Q&A: Why the US should invest in global health innovation — for its own sake

Chagas disease — a debilitating disease caused by a parasite in the feces of the Triatominae, also known as kissing, vampire or assassin bugs — is a neglected tropical disease, a term for diseases that affect the poorest communities in the world. But this disease, endemic in rural areas of Latin America, also currently infects 300,000 people in the United States. In addition to the impact on people who become infected — including an acute phase, which usually occurs unnoticed, and a chronic stage, which develops over many years and can include intestinal and cardiac complications — the disease costs the U.S. economy an estimated $900 million annually. There were many surprised looks in the audience when panelists mentioned the prevalence of Chagas disease in the U.S. at a global health event on Thursday in Washington, D.C. The discussion was organized by the Global Health Technologies Coalition, 25 nonprofit organizations advocating for research and development for new drugs, vaccines, diagnostics and other global health technologies to coincide with the release of a report called “Return on innovation: Why global health R&D is a smart investment for the United States.” Following the event, Devex spoke with Jamie Bay Nishi, director of GHTC, about takeaways from the report and how they will inform the organization’s advocacy efforts. The conversation has been edited for length and clarity. GHTC looks at all of the federal agencies leading the U.S. effort to support global health R&D, from the Department of State to the Department of Defense. This report helped me to understand the unique contributions each of those agencies makes. What were the key takeaways for you and how will they inform your work? It’s pretty impressive to see how much the U.S. has achieved with relatively little. One-tenth of 1 percent of U.S. GDP has advanced these 42 new technologies and 128 products in late stage development since 2012. That’s pretty amazing. Those technologies are saving millions of lives. That’s the top priority and it is going to continue to be the top priority. But in addition to that, we wanted to look at the impact in the U.S. So that $14 billion of U.S. government investment between 2007 and 2015 has created 200,000 new jobs and generated an additional $33 billion in economic output. We have this data to demonstrate how supporting global health R&D is not funding that’s going into a black hole. That $14 billion is going into job creation within U.S. agencies and generating opportunity from the grants that come out of those agencies. The takeaway here isn’t that it’s all about America. But you’ve got this really interesting example that can serve as an example for other countries. As they look at strengthening their health systems, if they’re able to invest in global health R&D, it’s not only going to protect their own lives, but it’s going to create jobs. It’s going to support their economy. Our original mission was how do we support the global health R&D ecosystem, with a particular focus on the U.S. From day one, our efforts have been focused on advocacy around U.S. government investment in global health R&D. How do we ensure that there is sustained funding, programs and infrastructure to support this research? And we track that from a whole-of-government perspective. So when we look at this report coming out, this data is the backbone of a lot of our advocacy efforts. To be able to go to the Hill and really illustrate for policymakers the benefits — not just the lives saved, but also what your constituents should care about. It’s really to sell domestically some of the global development and global health work that needs to get done out there and this is a great way we can connect those dots. The report explains that in 2015, more than one-quarter of U.S. government funding for R&D was for basic research. The National Institutes of Health contributed to more than half of the 42 new global health technologies developed with U.S. government support, yet its focus is on basic research, which by definition is not about advancing a particular product. How do you make the case for U.S. government funding for basic research as compared to other investors in this space? The big reason is market failures. You’ve got a lot of private industry with the technical expertise to advance this research but they don’t have the market incentives to. Why should they invest 10 or 15 or 20 years to advance a drug or vaccine when there’s no profit incentive or no market mechanism? In our community, we often talk about this as the valley of death. How to get things from basic research through that translational science phase — which is the phase we’re talking about when we say the valley of death — to something that is late stage product development? NIH is critical in advancing that work but it’s not just NIH directly. One of the statistics in the report is for every dollar NIH spends on basic research it generates an additional $8.38 of industry investment. We talked a bit today about the role of NIH and how NIH is able to start a lot of basic research and show that certain areas have promise. Let’s talk a bit more about the event. You included someone from the Center for Strategic and International Studies, someone from Johnson & Johnson, and someone who worked on global health security and biodefense for former U.S. President Barack Obama. What was your strategy? For me, I was looking for three things. I wanted somebody who could speak to a whole-of government approach to global health R&D as opposed to having just worked at one agency. I wanted somebody who could look at the whole global health system and global health community and connect the dots of why R&D matters to the broader community. And I wanted a private sector voice because part of the research is talking about the power of U.S. government investment and how that is a catalyst for private sector investment. Dr. Elizabeth Cameron, both in her previous role at the National Security Council and in her new role at the Nuclear Threat Initiative, is really leading a lot of the dialogue on the global health security agenda. So I wanted to make sure that when we think about pandemic preparedness, for example, her voice is represented. And Jami Taylor from Johnson & Johnson talked about the power of U.S. government incentives to bring private industry to be at the table. She mentioned, for example, the U.S. Food and Drug Administration’s priority review vouchers, which fast tracks review for drugs or vaccines that impact a high population where there isn’t an existing drug on the market. Global health security is U.S. security. We got a lot of surprised looks today when we mentioned that over 300,000 Americans are infected with Chagas disease and that it’s costing the U.S. $900 million a year. People might have historically thought, “Oh, that’s a Latin American disease. It’s not a problem for us. Why do we have to worry about it?” But we’ve got dengue. We’ve got tuberculosis. We’ve got HIV. We’ve got a lot of diseases here in the United States. So we’re also making sure that we’re connecting those dots. Can you talk about the connection between this report and advocacy efforts? From today’s event launch, and some of the media interviews I’ve done this week, there was a big assumption that GHTC decided to produce this report because of the current administration, and that is incorrect. This actually builds on some research that we had started for a 2012 report that looks at the U.S. impact of global health R&D investments by the U.S. government. One of the charts we showed today was a trend line of how funding has been on the decline. If you put aside emergency supplemental funding for Ebola and Zika, investment in global health R&D from U.S. government has declined since 2007. So this isn’t a Trump administration story. This is something that was concerning us even in the Obama administration. And discussions about this report were started before the presidential election. From GHTC’s perspective, regardless of who is in office now, this report was going to come out and focus on this economic and job creation argument within the U.S. Certainly it’s helpful to have the data now and we’re working on our advocacy efforts to make sure there’s sustained funding as we talk about FY18 and even FY19 within U.S. government. One of our next steps at GHTC is doing some initial analysis based on the data in this report to build out some state-based fact sheets. What we’re looking to do is, at a state-by-state level, to tell this story. So to be able to go to a representative from North Carolina or pick a state and say: “These are the research institutions within your state and therefore create jobs and support the economy of your state. Here are the federal agencies that have offices and research labs set up within your state.” And really be able to connect that so it’s not this idea that global is out there, and it doesn’t affect us, but it’s showing how this impacts constituents at a state by state level. Editor’s Note: Jamie Bay Nishi previously worked for Devex, but left for GHTC in February 2017. Read more international development news online, and subscribe to The Development Newswire to receive the latest from the world’s leading donors and decision-makers — emailed to you free every business day.