Which countries invest most in TB research?

By Marcus Low, Spotlight

Investment in TB research can be measured in many ways. The most obvious way is simply to look at who gives the most money for TB research. The country that gives the most, by far, is the United States – which gives more money than all other countries combined.

Of the $726 million invested in TB research and development (R&D) in 2016, 66% was invested by governments, 20% by philanthropic organisations, 11% by industry, and 3% by multilateral entities. Together, the United States National Institutes for Health (NIH) and the Gates Foundation contributed half of global investment in TB R&D. Many pharmaceutical companies do not invest in TB at all; and the few that do, invest relatively small amounts.

The top 10 countries in terms of absolute investment in TB R&D were:

  1. United States $316 471 566
  2. United Kingdom $27 575 390
  3. European Union $23 575 253
  4. Canada $16 898 180
  5. Germany $14 820 938
  6. India $14 768 283
  7. South Korea $12 359 135
  8. The Netherlands $9 858 859
  9. Australia $9 489 424
  10. South Africa $6 465 746

While a new BRICS TB Research Network was announced recently, of the five BRICS countries, only India and South Africa are in the top 10 in terms of absolute investment in TB R&D. Large developing economies such as China, Russia, Indonesia and Brazil make only very modest investments in TB R&D. Among wealthy countries, the very low investment made by France, Japan, Italy and Spain is notable.

SA top on two important measures

In the latest TAG R&D report, South Africa is ranked number one on two important measures of investment in TB R&D: percentage of GDP and percentage of GERD (explained below). In terms of the absolute investment in TB R&D, South Africa ranked 10th, with $6.5 million (around R90 million) invested in 2016. Whichever measure you use, South Africa invests more than most other countries with high TB burdens.

Yet, even with South Africa’s relatively high levels of investment in TB R&D, many of our researchers are still dependent on funding from the United States government to do their research. The United States invests almost 50 times as much as South Africa in TB R&D.

“South Africa ranks first when its spending on TB R&D is judged relative to its GDP and GERD; however, this is largely a function of South Africa’s lower GDP and R&D expenditures, compared to other countries that report data. The absolute amount of money South Africa gives to TB research is still low – only $6.5 million last year – and most goes to a handful of universities and academic medical centres.

“Given the burden of TB in South Africa, its significant clinical trials capacity, and the depth of its scientific talent, there is ample room for South Africa to increase its contributions to TB research. In addition to supporting domestic researchers through grant funding, South Africa should explore innovative ways to finance and incentivise TB research, including co-financing for regional and global initiatives such as The Life Prize or the BRICS TB Research Network.” – Mike Frick, author of the TAG TB R&D Report

Percentage of GDP

Because countries have different-sized economies and different levels of development, simply looking at who gives the most money is not always a fair comparison. One alternative is to see what percentage of a country’s GDP is spent on TB R&D. GDP, or Gross Domestic Product, is the total value of everything produced by all the people and companies in a country.

The top 10 countries in terms of percentage of GDP invested in TB R&D are:

CountryTB R&D Funding 2016GDP 2016 (USD Millions)TB R&D Expenditure as % of GDP Rank Order
South Africa$6 465 746$294 8411
United States$316 471 566$18 569 1002
Norway$5 503 497$370 5573
The Netherlands$9 858 859$770 8454
Canada$16 898 180$1 529 7605
United Kingdom$27 575 390$2 618 8866
Switzerland$5 938 196$659 8277
South Korea$12 359 135$1 411 2468
Australia$9 489 424$1 204 6169
India$14 768 283$2 263 52310

Percentage of GERD

Another option is to look at what percentage of all the money invested in R&D in a country is invested specifically in TB R&D. This total investment in R&D in a country is called GERD, or Gross Domestic Expenditure on R&D.

The top 10 countries in terms of percentage of GERD invested in TB R&D are:

CountryTB R&D Funding 2016Average Annual GERD 2010–2015GERD calculationTB R&D Expenditure as Percentage of GERD Rank Order
South Africa
$6 465 746
$4 718 475 774
0,14%
1
Norway$5 503 497$5 441 716 1000,10%2
United States$316 471 566$452 804 833 3330,07%3
United Kingdom$27 575 390$41 157 956 4650,07%4
Canada$16 898 180
$25 773 702 491
0,07%
5
The Netherlands$9 858 859$15 342 022 2200,06%6
Australia$9 489 424$21 554 008 7150,04%7
Switzerland$5 938 196$13 669 878 7100,04%8
The Philippines$302 178$762 079 5320,04%9
New Zealand$679 649$1 811 948 5690,04%10

TAG calculated that in order to meet the WHO End TB Plan’s target of $2 billion per year for TB R&D, all high-burden and G20 countries must invest 0.1% of GERD in TB R&D. Currently, the only two countries to meet this target are South Africa and Norway.

 

  • The figures in this article are taken from the Treatment Action Group report ‘The Ascent Begins: Tuberculosis Research Funding Trends, 2005-2016’, published in November 2017. Find the full report at TreatmentActionGroup.org/TB

Less money for TB research

By Mike Frick

Treatment Action Group

The world spent less on tuberculosis (TB) research in 2015 than it did in 2009. This decrease in spending does not track a similar decline in TB incidence or mortality.

