United States - Global health R&D

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This section focuses on donor countries’ support to global health research and development (R&D) that addresses the global health challenges disproportionately affecting the world’s most disadvantaged people. Following the methodological approach used by Policy Cures Research (read G-Finder’s scope document), it focuses on donor funding and policy in three main areas: 1) emerging infectious diseases (EIDs); 2) poverty-related and neglected diseases (PRNDs); and 3) sexual and reproductive health (SRH). As part of the EID R&D funding, this section also takes a closer look at donor contributions for COVID-19 R&D within the framework of the Access to COVID-19 Tools Accelerator (ACT-A). This section excludes domestic funding for health R&D that does not benefit low- and middle-income countries. Not all funding mentioned qualifies as ODA.)

The US was the largest funder of global health R&D in 2020 

According to data from the G-FINDER survey conducted by Policy Cures Research, the US contributed US$4.2 billion in total to R&D for EIDs, PRNDs, and SRH in 2020, making it the largest public donor to R&D for these areas by far. The largest portion of this funding (50%, or US$2.1 billion) was spent on R&D for EIDs only. 19% (US$794 million) was spent on R&D for PRNDs, and 4% (US$189 million) on SRH. The remainder was spent on R&D initiatives targeting more than one disease area.    

The US spent US$2.1 billion on R&D for EIDs in 2020

In 2020, the US spent US$2.2 billion on R&D for EIDs, including funding exclusively for EID R&D (US$2.1 billion) and funding for R&D relevant to both EIDs and PRNDs (US$98 million). This makes the US the largest donor to R&D for EIDs in 2020.   

US funding for EIDs decreased significantly in 2019 compared to 2018 (US$662 million) but remained above 2016 and 2017 funding levels (US$474 million and US$541 million, respectively). It is worth noting that it is common to see spikes and dips in EID funding as donors respond to outbreaks, and do not necessarily indicate a significant re/de-prioritization of the sector; however, consistent funding for EID R&D (for example, funding for the Coalition for Epidemic Preparedness Innovations; CEPI) is essential to ensuring preparedness in advance of EID outbreaks and ensuring a rapid response — in terms of both research and containment — to emerging disease threats.   

The US has stepped up R&D funding to EIDs through its international COVID-19 response, committing US$4.1 billion between March and December 2021

According to Policy Cures Research’s COVID-19 R&D tracker, between the start of the pandemic and December 2021 (latest data available), the US announced funding commitments totaling US$4.1 billion for COVID-19 R&D. US$2.6 billion of this will go toward vaccines, US$689 million towards therapeutics, US$578 million toward diagnostics, US$76 million toward unspecified purposes, US$44 million toward basic research, and US$29 million for platform technologies. 

Among its commitments, in October 2020, the US pledged US$20 million to CEPI for vaccine development to be disbursed over five years, along with an additional announcement of US$150 million toward CEPI to be disbursed over three years, in March 2022. CEPI, along with Gavi, the Vaccine Alliance (Gavi), convenes the vaccines pillar of the Access to COVID-19 Tools Accelerator (ACT-A). ACT-A is a framework for collaboration through which donor countries have committed funds toward R&D for COVID-19; however, not all ACT-A funding is for R&D since it also has strong health system strengthening and vaccine distribution components. President Joe Biden’s FY2023 budget request includes US$250 million in contributions to ACT-A. For additional information on the broader ACT-A global health response to COVID-19, please see Sector: ‘Global Health’.  

The FY2023 presidential budget request also includes a first-time request of US$6.5 billion in mandatory spending for a five-year effort “to invest in transformative programs and technologies focused on pandemic preparedness.” This effort includes US$500 million specifically to “support vaccine research, development, and delivery.” 

With major focus on HIV/AIDS response, US funding for PRNDs is high

In 2020, the US invested US$1.9 billion in R&D for PRNDs, including funding for R&D exclusively relevant to PRNDS (US$794 million) and areas of overlap with EIDs (US$78 million), SRH (US$1 billion), and funding that cuts across these all areas (US$19 million). This makes the US the largest public supporter of PRND R&D in 2020. In 2020, funding levels saw a large increase of 45% compared to 2019.  

