Shortfall of Global Fund pledges imperils future scale up

The outcome of the Global Fund Replenishment meeting this week disappointed many. While it appears that the Fund might have enough to finance Round Ten, the next round of grant making, it is hard to see how it will be able to approve new grants that gain the approval of the Technical Review Panel.  That means a massive slowdown in the pace of the expansion of health programs, unless more pledges come in, a situation that was discussed this week on NPR’s Tell Me More.

In the lead up to the meeting, advocates in developing countries put together a smart new video calling on the donors to keep their promises:

Since the Fund is the main source of funding to address TB, including drug-resistant TB, the shortfall is especially worrisome. 

U.S. pledges $4 billion to Global Fund, pushes for reform

In a much anticipated announcement during the Replenishment Conference in New York on Monday and Tuesday this week, the Obama Administration revealed a $4 billion pledge to the Global Fund to Fight AIDS, Tuberculosis and Malaria over the next three years.

Ambassador Goosby prepares to testify last week at a hearing on PEPFAR in front of the House Foreign Affairs Committee.

U.S. Global AIDS Coordinator Eric Goosby, MD, spoke to reporters Tuesday morning about the administration’s support for the Global Fund, emphasizing a firm call to action that the Fund make much-needed reforms to ensure investments and expanded ability to save lives.

“The $4 billion over three years represents a 38 percent increase over the preceding three years,” Goosby said. “That’s by far the biggest increase of any donor nation this year.”

Goosby outlined three goals for the U.S. pledge to the Global Fund that “would allow the Fund to do its job and do it better:”  to drive needed reforms and ensure smart, effective investments are being made utilizing an action agenda that includes clear timelines; to leverage other donor nations to make pledges; and to show continued U.S. leadership and commitment to saving lives.

FDA awards nearly $3 million for TB research

The U.S. Food and Drug Administration (FDA) announced $2.9 million to support six research projects related to the diagnosis, treatment and prevention of tuberculosis on Monday.

This investment is a component of the FDA’s Critical Path Initiative (CPI)—a national strategy for transforming the way FDA-regulated products are developed, evaluated and manufactured.  FDA launched the CPI in 2004 to address the decline in the number of innovative medical products being submitted for approval. One of the areas of CPI focus is new efforts to help meet unmet global public health needs.  Beginning in 2010, CPI launched a new project aimed at enhancing the development and availability of diagnostics and therapies for tropical diseases, especially tuberculosis.

On March 19^th, FDA Commissioner Hamburg and others announced a new collaboration to accelerate the development of combination treatments for tuberculosis.   (See March 19^th post—Public and Private Sector Partners Help to Jump Start Development of New TB Drug Combinations).

Monday’s announcement includes grant awards made in the areas of TB vaccines, drugs and diagnostics.

Hearing rebuts myths about PEPFAR’s impact

Critical questions surrounding the performance and future of the President’s Emergency Plan for AIDS Relief (PEPFAR) were publicly aired last week at a full-committee House Foreign Affairs hearing.

Government witnesses included U.S. Global AIDS Coordinator Eric Goosby, MD; head of the National Institute of Allergy and Infectious Diseases Anthony Fauci, MD; and Director of the Centers for Disease Control and Prevention Thomas Frieden, MD. (click on links to view testimony).

Drs. Eric Goosby (left), Thomas Frieden (center) and Anthony Fauci testify in front of the House Foreign Relations Committee.

They presented detailed updates on PEPFAR and U.S. backing for the Global Fund, while civil society witnesses, Ms. Paula Akugizibwe of the AIDS & Rights Alliance of Southern Africa and Wafaa El-Sadr, MD, of Columbia University’s International Centers for AIDS Treatment and Prevention Programs (ICAP), each gave an impassioned plea for greater financial support in the run up to this week’s Global Fund Replenishment meeting.  Dr. El-Sadr sits on the Center’s Scientific Advisory Committee.

A notable feature of the U.S. government’s testimony was the strong endorsement of the role of treatment in preventing new HIV infections.

