Restoring U.S. foreign aid to health


The need for research breakthroughs is as urgent as ever. Almost five million people die each year from HIV/AIDS, tuberculosis, and malaria. Yet vaccines for HIV and malaria do not yet exist and existing tuberculosis vaccines are outdated and ineffective. For many other neglected infectious diseases, effective prevention, diagnostics, and treatments simply do not exist, and many tools that do exist are not effective against some conditions.

Since the invention of the polio vaccine in the 1950s, the United States has led the world's efforts to develop the vaccines, drugs, diagnostic tools, and other products needed to combat disease and improve public health. America must maintain that position of leadership. Several American officials have recognized the need for an intensified U.S. commitment to global health research. The head of the U.S. Agency for International Development recently stated that "humanity demands" vaccines for AIDS, malaria, and TB, along with low-cost vaccines for pneumonia and rotavirus "that will eliminate hundreds of thousands of child deaths."

How can America accelerate the world's efforts to defeat infectious disease? For starters, our policymakers must ensure that research and development are included in three major U.S. global health and development efforts currently underway.

The first is President Obama's new Global Health Initiative, which is slated to devote $63 billion to improve health worldwide over six years. The second is a review ordered by President Obama to examine U.S. global development policy, called the Presidential Study Directive. A recently released draft of this review reveals several promising developments in foreign assistance reform, such as increased U.S. commitment to "game-changing innovations with the potential to solve longstanding development challenges." The third is a review launched by Secretary of State Hillary Rodham Clinton to strengthen and elevate global development and diplomacy as key pillars of U.S. foreign policy.

U.S. policymakers can elevate global health research and development in several ways, the first being robust funding for new health tools. As American officials weigh how to spend money allocated for global health and foreign assistance, they should take note of the potentially revolutionary impact that innovative new diagnostics, preventives, vaccines, medicines, and other products can have on global public health. Federal agencies that can deliver the most promising research and development initiatives should be funded accordingly.

American policymakers must also work to streamline regulatory pathways for new healthcare technologies-both at home and in the developing world. Without an effective regulatory system, unsafe or counterfeit treatments can proliferate. Further, patients can suffer needlessly as they wait for promising treatments that may not be approved in time.

U.S. regulators can help bridge this gap by sharing their expertise with public-health and regulatory authorities in endemic nations and collaborating with global health officials to accelerate approval of and access to life-saving products.

Finally, American policymakers should encourage more private-sector research on diseases afflicting the developing world. Products for the developing world are often perceived as risky bets that may not provide enough of a return to justify a hefty research investment.

It need not be so. Policymakers are already exploring incentives and innovative financing mechanisms to encourage private-sector research into the health problems plaguing the world's neediest. These efforts should be expanded and U.S. support should be increased.

One strategy for expanding research is the Advance Market Commitment (AMC), whereby governments, foundations, or other groups aim to create a viable market for a desired vaccine, should a private firm develop one. In 2007, the governments of five countries, along with the Bill & Melinda Gates Foundation, launched the first AMC-a $1.5 billion fund to accelerate the development and distribution of a vaccine against pneumococcal disease, which kills 1.6 million people every year. The United States should join with others to establish another AMC, this time focusing on support for a new vaccine in early stages of development. Additionally, the U.S. government should lead the way in exploring new sustainable funding mechanisms that draw upon both private- and public- sector purses to drive innovation in global health research and development for a wide range of global health preventives, diagnostics, and drugs.

Never before has America been better positioned to make a difference in the lives of the world's poor. We must seize the opportunity and ensure that the benefits of prosperity and technological innovation reach those who need them most.

R. Gordon Douglas, Jr., MD, Executive Chair, Aeras Global TB Vaccine
Foundation

Mitchell Warren, Executive Director, AIDS Vaccine Advocacy Coalition

Bernard Pecoul, MD, MPH, Executive Director, Drugs for Neglected Diseases
initiative

Seth Berkley, MD, President, CEO, and Founder, International AIDS Vaccine
Initiative

Christopher J. Elias, MD, MPH, President and CEO, PATH