Global health research: counting the cost
The world is spending more than ever on health research. Globally, annual spending rose by an average of US$4.6 billion a year during the 1990s to reach US$84.9 billion in 1998. It then rose much more steeply, by an average of US$7.0 billion per year, during the next three years, reaching a total of US$105.9 billion in 2001. These figures have just been revealed in the Global Forum for Health Research's latest publication Monitoring Financial Flows for Health Research 2004.
The Global Forum for Health Research, a Geneva-based foundation, is the only organisation to track global resources for health research. The sharp increase in spending over the past three years for which data is available is due to more resources coming from several sources. It reflects both the greater recognition of the importance of the role of health research in meeting the global health problems we are all now facing, and the increases in research and development costs in biomedical research.
Within the public sector (44 per cent of the total US$105.9 billion spent in 2001) the biggest increase has come from the steeply rising budget of the US National Institutes of Health, up from US$11.9 billion in 1996 to US$27.1 billion by 2003.
For the private for-profit sector (48 per cent of the 2001 total), increased spending is probably a reflection of the increased cost of bringing new drugs to market. One estimate puts the full cost of developing a new drug at more than US$800 million.
Within the private not-for-profit sector (eight per cent of the 2001 total), a major new source of funding has been the Bill and Melinda Gates Foundation, created in 2000. In 2001, the foundation gave US$470 million to health and medical research, with the figure rising to nearly US$520 million in 2002.
Low and middle income countries (LMICs) accounted for less than 3 per cent of global health research spending in 2001, but there is evidence that their expenditures are rising. In 1998, no LMIC was meeting the target set in 1990 by the Commission on Health Research for Development that they should spend two per cent of their national health budgets on health research: by 2001, four countries had reached this level — Brazil, Cuba, India and Mexico.
From a burden of disease perspective, the notion that the world is divided conveniently into two distinct parts — high income countries (HICs) most challenged by non-communicable diseases and LMICs fighting infectious and parasitic diseases — is out of date and no longer tenable. Growing convergence in the health problems of many parts of the world is placing health research in a new light as a global necessity.
HICs have a relatively burden of disease — and this burden is mainly due to non-communicable diseases such as cardiovascular disease, cancer and diabetes. But they are also now experiencing new waves of infectious diseases, such as SARS (severe acute respiratory syndrome) and HIV/AIDS — in fact, there have been 32 new infectious diseases recorded in human beings since 1970, an average rate of about one new disease each year.
Many LMICs now have high rates of non-communicable diseases and injuries, with the burden of such diseases equalling (for example, in India) or exceeding (for example, in China) that of communicable diseases; in China, non-communicable diseases account for two-thirds of the overall disease burden.
But there are some very large regional differences. In particular, in sub-Saharan Africa, the combination of communicable diseases, and maternal, perinatal and nutritional conditions accounts for three quarters of the burden of disease — reflecting especially the impact of HIV/AIDS, tuberculosis and malaria and emphasising the importance of looking beyond highly aggregated averages to improve the focus on the key gaps and needs in each country or region.
There is little information available on how the world spends its health research resources, but it is clear that, firstly, few of the infectious diseases that mainly affect developing countries are getting sufficient attention. Secondly, many of the solutions that have been or are being developed for chronic diseases in HICs may be less suitable for use in LMICs. And thirdly, there is insufficient research in a variety of neglected areas, including sexual and reproductive health, mental and neurological disorders, gender and health.
Together, HIV/AIDS, malaria and TB accounted for 12 per cent of the global disease burden in 2002 and were responsible for more than one in three deaths in sub-Saharan Africa. The total investment in research and development for these three infectious diseases was roughly estimated to be US$8 per Disability-Adjusted Life Year (DALY) — about one tenth of the average of about US$73 per DALY spent globally on all health research in 2002 (the DALY is a measure of the burden of disease, and reflects the amount of healthy life lost from premature mortality, injury or disability). There is also very little investment in research and development for new drugs against drug-resistant bacterial infections.
By focusing on specific problem areas, examining in detail what needs to be done and by whom, the Global Forum for Health Research aims to call attention to the vital importance of harnessing health research to improve global health, and thereby accelerate the pace at which the '10/90 gap' (in which only than 10 per cent of global spending on health is aimed at the health problems of 90 per cent of the world's population) in health research is closed.
Our 8th annual meeting — in Mexico City, 16-20 November 2004 — is joined with WHO's Ministerial Summit on Health Research to bring together close to 700 health researchers, policy-makers, and funders and users of health research from 100 countries, to confront these challenges.The author is the Executive Director of the Global Forum for Health Research