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