Neglected disease R&D

Every year since 2007, the G-FINDER project has provided policymakers, donors, researchers, and the pharmaceutical industry with a comprehensive analysis of global investment into research and development (R&D) of new products to prevent, diagnose, control, or cure neglected diseases in low- and middle-income countries (LMICs). This ‘Partner Perspective’ draws on the findings from the fourteenth annual G-FINDER report, launched on January 27, 2022 by Policy Cures Research (PCR), an Australia-based research and policy institute, which presents data on investments made in 2020.

In the first year of the COVID-19 pandemic, funding for neglected disease research and development (R&D) dipped by 4% from 2019’s near-record high — while remaining safely above its long-term average — at US$3.9 million. While a drop in funding is never good news for R&D, the small size of this decrease seems like mostly good news: funding appears to be weathering the COVID-19 storm relatively well, and we continue to enjoy the benefits of record funding growth in the years leading up to 2019.

But a single year of data is unlikely to tell the whole story about how the COVID-19 crisis will ultimately change neglected disease R&D funding. There is some concern that a focus on the COVID-19 crisis could capture the attention and resources traditional R&D funders might otherwise have given to neglected disease, and that the costs of stimulus during the pandemic — or its impacts on the global economy — will lead to future reductions in overall government funding for neglected disease R&D.

COVID-19 interrupted clinical trials in LMICs

The COVID-19 crisis seems to have primarily affected clinical trials; clinical development funding fell by 10% in 2020, or US$124 million. One major private sector funder reporting lower clinical development spending confirmed that this drop was due to the difficulties of conducting trials during the pandemic. This sort of COVID-19 interruption presumably explains much of the wider drop in clinical development.

This disruption to trials is expected to have continued into 2021 and even larger decreases in funding to clinical development are possible as disbursement schedules catch up to conditions on the ground.

Funding targeting multiple diseases grew rapidly

One major factor in the seemingly static level of overall R&D funding despite significant cuts to clinical development was a large increase in funding for platform technologies. Platform technologies, like Oxford’s ChAdOx1 platform that powers the AstraZeneca COVID-19 vaccine, are transferable tools for R&D which are initially developed without a specific target disease and can then be used to speed the development of treatments across a number of different diseases. Platform funding more than tripled since a 2017 dip, due in part to an additional US$33 million (34%) in funding in 2020.

Most of this recent growth has been driven by increasing funding for vaccine platforms (up nearly 800% since 2017) and diagnostic platforms (up 326%). These two areas now account for three-quarters of all platform funding, up from 45% in 2017.

Growth in philanthropic funding offset sectoral gaps

The large increase in philanthropic funding in 2020 is also very good news; this represents the only major funding sector that didn’t drop off that year. Overall philanthropic funding increased by US$28 million (3.6%) to its highest level since it peaked in 2008. The 2008 peak was driven by record funding from the Bill & Melinda Gates Foundation; 2020 saw a slightly more diverse set of funders. The Bill & Melinda Gates Foundation’s contributions to the sector accounted for nearly 90% of philanthropic funding in 2008; in 2020 their contributions represented just 76%, a record low. The growth in philanthropic funding was driven by increased contributions from the Wellcome Trust (the second-largest philanthropic funder in every year of the G-FINDER survey) and Open Philanthropy (a relatively young organization that began funding neglected disease R&D in 2017).

The facts of increasing philanthropic funding and the slight increase in the diversity of funders are both heartening and frustrating. Throughout the COVID-19 crisis, the global community has witnessed the kind of mobilization the philanthropic sector (and the global health establishment as a whole) is capable of when a crisis hits close to home. PCR’s tracking of 2020 COVID-19 R&D funding commitments demonstrates a total of nearly US$7.5 billion in committed R&D funding across all sectors, from at least 126 different funders. These commitments resulted in disbursements of at least US$4.0 billion for COVID-19-specific product R&D from G-FINDER participants alone.