What We’re Reading

3pm – Just announced: The U.S. National Institutes of Health (NIH) is now the first patent-holder to share intellectual property with the Medicines Patent Pool. The pool is a recently-established initiative – funded by UNITAID – to expand access to treatments in developing countries. The announcement is here.

Ken Mayer – co-chair of the Center’s Scientific Advisory Committee – has a review article on the use of antiretroviral therapy (ART) as HIV prevention in this month’s issue of the American Journal of Public Health. In it, he and co-author Kartik Venkatesh, PhD, discuss the status and prospects for successful use of ART in decreasing HIV transmission globally.

Plan USA released the video above as part of its “Because I Am a Girl” campaign, which focuses this year on how the digital world impacts women and girls. Kate Darlington gives a good overview of the report and campaign at Change.org, relating it to the increasing focus on women and girls as the key to reducing poverty and disease. The report, called “Digital and Urban Frontiers: Girls in a Changing Landscape,” is available through Plan USA [PDF].

HIV infection in Ukraine continues to spread, with the government doing little to intervene. David L. Stern at GlobalPost writes that the ex-Soviet republic has an estimated 360,000 people living with AIDS or HIV.

CAPRISA researchers – who released news of a groundbreaking vaginal gel that would give women the power to protect themselves from HIV this summer – are struggling to find funding

2nd Global Forum on TB Vaccines concludes, looks to the future

The following post is by Annmarie Leadman, Director of Communications at the Aeras Global TB Vaccine Foundation and Babs Verblackt, Associate Communications at TuBerculosis Vaccine Initiative – TBVI.

Christine Sizemore of the U.S. National Institutes of Health called on the TB vaccine research field to challenge dogma and to think outside the box as scientists and researchers move into the next generation of TB vaccine development.  Her sentiments echoed a common theme on the final day of the 2^nd Global Forum on TB Vaccines in Tallinn, Estonia as more than 200 participants from 31 countries brought the meeting to a conclusion. 

Moving forward toward a common agenda, attendees identified priorities for the next decade, the foundation for a revised Blueprint for TB Vaccines that will be developed over the next year.  The Blueprint will serve as a TB vaccine guidance document defining the critical challenges for basic research, product development, manufacturing and clinical development, and will lay the groundwork for rapid uptake and adoption of a new TB vaccine when licensed.

Live webcast of hearing on PEPFAR – Wednesday Sept. 29

Wednesday morning, September 29, the controversy over the Obama approach to funding AIDS programs will get a full airing during a congressional hearing on U.S. global AIDS policy. 

At 9:30 a.m., the House Committee on Foreign Affairs will hold a hearing entitled “PEPFAR: From Emergency to Sustainability and Advances Against HIV/AIDS,”  in room 2172 of the Rayburn House Office Building.

Be sure to tune in to the live webcast Wednesday at 9:30am ET! 

A number of tough issues will be discussed, including how countries will be able to expand access to prevention of mother to child transmission if major donors slow down the pace of their aid.  One of the witnesses, Paula Akugizibwe of the AIDS and Rights Alliance of Southern Africa (ARASA), has emerged as a young, eloquent leader of civil society in Africa.  She has made a priority of defending human rights, combating stigma about AIDS and TB, and calling on both African and donor governments to keep their promises. 

Wafaa El-Sadr, MD, MPH, director of the International Center for AIDS Care and Treatment Programs (ICAP) will be speaking as a major PEPFAR implementer.  She will be discussing how AIDS programs are essential for better maternal and child health. Dr. El-Sadr serves on the Center for Global Health Policy’s Scientific Advisory Committee.

The first panel of witnesses will include U.S. Global AIDS Coordinator Eric Goosby, MD; Director of the National Institute of Allergy and Infectious Diseases Anthony S. Fauci, MD; and Director of the Centers for Disease Control and Prevention and Administrator of the Agency for Toxic Substances and Disease Registry Thomas Frieden, MD. 

