What record-high funding for neglected diseases doesn’t tell us about R&D for them

In recent weeks, scientists have raced to understand the deadly new coronavirus and develop new tools to diagnose and contain it. As with past emerging threats, I’ve been impressed to see how this novel virus has mobilized collective action that transcends borders, sectors, and individual interests over such a short period.

During those same few weeks, more familiar pathogens have been quietly exacting a far heavier toll on human health and prosperity. Neglected diseases like diarrheal illnesses, tuberculosis, malaria, and pneumonia kill thousands of people every day. But because they have been doing so for decades, they simply don’t catalyze the same urgency we see in the face of a novel, fast-moving outbreak.

The fact that neglected diseases predominantly affect the poor explains — but cannot excuse —underinvestment in the tools needed to counter these threats. The effect of this underinvestment is clear: We lack effective and appropriate approaches to diagnose, treat, and prevent diseases that kill millions of people each year.

New data give me hope that this might change. Every year, my team at Policy Cures Research works to track and report every dollar put toward developing new tools against neglected diseases. This year, our survey of more than 200 public, private, and nonprofit funders delivered some positive news: For the first time, investment in neglected disease research and development grew for a third consecutive year, pushing funding to a record high of $4 billion.

We’ve already begun to see the impact of this recent and unprecedented growth in investment. After decades of hard-won but infrequent breakthroughs, the last few years have delivered a rush of new tools, including the first new treatment for river blindness in 20 years, a game-changing oral treatment for sleeping sickness, a single-dose cure for relapsing malaria, and new vaccines for diarrheal illnesses and pneumonia. And the research and development pipeline is filled with more than 500 possible drugs, vaccines, diagnostics, and other tools with the potential to transform lives.

This surge of innovation underscores how much we are poised to achieve over the next decade — and how much we stand to lose if global funding falters now. While growing R&D investments have pushed a flood of potential products through the early phases of innovation, many of these would-be tools now teeter on the cusp of the final and most expensive stage of development: clinical trials.

Furthermore, given that as few as 1 in 10 candidates that enter clinical trials will ever become an approved drug, even this relatively healthy pipeline will fail to deliver all of the new tools we need. Key gaps in the pipeline include nearly 20 missing game-changing diagnostics, drugs, and vaccines prioritized by the Commission on Investing in Health, including vaccines against malaria and hepatitis C and new drugs for neglected tropical diseases.

To bring existing candidates through human clinical trials and deliver these missing tools, an estimate from leading institutions, including the World Health Organization, indicates that that funders would need to commit an additional $1.5 billion every year — and probably much more. By merely maintaining the new record level of funding, we would still fall short of this goal. Dozens of tools — and millions of lives — would slip through our fingers.

To avoid this fate and bring more products across the finish line, we need more investment from more kinds of investors. That means top funders like the United States, United Kingdom, and European Union will need to continue their leadership while also embracing innovative solutions and partnerships that bring new funders to the table.

More emerging funders will need to follow in the footsteps of Germany, India, and Japan — bringing not only investment but also more of the bright minds needed to tackle complex health challenges like neglected diseases.

The private sector, which helped drive this year’s record funding increase with unprecedented investments in late-stage innovation, will need to step into an even larger role offering the expertise, technologies, and resources that philanthropies and governments don’t have. We’ve seen what industry can achieve. Over the past year, for example, Johnson & Johnson invested millions in collaboration with the National Institutes of Health and other partners to launch the largest Phase 3 clinical trial of an HIV vaccine. Private-public partnerships like these will be key to translating more breakthroughs into usable products.

Finally, all of these actors will need to work together to address bottlenecks in late-stage innovation by building new clinical trial capacity in developing countries in Africa, Asia, and Latin America, which would also ensure that products are better tailored to the people who need them.

An investment of $4 billion is an incredible sum of money — more than has ever before been spent on research for neglected diseases. But at the start of a new decade, we need to compare funding not to past commitments but to all that can be achieved.

Fast-moving diseases galvanize action for a simple reason: People everywhere, no matter where they live or how much money they have, could be at risk. We should expect no less of a commitment when it comes to fighting diseases that predominantly affect the world’s poorest people. The investments of the last few years have given us hundreds of opportunities to save millions of lives and cast some of the world’s oldest and deadliest diseases into the ash bin of history.

Stepping back from that chance, when so much is possible, would be a terrible mistake.

Nick Chapman, M.D., is the CEO of Policy Cures Research and lead author of the organization’s G-FINDER report, a comprehensive source for trends in global health R&D funding. The organization’s work is supported by grants from the Bill & Melinda Gates Foundation, the World Health Organization, and others.