Less than a year after the Ebola outbreak, political gridlock in Washington could produce another round of budget cuts that could deeply damage America’s and the world’s ability to face future threats — from epidemics exploding in war-torn Syria to the ominous prospect of a “post-antibiotic” world. Alternatively, America could double down on investments in global health research and development (R&D) that have consistently delivered innovations capable of conquering the major diseases of our time.
Search Google for “Ebola” and “wake-up call” and the hits pile up fast, and for good reason.
The sudden outbreak of Ebola in West Africa last summer was widely and rightly perceived as awakening the rest of the world to a reality many health experts have long understood: infectious diseases that prey disproportionately on the poor are not just a problem for low-income countries. They are a threat to us all. And the world needs to be much better prepared for future challenges, which could involve Ebola or any of a number of other diseases.
A few possibilities currently on the radar of global health experts include:
- Simultaneous outbreaks of polio, measles, typhoid fever, leishmaniasis, and meningitis in war-torn Syria, which may already be happening.
- The spread of drug-resistant tuberculosis from Papua New Guinea to Australia.
- The spread to Africa of malaria parasites that are resistant to the-life saving drug artemisinin — a development, which recently took an ominous turn, that could kill millions.
- A surge in drug-resistant superbugs that the World Health Organization warns are pushing us toward a “post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill.”
- Further intensification of dengue fever, which now threatens half the world’s population and is one of three tropical diseases — the others being Chagas disease and chikungunya — that are now moving into the southern United States.
- Further eruptions of Ebola or other major threats in any one of the 28 countries recently identified by Save the Children as “highly vulnerable” to a deadly disease outbreak right now.
“The most common final end to a pandemic is what I call profound amnesia. SARS? What’s that? We are not yet at ‘Ebola? What’s that?’ But I guarantee you we will be there. And that’s the real problem.”
Howard Markel, MD, PhD, the George E. Wantz Distinguished Professor of the History of Medicine at the University of Michigan [Source]
A key problem in dealing with these challenges is that the Ebola wake-up call of 2014 is in danger of being cancelled out by what might be called the “snooze button” of 2015. The problem is captured in a new report from the Global Health Technologies Coalition, an alliance of 25 nonprofit groups that are closely involved in developing new vaccines, drugs, and diagnostics that could greatly reduce dangers posed by a wide range of global health challenges.
The GHTC report notes that since 2009, US government investments in global health R&D have been either declining or stagnating. Moreover, GHTC is concerned that global health budgets could face a new round of automatic, across-the-board spending cuts that would kick in 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.”
This confounding situation raises several important questions:
- How did we get here?
- Why do these budget battles matter?
- How can US-led innovation help protect the world from threats like Ebola?
These issues are explored in detail in the GHTC analysis, but here are few brief answers.
How did we get here?
The GHTC notes that funding has been stagnant or in decline since 2009, followed by the devastating across-the-board “sequestration” cuts of 2013. No one singled out global health for a hit, but it was a casualty nonetheless. By 2013, total US government spending for global health R&D was down by $185 million, or 11 percent below 2009 levels.
A budget agreement last year at least stopped the bleeding, but it did not completely restore the cuts. Moreover, 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. The recent standoff over funding for the Department of Homeland Security is intensifying concern that politicians may fail to reach an accord, which by law would trigger sequestration.
“It would be nice if, for once, the world could be proactive. In ISIS-occupied Syria and Iraq we are already seeing refugees pouring across the border into Jordan, Lebanon, and Turkey. We are seeing rabies, huge amounts of leishmaniasis. We are going to see Middle East Respiratory Syndrome. We have got to build capacity for the next big thing that is going to happen.”
Peter Hotez, Dean of the National School of Tropical Medicine at Baylor University and President of the Sabin Vaccine Institute Product Development Partnership [Source]
According to the GHTC analysis, “sequestration could usher in another round of damaging cuts to global health programming at US agencies, which would not only delay the development of lifesaving tools, but also damage America’s reputation as a leader in science, hurt the US economy, and cost the nation domestic jobs.”
