Congressional budget pact is good news for global health, but cuts to key research agency loom as serious threat to US leadership and life-saving innovations

While a ceasefire in Washington’s budget wars has restored funding for a range of programs targeting global health threats like AIDS and tuberculosis (TB), the simultaneous underfunding of the world’s biggest sponsor of global health research and development (R&D) puts future progress at risk, warns a new report from a coalition of nonprofit groups focused on advancing innovation to save lives. The Global Health Technologies Coalition (GHTC) released their annual policy report today at a Capitol Hill briefing.

“The end of political gridlock in Washington put many global health programs on firmer footing with one notable exception: it continued to weaken the National Institutes of Health (NIH), which is the engine that drives innovation in the fight against infectious diseases,” said Kaitlin Christenson, MPH, director of the GHTC.

The report, Innovation for a changing world: The role of US leadership in global health R&D, examines the state of global health R&D in the wake of a bipartisan agreement reached earlier this year to end an acrimonious budget battle. The GHTC report applauds efforts to halt draconian cuts that were crippling global health programs. And it calls for a long-term budget solution to sustain R&D efforts that are delivering a wealth of new tools to fight diseases that disproportionately affect poor countries.The report places a high priority on urging Congress to approve the 21st Century Global Health Technology Act and seeks a stronger role for the Food and Drug Administration (FDA) in delivering new products for neglected diseases.

The big news for global health programs was the accord signed into law earlier this year that halted the so-called “sequestration” cuts that hit programs across the government in March of 2013 after negotiations over federal spending collapsed. The agreement revived appropriations for an array of global health initiatives.

But when the dust settled, the NIH budget for 2014—while $1 billion above its 2013 post-sequester funding—was actually $950 million less than the agency received in 2012. In particular, two NIH institutes critical to sparking global health innovations—the National Institute of Allergy and Infectious Diseases (NIAID) and the National Institute of Child Health and Human Development—have less money, in actual dollars, in 2014 than they had in 2012. A report by the Congressional Research Service found that when adjusted for inflation, funding for NIH—which leads the world in support for global health R&D—has been steadily declining for years, with the agency’s real spending power down by 22 percent compared to 2003.

“These cuts are short-sighted because our global leadership in the life sciences, a sector which contributes $69 billion annually to the US economy alone, rests on a foundation built with NIH-funded research,” said Steve Davis, president and CEO of PATH. “Just this past November, researchers from NIAID and Harvard announced they had developed a potentially transformative new treatment for HIV—and that’s precisely the kind of work we put at risk by failing to adequately support NIH.”

The GHTC report asserts that the budget reductions triggered by the sequestration process were having a major impact on the global fight against infectious diseases. For example, clinical trial sites in the US and abroad involved in testing a new TB drug were forced to shut down. The GHTC report also asserts that reduced funding for programs that provide poor countries with HIV/AIDS treatments and tools to control malaria may have resulted in thousands of preventable deaths.

The GHTC makes a case for stronger, more reliable funding for global health R&D by noting that US investments have consistently delivered valuable returns and that future breakthroughs are close at hand. It finds that between 2000 and 2010, the US government was involved in more than half of the vaccines, drugs, diagnostic tools, and devices that were developed to address global health problems. And US funding is now linked to 200 of the 365 global health products moving through the R&D pipeline.

Some of the products in development with US government support—and which could fail if that support falters—include:

• New drugs to treat TB and malaria.
  
• A new microbicide that women could use to prevent HIV infections, which could avert 2.5 million HIV infections and save $2.7 billion in health care costs.
  
• New insecticides to help control insects that spread diseases such as dengue fever, Chagas disease, filariasis and leishmaniasis, which are a major cause of serious illness and death in developing countries.
  
• New tools that would make diagnosing malaria, HIV, and TB easier and faster, especially in low-resource settings.
  
• A vaccine for preventing HIV infections.
  

The GHTC is urging Congress to make sure these and other tools become a reality by developing a long-term plan for retaining and expanding US leadership in global health product development. The GHTC notes that this work can begin with a 2015 budget agreement that provides strong support for global health programs government-wide.

For the Centers for Disease Control and Prevention (CDC), the GHTC recommends providing $464 million for the Center for Global Health and $445 million for the National Center for Emerging and Zoonotic Infectious Diseases. The GHTC also is recommending a 2015 budget of $4.7 billion for the FDA, which plays an important role in ensuring the safety and efficacy of health products for neglected diseases; $32 billion for NIH; and $10.358 billion for global health programs at the US Department of State and US Agency for International Development.

The GHTC also is seeking policy changes that would strengthen US-supported work in global health product development. And GHTC is calling for FDA to continue expanding its role in global health by allocating funding to match its global health commitments and ensuring it has the authority to review health products for all neglected diseases.

Finally, the GHTC is urging US government officials to play a stronger role within the World Health Assembly as that body develops and funds a series of global health demonstration projects. And it wants to ensure that global health research is prominent in the Sustainable Development Goals now being drafted to replace the United Nations Millennium Development Goals.