Federal budget update, Part 2: DoD, CDC, FDA, and NIH

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. The US Agency for International Development (USAID) and partners recently announced nominees for the Saving Lives at Birth: A Grand Challenge for Development initiative. In related news, plans are “taking shape to merge two offices” at USAID to create an institute that would test and scale up “technologies and innovations to spark major development breakthroughs,” Devex reports. The Treatment Action Group and HIV-iBase have released the 2013 Pipeline report, which calls on leaders in global health, government, and research to commit to and coordinate efforts that will expedite access to effective diagnostic, treatment, and prevention tools. The Infectious Disease Research Institute (IDRI) and Zydus, India’s fourth largest healthcare group, will partner to develop IDRI’s visceral leishmaniasis vaccine candidate. An op-ed in The Guardian by Dr. Anurag Mairal, global program leader of Technology Solutions at PATH, examines the importance of public-private partnerships for global health. “Our nation’s research ecosystem is now in a precarious state as a result of federal policies and proposals that continue to undermine medical innovation,” John Edward Porter, chair of Research!America’s Board of Directions, writes about sequestration in a new op-ed.

Recent weeks have seen a flurry of activity for both the House and Senate appropriations committees. Congressional policymakers have approved several pieces of fiscal year (FY) 2014 budget legislation, including bills for accounts that fund global health research and development (R&D). However, with August recess looming and the end of FY 2013 only eight weeks away, it’s looking even more likely that we’re heading for another continuing resolution to keep the government running. Below, we provide highlights from recent Congressional budget activity that will determine funding levels for State and Foreign Operations, including global health and R&D programs at the State Department and the US Agency for International Development (USAID). Tomorrow, we’ll provide an update on budget activities that will impact R&D programs at other key federal agencies that support global health R&D. Congressional policymakers have approved several pieces of FY 2014 budget legislation, including bills for accounts that fund global health research and development. State and Foreign Operations As expected, the Senate version of this bill was much friendlier to several global health programs compared with the House version. The Senate bill would: Provide $8.455 billion for global health programs, which is $140 million above President Obama’s FY 2014 budget request level and $280 million above the House’s version. The difference between the House and Senate versions of the bill seems to be entirely contained in USAID’s Global Health Programs account and the State Department’s family planning programs, as funding for the Global Fund to Fight AIDS, Tuberculosis, and Malaria and the President’s Emergency Plan for AIDS Relief through the State Department were even between the House and Senate. One stark difference between the House and Senate bills is the family planning funding levels. The House version of the bill would prohibit funding to the United Nations Population Fund (UNFPA) and allocates a total of $461 million to all State and USAID family planning and reproductive health programs. The Senate bill, by contrast, includes $670 million for the same accounts, with $40 million of that money going to UNFPA. On a positive note, funding for tuberculosis programs was restored to $236 million, its FY 2012 level, in the House bill and to $225 million in the Senate version—much higher than the $191 million requested by the President. Funding levels aside, the policy language included in the Senate bill report contained several mentions of global health research, including key language on contraceptive R&D: “The Committee recognizes that there is a need to accelerate research and development of contraceptives that are more effective, affordable, and easier to deliver and may also prevent sexually transmitted diseases,” the bill reads, adding that USAID should increase funding to its Office of Population and Reproductive Health for such efforts. There is also some good news in the policy language in the House bill report. On neglected tropical diseases, the House bill “encourages USAID to support research into new drugs to address these diseases,” which is a step in the right direction. The bill also includes supportive language for malaria and HIV vaccines, microbicides, and pediatric HIV diagnostics and treatments. For the first time, it also includes a paragraph on USAID’s role in developing new health technologies: “The Committee continues to support USAID’s health technologies programs, including the development of technologies that maximize the limited resources available for global health and ensure that products and medicines developed for use in low-resource settings reach the people that need such products and medicines.” As with past years, global health programs fared better than other international development sectors in the State and Foreign Operations bills, particularly in the House version. However, as our next update will illustrate, we continue to see a clear pattern of flat-funding key programs across all federal agencies supporting global health and R&D. Combined with the threat of indiscriminate sequestration cuts, this is not an effective way to set long-term fiscal and programmatic goals. Furthermore, in both the short and long term, cuts to these programs undermine the immense progress made in global health research and threaten the future of the US global health mission. Tune in tomorrow for more details. Links to other helpful analyses: Kaiser Family Foundation Science Speaks blog InterAction