Neglected Disease Research & Development (cont.)
Findings
Funding by Disease
I n 2008, reported funding for R&D of new neglected disease products reached $2.96bn ($3.09bn), a 15.5% increase on reported funding for 2007 ($2.56bn). However, only a quarter of this increase (25.3% or $100.1m) was due to an absolute increase in year-on-year funding, with the remainder reflecting expansion of the 2008 G-FINDER survey to include data from new countries and participants.
Funding remained highly concentrated with nearly three-quarters (72.8%) of global funding going to HIV, TB and malaria, similar to the 76.6% reported in 2007. A large number of neglected diseases and disease groupings each received between 1% and 5% of global R&D funding, including the kinetoplastids, diarrhoeal illnesses, dengue, bacterial pneumonia and meningitis, and the helminth and salmonella infections. Four diseases – leprosy, rheumatic fever, trachoma and Buruli ulcer – received less than $10m, or 0.3% of total global investment, each.
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When reading the funding tables, it is important to note that some of the diseases listed above are actually groups of diseases, such as the diarrhoeal illnesses and helminth infections. This grouping reflects common practice; for instance, burden of disease DALYs are generally reported according to these categories. It also reflects the shared nature of research investments in some areas. For example, research into kinetoplastids often pertains to more than one kinetoplastid disease e.g. Chagas’ disease, leishmaniasis and sleeping sickness, while Streptococcus pneumoniae R&D is often targeted at both pneumonia and meningitis. (Please see Table 1 for disease groupings used.) Where possible, however, information is broken down to disease level.
We also remind readers that all investments reported in G-FINDER are for neglected diseases only and exclude investments into commercial products for related Western markets e.g. the travellers’ market for diarrhoeal disease vaccines.
In 2008, HIV/AIDS received $1,164.9m ($1,215.8m) in R&D funding. This represented an increase of $81.9m on reported 2007 funding, with 17.4% ($14.3m) of this due to a real increase in year-on-year investments. A further $67.6m or 82.6% was due to reporting by new survey participants. HIV/AIDS again received the highest percentage of global investment (39.4% of the total), a modest decrease from the 2007 figure of 42.3% of global funding.
Over half of HIV/AIDS funding ($684.2m or 58.7%) was directed to preventive vaccines. A further $233.7m (20.1%) was directed to microbicides, $173.7m (14.9%) to basic research, $45.4m (3.9%) to HIV/AIDS drugs targeted at developing world needs (e.g. paediatric formulations and fixed-dose anti-retroviral (ARV) combinations), and $25.2m (2.2%) to diagnostics designed for developing world use (Figure 2).
HIV/AIDS funding was again highly concentrated, with the top 12 groups providing 91.7% of the global total, compared with 93.3% in 2007. Some top 12 groups significantly increased their funding in 2008; for example, Bill & Melinda Gates Foundation investments rose by $68.6m (a 74.5% increase).
Several organisations decreased their HIV/AIDS funding in 2008, in particular the NIH (down $35m), but also decreases of several million each by the US Department of Defense and UK Government funders. We note the decrease in NIH funding might be partly due to methodology (please see Methodology Annexe for more on this). Decreased funding by Irish Aid (down $11.1m, 80.9%) and the Dutch Ministry of Foreign Affairs (down $4.4m, 33.0%) led to both groups dropping out of the top 12 funders’ list in 2008. Funding from pharmaceutical companies surveyed in the Year One G-FINDER report also decreased by $2.0m in 2008, although this was masked by funding reported by new industry participants, which accounted for an increase of $29.8m in industry funding.
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Global funding for malaria R&D was $541.7m ($566.0m) in 2008, a 15.6% ($73.3m) increase on reported 2007 funding. More than half this increase (57.5% or $42.1m) was due to real increased investment, with the remainder reflecting additional survey participants in 2008. Overall, the share of global R&D investment captured by malaria remained the same as in 2007 (18.3%).
Nearly one-third of malaria R&D funding went towards drug development ($175.6m or 32.4%) with a further third channelled towards preventive vaccines ($171.1m or 31.6%). Basic research was the next highest funded category at $134.7m (24.9%). Vector control products, such as insecticides and biological control measures, received $12.5m (2.3%), while malaria diagnostics received limited funding of $7.8m (see Figure 4).
