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May 27, 2024

GHTC submitted the below response to a request for information (RFI) to inform the new five-year strategic plan of the US National Institutes of Health's National Institute for Allergy and Infectious Diseases (NIAID).

To Whom It May Concern: 

We write to you today representing the Global Health Technologies Coalition (GHTC), a group of more than 45 nonprofit organizations, academic institutions, and aligned businesses advancing policies to accelerate the creation of new drugs, vaccines, diagnostics, and other health tools to bring healthy lives within reach for all people. It is with this perspective that we intend to contribute input to the National Institute of Allergy and Infectious Diseases’ (NIAID’s) strategic plan, which will guide NIAID’s priorities over the next five years. 

The National Institutes of Health (NIH) has long been a cornerstone of basic and early-stage biomedical research, playing a pivotal role in driving scientific discoveries that pave the way for the creation of lifesaving global health technologies by the private sector, nonprofits, and other US agencies. In its new five-year strategic plan, GHTC advises that NIAID further integrate its global impact into its core mission and stated priorities. Within the five priority areas highlighted in the request for information, several jump out as opportunities to incorporate global health research and development (R&D) in both policy and practice. It is our opinion that these opportunities to include global health R&D should be seized, especially considering new economic data. 

A recent study by GHTC and Policy Cures Research revealed that between 2007 and 2022, the US government invested $46 billion in global health R&D, yielding $104 billion in direct returns and creating more than 600,000 jobs. Additionally, these investments are projected to generate $255 billion in future economic gains. Notably, NIH, predominantly through NIAID, accounted for three-quarters of this funding, solidifying NIAID's position as the world’s largest funder of global health R&D

Priority 1 highlights the need to better understand the immune system and its limitations. On this priority, our membership is interested in research aimed at improving our understanding of genetic mutations that play a role in drug resistance. This research would allow for the scale-up and development of drug susceptibility tests that can help inform patients with drug-resistant infections of their treatment options. Drug resistance is an issue for tuberculosis (TB) treatment as well as the treatment of other neglected diseases worldwide. The R&D undertaken for this priority should pay close attention to how new technologies and protocols can be used in low-resource settings for historically underserved populations like women and children.  

Priority 3 is a core priority of GHTC in pursuit of the development of effective treatment strategies for neglected diseases like HIV/AIDS. We urge NIAID to acknowledge underserved populations like women and children, including lactating women, who are an especially underrepresented community in clinical trials, at the outset of the R&D process. We also urge NIAID to prioritize establishing plans for access early in the R&D process to avoid barriers to uptake often seen in low- and middle-income countries, especially for products for diseases like HIV/AIDS that can carry stigma. NIAID received an award from GHTC for its work on cabotegravir long acting for HIV prevention because, among other reasons, it is fit for use in low-resource settings and simpler for patients because it can be taken bimonthly rather than daily. Moving forward, we hope that all HIV and non-HIV research is conducted with low-resource communities in mind, which is important for domestic and foreign settings alike. 

GHTC is pleased to see Priority 5 as a key topic for NIAID since it will bolster the critical work NIAID has done in the past to take basic science research and apply it to the most pressing health challenges of the day. We saw in the global responses to SARS, Zika, Ebola, and, of course, COVID-19 that NIAID-led research provided a vital cornerstone. Within this priority, GHTC hopes to see a specific mention of how this work is globally relevant and will position US-funded global health R&D as the front line against future threats, both known and unknown. Affirming NIAID’s work on neglected diseases, as well as new and emerging infectious diseases is core to GHTC’s goals for the institute. Like the other issue areas, it is important to incorporate equity and access into the R&D process for Priority 5, since in the case of a pandemic, it is in our best interests that technologies made to test, treat, and heal US citizens can also be applied globally to effectively mitigate the spread of a pathogen with pandemic potential. 

GHTC was also happy to see the inclusion of many new themes NIAID is considering incorporating into its strategic plan. Of course, the theme of global health should be central to the work of NIAID since infectious diseases are not and have never been a one-country issue. Additionally, the interconnectedness of the world we currently live in, coupled with shifts in the environment because of climate change, have contributed to a modified disease landscape in the United States, forcing us to grapple with diseases once labeled as “tropical” or not of consequence to US citizens. For example, just last summer, we saw local malaria transmission in the United States for the first time in decades, and this summer, we are already seeing the rise of fungal infections in the United States and dengue in Central America, South America and, more recently, Miami. These developments should inspire action within the R&D community, especially since we need more and better tools and treatments to address these threats. 

We also see room to grow in these themes through the lens of clinical trials. The themes of Diversity, Equity, Inclusion, and Accessibility; Women’s Health; Research Inclusivity; and Health Disparities should be considered in ensuring diversity in clinical trial participants, which will help lead to new global health technologies that are applicable and accessible in low-resource settings, suitable for racially diverse groups, and that address the needs of underserved populations like lactating woman and children—to name a few key issue areas. 

Increasing NIAID’s global health mandate will serve the institution well in the fight against emerging infectious diseases and neglected diseases at home and abroad. By learning from past successes at NIAID, the world grows to be stronger and healthier. The global health R&D community has consistently advocated for NIAID’s mission and prominence in a crowded field of global health champions. It is our hope that NIAID consistently maintains interagency coordination with other government agencies and partners, not just in times of crisis. We hope our advisement is considered when the new strategic plan is forged, and we are happy to provide consultation on the strategy throughout the strategy development process. 



Alex Long  

US Policy & Advocacy Officer  

Global Health Technologies Coalition (GHTC)