Looking back on last week’s AIDS2012 Conference, it is easy to see the impact that Washington, DC, and the proximity to Congress had on the tone of the discussion. Throughout the week-long conference, many of the events, panels, workshops and sessions highlighted the role of federal funding for global health research and development, as well as the impact of actions by Congress on the future of HIV/AIDS research. At Wednesday’s session, “The U.S. Congress and the Global AIDS Epidemic,” former Senate Majority Leader Bill Frist led a conversation with Sens. Chris Coons (D-DE), Mike Enzi (R-WY), Marco Rubio (R-FL) and Rep. Barbara Lee (D-CA), showcasing the past and future role of Congress in the effort to end HIV/AIDS.
During his tenure in the Senate, Frist played an important role in securing increased funding for global health initiatives. Throughout the panel discussion, the importance of bipartisan support and the value of research and development were repeated as key themes. As Lee pointed out, having AIDS2012 in DC has “helped to shed a global spotlight on a domestic epidemic,” noting that areas of the U.S. have HIV rates comparable to areas of sub-Saharan Africa. Washington, DC, itself is one example. Lee went on to note that in order to find a cure, resources and support for PEPFAR, the Global Fund and U.S. global health programs are vital.
Rubio noted that he has been pleasantly surprised by the bipartisan support he has seen in Congress concerning global health issues and emphasized that funding for global health and international development is not the cause of the budget deficit. Despite the perception of the public that the number is much higher, foreign aid comprises less than 1% of the U.S. budget.
“If you zeroed out foreign aid,” Rubio said, “it would do nothing for the debt, but it would be devastating not just for the world, but for America’s role in it.”
Concluding that research and development is the way to maintain support and move the HIV/AIDS field forward, Rubio emphasized the importance of developing more affordable, more effective medications, treatments and potential cures.
Following up on this theme, Coons called for continued support and investment in order to “innovate and cure our way out of this,” specifically pointing to vaccines as the future in HIV/AIDS research.
Capping off the conversation with some success stories from the field, Frist and Enzi recalled one of their first trips to Africa and the value of seeing firsthand the impact that antiretrovirals were having on the ground. Pointing to meetings with researchers on this trip, both Enzi and Frist reiterated the importance of investment in research in order to truly make a difference.
The panel discussion was interrupted by individuals advocating for increased rights for sex workers and the repeal of PEPFAR’s anti-prostitution funding restrictions. Regardless of one’s perspective on the impact of this disruption, it reinforces the strength of our nation’s democratic system and in no way compromised the strength of the panelists’ positive message about the importance of the federal role in advancing global health.
Tell your Member of Congress that research to combat HIV/AIDS, TB, malaria, neglected tropical diseases and other health threats here and abroad is an economic and humanitarian imperative by visiting our website.
When advocates speak with one voice, amazing things can happen. Here in the U.S., with help from high-visibility breast cancer advocates, the federal budget for breast cancer research has increased nearly eight-fold over a 20-year span. More recently, the National Alzheimer’s Project Act redoubles public efforts to find a cure for this devastating disease.
The fight against AIDS stands as perhaps the most telling example of the power of advocacy. The voices of so many, amplified by entertainment heavyweights, have helped shine a light onto efforts at combating the disease, from prevention to treatment.
Research, of course, plays no small part in either area, from the tantalizing goal of a vaccine to the antiretrovirals that have turned an HIV diagnosis from a death sentence into a manageable chronic disease. And one panelist at AIDS 2012 – going on this week in Washington, DC – sees research as an entryway into advocacy.
“Research is an opportunity to build sustainable advocates behind one voice for global health,” said Prince Bahati of the International AIDS Vaccine Initiative.
Research brings together diverse constituencies: It pushes the frontiers of scientific knowledge, it improves health around the globe and it positively affects local economies.
But one word in his statement is not to be minimized: “opportunity.” Research, and the people who perform research, cannot be the sole voice; instead, research becomes a gateway to help build out the advocacy community. A full – and full-throated – advocacy community has the chance to change the world.
Part of that diversity was on display all week at the conference: Veterans groups and faith-based organizations were among the constituencies represented.
