The support and investment of the United States has been responsible for some of the most groundbreaking and historic health milestones in the world. The National Institutes of Health (NIH) has led to highly effective treatments, such as of life-saving antiretroviral therapy and pre-exposure antiretroviral prophylaxis, turning a fatal infection into a chronic, manageable one in many places. Millions of lives have been saved by implementing those scientific advances through the US President's Emergency Plan for AIDS Relief (PEPFAR) and The Global Fund to Fight AIDS, Tuberculosis and Malaria, including the elimination of mother-to-child HIV transmission in several countries. These incredible achievements have positioned the US as a global leader in aspirational and innovative approaches to human health, garnering respect and gratitude from the world.
Today, potentially historic gains against HIV are within our grasp, including the possibilities of an HIV cure, a preventive vaccine and long-acting antiretroviral regimens. Yet, the US President’s first budget proposal threatens to slash support for the necessary life-saving scientific research that would get us there. This is not the time to pull back, but to put our foot on the gas to advance research and scientific discovery, as well as the delivery platforms, systems, and partnerships to make the research meaningful to reach the people who need it.
To generate the tools we need to save lives and tackle the health issues we face today, the NIH needs to be secure in its funding to make new commitments for multi-year research grants. The proposed 18% cut to the NIH budget – which includes the elimination of the NIH’s Fogarty International Center – would prevent the awarding of new grants and cripple important research endeavours. The budget savings from elimination of the Fogarty Center will be minimal – representing only 0.1% of the NIH budget – but the costs will be staggering, depriving the world of new generations of researchers who would undertake studies of vital importance.
To better understand the full ripple effects from the US funding cuts, we talked to three IAS Members and leading scientific researchers. Here is what Rochelle Walensky had to say…
Rochelle Walensky is professor of medicine at Harvard Medical School and a practising infectious disease physician at Massachusetts General Hospital and Brigham and Women's Hospital. Rochelle’s research interests focus on model-based analyses of the cost-effectiveness of HIV testing, care and prevention strategies to inform HIV/AIDS policy internationally and domestically.
This is unlike financing other diseases because this is a transmissible disease, and so the control that we have seen so far could really take a reverse course if we are not careful. I think that the infrastructure that HIV has forced us to create and the attention that this disease has resulted in have led to benefits that are far beyond just HIV itself. There are many dimensions of HIV programmes; some are keeping patients alive, some are keeping parents alive so that these countries are not financing orphans, and some of it is for political and social stability. There are studies that have documented that the labour force is stronger in PEPFAR countries versus non-PEPFAR countries. Or, for example, that there is political stability and absence of violence in PEPFAR countries versus non-PEPFAR countries, or that there is more rule of law. It is not necessarily just about health; there is a lot of motivation around this to do it for the stability of nations.
"In the HIV world, HPTN 052 demonstrated once and for all in a very large multisite, multi-country trial that was funded by the NIH: if we give treatment to people, their partners will not get infected. I was a beneficiary of NIH funds related to that trial, and we demonstrated that the intervention in some situations could actually save money and, in other situations, would be very cost effective in very resource-limited nations like India. With those studies, the guidelines changed. What we do in medicine for people, what we recommend, changed because of the results of those studies."
In the international health space, we know for certain that there will always be another infectious disease outbreak and that if we don’t have either the clinical manpower or the research manpower to understand these diseases and keep them at bay, we are going to have many problems to come.
Airplanes move, diseases move, and I don’t care how tall you want to build your wall; you’re going to get diseases that cross it. We need people to understand these diseases, to understand how they are transmitted, and that requires study. If you can’t understand diseases internationally, then you certainly will not understand them when they reach your homeland.
Note: this interview has been edited for length.