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Section C
Measuring Research Need and Research Investments:
Global Estimates and Dialogue
Population and BOD by Country Income Level, 2000
Low-middle
High
Population in thousands
(%)
4,976,748
(85%)
907,828
(15%)
Total DALYS (in
thousands)
(%)
1,274,259
(92%)
108,305
(8%)
3
The Burden of Disease by Group

The burden of disease by group (DALYs/100,000 pop.), 2000
Low-and
middle-income
High-income
Comm. dis. (incl.
mat., perin., & nutr.)
11,206
863
Non-communicable
diseases
10,200
9,664
Injuries
4,198
1,403
4
Comparison of Groups of BOD: HICs, China, & Africa
5
Rationale

Health research is essential to the design and implementation of
health interventions, health policies, and health service delivery

Financing health research and development (R&D) is critical to its
success

Information on investments for health research, however, is
fragmented
6
Resource Flows for Health Research: First Estimates

Preliminary assessments done for the year 1992

US$56 billion invested annually in health research worldwide

R&D investments in diarrhea, pneumonia, and TB—about 20% of
global disease burden—totaled just 0.2% of global health
expenditure in 1992
7
The Problem Is …

Less than 10% of global research funds are invested in exploring
health problems affecting 90% of the world’s population … now
called the “10/90” gap in health research

Captures the huge discrepancy between the magnitude of disease
burden in the world and the allocation of research funding

These are estimates and the exact figures are not known
8
Second Estimates

Global health R&D funding for 1998 (in US$ billion)
Total
Percent
Advanced/transition
34.5
47
Developing
2.5
3
Pharma industry
30.5
42
Private non-profit
6.0
8
73.5
100
Public funds
Private funds
Total
9
R&D Estimates for Selected Developing Countries, 1998
R&D as %
of health
Brazil
1.2
Cuba
1.4
Costa Rica
1.08
Argentina
0.98
India
0.88
Malaysia
0.4
10
Health R&D as Percentage of GDP, 1998
Data Source: Global Forum for Health Research. (2001). Monitoring financial flows for health research.
11
Observations for 1998

In comparison with 1992, there seems to be an increase in total
research funds for 1998

Research on conditions accounting for highest burden still underfunded

Biomedical research well-funded vs. health economics and social
sciences research
12
Global Health Research Spending, 1990–2001
13
Third Estimate

Global health R&D funding for 2001 (in US$ billion)
Total
Percent
Public funds
44
Private for-profit
48
Private non-profit
8
Total
106
100
14
Global Distribution of R&D Expenditures, 2001
15
International Activities Funding, NIH
16
Global R&D 2001 (1)

US$106 billion includes the largest known contributors

Most of increase from 1998, in expenditures by the private sector,
was in HIC

R&D efforts of many low- and middle-income countries are still
largely unknown or unaccounted

Measuring is far from precise and there are still huge gaps in our
knowledge
17
Global R&D (2)

Gates was the top foundation in health-giving, at US$518.9 million
in 2001, focusing on diseases of highest burden worldwide

HICs have also increased their investments through Official
Development Assistance programs

Most of the spending done by high-income countries is in high
income-countries generating products tailored to health care
markets of high-income countries

A small share is funded and carried out by low- and middle-income
countries
18
Global R&D (3)

An even smaller share is funded by high-income countries but
carried out in and for the benefit of low- and middle-income
countries

In fact, few LMICs have met the target set by the 1990 Commission
of Health Research for Development of 2% of national health
expenditures on health R&D

Mexico, Cuba, India, and Brazil have met target

Even a small shift in budgets of LMICs to allocate more money for
health research that addresses the urgent health needs of their
populations could make a big difference
19
Public Funding of Health R&D
20
Global Investments in Health R&D
21
Resource Flows

Reflections on resource flows
22
Issues: 1

Global allocation for diseases not done collectively or uniformly

Relation between priorities in developing countries and funding
sources (national vs. international) is critical

Funding for social science, health economics and such research very
poor
23
Issues: 2

Cost of R&D to develop drugs and vaccines is immense—but “magic
bullet” effect

Fraction of public funds into fundamental research leading to a
marketed drug

Funding by developed countries to Northern institutions for R&D on
problems relevant to developing countries
24
Issues: 3

Institutional structures to focus attention on research investments
absent at global level

The “politics” of resources heavily influenced by clinical and visible
products

The social accountability of research investments not considered

Decision making at institutional and national levels not consistent
with priorities
25
Future Actions?

Concerted efforts needed to reduce global inequities in investments
in health and health research
-

HOW?
Reasonable for the poorest countries to concentrate health
resources on delivering health services and on research on
operational and health systems research
-  TRUE?
26
Thanks To ...

Global Forum for Health Research

www.globalforumhealth.org

Dr. Andres DeFrancisco

Dr. Abdul Ghaffar
27