Expanding tropical disease R&D, control and elimination efforts:
A proposal for US foreign policy in fiscal year 2011 towards the worlds poorest.
Michael Oscar Harhay
April, 2009
Abstract:
In public health, the budget is the policy document, and in this respect the United States
(US) has virtually none for the neglected tropical diseases (NTDs). This is both surprising
and myopic given the heavy investment in global health and development by the US [e.g,
President's Emergency Plan for AIDS Relief (PEPFAR), US President's Malaria Initiative
(PMI), US Agency for International Development (USAID)]. In the following, I review
and propose a renovation of disease focus and financial allocation based on the US Fiscal
Year 09 (FY09) international affairs budget onto the NTDs as a tool for diplomacy and
increased efficiency of existing partnerships and initiatives to which the US invests.
Indeed, Harold Varmus, Co-chair of President Obama’s Council of Advisers on Science
and Technology has recently called for a major investment in tropical infections as a tool
for American diplomacy in March 2009. Further, diverse foundations for medical
diplomacy have already been established through a number of PEPFAR, USAID, and
PMI recipient countries.
Recognizing the recent social and political trends, the following is a consolidation,
review, and proposal meant to stimulate action and dialogue around the NTDs as the time
for the 2011 budget begins to be articulated and President Obama continues to fill the
senior health posts in his administration. The proposal is to allocate, beginning in 2011, a
10-year, three-fold expansion of the NTDs budget, based on the FY09 budget, which
currently poses 350 million for NTD programs. In this proposed framework,
approximately 15% of the existing (FY09) international affairs health program budget, or
1.065 billion dollars yearly would be devoted to the expansion of stand alone control
programs as well as research towards, and actual integration of the helminthic NTD
control programs into existing HIV/AIDS, Malaria and TB control initiatives. Significant
supplemental resources for new and improved therapies, vaccines, and therapeutics for all
the NTDs with specific focus on the protozoan kinetoplastids and bacterial infections are
included. Additional support will be devoted to bolstering drug supply chains (access to
essential medicines) and health infrastructure, as well as human resources and research
capacity. When combined with the poverty [which the NTDs are heavily responsible for
sustaining] alleviation monies of FY09, this equals ~%4 of the total US FY09
International Affairs Budget, a relatively small marginal cost given the potentially
profound return on investment. The FY10 budget, still under consideration by the US
Government, but as proposed by President Obama, offers a 9.5% increase to the
International Affairs budget to 53.8 billion. If this allocation remains unchanged, the
following would require ~2% of the FY10 budget. When viewed as a tool for foreign
policy and defense, this percentage of the budget, of course, becomes even smaller.