Just under 40% of malaria R&D funding was targeted at P.falciparum ($209.3m or 38.6%), with only 2.6% ($13.9m) reported as allocated to P.vivax. It is not known how the remaining 58.8% was allocated (unspecified strains; $318.5m). These reported allocations should, however, be treated with caution as many funders were simply unable to break data down to this level. With this in mind, the types of products funded in the P.falciparum group followed a very similar pattern to the overall malaria funding but with a higher proportion allocated to vector control products (4.9% or $10.3m).
Malaria R&D relied heavily on funding from public and philanthropic donors, who provided 83.3% ($451.1m) of total funding in 2008. However, industry also played a significant role, contributing 16.7% ($90.6m) of total malaria investment.
Overall funding was essentially unchanged in 2008, with the top 12 funders providing 93.7% of global malaria funding, compared with 94.4% in 2007 (See Table 4). There was a marked increase in funding from some organisations. The Bill & Melinda Gates Foundation and the NIH increased their contributions by $49.3m and $20.4m respectively, while a newcomer to the G-FINDER survey in 2008, the Indian Council of Medical Research (ICMR), contributed $8.3m to malaria research.
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Global funding for TB R&D totalled $445.9m ($467.5m) in 2008, an 8.6% increase compared to 2007. However, this was entirely due to inclusion of data from new survey participants. In fact, those surveyed in Year One of G-FINDER actually decreased their funding by $5.7m in 2008. TB also slipped slightly in terms of its share of global R&D funding, down from 16.0% in 2007 to 15.1% in 2008.
Just under one-third of TB funding was for basic research ($135.7m or 30.4%). TB drugs were the next highest funded category at $122.3m (27.4%) while preventative vaccines received $104.7m (23.5%). TB diagnostics received $44.7m (10.0%), with funding for therapeutic vaccines at a relatively minor $8.8m (2.0%).
The concentration of TB funding fell slightly from 2007, with the top 12 funders providing 91.6% compared with 94.0% in 2007. The Bill & Melinda Gates Foundation increased its contribution by $16.1m in 2008, while investment from the European Commission rose by $6.4m. However, the impact of these increases was offset by significant decreases in funding by several organisations, including the NIH ($8.9m) and Dutch Ministry of Foreign Affairs ($7.6m). We note the decrease in NIH funding might be partly due to methodology (please see Methodology Annexe for more on this). Decreased funding by Institut Pasteur (down $5.0m) and Irish Aid (down $2.8m) led to both groups dropping out of the top 12 funders’ list in 2008.
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Nearly half of TB funding came from HIC governments and public sector multilaterals, who provided $210.9m (47.3%) of the global total. A further $138.4m (31.0%) came from philanthropic organisations. MNCs and SMEs together contributed just under one-fifth of global TB funding, investing $74.0m (16.6%) and $13.1m (2.9%) respectively.
Kinetoplastid R&D funding increased by $14.1m in 2008, reaching $139.2m ($145.7m). Most of this increase was due to inclusion of new survey participants ($8.4m), with a real increased investment of only $5.7m. Overall, the share of global R&D investment captured by kinetoplastids remained roughly the same (4.7% in 2008, 4.9% in 2007).
Within the kinetoplastid family, funding was uneven. Leishmaniasis received nearly half of all funding (41.5%); followed by sleeping sickness, at around one-quarter (24.8%); and Chagas’ disease at 11.2%. We note, though, that nearly one-quarter of investment was into cross-cutting R&D that could potentially benefit any of the kinetoplastid diseases.
Across the kinetoplastid family, there was strikingly low investment in product R&D relative to basic research. Basic research accounted for 45.2% of kinetoplastids funding overall, as much as 60.7% of sleeping sickness funding and over two-thirds (67.8%) of Chagas’ disease funding. This is of note when we consider that there is no treatment for late-stage Chagas’ disease, and that the few products for early stage Chagas’ are toxic and inadequate as they require long treatment periods (30, 60 or 90 days) and do not exist in formulations suitable for children.
The focus of funding also varied across the kinetoplastids, with drug development accounting for around 30% of funding for both leishmaniasis and sleeping sickness and 75% of the cross-cutting kinetoplastids category; likely reflecting the activity of the Drugs for Neglected Diseases initiative (DNDi) and iOWH, two PDPs that are developing drugs for these diseases. Vaccine funding for all kinetoplastids was minimal, and well below the levels needed to achieve a vaccine in the next 50 years.
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Several organisations significantly increased their kinetoplastid disease funding in 2008, in particular the NIH, whose funding increased by $20.4m, making it the largest funder of kinetoplastids research globally. By contrast, the Bill & Melinda Gates Foundation, the top funder in 2007, decreased its funding by $16.1m in 2008 (Table 7); while industry funding also decreased despite inclusion of more companies in the survey.