Those many, diverse voices are needed now more than ever. The U.S. contribution to AIDS research is significant, but there are no priorities in the current political climate. Christine Lubinski of the Infectious Disease Society of America (IDSA) encouraged the audience to do its homework before meeting with congressional offices. She cited Research!America’s economic impact work, saying that we must try to demonstrate a domestic constituency for these issues, with U.S.-based research being a clear entry point. She also gave some words of advice for those who face policy makers that say our AIDS situation is leading us into a “treatment mortgage” for 30 years: It is actually a temporary bridge until research yields a vaccine. Congress used to have similar debates regarding polio and the “iron lung,” debates that evaporated when science produced a polio vaccine.
We also know that sometimes research has unexpected and multiple benefits for worldwide health. For example, AZT was developed to treat cancer. It failed in that regard, but federally funded scientists discovered that it works for HIV/AIDS.
Research and its advocates, as part of the larger advocacy community, have a clear role to play. Each voice adds to the chorus – and we’ve seen what those voices can do.
It’s time to find out where your congressional candidates stand on health research issues. Research!America has launched our award-winning voter education initiative, Your Candidates–Your Health 2012. This initiative gets candidates on the record with their views on health research and displays their responses to a questionnaire on our website.
We need your help TODAY to reach out to the candidates and ask them to complete this short questionnaire. Health and medical research are critical issues for our nation, and we must know where candidates stand. Send a message to the campaigns right away. Together, we can put the spotlight on health research in the 2012 elections. Like this alert on Facebook, like our Facebook page and share it with your networks.
The International AIDS Conference has been in town all week, stirring up community excitement, celebrity activism, political commitment and scientific progress for global health, specifically for HIV/AIDS. There is talk of achieving an AIDS-free generation.
“We can’t hope to eliminate AIDS in this country or around the world if we just tinker with one little problem or another timidly, at one time, if we let short-term thinking rule the day,” Sen. John Kerry (D-MA), chair of the Senate Foreign Relations Committee, told a packed room Monday. “Some will claim … that in the midst of a global economic crisis we don’t have the luxury of leading on this issue, that we ought to scale back PEPFAR, reduce U.S. support for the Global Fund. But what they ignore is that this is precisely the moment when our investment is most needed so that past investments are not lost, and we don’t slide backwards.
“So everyone knows that ending AIDS; not going to be easy, not going to be quick, not going to be cheap but we know now that it may be a huge effort or investment, but just like the eradication of smallpox, it’s an investment that is absolutely guaranteed to show enormous returns. It is also my friends, an inescapable test of our values as a nation, as human beings.”
Sen. Lindsey Graham (R-SC), a member of the Senate Appropriations Committee, also spoke.
“Now is not the time to retreat, now is the time to pour it on; money does matter. You have seen the benefit of the money being appropriated at Congress throughout the international community beginning to pay dividends,” Graham said. “Now is the time to focus on finding a vaccine like the future of the world depended on it.
“Part of what I am trying to do is encourage the international community and my government to have a vision very much like the [Bill & Melinda] Gates Foundation: Turn this into a business problem and solve it. It is a humanitarian exercise for sure; we all benefit when we do good things for those who are in need, but the opportunity to solve this problem exists now greater than ever.
Bill Gates spoke compellingly about the need for new tools and ultimately for a vaccine in order to seriously talk about moving towards the end of AIDS. He said that while we do not have the tools yet, we will get them if we stay the course in terms of research investments.
“The ultimate tool will be a vaccine. Scientists are making great progress, they understand the shape of the virus, how to count the antibodies … It is very exciting, and the U.S. government is by far the biggest backer, not only of these treatment things we have been talking about, but also all of these research programs. So, it is phenomenal to see that in that ongoing commitment.
“Earlier this year [the Gates Foundation] made a $750 million grant to Global Fund, but equally we support these research activities, so no one should think that we have got the tools yet. We will get these tools but only if we stay the course in terms of the scientific investments.”
Follow Research!America’s presence at AIDS 2012 through our Twitter feed https://twitter.com/ResearchAmerica.
