The US government is the world’s leading funder of global health research and development, investing more than US$12.7 billion over the past 10 years in new vaccines, drugs, diagnostics and other products for neglected diseases of the developing world, a new report has found.
The health and economic benefits of this support, both domestically and internationally, provide “clear reasons” for the US to maintain – and, where possible, increase – this support, says the Washington-based Global Health Technologies Coalition (GHTC), which released the report along with independent research group Policy Cures.
At the same time, the report suggests, US government funders could optimise the impact of their investments by focusing more intently on translational research and on clinical development in particular.
They should also step up funding for partnering mechanisms focused on the translation of global health research, including product development partnerships with industry, non-profit groups and the philanthropic sector.
According to the GHTC/Policy Cures report, Saving lives and creating impact: Why investing in global health research works, the US Government each year contributes around 45% of all investment in global health R&D and 70% of all government investment worldwide.
Over the last decade, US government agencies have doubled their annual financial commitment to global health R&D from US$685 million to US$1.4 billion, with a “negligible” impact on US taxpayers – less than 0.01% of Gross Domestic Product.
Five federal agencies – the National Institutes of Health (NIH), the US Agency for International Development (USAID), the Department of Defense (DoD), the Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA) – contribute funding and infrastructure, as well as their own unique capabilities and expertise, to global health R&D, the report notes.
Financial support is driven by three agencies – NIH, USAID and DoD – which are responsible for 87%, 6% and 6% respectively of US government funding for global health R&D.
Over the last decade, the largest portion of this funding has gone to HIV/AIDS R&D (57%), with sizeable investments also in tuberculosis (TB, 12%) and malaria (10%).
The US government was involved in developing more than half (24/53%) of the 45 global health products introduced between 2000 and 2010, while US federal agencies are working with other stakeholders on 200 (55%) of the 365 global health products currently in the R&D pipeline, including what is likely to be the first ever vaccine against malaria, three HIV vaccine candidates and a new generation of improved TB drugs, the report points out.
Not only can US funding for global health R&D save millions of lives and dollars around the world, it also gives a lift to the US economy, GHTC and Policy Cures add.
Around 64 cents in every dollar spent by the US government on global health R&D goes directly to US-based researchers and product developers, creating jobs and building national research and technological capacity.
Clinical development gap
There is room for improvement, though, the report cautions. For example, US government investment is not consistent across the R&D value chain, with two-thirds of funding directed at the early stages of the research and development process, while only around one-fifth goes to clinical trials in humans.
“The US government’s investment in early basic research is so great that it now provides nearly two-thirds (62%) of global funding in this area,” the report states.
“But when it comes to the final clinical stages of product development, which are the most expensive and the most in need of funding, other groups (in particular the Bill & Melinda Gates Foundation and for-profit industry) are providing around 60% of all funding.”
This situation “is unlikely to be sustainable as more products move into expensive late-stage clinical trials”, the report warns.
Moreover, research supported by US government investment has not always translated sufficiently into successful health products, GHTC and Policy Cures note.
Current programmes such as NIH’s Small Business Innovative Research initiative and Cooperative Research and Development Agreements “are poorly suited to global health product development”, they believe.
And US government support for PDPs – responsible for more than 40% of new global health products registered between 2000 and 2010 – has been “slow and limited”. US government agencies have supplied only 11% of PDPs’ global funding commitments from 1993 to 2019.