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These funding swings translated into a marked shift in funding patterns between 2007 and 2008, with the public sector increasing its share of kinetoplastid R&D from 40.6% to 62.4%, while the philanthropic share decreased from 54.3% to 35.5%, a drop of $18.6m.
Diarrhoeal diseases received $132.2m ($138.2m) in R&D funding in 2008. Although an apparent $18.3m increase on 2007 funding, in practice this ’increase’ was entirely due to inclusion of more funders in the 2008 survey. Indeed, this influx of new participants masked a decrease in funding by participants in the 2007 survey, whose investments dropped by $5.2m (from $113.9m in 2007 to $108.7m in 2008). The global share of R&D investment captured by diarrhoeal diseases remained approximately the same at 4.5% (4.4% in 2007).
Within the diarrhoeal diseases, rotavirus, cholera and shigella continued to account for around half of available R&D funding, receiving 54.3% of total diarrhoeal disease R&D funding compared with 48.5% in 2007.
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The most notable change on 2007 data was the increased investment in diarrhoeal disease R&D funding by several organisations in the top 12, with substantial increases from the NIH and the Global Alliance for Vaccines and Immunizations (GAVI). These increases were offset by reduced contributions from the Gates Foundation, whose funding decreased by $17.6m in 2008. The apparent increase in pharmaceutical industry investment was entirely due to increased survey participation.
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These investment shifts led to large shifts in the relative contributions of the public and private sector to diarrhoeal disease R&D. Public funding from HIC governments and multilaterals increased substantially, from $43.8m in 2007 to $60.4m in 2008 (up from 38.5% to 45.7%), with IDC governments contributing a further $5.2m (3.9% of the global total); while the philanthropic contribution dropped from 48.8% to 32.0%. Due to greater capture of industry figures, the private sector share of global investment increased from 12% to 18.3% of global funding.
Global funding for dengue R&D totalled $126.8m ($132.5m) in 2008, a 54.5% increase in reported funding compared to 2007. However, all of this increase was due to entry of new funders into the 2008 survey, including pharmaceutical companies and developing country organisations with substantial dengue investments. This influx of new participants masked a 10.5% decrease in funding by participants in the 2007 survey, whose investments dropped from $82.0m in 2007 to $73.4m in 2008. The increase in reported funding shifted dengue up the charts in terms of its share of global funding, from 3.2% of global funding in 2007 to 4.3% in 2008.
The majority of dengue funding ($79.7m, 62.9%) was devoted to vaccine development. Almost a quarter ($29.4m, 23.2%) of 2008 funding was devoted to basic research, while drug development received only $7.6m (6.0%). Diagnostic funding was moderate, at $5.4m (4.3%); while vector control products received $2.0m (1.7%).
Philanthropic organisations and the public sector in HICs, including governments and multilaterals, accounted for a little over half of dengue funding in 2008 (53.7%, $68.0m). Although still the largest public donor, the NIH decreased its dengue funding by 23.2%, while the US Department of Defense nearly halved its investments in 2008. These reductions were, however, partially offset by a substantial increase in Gates Foundation funding.
Private industry are major players in the dengue product field, providing over one-third of global funding in 2008 ($43.8m, 34.6%); while IDC governments, including Brazil and India, made up a further 11.8% ($14.9m) of global spend, perhaps reflecting the higher prevalence of dengue in these countries. This puts dengue in the unusual position of being a disease for which nearly half of global investment is driven not by donor funds, but by private industry and endemic country governments.
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Advance Market Commitment for pneumococcal vaccines
In June 2009, the Global Alliance for Vaccines and Immunization (GAVI) announced the world’s first Advance Market Commitment (AMC) designed to accelerate access to vaccines against pneumococcal disease. The AMC uses donor commitments to guarantee the price of vaccines once they have been developed, aiming to create a viable future market and incentivize product developers to invest in R&D. Under the AMC pneumococcal pilot, a total of .5bn was committed by the governments of Italy (5m), the United Kingdom (5m), Canada (0m), the Russian Federation (m), Norway (m) and the Bill & Melinda Gates Foundation (m) to purchase vaccines when, and if, manufacturers develop products that meet the AMC criteria. These donations are to be disbursed to the World Bank’s International Bank for Reconstruction and Development (IBRD), who will hold these payments until GAVI requests funds to pay for purchase of approved vaccines. ii This innovative financing mechanism is expected to underwrite manufacturing and rollout of pneumonia vaccines, and there is interest in determining whether it will also stimulate development of novel pneumonia vaccines tailored for the developing world.21,22
In 2008, $90.8m ($96.1m) was invested into R&D for developing world bacterial pneumonia and meningitis. This represents a $58.3m increase in reported funding over 2007, with nearly two thirds of this figure ($34.4m) due to new survey participants. This increase meant that the share of reported global funding going to bacterial pneumonia and meningitis increased from 1.3% in 2007 to 3.1% in 2008. Vaccines received 69.6% ($63.2m) of total funding, while diagnostics received 19.3% ($17.5m).
