The Joe Biden-Kamala Harris administration and its allies in Congress have already posted an impressive track record of early efforts to revive and champion U.S. leadership in global health. The American Rescue Plan, proposed by President Biden in January and passed in March, includes significant emergency funding to support the international COVID-19 response through initiatives like the Global Fund to Fight AIDS, Tuberculosis and Malaria; a multilateral vaccine development partnership; the President’s Emergency Plan for AIDS Relief; and global health programs at the US Agency for International Development (USAID). 

America’s shift to tackle COVID-19 beyond our borders cannot happen fast enough. 

Every day, this depressingly unyielding pandemic serves up reminders of not only the power of biomedical research and development (R&D) to deliver amazing innovations—several vaccines developed and deployed in just over a year—but also of the shocking disparities in gaining access to them. Low- and middle-income countries, despite being home to 85% of the global adult population, account for only 49% of COVID-19 vaccine doses administered worldwide.

With awareness of the importance of global health R&D at an all-time high—and global health champions now aligning to pull levers of power at both ends of Pennsylvania Avenue—policymakers have an opportunity to provide investments and reforms that can help us emerge from the pandemic primed to conquer a number of stubborn global health foes. Seizing this moment will involve building on the successes of the last year and learning from the failures.

As Congress and the administration get to work on the FY2022 federal budget, here are six things they can do to provide much better protection from enduring and emerging global health threats for hundreds of millions of Americans and for billions of people around the world.

1. Double Funding for Global Health Programs at USAID. From these increases, USAID should set minimum funding targets for the agency’s R&D work, establish a new chief science and product development officer position and create a $200 million USAID Grand Challenge for health security. USAID is the only U.S. agency with a mandate to focus on global health and development. Yet despite its track record of delivering high-impact health innovations, funding for global health R&D has waned in recent years and the agency’s unique capabilities have been underutilized and underfunded as part of the US government’s COVID-19 response. The American Rescue Plan includes funding that recognises USAID’s importance in combating COVID-19 and advancing global health. We need to build on this progress.

2. Increase Support for the Centre for Disease Control and Prevention – especially for its Centre for Global Health, the National Centre for Emerging and Zoonotic Infectious Diseases, and the Division of Tuberculosis Elimination and its Tuberculosis Trial Consortium. These programs have been operating on tight and relatively stagnant budgets even before COVID-19 diverted critical resources and expertise.

3. Provide Targeted Funding for Product Development and Translational Research Lacking Commercial Interest.

There is also a need for steady funding increases at the Fogarty International Center and sustained growth for the National Institute of Allergy and Infectious Diseases and the Office of AIDS Research. The National Institutes of Health’s high-profile work in confronting COVID-19 has highlighted the importance of past investments. But the pandemic also drained dollars and diverted talent from non-COVID priorities.

4. Establish a Permanent Funding Line at the Biomedical Advanced Research and Development Authority (BARDA) of at least $300 million annually to support work on emerging infectious diseases—a category of which COVID-19 is a high-profile, but not singular, example. Despite its proven value in dealing with a range of threats, BARDA has been overly reliant on “one-off” emergency supplemental appropriations for threats like Ebola and Zika, leading to dangerous gaps in its portfolio when limited funding runs dry. BARDA should also expand its research on antimicrobial resistance (AMR) to include drug-resistant tuberculosis (TB), which is a major health security threat to the United States. 

5. Protect Department of Defence Programs Focused on Malaria and Other Parasitic Diseases, TB and AMR. There have been internal proposals to potentially eliminate DoD’s malaria research programs, which would scuttle decades of progress achieved via research at the Walter Reed Army Institute of Research and the Naval Medical Research Center—despite malaria remaining a leading threat to U.S. troops deployed abroad. DoD’s efforts to develop new treatments for drug-resistant pathogens, which include dangerous strains of TB, are also essential to achieving global health security.

6. Increasing Support for Key Multilateral Initiatives, like the Coalition for Epidemic Preparedness Innovations (CEPI). Formalizing U.S. support for CEPI and committing at least $200 million annually would provide a much-needed boost to an initiative dedicated to developing vaccines against epidemic threats and making them globally accessible—but first, the U.S. should provide CEPI with $300 million of the global health funding just passed in the American Rescue Plan to boost its work on COVID-19. Also, Congress can support efforts at the Food and Drug Administration to provide technical support to under-resourced regulatory authorities around the world, which could accelerate access to a range of biomedical advances.

Together, these six recommendations can form the core of a broader effort to supercharge America’s global health R&D capabilities. Whether the motivation is to protect Americans from threats that have no respect for geography, to advance health equity around the world, or somewhere in between, the United States must take decisive action to resume its leadership in global health R&D.

Jamie Bay Nishi is director of the Global Health Technologies Coalition (GHTC), a coalition of more than 30 nonprofit organizations, academic institutions, and aligned businesses advancing policies to accelerate the creation of new drugs, vaccines, diagnostics and other tools that bring healthy lives within reach for all people. For more information, read GHTC’s agency-by-agency blueprint for supercharging global health R&D: Meeting the moment, fueling the future: Policy recommendations for a new era of US leadership in global health R&D

Image Credits: Global Health Technologies Coalition.