It turns out that, among other benefits, “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.”
While most R&D is funded through the National Institutes of Health (NIH), other key agencies involved in global health R&D include 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).
Why do these budget battles matter?
Sufficient and stable funding for global health R&D across the federal government is crucial if we want to roll back the rising tide of infectious diseases. Today, the world looks to the United States for biomedical breakthroughs that can address health threats like Ebola, and not just because the United States is the largest supporter of global health research. The United States has also developed a proven process for generating the steady discovery and development of groundbreaking drugs, vaccines, and diagnostic tests.
Essentially, the US taxpayer funds research that can reveal a wide range of new options for fighting infectious diseases. US agencies then look to the private sector and, increasingly, to nonprofit groups dedicated to combating neglected diseases to form product development partnerships (PDPs) that are translating this knowledge into useful, accessible, and affordable commercial products.
But healthy and — equally important — reliable funding from all involved is key, particularly for government-funded R&D, as that’s the foundation upon which all else is built. As NIH Director Francis Collins recently said, what biomedical researchers crave these days is a “stable trajectory.” And it doesn’t take much. For Collins, it simply means budgets that keep pace with “inflation plus a little bit” so that researchers can “flex their innovative muscles and take advantage of the amazing talent that we have in this country.”
“What NIH desperately needs […] is a sense of a stable trajectory so that we have the chance to be able to plan, to take risks, to do innovative research without the uncertainty about what will happen one year or the next.”
Francis Collins, Director of the National Institutes of Health, the world’s leading supporter of global health R&D [Source]
How can US-led innovation help make the world safe from threats like Ebola?
Ebola is a prime example of why it’s so important to invest now if we want to be prepared for future threats. One bright spot in the Ebola response was the ability of US government agencies to collaborate both with other agencies and with private sector partners to quickly roll out desperately needed diagnostic tests and launch clinical trials for new drugs and vaccines. For example, US-funded research has played a key part in the development of five drugs and three vaccine candidates for Ebola, with NIH, CDC, FDA, and DoD all assuming critical roles in accelerating their development.
“But these innovations are the product of past investments that provided consistent, long-term support to researchers who steadily generated incremental advances,” says GHTC Director Erin Will Morton. “So by failing to provide sufficient support today, we are systematically degrading our ability to respond to the next global health crisis.”
“Then there’s our failure to invest in effective medical tools like diagnostic tests, drugs and vaccines. On average it has taken an estimated one to three days for Ebola test results to come back — an eternity when you need to quarantine people until you know whether they’re infected.”
Bill Gates, Co-Chair and Trustee, Bill & Melinda Gates Foundation [Source]
There are many new innovations now in the pipeline that could suffer delays if support for global health R&D falters. They include a new drug for treating drug-resistant TB that is the first TB drug to make it to Phase 3 trials — the final step before licensure — in many years. NIH-funded researchers are also excited by an entire new class of antibiotics that could protect the world from being overwhelmed by drug-resistant superbugs.
Meanwhile, there is a new malaria vaccine now in Phase 3 testing, and efforts are underway to develop other malaria vaccines that could help eradicate the disease by interrupting transmission between humans and mosquitoes. Researchers are also optimistic about the prospects of a vaccine to prevent HIV and have developed new microbicides that could reduce sexual transmission of the disease.
GHTC notes that innovations likes these can save more than just lives. 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. And that’s likely a conservative estimate.
It’s easy to understand why global health experts are often incredulous that a political stalemate could erode preparedness at home and abroad at a time when scientific advances are poised to deliver such a wide array of lifesaving innovations. Many long for the days when support for a muscular US role in biomedical research transcended political divisions.
“Support for US leadership in global health R&D is still something that could be a source of bipartisan support,” Morton said. “American-led innovation is a great antidote to the fear that can surround threats like Ebola and a way to encourage a more stable, prosperous, and secure world.”