As in 2007, a significant proportion of 2008 bacterial pneumonia and meningitis funding was from private industry, collectively accounting for 55.6% ($50.5m) of global investment. This figure is likely to be an underestimate, since one multinational company (Wyeth) with a significant pneumonia R&D programme has not participated in the G-FINDER survey. Philanthropic funding was given a major boost by Gates Foundation funding, which increased by over $20m in 2008. As a result, philanthropic organisations were the second largest global investor, accounting for 29.5% ($26.8m) of bacterial pneumonia and meningitis funding.
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Helminth infections received $66.8m ($69.5m) in R&D funding in 20 08, including a $9.8m (19.0%) increase in investment. The remaining increase was due to reporting by additional survey participants in 2008. Collectively, the share of global R&D investment captured by the helminth infections increased marginally from 2.0% in 2007 to 2.3% in 2008, with schistosomiasis again receiving the highest proportion of funding ($23.5m, 45.6% in 2007; $19.7m, 29.5% in 2008).
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Funding was highly concentrated with nearly half going to basic research ($30.5m or 45.6%). Investment into applied product research ($26.1m in total) went mainly to drugs (21.3%) and preventive vaccines (15.7%), while helminth diagnostics and vector control products collectively received less than $1.4m (2.0%).
As in 2007, the bulk of helminth R&D funding came from the public and philanthropic sectors (98.4% in 2007, 92.2% in 2008). However, the relative contributions of these two groups changed markedly. Public sector funding decreased from 77.4% to 52.6% ($39.9m to $35.2m), despite the inclusion of funding from new public survey participants, while reported philanthropic funding increased from 21.0% to 39.6% ($10.8m to $26.4m), largely due to an almost tripling of Gates Foundation funding in 2008. It is also of interest that two Brazilian public funders – the Butantan Institute and State of São Paulo Research Foundation (FAPESP), ranked in the top 12 funders of helminth R&D in 2008.
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The scope of the G-FINDER survey was expanded in 2008 to include non-typhoidal Salmonella enterica (NTS) and multiple salmonella infections, while the 2007 survey was limited to typhoid and paratyphoid fever. This means that year-on-year comparisons of salmonella’s share of global funding cannot be viably made. Caution must also be exercised when comparing 2007 and 2008 funder data.
Salmonella R&D received $ 39.5m ($41.1m) in 2008, with almost half going to typhoid and paratyphoid fever ($19.5m). Nearly three-quarters of typhoid and paratyphoid fever funding was directed towards preventive vaccines (71.1% or $13.8m), with 19.9% ($3.9m) allocated to basic research and $1.4m (7.4%) to drug development. The picture for NTS and multiple salmonella infections was quite different, with the majority of funding (86.0% or $11.8m, and 92.2% or $5.7m respectively) invested in basic research, but virtually no product development activity.
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Salmonella R&D relied heavily on public and philanthropic donors, who collectively provided 68.8% ($27.2m) of total funding in 2008. Industry funding, the lion’s share from SMEs, was also significant at $12.3m or 31.2% of the total.
The top funder of salmonella R&D was the NIH (51.6%). However, this increase was entirely due to the extension of the G-FINDER survey to cover NTS. The next highest funder behind the NIH was the pharmaceutical industry. Funding for salmonella R&D otherwise tended to come from multiple small donors.
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Leprosy R&D received $9.8m ($10.1m) in 2008, a $4.1m increase on 2007 funding, but only one-fifth of this increase ($0.8m) was due to increased investment; the remainder reflects increased survey participation. Leprosy continued to receive a tiny share of global R&D funding – 0.3% compared to 0.2% in 2007.
