The mismatch between the health research and development (R&D) that is needed and the R&D that is undertaken: an overview of the problem, the causes, and solutions

Figures & data

Fig. 1 The figure from the report of the Commission on Health Research for Development that formed the basis for the term ‘10/90-gap’ (reprinted by permission of Oxford University Press, USA) (4).

Table 1 Distribution of global health R&D funding across neglected diseases

Disease	Global R&D funding 2011 (million US$)	Global BoD (million DALYs)	Global R&D funding in US$/global DALY
HIV	1,117	81.5	13.7
Malaria	596	82.7	7.2
Tuberculosis	584	49.4	11.8
Dengue	249	0.8	301.7
Diarrhoeal diseases	169	89.5	2.0
Kinetoplastids	142	4.4	32.0
Bacterial pneumonia and meningitis	107	68.0–104.9^a	1.0–1.6
Helminths (worms and flukes)	90	12.3	7.3
Salmonella infections	48	17.1	2.8
Trachoma	10	0.3	31.1
Leprosy	8	0.006	1400.9
Buruli ulcer	6	NA^b	–
Rheumatic fever	1	10.1	0.1

Notes: Table is based on Table 2 from the G-FINDER report 2012, which reports on global R&D funding for 31 neglected diseases (12). ‘Neglected diseases’ are defined in this report as diseases that disproportionally affect people in developing countries, for which there is a need for new products, and for which there is market failure. The list of 31 diseases includes HIV, tuberculosis and malaria, and thus adheres to a different definition of neglected diseases than WHO (24). Burden of disease (BoD) data are from the Global Burden of Disease (GBD) study 2010 (25). DALYs=disability-adjusted life years.

^aGlobal BoD for bacterial pneumonia and meningitis is displayed as a range because ‘other LRIs’ and ‘other meningitis’ in the GBD study 2010 were not sub-specified into viral or bacterial pathogens. The lower limit represents the BoD without the ‘other’ categories, while the upper limit includes the ‘other categories’.

^bGlobal BoD data for buruli ulcer were not available.

Table 2 Distribution of US National Institutes of Health (NIH) funding across cancers

Disease	US NIH R&D funding 2011 (million US$)	US BoD (thousand DALYs)	US NIH R&D funding in US$/US DALY
Prostate cancer	284	225	1262.0
Cervical cancer	143	114	1253.7
Breast cancer	715	612	1167.4
Ovarian cancer	138	145	951.8
Colorectal cancer	313	542	577.4
Liver cancer	74	138	537.0
Uterine cancer	40	75	530.0
Pancreatic cancer	112	238	471.1
Lung cancer	221	1,248	177.1

Notes: Table is based on Table 1 from Brower (2005) (28). US burden of disease (BoD) Data were derived from the WHO Global Burden of Disease (GBD) report from 2004 (29) (2010 GBD country data will not be released until September 2013). US NIH funding data were derived from NIH Research Portfolio Online Reporting Tools (RePORT) (30).DALYs=disability-adjusted life years.

Table 3 Distributions of research articles and clinical trial research across five neglected diseases in Africa

	Number of articles with at least one African author/million African DALY	Number of trials recruiting in Africa/million African DALY
Diarrhoeal diseases	9.1	0.2
Lower respiratory infections and meningitis	10.6	0.5
Malaria	59.7	6.6
HIV	53.6	4.5
Tuberculosis	82.8	4.1

Notes: To demonstrate how the distribution of R&D can be measured using different R&D indicators, numbers of African research articles and African clinical trials are related to African burden of disease for the five diseases with the highest burden of disease in Table 1. Numbers were calculated from Nwaka et al. (2010) (31).

DALYs=disability-adjusted life years.

Fig. 2 Health R&D need is determined by: (A) existing health problems, (B) the need for new knowledge and products, and (C) the health R&D that is already being undertaken.

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