but whatever happens, we’ll be watching the situation closely.