Breakthroughs Blog: US budget

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. Now that members of Congress are back in their Capitol Hill offices after five weeks of recess, lawmakers must decide what to prioritize and what to push off in the few short weeks left in session before members hit the campaign trail for the upcoming November mid-term elections. In the latest post on Breakthroughs, GHTC Senior Policy and Advocacy Associate, Jenny Howell, provides a breakdown of what lawmakers should do to ensure global health research and development gets the support it needs. Federal funding in the United States for biomedical research has declined by more than 20 percent in the last decade. At the same time, more scientists are competing for a smaller pot of money. NPR highlights two stories of researchers forced out of science because they either can’t get research funding or “because the rat race has simply become too unpleasant.” Scientists at the National Institutes of Health (NIH) have discovered an HIV antibody that could be effective in fighting the deadly disease. According to the scientists, the antibody—called 35O22—can prevent 62 percent of known HIV strains from infecting cells. The NIH-led scientists also found that the antibody closely resembles antibodies that naturally occur in HIV, which could help in the development of an eventual vaccine. Results from a recent clinical trial could change the approach researchers take on the delivery and development of tuberculosis (TB) drugs in the future. While the REMoxTB trial did not successfully prove TB treatment times could be shortened from six to four months by substituting antibiotic moxiflacin for a currently used drug, it did prove that moxiflacin was safe to use to treat TB on its own. Also, because the trial was one of the largest ever for a new TB regimen, the trial left a stronger research infrastructure to conduct other trials in the future. The Bill & Melinda Gates Foundation has committed $50 million to fight Ebola in West Africa. According to Gates Foundation CEO Susan Desmond-Hellmann, the new money will be available for emergency operations and to help develop drugs, diagnostics, and vaccines to fight the disease. The Gates Foundation’s commitment is the largest sum to ever for one outbreak.

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.

Last week, we reported on exciting policy language included in the Senate Department of Defense appropriations legislation, and earlier this summer, the House and Senate State and Foreign Operations bills also included recognition of the role that new technologies could play in advancing global health. Today we have even more good news to report: The Senate Appropriations Labor and Health and Human Services (LHHS) Subcommittee released its own fiscal year (FY) 2015 appropriations legislation, after a lengthy internal debate on domestic health concerns. Senate supports global health R&D in LHHS appropriations bill. Photo: NIAID Senate calls for increase in NIH funding; still lags behind need The legislation covers funding and policy issues for several key global health research programs at the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the Office of Global Affairs at the Department of Health and Human Services (HHS). At GHTC we’ve voiced concern that funding for NIH has lagged behind both inflation and the research program needs of the agency. Last week, we learned that the Senate LHHS appropriations subcommittee has appropriated $30.6 billion for NIH—which represents an increase of $606 million over FY 2014. This is a welcome increase; however, as the subcommittee noted in its report introduction, NIH’s funding is still unacceptably low, even with this improvement. Report language supports global health programming at NIH Within NIH, several key research centers were funded at reasonable levels, including the National Center for Advancing Translational Sciences (NCATS) and the National Institute for Allergy and Infectious Disease. The committee expressed its support for continued funding for neglected tropical diseases (NTDs), microbicides, and antibiotic research, as well as government-wide research collaboration, among other priorities. In an exciting move, the committee also included NCATS report language requesting that NCATS include a report in its FY 2016 budget justification “on initiatives targeted at neglected diseases and global health conditions, with specific focus on global health technologies and devices.” Global health is an essential part of NCATS’s mandate, and this language will ensure that it is prioritized within the program. CDC global health programming receives increased funding in bill The legislation also provides strong support for research at the CDC’s global health programs. Under the bill, the National Center for Emerging Zoonotic and Infectious Diseases (NCEZID) would receive an increase over FY 2014 funding levels. In addition, the subcommittee’s report mentions the Chikungunya outbreak in the Caribbean and the United States and encourages coordination between NCEZID and the CDC’s Center for Global Health on global health security efforts. Speaking of the Center for Global Health, this program received a rare increase in the Senate bill over even the President’s FY 2015 budget request. This is likely a result of support for the new Global Health Security Agenda. Most notable was the inclusion of a new line item in the Center’s budget for “Global Health Protection.” The bill also included positive language on CDC’s work on malaria and NTDs and provided continued funding for the National Public Health Institutes—an epidemiology and research capacity-building program in select countries. House LHHS bill has not been released; continuing resolution likely The House Appropriations LHHS Subcommittee has not released a bill for FY 2015 and may not do so at all. As it looks more likely that a continuing resolution will be necessary to continue uninterrupted government funding for NIH, HHS, and CDC global health R&D programs, Congress should work to come to an agreement that robustly supports funding and smart policy improvements for these programs. Ashley Bennett is GHTC’s policy officer.

  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.