Elsevier

The Lancet

Volume 382, Issue 9900, 12–18 October 2013, Pages 1286-1307
The Lancet

Health Policy
Mapping of available health research and development data: what's there, what's missing, and what role is there for a global observatory?

https://doi.org/10.1016/S0140-6736(13)61046-6Get rights and content

Summary

The need to align investments in health research and development (R&D) with public health demands is one of the most pressing global public health challenges. We aim to provide a comprehensive description of available data sources, propose a set of indicators for monitoring the global landscape of health R&D, and present a sample of country indicators on research inputs (investments), processes (clinical trials), and outputs (publications), based on data from international databases. Total global investments in health R&D (both public and private sector) in 2009 reached US$240 billion. Of the US$214 billion invested in high-income countries, 60% of health R&D investments came from the business sector, 30% from the public sector, and about 10% from other sources (including private non-profit organisations). Only about 1% of all health R&D investments were allocated to neglected diseases in 2010. Diseases of relevance to high-income countries were investigated in clinical trials seven-to-eight-times more often than were diseases whose burden lies mainly in low-income and middle-income countries. This report confirms that substantial gaps in the global landscape of health R&D remain, especially for and in low-income and middle-income countries. Too few investments are targeted towards the health needs of these countries. Better data are needed to improve priority setting and coordination for health R&D, ultimately to ensure that resources are allocated to diseases and regions where they are needed the most. The establishment of a global observatory on health R&D, which is being discussed at WHO, could address the absence of a comprehensive and sustainable mechanism for regular global monitoring of health R&D.

Introduction

In April, 2012, the WHO Consultative Expert Working Group published its report on financing and coordination of research and development (R&D) related to diseases that mainly affect the world's poorest people living in developing countries.1, 2 The report is the latest assessment of potential solutions to the inequity in the distribution of global health research efforts, first described by the Commission on Health Research for Development in 1990 and later referred to as the “10/90 Gap”, which indicates that only a small proportion of global health research expenditure is spent on diseases that have a large burden of preventable mortality in low-income and middle-income countries.3

Advances in knowledge and technology have contributed substantially to improvements in health,4, 5 but these gains have not been distributed or shared equally, with disparities in life expectancy and burden of disease especially notable between low-income and middle-income countries, and high-income countries.6 Widespread calls for universal health coverage and to address broader determinants of health show the global imperative to eliminate these avoidable disparities.7, 8, 9, 10 One crucial contributing factor is the inadequate investment in R&D to address the specific health problems of poor populations.11, 12 This well-recognised investment deficit formed the background to the work of the Consultative Expert Working Group and the process that preceded it including an international commission and several year-long multilateral negotiations.3, 13, 14, 15, 16, 17 The group's report, which is being discussed by the governing bodies of WHO, recommends a new approach to global health R&D that involves the implementation of three elements focused on meeting the R&D needs of low-income and middle-income countries: guarantee of sustainable financing; coordination of global efforts; and provision of functions to monitor and inform the research processes in the form of a global observatory on health R&D.

A global observatory on health R&D is needed because our understanding of what health R&D is undertaken, and where, by whom, and how, is very scarce, and such knowledge is necessary to improve priority setting and coordination for health R&D.18, 19 In this report, we describe how a global observatory could provide such information. We consider potential data sources for health R&D information; assess data availability and limitations of the available sources; propose a set of potential indicators; and discuss the value that a global observatory would have nationally, regionally, and worldwide.

Section snippets

Identification of data sources and indicators

Global and regional sources that present up-to-date information about health R&D on an ongoing basis at regular intervals were identified through searches of publications, grey literature, and websites. One-off data collection efforts and analyses were not included. National data sources representing one individual country and data from funding organisations or programmes were excluded because of comparability issues.

We used the Frascati Manual definition of R&D, which is: “Research and

Data availability

Substantial information gaps were apparent for all the assessed health R&D indicators, especially for and in low-income and middle-income countries, where disease burden is greatest. The availability of data for countries' investments—ie, what they report and how comprehensively and what is available in international databases—in R&D in general and in health R&D varied widely (table 3). Data for health R&D investments were found for only 37% of all countries. Data availability for this

R&D investments

We estimated the global total investment in health R&D (both public and private sector) to be roughly $240 billion purchasing power parity-adjusted dollars in 2009, with 89·5% ($214 billion) coming from high-income countries, 7·9% ($19 billion) from upper-middle-income countries, 2·6% ($6·2 billion) from lower-middle-income countries, and only 0·1% ($0·2 billion) from low-income countries (table 3). The countries contributing the most in absolute terms were the USA ($119 billion), Japan ($18

Clinical trials and publications

We assessed the volume of ongoing global clinical trial activity—ie, the number of actively recruiting trials registered on the International Clinical Trials Registry Platform, and the number of publications in health journals indexed by Web of Science. Denmark, Estonia, Finland, Sweden, and the Netherlands had the highest number of trials per person, whereas Switzerland, Sweden, Denmark, the Netherlands, and Iceland ranked highest for publications per person (table 3). An association was noted