The majority of leprosy R&D funding was dedicated to basic research ($5.7m or 58.3%). Development of new drugs to replace current lengthy multi-drug treatment regimens received only $ 0.7m (7.6% of total leprosy funding), while a further $0.5m was allocated to new leprosy diagnostics.
The majority (87.6%) of leprosy R&D funding came from public investors, in particular IDC governments, who accounted for 51.1% ($5.0m) of global funding. This likely reflects the priority of leprosy to these countries (Brazil and India have some of the highest incidences of leprosy worldwide).31, 32
Almost 99% of leprosy R&D funding in 2008 came from just 12 organisations (see Table 16), with three organisations accounting for over 80% of the global total. With the inclusion of India in the 2008 survey, ICMR now ranks second in the list of top leprosy R&D funders.
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R&D for rheumatic fever vaccines targeted at the developing world received $2.2m ($2.3m) in 2008, a $0.5m increase on reported 2007 funding. This apparent increase is, however, entirely due to survey extension to new groups, who reported $1.2m in funding. In fact, 2007 donors reduced their funding for rheumatic fever R&D by 42.1% in 2008, from $1.7m to $1.0m.
Rheumatic fever continued to rank as one of the lowest-funded neglected diseases, receiving less than 0.1% of global R&D funding. The 2009 announcement of a new joint venture to develop rheumatic fever vaccines by Merck & Co. and the Wellcome Trust (the MSD Wellcome Trust Hilleman Laboratories in Hyderabad) is therefore very welcome.
In 2007, rheumatic fever research was funded entirely by the public sector. Although it continued to rely heavily on public donors, who provided over half ($1.1m) of what little funding this disease received in 2008, the appearance of industry funding ($1.0m, 44.0%) was notable. As in 2007, only a handful of organisations funded rheumatic fever R&D. Several are Australian-based, likely reflecting the fact that Australia’s indigenous peoples have one of the world’s highest incidences of rheumatic fever and rheumatic heart disease.33
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Trachoma funding totalled $2.1m ($2.2m) in 2008, an increase of $0.4m on 2007 figures, mostly due to increased investment by participants in the 2007 survey. This was, however, not enough to increase trachoma’s share of global R&D funding, which remained at 0.1%. Just under half (48.1%) of trachoma investments were directed to preventive vaccines ($1.0m), and a further $68,018 (3.3%) to diagnostics.
In 2007, 87.0% of trachoma R&D funding came from a single philanthropic organisation, the Wellcome Trust. This pattern changed in 2008, with 95.4% of funding coming from public funders and research institutions, in particular the NIH. A further $0.1m (4.6%) came from private industry. The organisations listed in Table 18 are all existing funders who began funding trachoma in 2008 (with the exception of the Swedish Research Council, a new survey participant).
As with other low-funded areas, these ‘trends’ should be treated with caution, since they more likely reflect changes in single grants or programmes than a significant underlying pattern.
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Buruli ulcer R&D received $2.0m ($2.1m) in 2008, a decrease of $0.5m from 2007 funding. In practice, the decrease in funding was even greater, with most 2007 donors reducing their Buruli ulcer funding in 2008. However, this effect was masked by extension of the 2008 survey to new participants. As a result, Buruli ulcer held steady at 0.1% of global R&D funding.
The majority of Buruli ulcer funding went to basic research ($1.4m, 72.4%), with very modest additional amounts to drugs ($209,864, 10.7%), diagnostics ($64,797, 3.3%) and preventive vaccines ($35,462, 1.8%) (see Figure 19). These amounts are clearly insufficient to deliver any new products for many decades.
The European Commission was once again the top funder of Buruli ulcer R&D in 2008 (although with very modest funding), while the Institut Pasteur and Australian National Health and Medical Research Council (NHMRC) reported decreases in funding.
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The public sector provided three-quarters of Buruli ulcer investment ($1.5m), with industry providing a further 14.6% ($285,685), and philanthropic organisations the remainder ($194,224, 9.9%). IDCs did not report any funding for Buruli ulcer this year.
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Neglected Disease Funders
Funder overview
Before reporting on funder trends, we caution that the majority of changes are due to survey expansion to new participants in 2008, including the entry of new countries, organisations and companies.
New survey participants accounted for three-quarters $295.8m (74.7%) of the reported increase in global funding in 2008, with over half this amount ($156.3m) due to new pharmaceutical company entrants, $129.1m to participation of new public organisations, and $10.3m to new philanthropic and other organisations. Many of the changing investment patterns reported below therefore reflect increased survey coverage as much as funding trends per se.
