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 2019

According to data from the G-FINDER survey conducted by Policy Cures Research, the US contributed US$2.6 billion in total to R&D for EIDS, PRNDs, and SRH in 2019, making it the largest public donor to R&D for these areas. The largest portion of funding (31% or US$788 million) of this funding was spent on R&D for PRNDs only. 21% (US$537 million) was spent on R&D for EIDs, and 5% (US$138 million) on SRH. The remainder was spent on R&D initiatives targeting more than one disease area.

The US spent US$602 million on R&D for EIDs in 2019

In 2019, the US spent US$602 million on R&D for EIDs, including funding exclusively for EID R&D (US$602 million) and funding for R&D relevant to both EIDs and PRNDs (US$53 million). This makes the US the largest donor to R&D for EIDs in 2019.

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 October 2020    

According to Policy Cures Research’s COVID-19 R&D tracker, between the start of the pandemic and October 2020 (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 towards 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, as of October of 2020, the US had pledged US$20 million to CEPI for vaccine development to be disbursed over five years. CEPI (along with Gavi, the Vaccine Alliance) is convening the vaccine 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. For additional information on the broader ACT-A global health response to COVID-19, please see Sector: ‘Global Health’.  

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

In 2019, the US invested US$1.9 billion in R&D for PRNDs, including funding for R&D exclusively relevant to PRNDS (US$787 million) and areas of overlap with EIDs (US$54 million), SRH (US$1.0 billion), and funding that cuts across these all areas (US$11 million). This makes the US the largest public supporter of PRND R&D in 2019. In 2019, funding levels saw a slight increase of 5% compared to 2018.

Most US funding for PRNDs in 2019 funded vaccines (36%), followed by basic research (30%) and vector drugs (15%). Over half of total US spending on R&D for PRNDs was directed toward HIV/AIDS (54% of PRND funding in 2019), with tuberculosis and malaria taking 18% and 11%, 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 2019, 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 2019. 2019 saw an 8% increase in US funding for SRH R&D compared to 2018.

In addition to HIV/AIDS (87% of SRH R&D funding), the US made disbursements for R&D for sexually transmitted infections (STIs; 4%), contraception (3%), and human papillomavirus (HPV) and HPV-related cervical cancer (2%). Vaccines took 49% of SRH R&D funding, while basic research took 20% and drugs 9%. Devices and combinations took 3% and diagnostics took 1%.

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$4.0 billion. It also indicated that it supports the waiver of COVID-19 vaccine patents. The American Rescue Plan, signed in March of 2021, allocated US$905 million to USAID for global health activities, including vaccine development.

The Biden administration’s first budget has been released but exact funding levels for specific R&D mechanisms are not yet known and not always publicly specified in US budget documentation.

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 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. The NIH disbursed US$2.1 billion (84%) in R&D funding in 2019, 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$180 million (7%) in R&D funding in 2019, 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$70 million in R&D funding (3%) in 2019, 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 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$19 million (1%) in R&D funding in 2019, 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.