Breakthroughs Blog: US budget

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.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. As the DC summer kicks into full swing, Congress has had a busy month moving forward fiscal year (FY) 2015 funding legislation for a variety of government programs including global health research and development (R&D). Last week, both the House and Senate State and Foreign Operations (SFOPs) appropriations subcommittees held mark-ups of their draft bills. Unfortunately, the results were lukewarm for many global health R&D programs. Sens. Cardin (D-MD), Boozman (R-AR), and Coons (D-DE), along with Reps. Castro (D-TX) and McCaul (R-TX) have introduced legislation to authorize the US Agency for International Development’s (USAID) Global Development Lab. The Lab would expand innovative public-private partnerships focused on ending extreme poverty. A group of 35 leading scientists have come together to explore new strategies to accelerate vaccine development for deadly diseases such as malaria, HIV, tuberculosis. The scientists are part of a new initiative—called the Human Vaccines Project—aimed at paving a road map of the human immune system to help researchers speed up the development of vaccines for existing and emerging diseases. SciDev.Net reports that despite the fact that the United Nations World Intellectual Property Organization (WIPO) Re:Search project has brokered at least 60 partnerships to facilitate patent sharing between owners and researchers since 2011, no new drugs or therapies are in development as of today. However, Thomas Bombelles—head of global health at WIPO—says the creation of partnerships is an important first step and that WIPO now has funding to build research capacity in low- and middle-income countries, as well as aid information flow. USAID has released its report to Congress on its global health programs during FY 2013. The report describes the agency’s work to “end extreme poverty through its contributions in global health by ending preventable child and maternal deaths, creating an AIDS-free generation, and protecting communities from infectious diseases.” Pharmaceutical companies GlaxoSmithKline and Johnson & Johnson will collaborate to develop a new HIV treatment that will require only a single pill. If the trials are successful, the new treatment could offer a less toxic alternative to the current therapies available to treat HIV.

As the DC summer kicks into full swing, Congress has had a busy month moving forward fiscal year (FY) 2015 funding legislation for a variety of government programs including global health research and development (R&D). Global health R&D at USAID: Yesterday, both the House and Senate State and Foreign Operations (SFOPs) appropriations subcommittees held mark-ups of their draft bills. The House draft provides only topline spending numbers, with the addition of family planning/reproductive health, polio, the President’s Emergency Plan for AIDS Relief (PEPFAR), and the Global Fund funding levels. The House funded the overall account above the White House request, but below what was appropriated in FY 2014. Including the State Department and the US Agency for International Development (USAID) numbers, funding was $132 million below the numbers Congress appropriated in FY 2014, but a welcome $257 million more than what the White House had requested. For a quick comparison of numbers, check out the Kaiser Family Foundation’s SFOPs policy analysis. The other accounts called out in the House bill were $59 million for polio (the same as FY 2014, but 18 percent higher than the President’s request) and family planning at $461 million. Funding for family planning was a significant but not unexpected cut from both the FY 2014 number (24 percent cut) and the White House request (28 percent cut). As the full House appropriations committee has not yet marked up the bill (and it’s not clear that they will), details on the contents of the bill report’s priorities and other policy riders are not yet known. We do know the House bill reinstates the Mexico City Policy—which prevents nongovernmental organizations who receive federal dollars from promoting abortion services as part of family planning­—or prohibits any funding to the United Nations Population Fund (UNFPA). The full committee may take the bill up for consideration sometime next week. The Senate summary provides considerably more specific account figures for global health than the House bill. The Senate bill flat-funds the Global Fund and PEPFAR compared with FY 2014 and is even with the White House request—it’s interesting to note that for this overall account, the House bill appears to provide a higher funding level, even though we don’t yet know the exact funding distribution. Most other accounts were funded at levels either matching or slightly above FY 2014 funding. One exception is the tuberculosis (TB) account, which faces an $11 million cut from FY 2014 levels, although it is not as dire as