In practice, if data from new survey entrants is excluded, there was a net increased investment of only $100.1m (3.9%) into neglected disease R&D in 2008. This was the result of modest decreases in funding virtually across the board, offset by a very large increase in funding from the Bill & Melinda Gates Foundation and much more modest increases from other philanthropic organisations. The Gates Foundation increased its funding by $164.9 m in 2008, offsetting decreased funding from public sector governments (down $31.4m), (including IDCs (down $5.0m), multilaterals (down $0.1m) and the private pharmaceutical industry (down $23.0m).
As in 2007, the onus of funding neglected disease R&D fell on public and philanthropic donors , who collectively provided 87.6 % of total funding ($2.59 bn) , compared to 90.4% in 2007. HIC governments and multilateral groups together provided $1.80bn (60.8%), while philanthropic funders invested $716.5 m (24.2%) . Funding from IDCs (Brazil, India and South Africa) accounted for 2.6% of total global funding ($76.6m).
Compared to 2007, the relative contribution of HIC public funders to ne glected disease R&D dropped by around 8% (68.1% to 60.5%). At the same time, philanthropic organisations increased their reported share of global spend from 21.0% to 24.2%; industry from 9.1% to 12.4%; and IDCs from 1.0% to 2.6%.
With a collective investment of $365.3m, the pharmaceutical industry was again the third largest global investor in neglected disease R&D, behind the NIH and the Bill & Melinda Gates Foundation.
Public funders
Once again, the US Government contributed the majority of global public investment, providing 67.2% ($1.26bn) of funding in 2008, 85.7% of which was channelled via the NIH. However, as the US contribution remained largely unchanged from 2007, its share of global investment was diluted in 2008 by increased contributions from other top-funding countries. We note that, for some countries, this increase reflected increased reporting as well as increased funding, in particular for Sweden, where the entire increase was due to reporting by new survey participants.
Overall funding from the European Commission and European governments increased by $17.7m from $394.2m iii in 2007 to $411.8m in 2008 (22.0% of global public spend). However, this headline figure hides significant underlying changes in funding. Ireland and Belgium disappeared from the list of top 12 public funders, while investments from the Netherlands decreased significantly. Other European governments reported substantial increases in funding, notably France and Spain.
Two IDCs appeared in the top five government funders for the first time – Brazil and India – who contributed $36.8m and $32.5m respectively in 2008. The inclusion of India in this year’s survey is an important step forward and reflects the importance of IDCs and non-traditional funders in the development of neglected disease products.
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In many ways, absolute funding is an unfair comparator, particularly for smaller countries and for IDCs coming off a smaller base. Therefore, countries have also been ranked by their neglected disease R&D investment in relation to GDP (See Figure 22).
Reshuffling the cards in this way highlights some marked differences. The US and the UK continue to rank highly, and consonant with their absolute funding. However, France and Canada fall well down the list, providing less funding per GDP base than many smaller countries. By contrast, a handful of smaller countries have above average performance, including Sweden, Norway, Denmark and Ireland, all of whom enter or move up the top 12 funders chart if GDP is taken into account. We particularly note the case of Ireland, which in 2007 was among the top five public funders, ranking first in terms of dollars invested into neglected disease R&D relative to GDP in 2007.36 Although the global financial crisis severely impacted on Ireland’s aid budget, translating into a drop of $15.8m in neglected disease funding in 2008, Ireland nonetheless still ranked sixth in terms of funding compared to GDP in 2008.
Several countries who appear in the top 12 in terms of funding compared to GDP, such as Spain and Australia, have lower investments than would be expected relative to their counterparts. Despite significantly lower per capita GDPs, disease-endemic countries such as India, Brazil and South Africa appeared in the top 12 government funders although their spend per GDP was below that of others.
High Income Countries
Public funding by HIC governments and multilaterals in 2008 confirmed the 2007 tendency to focus on only a few diseases and to fund traditional products rather than new platforms.
Over three-quarters (76.8%) of funding from HICs and multilaterals was allocated to HIV/AIDS, TB and malaria in 2008. HIC public funding increases were recorded for some of the more neglected diseases, including $33.9m for kinetoplastid R&D (up 73.8%) and $16.6m for diarrhoeal diseases R&D (up 37.9%). Platform technologies saw only a very modest increase in public investment (under $2m); although a component of this reported underfunding may be due to funder inability to tease out platform investments. Core funding for R&D organisations decreased by nearly $9.6m in 2008, although this may be an artefact of uneven multi-year grants.
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