The World Health Organisation (WHO) recently announced that the TB epidemic is larger than previously estimated, a grim truth uncovered by improved surveillance data from India. More than 10 million people fell ill with TB in 2015 and 1.8 million died from the disease, making TB the leading cause of death from a single infectious agent globally. Yet research by the Treatment Action Group (TAG) shows that funding for research to develop the diagnostic tests, preventive interventions, and combination drug treatments needed to eliminate TB fell for the second year in a row, landing at US$620,600,596 – the lowest level of funding since 2008.

The TAG’s 2016 Report on Tuberculosis Research Funding Trends: No Time to Lose is the 11th in a series of reports that track annual spending on TB research and measure actual spending against the targeted funding called for by the Stop TB Partnership’s Global Plan to Stop TB, 2011-2015.

Only one third of needed investment

The Stop TB Partnership estimated that the world needed to spend $9.84 billion on TB R&D between 2011 and 2015 to end TB as a public health threat. Instead, actual funding for TB R&D amounted to $3.29 billion, just one-third of this target. Most alarming, funding for TB R&D fell in three of the last five years – by $36.5 million in 2012, $12.3 million in 2014, and $53.4 million in 2015. This downward trend belies the upward revisions to the extent of the TB epidemic over the same time period and points to an acute anemia of political will to address TB. The fact that spending on TB research is falling as estimates of TB mortality rise is a damning illustration of how governments have failed to mobilise against TB.

All sectors – including the pharmaceutical industry – have an obligation to fight TB by investing in the science required to end this epidemic, but the heavy lift will need to come from governments. (In 2015, the private sector spent $86.8 million on TB R&D, 40 percent less than the $145 million industry invested in 2011.) Over 60 percent of TB research funding comes from the public sector, and over half of all public money for TB R&D from 2011 to 2015 came from a single country: the United States. This degree of concentration has produced a precarious reliance on the political commitment of a single country.

BRICS: Half of TB, 4.3 percent of TB R&D

Countries that shoulder the heaviest burdens of TB are conspicuously absent from the list of leading TB R&D funders. Together, the BRICS countries (Brazil, Russia, India, China, and South Africa) accounted for nearly half of all TB cases and deaths in 2015, but only contributed 4.3 percent of public financing for TB R&D. In absolute terms, India led the BRICS countries with $11.1 million, followed by South Africa with $3.9 million and Brazil with $1.9 million. (Despite repeated requests, the governments of China and Russia did not return TAG’s survey.)

South African universities – which conduct some of the world’s most cutting-edge TB research – received more funding from the US National Institutes of Health (NIH) and the Bill & Melinda Gates Foundation (Gates Foundation) than from the South African Medical Research Council or other domestic agencies.

In 2015, the South African Medical Research Council disbursed $3.1 million in support of TB research (some of these funds came from budgetary allocations by the Department of Science and Technology and the Department of Health). By comparison, the Gates Foundation gave $17.5 million to South African research organisations, and the NIH gave $3.9 million.

A crisis of political will

The growing recognition that the deficit of TB R&D funding is a crisis of political will owes a lot to the unflinching analysis of South African TB and HIV activists. After reviewing TAG’s 2015 TB R&D funding data, Lynette Mabote of the AIDS and Rights Alliance of Southern Africa offered this frank diagnosis: ‛There can be no end to TB without an end to political indifference in this R&D agenda.’

Mabote’s words echoed a point Anele Yawa, General Secretary of the Treatment Action Campaign, made in his closing speech at the 46th Union World Conference on Lung Health in Cape Town: ‛The lack of investment in TB is a political problem. It is political, because at its essence it is about governments not being held accountable for failing to respond to TB. We are not going to change it if we accept business as usual. We can’t win this battle if we don’t make it a political battle.’

Key UN processes

The tools, frameworks, and platforms for making TB R&D a political battle are starting to coalesce. In particular, two UN-led processes that culminated in September 2016 have created unprecedented opportunities for TB research activists to engage political leaders on the global stage.

The first is the final report of the UN Secretary-General’s High-Level Panel on Access to Medicines, which issued a formidable set of recommendations to address the market failures that have resulted in meager research funding for diseases like TB.

The second is a political declaration adopted at the first-ever UN High-Level Meeting on Antimicrobial Resistance in which UN member states expressed a broad intention to tackle the threat of antimicrobial resistance through joint action, including fixing the ‛lack of investment in research and development’.

The TB field should not let this flurry of ‛high-level’ activity dislodge its grounding in the organising and mobilisation work that must take place at the country level and in the communities hit hardest by TB. In the words of Mabote, there is a need for ‛actionable strategies which support R&D resource mobilisation’, both within countries and regionally.

Previous attempts to harness more support from the BRICS countries for TB R&D – for example, the 2012 Delhi Communiqué of the 4th BRICS Ministers of Health Summit – have resulted in mellifluous statements about the need to collaborate without any actual commitments of funding. Future statements of intent must come with all the ingredients of accountability – clear targets, action plans, and timelines – that have previously been missing, and empowered civil societies in the BRICS countries and elsewhere must ensure that promises to support TB research are followed by a real increase in funding.