Breakthroughs Blog: Malaria

  Senate supports global health R&D in defense appropriations bill and report. Photo: Ken Kistler Earlier this month, we reported that both the House and Senate Appropriations Committees included language supporting global health research and development (R&D) in their reports concerning funding for the Department of State, foreign operations and related programs. Last week, we heard even more good news for global health R&D out of the Senate Appropriations Committee—this time related to the Department of Defense (DoD). The fiscal year (FY) 2015 defense appropriations bill—which was approved by the Committee last Thursday—includes a $7 million increase for peer-reviewed medical research—from $200 million in FY 2014 to $207 million this year—despite reducing overall DoD funding from FY 2014 levels. In addition, in the accompanying report, the Appropriations Committee includes very strong language recognizing DoD’s substantial contributions to global health R&D and the need to support sustained US investments in this area. The committee report includes language submitted by GHTC recognizing “the critical contribution that the department’s [R&D] portfolio makes in protecting our troops from infectious and neglected diseases they may encounter on missions around the world” and noting “the need to sustain and support US investment in this area by fully funding those R&D programs that carry out this work.” Committee recognizes role of infectious disease research in improving US security The committee report also recognizes the threat that neglected infectious diseases—such as malaria, dengue fever, and Chikungunya—pose to the effectiveness of US forces deployed overseas and expresses concern over reductions in research funding for these disease areas. In the report, the committee notes that it is “concerned with the department’s decisions over recent years to precipitously decrease funding for malaria research” and that it “encourages the department to address diseases of military importance and invest in research for chemoprophylaxis, surveillance, and other countermeasures.” Photo: PATH/Gabe Bienczycki Report calls for DoD to improve coordination across R&D programming The committee report also includes language—submitted by GHTC—which directs each DoD program involved in infectious disease research to submit a report of its R&D activities to the House and Senate Defense Committees outlining the program’s funding and accomplishments from FY 2011 through 2014. As well, the committee urges DoD to partner with other organizations involved in infectious diseases research—including other federal agencies—to mitigate the duplication of research efforts and maximize the use of DoD resources. It is GHTC’s hope that these reports and activities will lead to improved coordination across DoD global health R&D programs, as well as improved coordination across all US agencies involved in global health R&D, which will in turn help fill current gaps in research programming and assure US investments are used most effectively. GHTC is glad to see the Senate recognizing DoD’s critical role in global health R&D, as well as advocating for sustained funding and improved coordination for global health R&D programming at DoD. We are hopeful that the language included in the Senate defense appropriations report will be included in whatever final legislation is passed.

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.

