The SIGHT Fund: A proposal to drive inclusive innovation at USAID

USAID is best positioned to house the SIGHT Fund because of 1) its unique mandate—as the only US agency with a primary mission to improve global health and development; and 2) its proven expertise in global health innovation. The agency has a decades-long track record of developing technologies to address unmet health needs of people in the world’s poorest places.

While other research agencies primarily focus on increasing scientific knowledge or advancing products for a US market, USAID is focused specifically on developing health technologies for global use. That means its specialty is creating products that are not only safe and effective, but also affordable and designed to work in places where infrastructure is limited, electricity is unreliable, and trained health workers are scarce.

Consider for a moment a new medicine or vaccine. If that product ends up costing hundreds or thousands of dollars or must be stored consistently at frozen or refrigerated temperatures, many low- and middle-income countries may struggle to make it broadly available and administer it to people in hard-to-reach, rural settings. When funding R&D, USAID considers these challenges from the beginning, so that the innovations it produces can ultimately be widely adopted and used around the world.

With its deep international footprint and strong relationships with health decision-makers in partner countries, USAID also has a keen understanding of what technologies are most needed to improve health programs—as a primary implementer of global health programs, the agency is able to see where current tools are falling short in real time. This enables it to prioritize investments in areas of highest need and potential impact.

USAID would have the opportunity to leverage the SIGHT Fund to build upon and strengthen its ongoing collaborations and coordination with other US agencies sponsoring health research.

USAID already has a strong tradition of partnering with other agencies like the National Institutes of Health (NIH), Centers for Disease Control and Prevention, and Department of Defense on health research. Sometimes this occurs through formal interagency initiatives, like the President’s Emergency Plan for AIDS Relief (PEPFAR), or through specific joint projects. In other cases, USAID informally consults and shares information with other agencies, involving their staff in decisions on research strategy and investments. This continual coordination helps ensure USAID’s R&D investments are additive and complementary, rather than duplicative of other agency investments.

Given that USAID focuses on late-stage clinical development—translating scientific discoveries into proven products—greater interagency coordination enabled by the SIGHT Fund would help ensure promising products move successfully through the research pipeline, from early-stage research supported by NIH to later-stage research and market introduction supported by USAID.

The SIGHT Fund would be a flexible, disease-agnostic fund designed to support R&D of drugs, vaccines, diagnostics, and other medical devices across a range of global health areas. That could include HIV/AIDS, tuberculosis (TB), malaria, neglected tropical diseases (NTDs), maternal and child health, emerging infectious diseases, antimicrobial drug resistance, and more.

The fund could be used to advance discrete disease- or health-area specific innovations currently missing from our toolbox—such as more effective vaccines against TB or treatments and vaccines for NTDs. It could also be used to develop multipurpose tools that address multiple health areas simultaneously. The latter includes products like insecticides and other vector control tools, which reduce the burden of multiple diseases carried by mosquitoes, or combination HIV-prevention/contraception innovations, like vaginal rings or injectable therapies.

To establish the SIGHT Fund, the US Congress would need to provide dedicated funding to USAID. Congress would do this by creating a new funding line for global health innovation under Global Health Programs within the State, Foreign Operations, and Relations Programs appropriations bill—the annual legislation that funds USAID. 

Once it receives this funding from Congress, USAID would then have the resources and directive to establish and run the fund.

Congress could additionally choose to pass separate authorizing legislation for the SIGHT Fund, creating it as a formal entity through US law. This pathway would allow Congress to be more prescriptive in dictating how the fund should operate and make the fund more permanent by enshrining it in law and authorizing multiple years of funding. This step, however, is not required to launch the SIGHT Fund: the key is that Congress provides new dedicated funding to USAID for the specific purpose of funding global health innovation. This dedicated funding would have to be included annually in subsequent appropriations bills for the SIGHT Fund to continue providing dedicated resources for innovation in future years. 

While USAID already specializes in advancing health technologies that are responsive to the needs of people living in low-resource settings, the establishment of a SIGHT Fund would provide opportunities for USAID to engage impacted communities more intentionally in setting and carrying out its research agenda.

GHTC recommends USAID, in establishing the fund, create a governance structure that includes representatives from affected communities in low- and middle-income countries. This would give these stakeholders a greater voice in setting priorities for the fund and in determining which research projects it supports. This would also represent a shift from USAID’s current approach, in which research investment decisions are made primarily by US-based leadership of disease- and health-area offices.

In making research awards via the SIGHT Fund, USAID would also have opportunities to build upon its track record of advancing user-centered design approaches and making investments that not only produce new tools, but also strengthen local scientific capacity. All these actions would serve to support USAID’s broader commitment to inclusive development, which seeks to ensure that every person, no matter their identity, is instrumental in transforming their societies

Despite tremendous progress achieved in global health over the last few decades, we are still without essential tools to combat many global health challenges.

No matter what global health area you work in, innovation gaps persist. Take malaria, for example. While past research successes like insecticide-treated bednets and antimalarial drugs have driven huge gains, growing drug and insecticide resistance is undermining the effectiveness of our current tools, leading to stalled progress. To eradicate this disease, next-generation treatments, vaccines, diagnostics, and vector control tools are urgently needed.

Or look at tuberculosis, the world’s second leading infectious disease killer after COVID-19. It is clear our current tools are insufficient to end this epidemic. The one vaccine we have, which is over 100 years old, does not work consistently in adults, and existing treatments, particularly for drug-resistant strains, can require taking thousands of pills and painful injections for six months to nearly two years. To turn this tide, we need new and improved innovations.

Even for HIV/AIDS programming, where our existing toolbox is relatively strong, it is common for patients to struggle to adhere to daily antiretroviral therapies (ARVs) taken as treatment or prevention. In the medium term, new technologies like longer-acting injectable ARVs or innovations that combine ARVs with contraception could help more people reliably use treatment and prevention products. Longer term, the development of an effective HIV/AIDS vaccine and cure would have a transformative impact toward ending this crisis.

The fruits of R&D—new and improved technologies—can help make all global health programming and services more effective and efficient, as well as help close access gaps to reach everyone, everywhere with quality care. That’s why it is vitally important that investing in R&D and investing in global health service delivery be viewed as two sides of the same coin in achieving health equity.

For a more detailed look at key missing tools across global health areas, view our fact sheet series.