New Analysis Reveals Significant Gaps In Funding For Health Innovation

Many of the products critically needed to fight some of the world’s most prevalent infectious diseases are not likely to be developed. This is the outcome of a new analysis, which reveals significant gaps in funding for health innovation.

18 high-priority products are missing in the pipeline, including highly effective vaccines against HIV, tuberculosis, malaria and hepatitis C.

These findings are based on the first independent use of a modelling tool developed by the Special Programme for Research and Training in Tropical Diseases (called the Portfolio-to-Impact or P2I) that was applied to the research & development (R&D) pipeline by the Duke Global Health Institute. Two papers published in the Gates Open Research platform describe the financial model and the pipeline analysis.

“The results were not unexpected, with respect to financing and the sizable gap in investments. What is new here is the potential mismatch of products that could be launched (and made available in the market) compared to public health needs,” Robert Terry, manager at the special programme for research and training in tropical diseases (TDR) – a global programme of scientific collaboration that helps facilitate, support and influence efforts to combat diseases of poverty – told Health Policy Watch (see the full interview below).

18 High-Priority Missing Products

The study identifies, indeed, 18 high-priority missing products in the pipeline, including highly effective vaccines against HIV, tuberculosis (TB), malaria and hepatitis C; a combined vaccine against multiple diarrheal diseases as well as new drugs for TB and 12 of the most neglected tropical diseases.

About 500 products already in development are estimated to cost about US$ 16.3 billion to complete, with three-quarters of those costs coming in the first five years, and would result in about 128 expected product launches, as reported by the researchers.

“The costs to move current products through the pipeline plus additional costs to develop the 18 missing products, when compared to current annual global spending on product development, reveals an annual funding gap of at least $US 1.5 billion to US$ 2.8 billion per year over the next 5 years. Authors note that their estimate likely understates the cost,” the TDR press release says.

Unbalanced across Health Needs

The analysis also shows the portfolio to be unbalanced across health needs, with several high-burden diseases receiving very little R&D funding.

“We found very few candidates for these diseases, e.g. just one each for cryptococcal meningitis and leptospirosis and two each for leprosy, rheumatic fever, and trachoma, the authors say in one of the two newly published articles (find the other one here). “The proportion of total funding directed at each disease is poorly correlated with its overall disease burden.”

They also take hookworm as an example: the Global Burden of Disease Study 2016 estimated that there were about 450 million people with hookworm in 2016, yet it received just $3.87 million in funding for product development in that year, according to G-FINDER report for 2017.

Other key results of the analysis show that the pipeline is dominated by three diseases – malaria, HIV/AIDS and TB – comprising more that half of all candidates. Moreover, the four diseases responsible for the highest costs would be TB (US$ 2.6 billion), HIV (US$ 2.3 billion), malaria ($2.3 billion) and Ebola (US$ 1.2 billion).

Interview with Robert Terry

HEALTH POLICY WATCH (HPW): The analysis reveals major gaps in critical tools and funding. What can you say about these findings? Were you expecting such results?

Robert Terry, Manager at TDR

Robert Terry: The results were not unexpected, with respect to financing and the sizable gap in investments. What is new here is the potential mismatch of products that could be launched (and made available in the market) compared to public health needs – the missing products. From TDR’s view this is especially true for the key tools – vaccines for HIV, TB and malaria and no new medicines for neglected tropical diseases – that could protect the most vulnerable populations.

HPW: How can the current portfolio be made more balanced across health needs?

Terry: These findings reinforce the recommendations from the Health Product R&D Fund 2016 report. In sum, there needs to be greater efforts at coordinating global health product development and the investments that support them.

HPW: What solutions can be found, on a global policy level, to close this “large financing gap”?

Terry: Currently more than 40 percent of global health R&D is paid for by the US government, and a further near-20 percent comes from the Bill & Melinda Gates Foundation, with the remainder coming from European funding. Clearly we need to attract investments and commitments from a broader range of countries and private donors. The first report (done in 2016) and the results we release today improve our understanding of the situation. Now we need to look for ways and mechanisms to draw in funding from other sources, especially middle-income countries. With greater coordination overall we can stay focused on investments that solve the health needs of the poorest and most vulnerable population – which is our focus at TDR.


Image Credits: WHO/TDR.

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