Tomorrow US policymakers and global health advocates will come together to talk progress made on preventing maternal and child deaths. During the day, the US Agency for International Development (USAID) will host a high-level forum called Acting on the Call: Ending Preventable Child and Maternal Deaths to both celebrate progress and assess the challenges that remain. That evening, the 5th Birthday and Beyond coalition will celebrate America’s leadership and investments worldwide to help children reach their fifth birthday. US investment in R&D has led to new innovations that are saving the lives of mothers and children. Photo: PATH/Teresa Guillien While you’ll probably hear a lot of different facts and figures, one message will be clear—the world has made remarkable progress in preventing the deaths of millions of women and children. In fact, maternal and child deaths have been cut in half in just over two decades. That means that every day this year, 17,000 more children will live and 700 more mothers will survive childbirth than did two decades ago. Central to this progress has been US investment in research and development (R&D) that has led to new medicines and innovative health products that are saving the lives of mothers and children. Globally new vaccines, drugs, diagnostics, and other health innovations have led to 4.2 million fewer child deaths in 2013 compared to 1990, according to a report by the Institute for Health Metrics and Evaluation. Innovations like the polio vaccine, oral rehydration solution to treat diarrhea, and antiretroviral therapies that prevent maternal to child HIV transfer, and others treatments have resulted in incredible gains for maternal and child health.   No country has done more than the United States to help save the lives of the world’s poorest mothers and children. A critical part of the US approach has been our world-leading investment in global health R&D. In fact, the US government is the largest funder of global heath R&D in the world—contributing over 45 percent of total investment. US government investment in global health R&D has led to breakthroughs that have transformed or are poised to transform efforts to reduce maternal and child mortality. Some examples include: The Oxytocin-Uniject™ This is a device filled with oxytocin that helps contract the uterus to reduce post-partum hemorrhage—or excessive bleeding—the leading cause of maternal death worldwide. It is easy to inject and requires little training to administer, so it’s made a dramatic difference in the ability of health workers to administer oxytocin in emergencies or in remote locations outside of traditional hospital facilities. USAID played a crucial role in funding research towards the development of this product. RTS,S malaria vaccine candidate RTS,S is the most clinically-advanced vaccine candidate for malaria—a disease which kills a child every 40 seconds. A recent study showed that infants who receive the RTS, S vaccine had one third fewer cases of both clinical and severe malaria. A vaccine could be an important tool in reducing child sickness and death from malaria. The Department of Defense provided critical funding for the early development and clinical testing of RTS,S. Rotavirus vaccines Rotavirus-induced diarrheal disease kills roughly 435,000 children younger than five each year. Two currently available rotavirus vaccines were introduced in the past two decades, with other vaccines under development showing tremendous progress. The National Institutes of Health developed the first available rotavirus vaccine and has been a financial partner in the development of subsequent vaccines. In addition, the Centers for Disease Control and Prevention also monitors efficacy and safety, and supports clinical trials of rotavirus vaccines. New contraceptive technologies Family planning technologies allow women to space their pregnancies—making it more likely for both the mother and child to survive childbirth. An analysis of 172 countries found that family planning prevented 272,000 maternal deaths in just one year. However, the contraceptive options that exist today don’t always meet the needs of women in developing countries. New vaginal rings are being developed that will be long-lasting and easy for the user to insert and remove without a doctor’s assistance, while new multipurpose prevention technologies combine the delivery of contraceptives with microbicides which reduce the transmission of HIV and other sexually transmitted infections. USAID provides funding towards the development of many of these new contraceptive technologies. While tremendous progress has been made in decreasing maternal and child deaths worldwide thanks in part to new health innovations, each year 6.6 million children still die before their first birthday and 289,000 women still die from pregnancy-related causes. That translates to 18,000 children under the age of five and 800 pregnant women or women in childbirth dying every single day. The United States can and must do more. While the United States should increase access to proven and existing drugs, vaccines, and other health tools for maternal and child health, it is just as critical to develop the next generation of tools to prevent and treat existing and emerging diseases. Sustained and continued investment by the US government in global health R&D is critical to ending maternal and child deaths.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. Last week, the Center for Strategic and International Studies hosted a panel on the occasion of the release of its summary report, Strategic US Leadership—Essential to Address the Global Tuberculosis Pandemic, which examines US approaches to tackling tuberculosis (TB) both in the United States and abroad. The report concludes that the United States needs to better lead, coordinate, and prioritize its TB efforts, as well as create robust, long-term research partnerships with key institutions in select emerging economies to promote the discovery and development of new TB tools. GHTC member PATH has been awarded a three-year, US$15.6 million grant from the Bill & Melinda Gates Foundation to develop effective treatments for severe acute secretory diarrhea (ASD). The new grant will support a portfolio approach to drug development in an effort to maximize the chances of successful drug candidates to treat ASD, as well as support new engagement with the public and private sectors. Last week, the US House of Representatives introduced the End Neglected Tropical Diseases Act in an effort to turn the tide in the fight against neglected tropical diseases. The bill was introduced by Rep. Chris Smith (R-NJ) and already has bipartisan support from Reps. Matt Salmon (R-AZ), Hank Johnson (D-GA), and Greg Meeks (D-NY).   Osman Sankoh, executive director of INDEPTH, emphasized the important role of research and innovation for development in low- and middle-income countries (LMICs) in The Lancet Global Health Blog. Sankoh writes that “stronger international commitment to investing in research, development, and innovation in LMICs” is crucial in the post-2015 development agenda. He added that “research into health threats not only saves lives—it also helps governments and donors to save money.” Scientists at Imperial College London have created genetically-modified mosquitoes that produce 95 percent male offspring with the goal of helping control malaria. They believe introducing these mosquitoes into the normal mosquito population could lead to a shortage of females and a crash in overall population, thus reducing malaria incidences. GHTC member Aeras has released a new film exploring the TB crisis in the mines of South Africa. The film—called Undermined—looks at “the river of TB flowing out from the mines, and why a vaccine is critical to the global fight against this disease.”