Breakthroughs Blog: Tuberculosis

The world of HIV and AIDS research and development (R&D) is changing dramatically, and sessions this week at the XIX International AIDS Conference have examine how R&D advocates need to adapt and adjust their strategies in this new environment. The global financial crisis is at the forefront of many people’s minds, along with issues like increasing demands on already strapped country-level budgets and the possible shift from the Millennium Development Goals to the Sustainable Development Goals. At a session on Tuesday to discuss persuading policymakers to invest in tuberculosis (TB) R&D, Richard Horton from the Lancet said that TB advocates have recently recognized the need for a different approach that involves going directly to policymakers, as well as bringing TB scientists and researchers together with national decision-makers in order to create a collective will to address the leading killer of HIV-positive people worldwide. Two members of parliament from the United Kingdom—Cathy Jamieson and Pamela Nash—stressed that in addition to making their evidence and arguments simple and understandable, advocates need to connect their issues to a politician’s constituents, as constituents are always a policymaker’s top priority. “My job as a politician is to listen to the evidence and expertise that you bring, and then make sure funding is available to address those priorities,” Jamieson said. (from left to right): GHTC Director Kaitlin Christenson, IAVI's Prince Bahati, Henriette Laursen of AIDS-Fondet, Christine Lubinski from the Infectious Diseases Society of America, and Chamunorwa Jefrey Mashoko from AVAC. Photo credit: PATH Later that afternoon, the GHTC and several coalition members—Aeras, AVAC, the International AIDS Vaccine Initiative (IAVI), and the International Partnership for Microbicides—hosted a session to discuss how advocates can adapt their advocacy to meet today’s challenges. Four main themes emerged—the first focused on taking a community approach to R&D advocacy that includes a range of diseases and products. “Policymakers are tired of vertical advocacy,” Prince Bahati of IAVI said, adding, “We as advocates have the opportunity to create a platform of integrated advocacy, comprised of advocates, and scientists. We need to adapt to the transition that is happening and create one voice.” Chamunorwa Jefrey Mashoko, an AVAC advocacy fellow, added that a key part of this effort will involve scientific collaboration between African and American researchers. Panelists also discussed the need to engage new voices in their advocacy, including researchers working on new HIV and TB tools, as well as the people and communities who will ultimately benefit from these new products. Christine Lubinski from the Infectious Diseases Society of America said that some of the most successful project she’s worked on involved taking members of Congress to African countries in order to see first-hand TB and HIV research projects and clinical trials, and to meet African scientists. She added that it’s vital to show policymakers that there is a domestic constituency who believes in global health R&D, comprised of academic institutions, scientists, and researchers. “We have game-changing tools in the pipeline,” Lubinski said, adding, “We have a real opportunity with some of these new products, and I believe that’s our biggest weapon as advocates.” Additionally, the panelists talked about how there is a great need to recognize investments that have been made in global health R&D from donors, as well as how to engage new donors from countries such as Brazil, Russia, India, and China. Finally, the panelists stressed the importance of advocating for new tools as well as increased access to existing and proven tools. “There really isn’t a division between advocating for R&D and advocating for existing tools,” Henriette Laursen of AIDS-Fondet said. She added, “We can look at the historical successes of R&D and recognize that they are both part of the package.” Kim Lufkin is the GHTC’s communications officer.

