90% of rich countries' global health R&D goes to domestic institutions

A new report has found that the majority of funding for global health research and development is flowing to high-income countries. The report titled “The ripple effect: How global health R&D delivers for everyone” makes the case for governments to sustain such investments amid shrinking donor aid budgets. But it also illustrates the need to diversify funding to help develop local infrastructure and systems in low- and middle-income countries. Investments in R&D lead to innovations that save lives globally, from vaccines that protect against COVID-19 and malaria to treatments for river blindness and Ebola. Between 2007 and 2023, data from Impact Global Health, the research and policy organization that published the report, show $71 billion, or 66%, of the total funding for global health R&D came from 44 high-income countries. While a large part of that was spent on neglected diseases (63%) and emerging infectious diseases (33%) affecting LMICs, about 90% of the $71 billion funding went to domestic institutions in high-income countries, such as universities, government agencies, and nonprofit organizations. Only about 10% of the funding from high-income countries went directly to LMICs, such as Brazil, Costa Rica, Gambia, Peru, South Africa, and Uganda. The report provides several reasons why the flow of funding is so heavily concentrated in high-income countries. It argues that many of the institutions in these countries already have the infrastructure and track record to receive and manage large public grants, but also that donor countries’ procurement rules, reporting standards, and eligibility requirements often work in favor of these institutions. Funding from the United States, the United Kingdom, and the European Commission, for example, often requires or promotes collaborations involving a researcher based in a high-income country. These investments are projected to have significant economic returns for high-income countries themselves. The report finds that the U.S. is expected to generate $387 billion in economic impact from its R&D investments, while investments made by EU member states and the European Commission are projected to have an economic impact of almost $58 billion. It also created jobs and helped crowd in private sector capital in high-income countries. The investments have led to innovations that benefit both high-, low-, and middle-income countries. The AS01 adjuvant, a type of compound that boosts vaccine effectiveness, which was developed by GSK for the RTS,S malaria vaccine, is now used for the shingles and respiratory syncytial virus vaccines that are approved in many high-income countries. Vanessa Candeias, strategy and external affairs lead at Impact Global Health and coauthor of the report, told Devex it is critical to highlight the benefits to high-income countries to make the case for continued investments in the R&D space. “We believe this is particularly important in the current geopolitical context, where aid budgets are under pressure and governments are looking for evidence that their spending generates value not only globally but also domestically,” she said. While the report does not include recent aid budget cuts, data from the organization’s own survey shows global funding for neglected disease R&D has been declining since 2021, although it remains above pre-pandemic levels. Funds for the development of an HIV vaccine have also declined — likely due to the results of some HIV vaccines in late-stage trials in recent years failing to prevent HIV infections. Despite the win-win nature of the current flow of funding, particularly for high-income countries, the report authors argued that a shift in funding also needs to happen. The report states that more funding needs to be channeled to institutions in LMICs to help develop their R&D infrastructure, clinical trial networks, and regulatory systems. Matched cofunding mechanisms can also help catalyze funding from LMIC governments for R&D. Governments can also expand the use of product development partnerships, or PDPs, which bring together public, private, philanthropic, and academic entities to develop health products for diseases affecting LMICs. PDPs have been instrumental in the development of several lifesaving drugs, such as pretomanid for the treatment of highly drug-resistant forms of tuberculosis, and MenAfriVac®, the first vaccine targeting Group A meningitis that was causing outbreaks in Africa. “PDPs can strengthen local innovation systems and workforce capacity, even if historically their primary focus has been product development rather than broader infrastructure building,” Candeias said.