The AIDS 2012 Conference is being held here in Washington, DC, this week. Research!America has been in attendance as well, and we’ve gathered some images from the global village and in different sessions to share with you.
Check back later in the week for more images from the conference!
A display from the Red Umbrella Project invites attendees to listen to the stories of sex workers.
Another display from the global village, which hosts art, workshops and seminars, all free to the public.
This sign, from an unidentified group, echoes a point Research!America makes in its advocacy.
Artwork is displayed in the global village.
This display is part of The Condomize Campaign; according to its website, the campaign works to reduce the stigma surrounding condoms and ensure global access to quality condoms and education. The campaign is an initiative of the United Nations Population Fund.
This session at the conference, titled “The Role of Faith-Based Organizations in Turning the Tide on the HIV Pandemic,” included (from left) Phramaha Boonchuay Doojai, a Thai monk; Kay Warren, wife of well-known pastor Rick Warren and cofounder of the Saddleback Church in Lake Forest, CA; McDonald Sylves Sambereka, an Anglican priest from Malawi; and moderator John DeGioia, PhD, president of Georgetown University.
Research!America’s mission statement mentions that we work to make “research to improve health a higher national priority.” Most often, that’s medical research, in all the varying forms that the term encompasses.
Agriculture research may seem to be tangential to research to improve health; but in truth, there are many shared goals: improving access to food for hungry populations here and abroad; prevention of foodborne illnesses, whether accidental or intentional; and eliminating childhood obesity.
Four thought-leaders in agricultural research will be discussing these goals and more in a webinar on Wednesday, July 25:
- Roger Beachy, PhD, former chief scientist at the Department of Agriculture;
- William Danforth, MD, chancellor emeritus of Washington University and chair of the Board of Trustees of the Donald Danforth Plant Science Center
- Carol Tucker Foreman, distinguished fellow at the Consumer Federation of America’s Food Policy Institute
- Donald Kennedy, PhD, president emeritus of Stanford University, former commissioner of the Food and Drug Administration and former editor-in-chief of Science
These four have also come together to form a new organization called SOAR (Supporters of Agricultural Research). SOAR’s goal is to increase support for investigator-initiated agriculture research grants; and, in the end, that helps the health of Americans and people around the world too.
The webinar will be held July 25 from 11 a.m. to 12:15 p.m. Eastern. Registration is required; to register, click here.
Research!America President and CEO Mary Woolley released a statement, saying that a House appropriations subcommittee bill places the health and well-being of Americans in jeopardy:
“How can Congress justify the elimination of a critical health agency and severe cuts to other programs under the House Labor-HHS-Education appropriations subcommittee bill? We cannot afford to zero out funding for the Agency for Healthcare Research and Quality (AHRQ) at a time when it is addressing medical errors that kill more than 100,000 people a year and accelerating patient access to the best medical practices. We cannot afford to slash the Centers for Disease Control and Prevention (CDC) budget when it barely has enough funds as it is to protect Americans against pandemics, bioterrorism, and outbreaks of dangerous and deadly infectious diseases. Unfortunately, the subcommittee started with a funding level that almost assured the measure released today. Fortunately, this is not the end game; there are more negotiations ahead, when, we trust, better decisions will be made.
“Essentially, the measure turns its back on the health and safety of Americans. As the House and Senate negotiate final spending levels for FY13, we hope that they will assign priorities with an eye toward assuring that we retain and sustain agencies that are well-respected by citizens and critical to improving the health and well-being of us all.”
The numbers were shocking, but they weren’t meant to be. Amir Attaran, DPhil, LLB, a panelist at Tuesday’s event at the American Enterprise Institute on poor-quality and fake drugs in emerging markets, reframed some statistics that had been discussed earlier.
What if, he said, 40% of the arriving flights at Dulles International Airport originated outside the U.S. and were unknown to air traffic controllers until each plane was on final approach? What if 7% of flights were using substandard engines?
Such statistics, of course, would be unacceptable to the American public and its government. But Attaran’s larger point was that we never have to worry about such things because there are policies, whether treaties or international organizations, that manage such regulation. Air traffic controllers are made aware of all inbound flights to the U.S., even for general aviation aircraft. And the European Union has banned hundreds of airlines for not meeting safety regulations.