R&D profiles

Many of the health R&D indicators were linked to wealth—ie, the richer the country, the greater their R&D investments, volume of ongoing clinical trials, and number of publications. However, some indicators seemed to be less dependent on country income than others. Although a weak relation was noted between wealth and health R&D investments as a proportion of total R&D investments, with richer countries usually investing relatively more on health research than poorer countries, this proportion

Research to address unmet needs

Available data and indicators for assessment of countries' contributions to the health R&D needs of low-income and middle-income countries are scarce. One method to assess this factor is to study countries' investments in R&D aimed at developing health products for neglected diseases as defined by the G-FINDER report.19 Global public and philanthropic investments for neglected disease R&D were $2·4 billion purchasing power parity-adjusted dollars in 2010, which is roughly 1% of total global

Investments compared with norms

The Consultative Expert Working Group report concluded with recommendations about countries' investment levels in health R&D.1, 11 Governments in developing and developed countries were recommended to invest 0·05–0·1% and 0·15–0·2% of GDP on total health R&D, respectively, and at least 0·01% on research on products to meet the specific health needs of developing countries. These targets are roughly in line with the 2% target of governmental health expenditures proposed by the Commission on

Persistent R&D gaps

Global investments in health R&D are increasing and reached $240 billion purchasing power parity-adjusted dollars in 2010, with $26 billion of this amount spent in low-income and middle-income countries. Estimates of the global total of health R&D investments have been reported at intervals from 1986 (US$30 billion invested, of which $1·6 billion was devoted to the health problems in low-income and middle-income countries) through to 2005 ($160 billion invested, including $5 billion in

Existing information gaps

We have proposed a set of health R&D indicators to allow for better monitoring and analysis of existing priorities and of countries' performance. A broad set of indicators allows for a triangulation approach, in which different types of information provide different windows of understanding into the R&D landscape. However, several challenges persist in data availability and applicability for collation of such a set of indicators.

Data sources for monitoring of health R&D are collected mainly by

A global observatory on health R&D

The creation of a global observatory on health R&D, as recommended by the Consultative Expert Working Group and outlined in a draft resolution for discussion at the 66th World Health Assembly in May, 2013, could address the information gaps.1, 37, 38 The functions of such an observatory could include monitoring and reporting of financial flows in support of global health needs; integration of information about R&D financial flows with product pipelines and other resources that support

Conclusions

The persistent nature of the gap between health R&D needs and the R&D that is presently funded and undertaken calls for managed approaches to the allocation of scarce health research resources. Health R&D funders, both public and private, should be able to access appropriate and accurate information about health R&D inputs, processes, and outputs. To achieve this aim, national, regional, and global monitoring of health R&D must be strengthened.38 A global observatory on health R&D would be

References (42)

  • JA Røttingen et al.

    Securing the public good of health research and development for developing countries

    Bull World Health Organ

    (2012)
  • S Moon et al.

    Innovation and access to medicines for neglected populations: could a treaty address a broken pharmaceutical R&D system?

    PLoS Med

    (2012)
  • Investing in health research and development

    (1996)
  • International Conference on Health Research for Development, Bangkok 10–13 October 2000. Conference Report

    (2001)
  • Macroeconomics and health: investing in health for economic development

    (2001)
  • Public health, innovation and intellectual property rights. Report of the Commission on Intellectual Property Rights, Innovation and Public Health

    (2006)
  • Sixty-first World Health Assembly, 19–24 May 2008, Resolution WHA61.21

    (2008)
  • RF Terry et al.

    Mapping global health research investments, time for new thinking— a Babel fish for research data

    Health Res Policy Syst

    (2012)
  • M Moran et al.

    G-FINDER 2011. Neglected disease research and development: is innovation under threat?

    (2011)
  • Frascati Manual 2002: proposed standard practice for surveys on research and experimental development

    (2002)
  • CJ Murray et al.

    A study of financial resources devoted to research on health problems of developing countries

    J Trop Med Hyg

    (1990)
  • Cited by (219)

    • Global human burden and official development assistance in health R&D: The role of medical absorptive capacity

      2021, Research Policy
      Citation Excerpt :

      Against this backdrop, we set out to understand the determinants of health R&D ODA receipt across the globe using latest available data. We follow a thrust in the literature on health R&D spending in that (limited) funding follows (greatest) human need (Confraria and Wang, 2020; McMahon and Thorsteinsdóttir, 2013; Røttingen et al., 2013) while acknowledging that this is not always agreed upon (Viergever, 2013). The ‘needs-driven’ logic is strongly supported by our range of tests for H1.

    • Nurturing equality, diversity and inclusion: Support for research careers in health and biomedicine

      2024, Nurturing Equality, Diversity and Inclusion: Support for Research Careers in Health and Biomedicine
    View all citing articles on Scopus
    View full text