The US is the largest funder of global health R&D; funding is primarily channelled through NIH

The US’s funding for research and development (R&D) on poverty-related and neglected diseases (PRNDs), referred to as ‘global health R&D’ in this profile, stood at US$1.7 billion in 2015, according to G-FINDER. The US is by far the largest public funder to global health R&D, contributing 74% of all government funding and 46% of funding across sectors (including industry, philanthropic organizations, and public funders). Excluding one-time emergency investments for Ebola, US funding for global health R&D has been declining since 2007. According to the Global Health Technologies Coalition (GHTC), 89% (US$ 1.5 billion) of the US’s global health R&D budget was invested domestically in 2015.

In 2015, US global health R&D funding focused primarily on HIV/AIDS (US$756 million), representing 45% of total US global health R&D. Other focus areas included African viral haemorrhagic fevers (VHFs; US$298 million, 18%), TB (US$218 million, 13%), and malaria (US$195 million, 12%), followed by dengue fever (US$47 million, 3%), diarrheal diseases (US$45 million, 3%), and kinetoplastids (US$39 million, 2%).

The US allocated nearly half of its funding in 2015 to preventative vaccines (US$711 million, 42%), basic research (US$456 million, 27%), drugs (US$248 million, 15%), and microbicides (US$126 million, 7%). This focus on preventative vaccines and basic research has been stable since 2007.

Currently, the US does not have an overarching strategy for global health R&D. Funding comes from, and is implemented through, a variety of programs across several agencies. The main ones are (in order of the amount of funding provided in 2015):  

National Institutes of Health (NIH), an agency comprising 27 institutes under the Department of Health and Human Services (HHS) (see Key question: Who are the main actors in the US’s development cooperation?), is the biggest funder of global health R&D in the world. It is also the leading US agency for medical research and channeled 79%, or US$1.3 billion, of total US investment for global health R&D in 2015. The largest share of funding went to preventative vaccines (US$550 million, 42%), followed by basic research (US$452 million, 35%). US$831 million went to academic and other research institutions (64% of NIH provided global health R&D). NIH prioritized R&D on HIV/AIDS in 2015 (US$664 million, 51%), followed by TB (US$196 million, 15%), and malaria (US$156 million, 12%). Global health research has been identified as one of five opportunities for the tenure of Dr. Francis Collins, the current NIH director. Within NIH, the National Institute for Allergy and Infectious Diseases (NIAID) leads on research for infectious diseases such as HIV/AIDS, Ebola, and Zika.

Department of Defense (DOD) is also a main actor in US global heath R&D efforts, mostly to address infectious diseases and other neglected health conditions that US service members may encounter while stationed overseas. One of every four vaccines approved by the US Food and Drug Administration (FDA) in the last century has been developed with the participation of DOD. The department channeled US$145 million, or 9%, of US global health R&D funding in 2015. VHFs received the largest share of funding (US$73 million, 50%), followed by malaria (US$29 million, 20%), and HIV/AIDS (US$28 million, 19%).

US Biomedical Advanced Research and Development Authority (BARDA), also part of HHS, focuses on medical countermeasures for public health medical emergencies. BARDA disbursed US$104 million in global health R&D funding in 2015 (6% of total US investment in global health R&D). This work was only made possible through one-time, emergency Ebola appropriations in 2015. As such, it exclusively funded global health R&D for VHFs (US$104 million) and dengue fever-related R&D (US$100,000).

US Agency for International Development (USAID) is the US’s lead development agency. It channeled US$80 million, or 5%, of the US’s global health R&D funding, led by its Bureau for Global Health. USAID focuses all funding on HIV/AIDS, malaria, and TB, in line with its role as an implementer of the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative (PMI). The largest share by far was spent on HIV/AIDS R&D in 2015 (US$58 million, 56%). Product development partnerships (PDPs) are strongly prioritized. In 2015, 41% of USAID funding went to the International AIDS Vaccine Initiative (IAVI; of which USAID is the largest funder). Other PDP recipients include the TB Alliance and Contraceptive Research and Development (CONRAD). The agency houses the Malaria Vaccine Development Program.

Centers for Disease Control and Prevention (CDC) make up the largest government agency worldwide working in disease surveillance, control, and prevention. CDC operates under HHS. In 2015, CDC channeled 1% of R&D funding (US$18 million). In 2010, the CDC established the Center for Global Health, which oversees all of CDC’s global health operations, and focuses on topics such as women’s health, HIV/AIDS, malaria, refugee health, and health systems strengthening. In 2015, the CDC focused its global health R&D funding primarily on TB (US$9 million) and VHFs (US$8 million). It leads the TB Trials Consortium and is an implementing partner of the PMI, the USAID’s Neglected Tropical Diseases program, and PEPFAR.

In addition, while not a main funder of global health R&D in the US, the FDA, also under HHS, oversees the safety and efficacy of pharmaceutical and biological products, and works with partner governments on improving regulatory capacity. The agency has expanded its global health engagement in recent years, helping to reduce challenges that hamper regulatory review and access to health technologies in developing countries.

President Donald Trump’s budget request for FY2018, released in May 2017, proposes major cuts to US global health programming and biomedical research, which would have significant implications for US global health R&D. Specific proposed cuts included eliminating USAID’s HIV/AIDS account, which funds R&D for microbicides and HIV vaccines. Other global health accounts at USAID and the State Department were also proposed for cuts, including global TB programs—which includes TB drug facility- and multidrug-resistant financing—neglected tropical diseases, malaria, and maternal and child health programs (see Key question 4: How is the US’s ODA budget structured?). As individual programs within the State Department and USAID make their own decisions on how to invest in R&D, constrained top-line budgets put pressure on global health R&D spending. According to government information and GHTC analysis, the president’s budget request also includes cuts to biomedical research through the Labor, Health and Human Services (LHHS) appropriations bill (see Deep Dive: Global health), which could significantly impact US global health R&D. It proposes a US$7 billion, or 21%, cut to NIH, including a US$1.1 billion decrease in the budget of NIAID, and the elimination of the Fogarty International Center, which facilitates partnerships and trains researchers globally. Further, CDC’s overall budget would also face around a 15% cut.

However, as Congress controls government spending, the final outcome for US global health R&D spending in FY2018 may not be as severe. The Appropriations Committees of the House of Representatives (House) and the Senate each reject most of the proposed cuts to programs that support global health R&D in their relevant appropriations bills, especially the State-Foreign Operations (SFOPs) and LHHS. Overall, the House Appropriations Committee's LHHS bill proposes about a US$1 billion increase to the NIH budget from FY2017; the Senate Appropriations Committee's LHHS includes a US$1.7 billion overall increase. Since the appropriations process is still ongoing, the outcome of global health R&D funding is not yet clear for FY2018.