This is an impressive global response to the pandemic, but the scale of the mobilization also highlights how narrow philanthropic engagement in neglected disease remains. In an average year, fewer than ten philanthropic organizations provide even a million dollars in funding for neglected disease R&D.

Over the 14 years of the G-FINDER survey, the 17 different neglected tropical diseases have, cumulatively, received less than a billion dollars between them, meaning that a single year of COVID-19 funding would have been enough to quintuple the funding received by neglected tropical disease R&D over more than a decade.

A similar contrast to the broad global response to COVID-19 can be seen across other sectors, with a few large organizations providing the vast majority of global funding, and a short tail of smaller funders providing almost all of the remainder. Several of the most neglected diseases count on an even narrower pool of funders: leprosy, cryptococcal meningitis, leptospirosis, and most helminth infections have relied on just one or two funders for more than 70% of their R&D funding over the past decade. This leaves them vulnerable to shifts in a single organizations’ resources or funding priorities and in practice makes any progress in treating them reliant on the gradual progression of just one or two product candidates through the pipeline.

The global R&D response to the COVID-19 pandemic from dozens of funders shows how the quantity and diversity of a funding base can speed development timelines and build a pipeline that is able to withstand the inevitable failures of individual candidates. Having seen what prioritizing research and development can achieve, it is clearer than ever that neglected diseases only persist because we choose to let them.

Further details on trends in public, private and philanthropic funding for neglected disease R&D are available in the G-FINDER report, starting on page 60.

The COVID-19 crisis' impact is hard to gauge

Beyond its initial impact on conducting trials, the COVID-19 crisis has the potential to disrupt neglected disease funding in two distinct ways: a direct displacement of neglected disease funding in favor of the COVID-19 response, and an overall reduction in government spending on global development initiatives due to the crisis’ economic impacts, leading to tighter budgets for global health initiatives across the board.

PCR did find some statistical evidence that funding is being redirected; for every million dollars an organization invested in COVID-19 related R&D, their funding for neglected disease R&D declined by an estimated US$30,000, a comparatively small sum. History also shows that there was no direct displacement of neglected disease R&D funding during the major increase in emerging infectious disease investment following the 2014-2016 Ebola pandemic, cause for cautious optimism that COVID-19 may not directly divert much funding from neglected disease R&D in the years to come. 

The second possibility of a global belt-tightening in response to COVID-19-related economic deficits or a post-pandemic recession is more worrying because it has happened once before, After the 2008 Global Financial Crisis (GFC), stimulus-driven growth in high-income country public funding in 2009 was followed by years of economic recession and slower growth in overall government spending — going mostly to increased welfare costs with real-terms cuts in most discretionary spending. Following this, we saw what looked like deficit-inspired reductions in funding for neglected disease R&D, which bottomed out in 2015, leaving funding slightly below its pre-GFC level (in real terms), seven years later.

This time around, the crisis has not been accompanied by any stimulus-driven boost in funding since the increase in public health funding unsurprisingly focused on COVID-19. Thus, we may enter a period of stagnant or decreasing government expenditure without that buffer. The advantage this time around could be much higher — and seemingly stable — overall neglected disease R&D funding. This might, hopefully, allow R&D funding for neglected diseases to weather a post-COVID-19 period of austerity relatively unharmed. However, statistical analysis conducted by PCR based on 13 years of G-FINDER data across 24 different countries does show a clear relationship between government spending and neglected disease R&D funding. This suggests that a global dip in government spending like that seen in 2015 could lead to a US$177 million drop in neglected disease R&D funding, which would be the largest reduction ever seen.

As much as the costs of the pandemic might raise concerns about the availability of funding, it has also been a stark demonstration of the harm caused by an uncontrolled infectious disease, and of how rapidly a global response can turn the tide. The COVID-19 crisis has made global health more salient in the minds of policymakers and philanthropists, attracting new funders to emerging infectious disease R&D and providing evidence that tools for controlling infectious disease are both valuable and within reach.