George Fistonich is a recent graduate of the University of Southern California with a Master of Public Health degree, and currently serves as a research and policy fellow at amfAR, The Foundation for AIDS Research. He wrote this guest post about a new amfAR analysis that details the human impact of possible federal budget cuts on global health programs. amfAR recently released a new analysis that outlines the potential effects of budget sequestration on global health programs, using updated figures to reflect recent and accurate estimates. As our analysis illustrates, cutting funding for global health programs—including those that support access to lifesaving HIV and AIDS, tuberculosis (TB), and malaria tools and programs that fund research for the next generation of global health products—would barely make a dent in reducing the US federal deficit. However, cuts to global health and health research programs would have a crippling impact on people around the world. “Sequestration” is a fiscal process by which automatic, indiscriminate, across-the-board cuts would be made to most budget line-items at a certain set percentage. This process was included as a provision in the Budget Control Act of 2011, which would trigger sequestration at the start of the 113th Congress in January, unless Congress is able to pass $1.2 trillion in deficit reductions by the end of this year. The Center on Budget and Policy Priorities estimates that sequestration would lead to an 8.4 percent reduction in funding for non-entitlement federal programs, including all global health and health research and development programs. Under the rules of sequestration, a total of $109.4 billion would be cut for fiscal year 2013, of which nearly $690 million would be taken from global health programs. This cut to global health represents a negligible 0.6 percent of the total deficit reductions for that year, but would lead to devastating human impact worldwide. Secretary of State Hillary Clinton and President Obama both set an ambitious goal last year by announcing the United States’ intent to create an AIDS-free generation. Sequestration would not only undermine this achievable goal, but would undermine the progress we have made so far in providing treatment and care for millions of people worldwide, restrict funding for groundbreaking AIDS research, and ultimately result in thousands of unnecessary deaths in the next year alone. amfAR’s analysis estimates that an 8.4 percent cut to bilateral funding through the President’s Emergency Plan for AIDS Relief (PEPFAR), the President’s Malaria Initiative (PMI), and TB programs would lead to the following in 2013: 273,000 fewer people receiving AIDS treatment. 62,000 more AIDS-related deaths. 122,500 more children becoming orphans. 111,000 fewer HIV-positive pregnant women receiving services to prevent mother-to-child transmission. 21,000 more infants being infected with HIV. 354,000 fewer children receiving food, education, and livelihood assistance. 2.2 million fewer insecticide-treated nets procured. 3.7 million fewer people receiving malaria treatment. 6,000 more malaria-related deaths. 65,000 fewer people receiving TB treatment. 8,000 more TB-related deaths. Sequestration would also lead to the following in 2013 alone due to cuts in multilateral investments: 1.2 million fewer pentavalent vaccines procured through the GAVI Alliance, leading to 13,000 child deaths due to diphtheria, tetanus, pertussis, Haemophilus influenza type B, and hepatitis B. 2.8 million fewer insecticide-treated nets procured; 7,500 more malaria deaths; 102,000 fewer people receiving TB treatment; 12,000 more TB deaths; and 114,000 fewer people receiving AIDS treatment through the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Sequestration would not only limit access to currently available treatment and prevention tools, leading to an increase in HIV and AIDS, TB, malaria, and childhood deaths—it would also hinder research into new tools that are critically needed to fight these diseases. Cutting these programs would do nothing to reduce the federal deficit, and Congress must therefore work to prevent sequestration and protect funding for global health and research and development. Full text of the analysis, including methods for determining these estimates, can be found here.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. Secretary of State Hillary Clinton and US Agency for International Development Administrator Rajiv Shah were joined by more than 700 leaders from the private sector, government, and civil society for a major conference devoted to preventing childhood deaths worldwide. "Amid these financial threats and budgetary realities, it is inevitable that some will question the role of the United States in global development," Sen. Richard Lugar (R-IN) said at the conference. "But I would assert this morning that development assistance, when properly administered, remains a bargain for US national security and for our own economic and moral standing in the world." Five new pharmaceutical companies have joined a National Institutes of Health (NIH) program that will pair researchers with certain pharmaceutical industry compounds to help scientists explore new treatment options for patients. The program, called Discovering New Therapeutic Uses for Existing Molecules, is run by the NIH's National Center for Advancing Translational Sciences (NCATS). The US Food and Drug Administration (FDA) has decided to delay its final decision on whether the drug Truvada, made by Gilead Sciences, can be used by certain high-risk, HIV-negative people as a preventive measure against HIV. The FDA says its decision will be announced by September 14, 2012. A Baltimore Sun letter-to-the-editor argues that there are more people living with tuberculosis (TB) “now than at any time in history.” The letter adds that prevention with “new vaccines is the only way to truly make TB a thing of history.”

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. The Associated Press reports that “[o]ne in 10 cases of tuberculosis in China cannot be treated by the most commonly-used drugs,” due to drug-resistant strands of the epidemic. Because of this, there is an even greater need for newer or improved health technologies. Researchers at the fifth annual World Science Festival discuss the need for universal vaccines as “new diseases…continue to emerge.” Pharmaceutical company Sanofi could potentially find out in the fall of this year whether or not they can move forward in developing the most advanced vaccine to prevent dengue. Secretary of State Hillary Clinton announced a new public-private partnership initiative between the US and Norway to improve maternal health, including a partnership with drug maker Merck & Co.