You can watch the hearing live on this website (look to the lower left of the page). Please note that the recording of the hearing will not be archived, it will only be posted for live viewing.

The written testimony will also be posted on the House Foreign Affairs Committee website. 

The Global Health Council submitted questions to the committee on behalf of its membership, highlighting key issues to keep track of during the hearing including prevention of mother-to-child transmission and violence against women and girls.

Clinical research fellows educate lawmakers on value of global HIV/TB programs

Eleven current and former Fogarty International and Doris Duke clinical research fellows made their way to Capitol Hill Thursday for congressional office visits with key legislators.

Four Fogarty fellows and the Center's Christine Lubinski meet with a staff member from the Senate Foreign Relations Committee.

The Center for Global Health Policy staff escorted the group to meetings with the offices of 15 policymakers. The fellows highlighted their research experience abroad through the Fogarty and Doris Duke programs, the first of which is funded through the National Institutes of Health, emphasizing the value of U.S. investment in global HIV and tuberculosis programs.

The Fogarty International and Doris Duke clinical research fellowships send medical students and young physicians with an interest in global health to sites in the developing world to perform a year of hands-on clinical research training. The U.S. fellows who participated in the Hill visits had spent their year abroad either in Uganda, South Africa, Thailand or Malawi. Their research projects ranged from monitoring antiretroviral treatment adherence among female South African patients with the use of text messaging and SMS, to evaluating treatment outcomes for Kaposi’s sarcoma patients undergoing combination chemotherapy for advanced or persistent disease in Malawi.

The Fogarty program, which started in 2003, uses what is called “twinning” to match the visiting U.S. scholars with in-country medical students and physicians, helping the fellows to integrate into the system more quickly.  Four foreign nationals joined in the day of Hill meetings. These fellows hailed from South Africa, Kenya, Zambia and Peru.

The scholars brought various issues to the table when meeting with legislators, like the linkages between HIV and cancer risks and the impact of HIV on maternal and child health.. They also spoke about the intrinsic value of international physician fellowship programs, which support U.S. foreign assistance by increasing the training of in-country physicians and building health infrastructure abroad. They also support the treatment and research education of U.S. doctors that take what they learn abroad and bring it back to improve patient care in the U.S., including a new awareness of how to treat refugees and new immigrants from other countries.

“These experiences broaden how doctors will approach patient care and the ethos of training,” said Doris Duke fellow Andrea Dean, a medical student at Brown University who spent her fellowship year in South Africa.

TB vaccine advocates assess efforts to raise TB vaccine support

The following post is by Annmarie Leadman, Director of Communications at the Aeras Global TB Vaccine Foundation, and Babs Verblackt, Associate Communications at TuBerculosis Vaccine Initiative – TBVI

Knowledge about the global tuberculosis epidemic is misunderstood and will only change with greater understanding of the disease, said TB advocates during a facilitated discussion on TB vaccine advocacy September 24 in Tallinn, Estonia, part of the 2^nd Global Forum on TB Vaccines.  Advocates and researchers discussed methods to reframe the issues for donors and stakeholders to significantly increase general support and funding for TB vaccine research.

Sixty-one percent of the TB vaccine funding pool comes from The Bill & Melinda Gates Foundation, according to Claire Wingfield, TB/HIV Project Coordinator of the Treatment Action Group (TAG).  Her organization publishes a report called “Tuberculosis Research Funding Trends,” the second edition was published last year. The first TAG funding report called for an increase in TB research and development spending to $2 billion per year to eliminate TB by 2050. “We need to diversify the funding pool,” Wingfield commented. “Basic research and operational research are woefully under funded.”

“The major misconception

What We’re Reading

The ONE campaign has launched a campaign to ensure that by 2015, no child is born with HIV (campaign video accompanies this post). Erin Hohlfelder has a great post on the ONE blog explaining how we can accomplish that goal.

Alanna Shaikh discusses the “corporatization of global health” on the End the Neglect blog this week. Prompted by a session at the Clinton Global Initiative,