The United States remains by far the most important source of funds for medical research and development for scores of diseases well-known to the developing world.
According to the latest available data from the independent research group Policy Cures, global donors contributed over $2 billion in public funding for research into what the medical community calls neglected diseases. The U.S. government accounted for over 70 percent of the amount.
But a new report from the Global Health Technologies Coalition, a group of nonprofits that promotes creation of vaccines and other tools to improve global health, says that over the past five years, funding has largely been flat. This is in contrast to the first decade of the 21st century, which saw a doubling of financial support.
"We have seen a decline or stagnation in funding since 2009, and I think one of the biggest reasons for that is the budget sequestration in the U.S. government in 2013," said Erin Will Morton, GHTC executive director. "It really was detrimental for agency funding across the board and certainly made global health R&D take a hit in terms of funding levels."
Usually, U.S. administrations make yearly budgetary requests to Congress for funds for global health programs. In other cases, emergency requests are made. Critics say the amounts granted often fall short of what’s needed to ensure the development of drugs and other health products, especially for fast-breaking pandemics.
Recently, the White House announced it might divert funding for controlling Ebola to fighting the spread of the Zika virus. Morton said that's a bad idea.
“We are not in the clear with Ebola," she said. "We still don’t have the tools we need to fight [it], and so we risk a lot by moving that money to fight the next public health crisis. Zika happened very shortly after Ebola and we weren’t necessarily finished with that, and we don’t know what’s coming next. Moving funds around from one public health crisis to the next is an unsustainable way to address global health issues.”
The GHTC report asks the U.S. government to encourage private sector involvement in R&D with prizes, small-business innovation awards, tax credits and other incentives. It also recommends improved cooperation among the seven U.S. agencies involved in global health.
"Getting those agencies to work closely together is an effective strategy for better using the dollars that we do have," Morton said. "So it doesn’t always have to be about new money, but better using the money we have. We saw this in the response to Ebola … where there was great coordination" by federal agencies to solicit new innovations to help stop the outbreak.
Morton said the government could work with middle-income countries like Brazil, India and South Africa to enhance their own R&D efforts. The U.S. Food and Drug Administration could provide scientific guidance to regulatory authorities as they review health products. Morton said the FDA could also help boost the regulatory capacity needed by lower- and middle-income countries seeking to adopt new medical technologies.
"The regulatory authorities that oversee new products and drugs in any country are crucial in protecting citizens from adverse effects from tools or technologies that are not safe," she said. "Those guidelines or restrictions can be different from country to country," so it's a matter of "making sure the regulatory authorities are able to understand the populations within the country and then the tools, drugs, diagnostics that will be used by those populations and communities."
The GHTC report says U.S. investment has helped develop a pipeline of 500 tools that could be effective in treating neglected diseases. They include new medications for malaria, tuberculosis and Ebola, a microbicide ring for preventing the transmission of HIV/AIDS, and a new class of antibiotics for drug-resistant diseases.
The cost of developing new global health products will most likely increase as they go from laboratory testing to clinical trials. Now is not the time, Morton said, to pull back U.S. investments and put that arc of progress at risk.