That’s not the case with substandard or fake drugs.
Attaran, a professor at the University of Ottawa, said an international body to handle criminal conduct in the area of public safety is necessary before any substantive curbing of bad drugs can begin. For example, he said, if a resident of Canada exports fraudulent pharmaceuticals into the U.S., the Canadian government has no legal obligation to arrest the perpetrator. Until that happens, efforts to curb bad drugs are “extremely laudable but utterly unattainable,” he said.
But the problem of substandard and fraudulent drugs won’t merely be solved at the 30,000-foot level, as other panelists noted.
Patrick Lukulay, PhD, vice president of Global Health Impact Programs at the United States Pharmacopeial Convention, said poor regulation, an unmonitored market and an uninformed — i.e., unsuspecting — patient all add up to a deadly combination. And some problems aren’t even that broad; many companies mean no harm but lack the resources for quality control or proper equipment. Even, Lukulay said, installing air conditioners instead of air handling units represented a problem; air conditioners can carry particles to different areas and increase the risk of contamination.
Local health care delivery, legitimate and otherwise, may present a barrier also. Bernard Nahlen, MD, deputy coordinator of the President’s Malaria Initiative, noted that many areas affected by malaria assume that fevers equal malaria until proven otherwise. On a recent trip to Burma, Nahlen noticed local fisherman purchasing bags of pharmaceuticals (all of unknown quality) from salesman.
“These young men were at the mercy of itinerant drug salesmen,” Nahlen said, “and I think we can do better than that.”
Better oversight from non-governmental organizations would help too, said Richard Tren, co-founder and executive director of Africa Fighting Malaria.
There are reasons for hope, however. Andreas Seiter, MD, senior health specialist and expert in pharmaceutical policy and management at the World Bank’s Health, Nutrition and Population Anchor, noted a program in Nigeria that was able to reduce counterfeits and substandard drugs in urban areas. Scaling the program nationwide, at the very least, could “name and shame” bad operators but would cost $20 to $30 million. So far, only the U.S. has shown willingness to fund the program.
But several of the panelists agreed that local and national rules can only do so much. International mechanisms are needed most, and that starts with getting a consensus on what constitutes substandard drugs and what constitutes fraudulent drugs. Attiran recalled the Kyoto Protocol, which demanded that countries reduce carbon emissions by at least 6%; countries that wanted to do more were welcome to. Setting a reasonable floor — and the accompanying unlimited ceiling — would be a start, he said.
“The floor should be high enough that we’re comfortable” using those drugs, Nahlen said.
Last week, we noted the Centers for Disease Control and Prevention report about a spike in dengue cases in Puerto Rico. It’s just more evidence of what we’ve been saying all along: global health R&D matters for Americans, both in terms of health and economics.
And, this weekend, a story in the Palm Beach (FL) Post helped fortify that and another argument we make: Cutting research is not a deficit-reduction strategy.
According to reporter Stacey Singer, a CDC official warned the Florida Department of Health that Jacksonville was facing the worst tuberculosis outbreak the official had seen in two decades. But policy makers never got the message. They were too busy focusing on a restructuring – i.e., shrinking – of the Department of Health that Gov. Rick Scott (R) had signed into law only days earlier. Among that restructuring was the closing of A.G. Holley State Hospital in Lantana, located between West Palm Beach and Boynton Beach on Florida’s Atlantic coast. Holley had experience treating TB cases for more than 60 years.
Apparently unaware of the CDC report, the Department of Health mandated that Holley be closed six months ahead of schedule.
Now, as many as 3,000 people may have been in close contact with contagious people, yet only 253 have been tracked down. And TB has begun popping up in other parts of the state, including Miami.
The story notes State Rep. Matt Hudson (R-Naples) – the “champion of the health agency consolidation,” according to the story – said he too was unaware of the CDC report but promised that funding would be made available to treat those who were infected.
