US invests more in TB research, SA investment drops, report finds

The World Health Organization (WHO) estimates that South Africa has approximately 27 000 children (under the age of 15) living with TB. IMAGE: Health24

Total global investment in tuberculosis (TB) research and development (R&D) hit a new high of $906 million in 2018. This was a $134 million increase from the $772 invested in 2017, but still less than half the $2 billion per year target that was endorsed at a United Nations High-level meeting on TB in 2018.

These figures are from Tuberculosis Research Funding Trends 2005-2018, the latest edition of New York-based think tank Treatment Action Group’s (TAG) annual survey of TB R&D.

According to the report the United States (US) government remains by far the largest funder of TB R&D in the world having invested $371 million in 2018. The Bill and Melinda Gates Foundation is the second largest funder with an investment of $141 million. Between them, the US government and the Gates Foundation contributed 56% of total global investment in TB R&D in 2018.

Despite fears that US funding for TB R&D would decline under the Trump administration, investment actually increased in 2018 by $62 million. But according to Mike Frick, TB Project Co-Director at TAG and co-author of the report, the Trump administration deserves “absolutely no credit for the fact that U.S. government funding for TB research has increased substantially in recent years”.

“These increases are owed to strong bipartisan support for the U.S. National Institutes of Health (NIH) among U.S. legislators, who have repeatedly rejected requests by the President to slash the NIH budget,” Frick told Spotlight. “That funding has increased in spite of the anti-science stance of the Trump administration is also thanks to vigorous, organised advocacy by U.S. civil society and grassroots activists who recognise biomedical research as essential to good health. Importantly, TAG and our allies have defended TB research funding without appealing to the Trump administration’s more craven pre-occupations, such as framing TB as a security issue.”

How does SA compare?

In absolute terms, South Africa’s investment of $4.5 million (R64,9 m) in TB R&D is dwarfed by those of the US government and the Gates Foundation. It is also well below investments by the United Kingdom ($63 million), India ($38 million) and Germany ($28 million).

South Africa’s 2018 investment of $4.5 million is dramatically lower than the country’s investment of $8.4 million in 2017.

“There are several sources of funding – both local and international – for TB research and there may be a host of reasons for the decline in year-to-year funding,” said Dr Fareed Abdullah, Director of AIDS and TB Research at the South African Medical Research Council (SAMRC) when asked about the decline. “The levels of funding are better understood if averaged over multiple years. In some years the SAMRC will issue a call for proposals and this increases the funding for that year whilst for other years there may not be a call for proposals.”

More generally, and not only regarding TB, Abdullah said that “government is underfunding R&D and innovation in South Africa” and that “given the weak fiscal position we are in, there are no signals for a substantial increase in funding in the next few years”. “The SAMRC takes the view that greater investments in TB research funding are a high priority and is focusing its efforts on leveraging funding through partnerships,” he said.

SA one of only three countries to meet ‘fair share’ target

Despite the year-on-year decline, when investment in TB R&D is considered as a proportion of a country’s total investment in all forms of R&D, South Africa is nevertheless one of only three countries to meet the so-called ‘fair share’ targets. The other two are the UK and the Philippines. The fair share targets require that countries invest 0.1% of all R&D investment in TB R&D.

While South Africa has around 3.2% of the global TB burden, the country contributed 0.74% of all public sector investment in TB R&D in 2018.

India’s investment of $38 million in TB R&D in 2018 continues an encouraging upward trend in the country with the world’s highest TB burden. In 2018 India invested around 66% of its fair share target. India’s investment in TB makes up only around 5% of global public sector investment in TB R&D, while the country has 27% of the global TB burden.

Together the BRICS countries have over 40% of the global TB burden, but contribute less than 6% of global public sector investment in TB R&D according to figures in the report. Since China and Russia did not provide figures for the report, the real figure will likely be a few percentage points higher than 6%.

“Discussions to establish a BRICS TB Research Network count among the more promising developments in the TB research funding landscape in recent years. But we have yet to see the network come together around a unified funding figure that rivals what is spent by the European Union or the United States,” said Frick. “Just as important as the amount of money committed will be the commitment of the BRICS nations to a clearly articulated set of norms, principles, and standards for financing innovation that put equity, access, and inclusion at the forefront of decision-making. In this respect, the BRICS countries can chart a different course than that taken by funders in the U.S. and Europe, where access has too often been an afterthought in R&D or even secondary to private-sector interests.”

Only 9% from private sector

The public sector (governments) was responsible for 68% ($617 million) of total global investment in TB R&D in 2018. Philanthropies (mainly the Gates Foundation) were responsible for 18% ($159 million). The private sector contributed only 9% ($85 million) with multilateral agencies making up the remainder.

“The private sector is not going to be the saviour,” the report quotes Els Torreele, executive director of Doctors without Borders’ (MSF) Access Campaign, as saying. “It needs to be a public-interest-driven public-private partnership. What we’ve often done is create public-private partnerships where we leave a lot of power and leeway to the private sector trying to still make it a viable business for them. In the situation of TB, even when buying the drugs, where does the money come from? Again, the public. So, let’s take it toward a fully public-responsibility-driven R&D model.”

*Note: Spotlight editor, and author of this article, Marcus Low co-authored the 2018 edition of TAG’s TB R&D report. He had no involvement with the 2019 edition of the report reported on here.