the proposed White House funding level, which would have cut an additional $23 million. There is better news to be found for family planning and reproductive health, neglected tropical diseases, polio, and vaccine access. There’s no explicit word in either the House or Senate bills regarding the overall Maternal and Child Health account. NIH, CDC, and FDA Last week the Senate held its Labor, Health, and Human Services (LHHS) subcommittee mark-up and released a summary of their draft bill. A full Senate committee mark-up has yet to be scheduled, and the House has yet to move forward with its own draft bill. This account remains one of the most contentious, both because of ongoing efforts to alter the health care reform programs and because of a Senate plan to use the Overseas Contingency Operations account as a complicated and likely unsustainable mechanism to boost up funding for domestic priorities. The committee requested $30.459 billion for the National Institutes of Health (NIH), an increase to both the White House and FY 2014 levels by $324.0 million and $605.7 million, respectively, but still far less than the $32 billion needed. Global health programs within both NIH and the Centers for Disease Control and Prevention (CDC) also did quite well in the Senate bill—the CDC’s Centers for Global Health and Emerging Zoonotic and Infectious Diseases, the NIH’s National Institute of Allergies and Infectious Diseases (NIAID), and the Fogarty International Centers were nearly all funded at levels above both FY 2014 and the White House request. Both the House and Senate have also marked-up their legislation to fund the Food and Drug Administration (FDA). The House bill funds the FDA at $2.583 billion (this number represents budget authority and does not include user fees), which is a $23 million increase over FY 2014 and is about level with the White House request. The Senate bill funds the FDA at $2.588 billion, an increase of $36 million over FY 2014. The Senate is taking up this bill as part of a “minibus” along with the bills from the Commerce, Justice, and Science subcommittee, the Transportation subcommittee, and the Housing and Urban Development subcommittees. The Senate version of the bill also included some interesting report language around FDA’s international leadership to combat threats to global health and the global drug supply chain.  Defense The House Appropriations Committee approved their FY 2015 bill which essentially flat funds Department of Defense (DoD) R&D—which includes all research at DoD, not just neglected disease R&D—from FY 2014 levels. The American Association for the Advancement of Science provides a helpful summary of R&D funding within the draft bill which can be found here. The Senate Appropriations Committee has yet to mark-up a bill. In both the House and Senate, we see policymakers diverging from the priorities emphasized by the White House in its original budget request: there is little mention of any implementation of the infamous Opportunity, Growth, and Security account suggestions for global health or health research, although the Senate Appropriations Committee has developed its own plan for handling the declining budget caps while still supporting accounts they view as important to US health research programs. While the progress we’ve seen so far is commendable, Congress must speed its efforts to enact smart, evidence-based appropriations for global health R&D programs and their overarching accounts. As the end of the current fiscal year looms closer, policymakers must work together to avoid the stalemate that caused the government shutdown of the fall of 2013 and should support strong funding levels for global health R&D.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. GHTC member TB Alliance and partners announced this week that they have advanced the first-ever drug regimen designed to treat both drug-sensitive and some forms of multi-drug resistant tuberculosis (TB) to a global Phase III clinical trial. The drug regimen—called PaMZ—is expected to reduce the cost of multi-drug resistant TB treatment by over 90 percent in some countries. This week in Seattle, the Bill & Melinda Gates Foundation convened the Global Health Product Development Forum—where more than 500 people will discuss how funders, researchers, nongovernmental organizations, and the private sector can work together to accelerate the development and delivery of life-saving products. The United Kingdom has launched a five-year, £375 million fund to support science and innovation partnerships with researchers in low- and middle-income countries. The new fund will support joint research projects, student and researcher fellowships, capacity building, and translational research. The Kaiser Family Foundation has created an infographic that shows global health funding’s share of the US federal budget. The infographic highlights the recent flattening of US funding for global health and the major areas US global health funding goes to.