Breakthroughs Blog: Guest post

This post, written by John Donnelly, originally appeared in the GlobalPost. Donnelly is a Washington, DC based writer. For those in the global health world—and there are many in the nation’s capital—one common question is why in tight budgetary times should Congress support spending on research and development (R&D) to fight diseases around the world. At a congressional briefing today put on by the Global Health Technologies Coalition (GHTC), a group that represents 40 global health research and advocacy organizations, several experts gave a variety of answers to that question. Katherine “Kemy” Monahan, deputy executive director of the Obama administration’s Global Health Initiative, said, “These global health programs are literally saving lives, and not just a few lives, lots of lives … We are [also] protecting Americans at home and traveling abroad from infectious diseases.” Col. Peter J. Weina, deputy commander of Walter Reed Army Institute of Research, said, “We protect soldiers’ lives … Infectious diseases have ravaged military forces operating worldwide. … It also ravages populations we’ve worked with.” From 2003 to 2008, for instance, US troops in Iraq and Afghanistan had roughly 2,000 confirmed cases of leishmaniasis, a disease transmitted by the bite of a tiny sandfly. The disease causes a broad range of outcomes, some of them fatal. Then US Sen. John Boozman, a Republican from Arkansas, took the microphone from the back of the Kennedy Caucus Room at the Russell Senate Office Building, and gave his case for ongoing global health research. “It’s achievable stuff,” he said. “It represents real calamity. These are difficult problems, but they are very, very solvable. … You have a lot of support on Capitol Hill. We can be very, very proud of what has been accomplished so far.” A GHTC analysis of the Obama administration’s global health budget found a large number of decreases in funding compared to the previous year’s budget. Funding cuts were most glaring in the President’s Emergency Plan for AIDS Relief (PEPFAR), neglected tropical disease programs, and several other programs at the US Agency for International Development (USAID). But the budget also included increases to The Global Fund to Fight AIDS, Tuberculosis, and Malaria and the GAVI Alliance. The National Institutes of Health and the Centers for Disease Control and Prevention (CDC) were funded at the same level. “It’s a time of fiscal austerity,” Kevin De Cock, the director of CDC’s Center for Global Health, said in an interview after the briefing. “The cuts for global health programs might have been less than many people feared. There’s a need now for everyone in government to strive for greater efficiency and to find savings wherever they can in their budgets.” Karen A. Goraleski, the executive director of the American Society of Tropical Medicine and Hygiene who was the moderator at the event, said global health R&D also has economic benefits at home, including the creation of thousands of jobs. “It’s fueling our economy,” she said. For Marc LaForce, director of the Meningitis Vaccine Project, the importance of research could be seen in the story of the fight against meningitis. He said last year’s results were enough to show how US research can have a major impact in saving lives. In West Africa, the often-fatal disease has been so prevalent that the area is referred to by the name of the disease. It’s the Meningitis Belt. His project, a partnership between the World Health Organization and PATH, which included earlier research done by the Walter Reed Army Institute of Research, produced a vaccine that cost less than 50 cents a dose. It was administered to 19 million people last fall in three West African countries. Usually, the countries report thousands of cases of meningitis. Last year, the countries reported fewer than a dozen—all from children who were not vaccinated. “The coverage rates with the vaccine have been extremely good,” LaForce said. “We are probably at the beginning of the end. With sufficient funding, this epidemic is likely to be pretty much over in the next 10 years.”

GHTC member OneWorld Health (OWH) recently announced that its treatment for kala-azar, or leishmaniasis, was registered for use in Nepal. In this guest post, OWH explains why this announcement is so significant for global health. Today we are thrilled to announce that our antibiotic Paromomycin Intramuscular Injection (PMIM), developed to treat visceral leishmaniasis (VL or kala-azar), has been registered by the government of Nepal. This is the second registration for PMIM in South Asia. It was previously registered with the government of India and added to the National Lists of Essential Medicines of India, Nepal, and Bangladesh. It was also added to the World Health Organization’s Model List of Essential Medicines. Now that the treatment is registered in Nepal, OWH will move forward with our partners on public health studies to help the government determine the best way to distribute and use the treatment in its public health system throughout the VL-endemic regions. What is visceral leishmaniasis? With approximately 500,000 new cases occurring annually, visceral leishmaniasis is the world’s second most deadly parasitic disease after malaria. Fatal if untreated, the official death toll for VL each year is between 50,000 and 60,000. VL is endemic in 79 countries, and primarily afflicts rural, resource-poor populations in India, Nepal, Bangladesh, Ethiopia, Iraq, Sudan, and Brazil, where affordable therapies are needed. Learn more about kala-azar: Kill or Cure: Kala-Azar Now that the treatment is registered in Nepal, OWH will move forward with our partners on public health studies to help the government determine the best way to distribute and use the treatment in its public health system throughout the VL-endemic regions. Photo credit: OneWorld Health What is Paromomycin Intramuscular Injection? An off-patent aminoglycoside antibiotic, paromomycin is an established drug with an extensive history of use and a well-characterized safety profile. OWH developed PMIM as an effective, inexpensive, and safe treatment for VL, and worked with the Indian government and Indian pharmaceutical company Gland Pharma to manufacture and distribute the treatment. PMIM is administered as a once-a-day injection for 21 days. The cost of a course of treatment with PMIM is less than US$20, which is significantly lower than other currently approved VL therapies. Please visit our website for more information – www.oneworldhealth.org.

