United States - Global health R&D

US' Global Health R&D

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The US is the largest funder of global health R&D, with a focus on HIV/AIDS

The US is the world’s largest public funder for research and development (R&D) on poverty-related and neglected diseases (PRNDs), referred to as ‘global health R&D’ in this profile. According to G-Finder data, funding stood at US$1.8 billion in 2018 making up 68% of all public funding (for context, the second-largest funder, the UK, contributed US$230 million or 9% of the total). 2018 funding represents a US$148 million increase over 2017, and the US’ highest funding level for R&D since 2009 (US$1.8 billion).

In 2018, US global health R&D funding focused primarily on HIV/AIDS (US$968 million), representing 54% of the country’s total global health R&D and an increase of US$110 over 2017. Other focus areas included tuberculosis (TB; US$305 million, 17%) and malaria (US$221 million).

Major US funding agencies include the National Institutes of Health, (NIH) channeling 89% of the US’ total R&D spending (NIH; see ‘Key actors’), followed by the United States Agency for International Development (USAID; 5%), and the US Department of Defense (DOD; 4%).

In terms of product development, the US allocated its funding in 2018 to preventative vaccines (US$642 million, 36% of total funding), basic research (US$525million, 30%), drugs (US$298million, 17%), and microbicides (US$114 million, 6%). This focus on preventative vaccines and basic research has been stable since 2007, the furthest year back that data is available.

In 2020, Congress funded the National Institutes of Health (NIH) at US$41.7 billion, an increase of US$2.6 billion from fiscal year FY2019. The Centers for Disease Control and Prevention (CDC) received US$571 million, an increase of US$75 million from FY2019. The entire increase in CDC funding is to support global health security activities.

The NIH provided US$590 million for HIV/AIDS research activities in FY2019, an increase of US$25 million above the FY2018 level. US funding to neglected tropical diseases (NTDs) and TB also goes to research, including to a TB drug facility and multidrug-resistant financing. The FY2020 congressional appropriations maintains NTD funding (not necessarily research-specific) at US$103 million and TB funding at US$7.2 million.

President’s FY2021 budget request again proposes cuts to the budgets of NIH and CDC; however, if FY2020 is any indication, these cuts will not be enacted in the future FY2021 budget bill. Furthermore, developments related to the COVID-19 crisis suggest that funding will likely continue to increase. Funding for global health security is expected to reach as much as US$535 million in 2020, up from US$100 million in 2019. Additionally, USAID’s Global Health Bureau is likely to receive an enormous resurgence in funding for PREDICT, a pandemic identification program which was meant to be shut down in late 2019.

Under the leadership of President Donald Trump, the US has not joined  the efforts of the COVAX Facility, an international initiative which contributes to the development a COVID-19 vaccine and funding for low- and middle-income countries. Other major world leaders have referred to the US’ decision not to participate, (which has been attributed to the Trump administration’s dislike of the World Health Organization or WHO a co-leader of the vaccine effort) as “disappointing”, given the scale of the US budget and the influential role that the US has played in the past in coordinating global health responses. The incoming Biden administration has not indicated  whether they will or will not join COVAX, although vaccine development and distribution are high priorities.

USAID has pledged US$20 million for vaccine development to the Coalition for Epidemic Preparedness Innovation (CEPI) in October of 2020 to be disbursed over five years.

Multiple agencies lead on global health R&D, chiefly the NIH

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 2018):

National Institutes of Health (NIH), an agency comprising 27 institutes under the Department of Health and Human Services (HHS) (see ‘Main actors’), is the biggest funder of global health R&D in the world. 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 in addressing infectious diseases and other neglected health conditions that US service members may encounter while stationed overseas.

US Agency for International Development (USAID), the US’ lead development agency, 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). Product development partnerships (PDPs) are strongly prioritized. 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 as part of HHS. 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. CDC leads the TB Trials Consortium and is an implementing partner of the PMI, the USAID’s Neglected Tropical Diseases program, and PEPFAR.

The US Department of Agriculture focuses on research programs.

In addition, while not a main funder of global health R&D in the US, the Food and Drug Administration 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.