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Global Health Technologies Coalition (GHTC) Outside Witness Testimony for the Record Subcommittee on Labor, Health and Human Services, Education and Related Agencies Testimony Submission by Jamie Bay Nishi, Executive Director, GHTC I am providing testimony on fiscal year 2024 (FY24) appropriations for the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the Biomedical Advanced Research and Development Authority (BARDA). I am here on behalf of the Global Health Technologies Coalition (GHTC), a group of 45 nonprofit organizations, universities, and aligned businesses advancing the development of new drugs, vaccines, diagnostics, and other tools for global health and global health security. I am testifying today because we still do not have the technologies that we need to achieve a future where pandemics are prevented, and health is within reach for everyone. In 2019, at least 1.27 million people were killed by antibacterial resistance. In 2021, 1.6 million people were killed by tuberculosis, 1.5 million people were newly diagnosed with HIV, and 247 million people were infected by malaria. Today, more than 1 billion people worldwide are still affected by neglected tropical diseases (NTDs). Unfortunately, it is women and children who are often most vulnerable. And as we look towards the future, we cannot afford to sit idle and wait for future pandemic threats with the potential to match or exceed the disruption of COVID-19. To develop the technologies that we need to defeat these diseases and to prevent future pandemics, the US government needs to sustainably increase its investments in global health research programs. Public funding is critical for this sector because companies have little commercial incentive to invest in health areas that impact people in poverty.  As the world’s leader in biomedical research, the United States has both a responsibility and an opportunity: with relatively small public investments, we have the power to save and improve millions of lives. Three agencies that support global health research are NIH, CDC, and BARDA, and we thank the Committee for its past support of these agencies. Still, there is a large hill ahead of us. To continue our progress toward developing lifesaving tools, we respectfully request:  • Increased funding for NIH, including an additional US$21 million for the Fogarty International Center (FIC) to a total of $116.1 million.  • Increased funding for CDC to maintain its capabilities in global health and global health security research, especially for the Global Health Center (GHC) and the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   • An additional $775 million in new funding for the Pandemic Preparedness and Biodefense program under the Administration for Strategic Preparedness and Response for BARDA ($400 million in the President’s Budget Request). In addition to funding, we urge the Committee to request that leaders in the Department of Health and Human Services coordinate across the department’s agencies and with the State Department to ensure that US investments in global health research are efficient, coordinated, and streamlined. NIH is a global leader in biomedical research. Within NIH, Fogarty accelerates science through international partnerships, technical assistance, and researcher trainings. The agency delivers significant scientific results and foreign goodwill with less than one-quarter of one percent of the total NIH budget. Many FIC-trained scientists have led their countries’ responses to COVID-19, Zika, and Ebola, as well as to long-standing challenges such as HIV/AIDS.  Fogarty is positioned to expand its role in pandemic preparedness and global health research capacity-building. With additional funding, the center could improve global disease surveillance, coordination, and training of scientists in fields that strengthen pandemic preparedness, such as disease transmission modeling. We urge appropriators to increase FIC’s relatively modest budget by $21 million in FY24. Also within NIH, the National Institute of Allergy and Infectious Diseases is the single largest funder of research on neglected and emerging infectious diseases in the world. As it undergoes a historic leadership change, we urge Congress to include report language that emphasizes the importance of the institute’s support for global health research. CDC tracks the spread of diseases and supports the development of new global health technologies, including diagnostics and vaccines. This research happens across several centers including GHC and NCEZID. CDC has just appointed a new deputy director for global health who will connect and oversee global health programs across the agency.  CDC’s GHC leads CDC’s global health security efforts; provides technical support to the President’s Emergency Plan for AIDS Relief, the President’s Malaria Initiative, and the US Agency for International Development’s NTDs Program; and develops and validates tools such as insecticides to prevent malaria. GHC also hosts a gold-standard parasitic diseases laboratory that serves as a reference for scientists around the world. GHC needs additional funding to maintain and expand its laboratory services, expand its public health workforce, and improve its global health security efforts.Also at CDC, NCEZID develops diagnostics for global health threats and is an international reference hub for identifying and tracking known and unknown viral and bacterial diseases. The center has a leading role in the National Strategy for Combating Antibiotic-Resistant Bacteria to prevent, detect, and control outbreaks of antibiotic-resistant pathogens.  BARDA sponsors the late-stage development of vaccines, drugs, diagnostics, and other medical devices for naturally occurring biothreats that lack a commercial market—including emerging infectious diseases, pandemic influenza, and antimicrobial resistance. To date, however, BARDA’s work in advancing tools for emerging infectious diseases has mostly been funded through emergency supplemental appropriations. This pattern produces a delayed response with every new outbreak of emerging or reemerging diseases like Ebola, Zika, and COVID-19. We urge Congress to break this cycle by creating a new, dedicated funding line of at least $775 million to support BARDA’s efforts against emerging infectious diseases. Such funding will enable the agency to prepare for—rather than react to—future pandemic threats. Global health research and development is unique as a foreign policy goal in that it also supports researchers in the United States. From 2007 to 2020, more than $18 billion in federal funding went to US-based institutions for research on neglected diseases, supporting estimated hundreds of thousands of jobs and generating billions more in economic growth. In addition, many of the tools and technologies developed from this funding benefit people living in the United States either directly or indirectly by strengthening national health security and global prosperity.   As we emerge from a global pandemic subdued by publicly supported science, it is clearer than ever what we can achieve with sustained funding and attention. With increased public funding for global health research, we can achieve a world that is healthier and safer for everyone.