Phil Carroll is PATH’s Senior Policy Communications Associate. He spent two weeks in India last fall visiting PATH programs related to maternal and child health, tuberculosis, immunizations, and safe water and diarrheal disease. India is a country that changes dramatically from place to place, something I experienced firsthand while on a two week trip there this past fall. One day I was listening in on a mothers’ group meeting in one of the poorest villages in Uttar Pradesh state, and less than 24 hours later I was standing in one of the world’s most technologically advanced airports in Hyderabad—often referred to as the ‘Silicon Valley’ of India. It was during this leg of my journey where I was further convinced of the need for sustained investment in research and development. In a laboratory on the outskirts of the city, I met a handful of Indian doctors and researchers who are doing some pretty amazing, albeit subtle, things in health. Thanks to a small, less than $100,000, investment by the US Agency for International Development (USAID), the Blue Peter Public Health & Research Centre upgraded its tuberculosis (TB) lab to a higher level of biosafety. Improvements like better equipment and infrastructure and enhanced safety measures have enabled researchers here to diagnose a case of multi-drug resistant tuberculosis (MDR-TB) in a matter of days, a process that used to take the same team several months. Click on the photo to look at the full “Fast TB diagnosis helps save lives in India” slideshow. Photo: PATH/Gabe Bienczycki This is significant for a host of reasons. Diagnosing TB on the early side can help get patients on treatment faster, thereby reducing further deterioration of their lungs and other organs and ultimately save their lives. Catching TB early on can also curtail the spread of this incredibly contagious disease to others. India, which has the highest incidence of TB in the world, and 20 percent of the world’s burden, needs these sorts of advancements now more than ever. Currently, the government of India, as part of its National TB program, is only reaching 25 percent of MDR-TB patients with diagnosis. However, by 2013, it is aiming for 100 percent coverage, or around 2 million TB patients. While this goal might appear daunting, it should hardly be seen as insurmountable. As evidenced by its incredible response to polio in the last few years, the Indian government—with the help of key partners like PATH—is capable of pulling off some amazing global health feats when it resolves to do so. The government of India, under its National TB Laboratory Scale-Up plan, is in the process of upgrading other labs like the Blue Peter Public Health & Research Centre lab throughout the country. PATH is helping to make these labs airborne infection control compliant, thereby reducing the spread of TB. This, combined with other TB-control interventions and sustained advocacy at the national level, has the promise to one day make this disease a distant memory for the people of India. Look at the full “Fast TB diagnosis helps save lives in India” slideshow.

Research!America, a member of the GHTC, recently conducted analyses in target states to measure the health and economic impact of global health research and development (R&D), highlighting its benefits for states across the nation and strengthening the evidence base for Congress’ support of federal investments in global health R&D. Mandy Goldberg, Global Health R&D Advocacy intern, shares the organization’s findings in Illinois. This is the fourth post in a series. “The world is interconnected, and that demands an integrated approach to global health,” President Obama stated when he announced the US Global Health Initiative on May 5, 2009. His former neighbors in Illinois agree. More than 50 percent of Illinoisans think more about global health today than they did five years ago, and for good reason. In addition to innumerable health benefits worldwide, global health research and development (R&D) has an important economic impact on the state of Illinois. Illinois boasts more than 200 academic, government, and nonprofit research institutions, as well as seven research and technology parks, all of which contribute significantly to employment within the state. Illinois is one of the top 10 bioscience employers in the United States, with more than 57,000 people working in the industry. For each bioscience job, almost six additional jobs are created on average, according to a 2010 analysis by Battelle and BIO. Dollar for dollar, global health is one of Illinois’s best investments. Photo: Evelyn Hockstein/PATH Spending on global health R&D not only adds jobs to the market, it also directly contributes to state economic growth. In 2010, Illinois received more than $700 million from the National Institutes of Health (NIH), the world’s largest funder of global health research. Every $1 million that the NIH invests generates more than $2 million in new state business activity. Public-sector investment provides important economic incentives to stimulate private-sector investment. One private-sector partner doing notable work in global health is Abbott, an Illinois-based healthcare company. Abbott invested $4.1 billion in R&D in 2011 and generated $38.9 billion in revenue, a great boost to the state economy. Just last week, Abbott announced a new joint research agreement with the Drugs for Neglected Diseases initiative (DNDi), a product development partnership dedicated to developing new drugs for patients suffering from the most neglected tropical diseases. Abbott and DNDi will work together to discover and advance new antimicrobials that fight disease, leading to the end-goal of finding new treatments for several of the world’s most neglected diseases, including Chagas disease, helminth infections, leishmaniasis, and sleeping sickness. Dollar for dollar, global health is one of Illinois’s best investments. Illinoisans recognize its value: 92 percent of state residents believe it is important for Illinois to be a leader in health R&D. However, Illinois ranks only 8th in R&D investment and 13th in federal funding despite ranking 5th in the nation in population. Increased investment is needed to secure this economic pillar and produce further growth in one of Illinois’s most rewarding economic sectors.