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A recent report from a global health advocacy group in Washington, DC shows the importance to the United States of US government investment in global health research and development and argues that more investment would have a tremendous positive impact on lives worldwide, including in fighting neglected diseases.

The 44-page report, entitled “Return on Investment: Why global health R&D is a smart investment for the United States,” available here [pdf].

The report was conducted by the Global Health Technologies Coalition (GHTC), a Gates Foundation-backed group in Washington, DC, and Policy Cures Research of Sydney, Australia.

It provides “an in-depth analysis of US government funding for global health research and development (R&D), as well as analysis of health impact and economic returns from these investments.” It describes the role of various US agencies in the R&D pipeline, and says the pipeline is “robust”, with hundreds of products under development.

The findings show that recent US government investment in R&D for global health was a fraction of what it was many other areas such as health and Medicare, military or education. It found that US investment in global health R&D brings substantial benefits to the US economy, that US funding has been essential for advancing technologies and products against a range of diseases, and has led to lower costs that have saved hundreds of thousands of lives worldwide.

But the report adds, “There is a market failure for new drugs, vaccines, diagnostics, and other tools for neglected diseases. Because these diseases primarily affect people in some of the world’s poorest places, there is little commercial incentive for the private sector to develop these tools.”

It said US government investment “is critical to jumpstart research for urgently-needed health tools and to incentivize private sector engagement by de-risking investment.”

The report details government agencies’ health R&D spending (with the National Institutes of Health leading the way, followed by the Defense Department), and says, for instance, that “the US government was heavily involved in the successful development of new drugs and vaccines for neglected diseases, supporting nearly three-quarters (14, 74%) of all new neglected disease drugs and two-thirds (6,67%) of all new neglected disease vaccines developed in the last decade and half.”

A footnote in the report states, “In this report, ‘support’ includes both direct financial investment and non-financial contributions (active participation in R&D, or the provision of expertise, infrastructure, capacity building, or intellectual property & technology transfer).”

Benefits of Investment

The report shows the impact of more funding upfront, for instance in the case of the Ebola virus which broke out in West Africa and began to spread to the United States and elsewhere. The US spent billions stopping the virus after thousands of people had died.

“If a point-of-care diagnostic and vaccine against Ebola had been available at the start, the 2014 West African Ebola outbreak would never have grown into the global health emergency it became,” the report states. “Not only would thousands of deaths have been prevented, but the US government would also have saved billions of dollars.”

The report details a variety of diseases, like Zika, that are known and are spreading to the United States while funding is not sufficient to prevent them. Chagas, multi-drug resistant tuberculosis and extensively drug resistant TB were also mentioned.

It offers a table of cost savings related to investment, comparing for instance the $60 billion estimated for a large-scale pandemic outbreak with the $1 billion in R&D investments per year that could protect against this happening. Another example was the $26 million invested in the 1950s to fight polio, saving $180 million per year for treatment costs in the US alone.

Yet a further example is that, according to the report, the US spends $6.5 billion annually to fight HIV/AIDS, where even a 70 percent effective vaccine would cut HIV incidence globally in half.

Industry Leveraging

Another key argument in the report is that government spending has a “multiplier effect” and leverages funding from the private sector and donors.

The report says industry can be led to invest in neglected disease areas. It states that “in 2015 the US government provided $192 million to US-based pharmaceutical companies, including both multinational pharmaceutical companies and small pharmaceutical and biotechnology companies, to undertake global health R&D activities. In return, these US-based pharmaceutical companies invested an additional $294 million in 2015 alone, with the vast majority of this money spent domestically in the United States. In the field of global health – where companies have little to no chance of recouping their R&D costs via product sales – this degree of industry investment would not have happened without supporting investment from the US government.”

Conclusions

Overall, between 2007 and 2015, the US government invested nearly US$14 billion dollars in R&D for global health, according to the report. In comparison, it said, in 2015 alone, the US government spent $1.05 trillion on Medicare and health, $609 billion on the military, and $102 billion on education.

The report concludes: “Not only does US government investment play an essential and catalytic role in developing new drugs, vaccines, diagnostics, and other urgently-needed tools for neglected diseases and health conditions, but it also delivers tangible economic and security returns for Americans. This is a win-win from a humanitarian and strategic perspective – these investments save and improve lives in vulnerable populations around the world, while at the same time advancing American leadership in science and innovation, creating jobs and economic growth at home, supporting public-private partnerships, and protecting American and health security.”

“At present, however,” it adds, “the United States’ funding commitment to global health R&D doesn’t reflect these documented returns. Despite both global health and economic imperatives – in addition to the increasing frequency of global pandemics, growing antimicrobial resistance, and heightened ability for diseases to cross borders – core US government investment in global health R&D continues to decline. In 2015, funding levels for neglected disease R&D reached their lowest point since tracking began in 2007. This must change.”