And it’s also left the local health department in a bind. Robert Harmon, MD, MPH, director of the Duval County Health Department, noted that in 2008, his agency had 946 employees and a $61 million budget. Today, there are 700 employees and a $46 million budget. If he can find $300,000, Harmon plans to hire experts to track down the thousands of others who may be unknowingly affected.
The story notes that a person with uncomplicated TB needs a months-long course of drugs to defeat the disease, which costs around $500. Not sticking to the course can and often does result in drug resistance.
“However,” Singer writes, “the itinerant homeless, drug-addicted, mentally ill people at the core of the Jacksonville TB cluster are almost impossible to keep on their medications.”
The cost of treating drug-resistant TB? $275,000.
Research!America’s recent event in Houston made the point that global health concerns are also American concerns, and neglected tropical diseases don’t merely reside in the tropics. They’re in Texas too.
More evidence came to light yesterday through a startling report from the Centers for Disease Control and Prevention. It found that, in recent weeks, dengue cases in Puerto Rico are trending well above the threshold to be considered an epidemic. In the past two weeks alone, 228 suspected cases were reported, bringing the 2012 total to 2,101. Twenty-one percent, or 446, were confirmed as dengue by lab analysis and – thankfully – only eight have been classified as the more serious dengue hemorrhagic fever. Also, thankfully, no one has died.
According to the Associated Press, Puerto Rico’s health secretary, Lorenzo Gonzalez, MD, said that the rate of reports may be increasing because doctors are better able to identify symptoms.
But late June and early July are the low point of the year for dengue cases reported, according to a chart in the CDC’s Dengue Surveillance Weekly Report. But for the rest of the summer, they’ll begin climbing until reaching the peak in October.
If Puerto Rico still seems too disconnected and remote, consider this: Puerto Rico has three airports with direct service to the U.S. Those three airports combine to send at least 83 flights to the U.S. mainland each day. Those flights go to Atlanta; Baltimore; Boston; Charlotte, NC; Chicago; Dallas/Fort Worth; Fort Lauderdale, FL; Hartford, CT; Houston; Jacksonville, FL; Miami; New York; Orlando; Philadelphia; Tampa; Washington, DC; and West Palm Beach, FL. Many of those aircraft continue on to western destinations too, including Los Angeles.
(Depending on the day, it could be more than 83; we crafted our numbers from the timetables of seven different airlines, none of which are standardized. But we tried our best to count only those flights coming to the mainland at least six times a week.)
Even in the low season, that’s a lot of chances to spread dengue to a place that isn’t expecting to see it.
Global health R&D protects the health of Americans, and that’s why it’s important.
Research!America’s report on sequestration detailed the devastating impact that the sequester, or across-the-board cuts that are scheduled to take place in 2013, will have on federally funded research to improve health. Now, a recent report by amfAR trains the focus of sequestration on global health.
Just as we found, amfAR reaches the same conclusion: Sequestration isn’t worth the cost.
The cuts would save $689 million — or 0.63% of the required deficit reduction for FY13. And at what cost?
- HIV/AIDS treatment for 273,000 fewer people, potentially leading to 62,000 more deaths
- Malaria treatment for 3.7 million fewer people, potentially leading to nearly 6,000 more deaths
- TB treatment for 65,000 fewer people, potentially leading to 8,000 more deaths
- Reduced funding for the GAVI Alliance, potentially resulting in 13,000 more deaths from diptheria, tetanus, pertussis, hib and hepatitis B
That’s hardly all. Besides an increase in the death rate, critical interventions will never get a chance to prevent disease: antiretroviral drugs that prevent transmission of HIV from a pregnant mother to her child and insecticide-treated nets to prevent bites from malaria-infected mosquitoes.
And that has consequences further down the line, the report notes.
“The savings achieved in across-the-board cuts in global health funding will have a negligible impact on deficit reduction,” the report states, “but will adversely affect the lives of millions of men, women and children worldwide, resulting in substantial human suffering and squandering of opportunities to build on successes in U.S. global health programming.”
Your voice can make a difference, however. Click here to contact your representatives, and tell them that sequestration is an unacceptable outcome.
amfAR is a Research!America member.