As the world looks to American innovation to fight Ebola, malaria, tuberculosis, and a host of other health threats, a new report released on Capitol Hill warns budget battles in Washington are eroding preparedness at home and abroad at a time when scientific advances are poised to deliver new lifesaving drugs, vaccines, and diagnostics.
"Since 2009, we've seen declining, or at best stagnating, support for global health research and development, with politics trumping prudent investments that could protect the US and the world from an array of threats," said Erin Will Morton, director of the Global Health Technologies Coalition (GHTC), an influential alliance of 25 nonprofit organizations seeking new tools to address existing challenges, including HIV/AIDS and tuberculosis; emerging problems, such as drug-resistant superbugs and dengue; and neglected diseases, like sleeping sickness and river blindness.
The prospect of additional cuts is alarming disease experts, who warn that the next global health crisis could already be brewing in places like war-ravaged Syria and ISIS-occupied Iraq, where there has been an alarming rise in polio, measles, leishmaniasis, typhoid fever, hepatitis A, and meningitis. Meanwhile, Chagas, dengue, and chikungunya are gaining a foothold in the US. And the degraded health systems that abetted the spread of Ebola are not peculiar to West Africa: a recent report from Save the Children warns 28 countries are "highly vulnerable" to a deadly disease outbreak.
Morton noted that while the Ebola crisis exposed the dangers of ignoring neglected diseases, one bright spot was the ability of US agencies to collaborate and quickly roll out desperately needed diagnostic tests and launch clinical trials for new drugs and vaccines. "But these innovations are the product of past investments that provided consistent, long-term support to researchers who steadily generated incremental advances," she said. "So by failing to provide sufficient support today, we are systematically degrading our ability to respond to the next global health crisis."
The GHTC analysis notes that in the first decade of the 21st century, the United States doubled support for global health research and development (R&D). And it was rewarded with dozens of health innovations that have contributed significantly to major milestones in global health: since 1990, there has been a 50 percent drop in childhood deaths, a 45 percent decrease in maternal deaths, and a 25 percent reduction in deaths from infectious diseases. But since 2009, a succession of budget battles that culminated in the across-the-board "sequestration" cuts of 2013 reduced total US government spending for global health R&D by US$185 million, or 11 percent below 2009 levels. (Overall, global investments in neglected diseases fell by 6.2 percent in this period, placing more importance on the US--where economic conditions are improving faster than in other wealthy regions--to lead the fight.)
The GHTC report acknowledges budget agreements in 2014 and 2015 have provided a respite from the sequester cuts. But it points out that, aside from the $5.4 billion in FY 2015 in emergency funding for Ebola, investments have remained largely stagnant for global health R&D activities across the government, which includes work at the US National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the Department of State, the US Agency for International Development (USAID), the Food and Drug Administration (FDA), and the Department of Defense (DoD). And global health budgets could face another round of automatic spending cuts this fall if President Obama and Congress fail to strike a new budget agreement.
"Governments were in many ways caught unaware by Ebola--despite decades of warnings from disease experts--yet instead of learning the lesson, we could end up heading in the opposite direction with investment decisions that would actually make the world even more vulnerable," said Daniel G. Bausch, MD, MPH&TM, a consultant to the Office of Pandemic and Epidemic Diseases at the World Health Organization, who has worked on the front lines of the Ebola outbreak. "That's unfortunate, because global health challenges present not only an opportunity for leaders in the field, such as the United States, to assert humanitarian leadership and do what's right, but also an opportunity to ensure that those leaders remain global hubs for biomedical innovation."
For example, the GHTC analysis notes that about "sixty-four cents of every dollar spent by the US government on global health R&D goes directly to US-based researchers and product developers, creating jobs, spurring business activity, and strengthening US competitiveness in research and technology." And the report asserts these innovations directly contribute to economic progress in the global economy. The Lancet Commission on Investing in Health found that between 2000 and 2011, health improvements accounted for at least 11 percent of the economic growth in the world's low- and middle-income countries.
Dropping Our Guard at a Time of Peril and Promise
The GHTC report reels off a long list of critically important innovations now under development that could be slowed or even derailed by anemic funding for global health R&D. They include new treatments to counter the disturbing rise of drug-resistant tuberculosis, malaria parasites, and bacterial superbugs; new diagnostic tools to help fight outbreaks like Ebola, where health professionals struggle to distinguish between conditions that have frustratingly similar symptoms; and new drugs and vaccines for neglected diseases like leishmaniasis, which threatens 350 million people around the world, and Chagas, which in Latin America kills more people than malaria.
The GHTC is particularly concerned about how the budget cuts could affect work at the NIH, widely recognized as the powerhouse behind global health R&D and where a greater focus on translational research is placing more emphasis on product development. For example, in addition to its leadership in developing Ebola drugs and vaccines, NIH is supporting development of AIDS vaccines that could prevent infections, along with microbicides that could reduce sexual transmission of HIV. NIH also is supporting a new universal influenza vaccine candidate that could provide a major breakthrough for fighting both seasonal and pandemic flu and a new class of antibiotics that could be a potential game changer in the fight against drug-resistant superbugs.
GHTC members noted that all of this work would be disrupted by across-the-board cuts. In addition, the GHTC warns that further cuts could hamstring the USAID's new Global Development Lab, which includes a focus on innovations to advance maternal and child health, as well as the Grand Challenges competition for Ebola, a project that includes partners from the CDC, DoD, and the White House Office of Science and Technology Policy (OSTP). Meanwhile, consistent funding is seen as crucial to CDC's effort to develop better diagnostics and protective gear for fighting infectious diseases, the DoD's role as a crucial player in the push for Ebola and AIDS vaccines, and the FDA's initiatives to encourage product developers to coordinate early to tackle global health problems.
In addition to providing strong and stable funding for global health R&D, the GHTC report also urges policymakers to make better use of existing investments and accelerate product development by taking concrete steps to better coordinate the global health work taking place across the government. Key activities include passage of legislation to support R&D efforts at USAID, incorporation of R&D into the Global Health Security Agenda, and creation of an overarching government-wide strategy for global health R&D. The GHTC also believes the US can leverage its leadership and influence in world affairs to ensure global health R&D assumes a prominent place in the United Nations' new agenda for global development that will be finalized in September.
"At a time when entrenched political divisions are causing many to search for areas of consensus, support for global health R&D stands out as important issue that can attract bipartisan support," said Morton. "American-led innovation is also a great antidote to the fear that can surround threats like Ebola and AIDS and a way to encourage a more stable, prosperous and secure world."