Most US funding for PRNDs in 2020 funded vaccines (35%), followed by basic research (31%) and vector drugs (14%). Over half of total US spending on R&D for PRNDs was directed toward HIV/AIDS (53% of PRND funding in 2020), with tuberculosis (TB) and malaria taking 17% and 12%, respectively.  The US has a longstanding focus on HIV/AIDS, with the President’s Emergency Plan for AIDS Relief (PEPFAR), the umbrella program for all US HIV/AIDS activities, channeling about two-thirds of US funding for global health.  

SRH, particularly the eradication of HIV/AIDS is a development priority; funding remains high

In 2020, the US spent US$1.2 billion on R&D for SRH, made up primarily of US$1.0 billion on HIV/AIDS (also included in PRND funding, see above). This makes the US the largest donor to R&D in this disease area in 2020. 2020 saw a very slight decrease of 0.2% in US funding for SRH R&D compared to 2019.  

In addition to HIV/AIDS (82% of SRH R&D funding), the US made disbursements for R&D for sexually transmitted infections (STIs; 6%), contraception (4%), and human papillomavirus (HPV) and HPV-related cervical cancer (4%). Vaccines received 49% of SRH R&D funding, while basic research received 21%, and drugs took 9%. 

Although the US has had a complicated history in terms of funding for some aspects of sexual and reproductive health, overall funding to the sector remains high due to the US’ major prioritization of the eradication of HIV/AIDS through its flagship program, PEPFAR. 

COVID-19 R&D is a key focus of the Biden Administration

The US was late to join the global response to the COVID-19 crisis. The new Administration, under President Joe Biden, joined the COVAX Facility, an international initiative that contributes to the development of a COVID-19 vaccine and funding for low- and middle-income countries, pledging US$4.4 billion, as of June 2021. In May 2022, the US announced the new COVAX Rapid Financing Facility, through the US International Development Finance Corporation (DFC), which will provide access to US$1 billion in funding that the COVAX Advance Market Commitment (AMC) needs to respond to unforeseen risks and helps to build partner countries’ ‘health resilience.’ 

In addition, the US co-hosted the second ‘Global COVID-19 Summit’ in May 2022. In terms of pledges at the summit, the US committed an additional US$200 million to the pandemic preparedness and global health security financial fund at the World Bank in 2022, bringing the total to US$450 million. Additional non-financial commitments included sharing vaccine research and development tools, increasing testing on generics, expanding ‘test and treat’ strategies for low- and middle-income countries, and expanding dose donations through COVAX. At the summit, the US also committed to supporting the establishment of the new Financial Intermediary Fund (FIF) for Pandemic Prevention, Preparedness and Response, which is run through the World Bank and World Health Organization (WHO). 

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:   

National Institutes of Health (NIH), an agency comprising 27 institutes under the Department of Health and Human Services (HHS; see ‘Main Actors’), is the largest 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. The NIH disbursed US$2.7 billion (64%) in R&D funding in 2020, according to Policy Cures Research’s G-FINDER data. 

The US Biomedical Advanced Research and Development Authority (US BARDA) is an office within the US Department of Health and Human Services (HHS) responsible for the procurement and development of medical responses primarily to biological, chemical, and nuclear threats as well as pandemics and emerging diseases. US BARDA disbursed US$1 billion (24%) in R&D funding in 2020, according to Policy Cures Research’s G-FINDER data. 

Department of Defense (DOD) is also a main actor in US global health R&D efforts, mostly in addressing infectious diseases and other neglected health conditions that US service members may encounter while stationed overseas. DOD disbursed US$146 million (6%) in R&D funding in 2019, according to Policy Cures Research’s G-FINDER data. 

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 PEPFAR and the President’s Malaria Initiative (PMI; USAID’s Neglected Tropical Diseases program), product development partnerships (PDPs) are strongly prioritized. The agency houses the Malaria Vaccine Development Program. USAID disbursed US$337 million in R&D funding (8%) in 2020, according to Policy Cures Research’s G-FINDER data. 

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 the 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, and PEPFAR. The CDC disbursed US$22 million (1%) in R&D funding in 2020, according to Policy Cures Research’s G-FINDER data. 

The US Department of Agriculture focuses on research programs. 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 low-income countries.