WHO Expert Group on R&D Financing: Geneva, 12-14 January 2009

Tracking Financial Resources

for
Health R&D

Stephen Matlin

Executive Director
Global Forum for Health Research
Geneva

because health equity is a priority

 The spectrum of health research for development

Biomedical research Health policy and systems Social sciences and Operational
research behavioural research research

Understanding the
biological nature of Understanding how to test, scale-up and follow through the introduction of
diseases; creating interventions and optimize their benefits
products to prevent or
treat disease states

Innovation
Impact

because health equity is a priority

Resources for health R&D are situated in the
domains of:

1. development cooperation (ODA)

2. health

3. research

because health equity is a priority

Targets: commitments and aspirations

e.g. Commitments
1. Each economically advanced country will progressively increase its
official development assistance to the developing countries and will
exert its best efforts to reach a minimum net amount of 0.7 per cent of
its gross national product at market prices by the middle of the
decade.
Adopted: UN General Assembly 1970
Reinforced: Monterrey Consensus on Financing for Development 2002
Timetables: by 2015, set by many EU countries since 2002

2. Ministers of S&T of 20 African countries reaffirmed their commitment

to increasing public spending on R&D to at least 1% of GDP within five
years.
Adopted: First NEPAD Ministerial Conference on S&T:
Declaration and Outline of a Plan of Action adopted in
Johannesburg on 3-7 November 2003

because health equity is a priority

Targets: commitments and aspirations

e.g. Aspirations ( Commitments)

1. LMICs should aim to spend 2% of their government health budgets on
health research and research capacity strengthening; this should be
complemented by donors committing 5% of their health aid similarly.
Recommended: Commission on Health Research for Development 1990
Reinforced: Mexico Ministerial Summit on Health Research 2004
and WHA 2005
Committed: We, ministers of health and heads of delegation of the
African countries, meeting in Algiers on 26 June 2008 for
the Ministerial Conference on Research for Health in
Africa… commit ourselves to launching before the end of
2009 the actions that follow:
j. Allocate at least 2% of national health expenditures and
at least 5% of health external project and programme aid
to research and research capacity building; and invest
more on research aimed at improving health systems.

because health equity is a priority

Targets: commitments and aspirations

e.g. Aspirations
2. The Ministers of Health and Heads of Delegation (of 14 African
countries) urge:
9.iii Global Health Initiatives and development agencies to devote at
least 5% of their overall health investment portfolio to support research
capacity of countries, dissemination of research findings and
management of knowledge.
Recommended: Accra Communiqué: High Level Ministerial Meeting on
Health Research for Disease Control and Development.
Accra, Ghana 17th June 2006

because health equity is a priority

 Report Card for R&D for Health

A All Countries
A-1 National R&D total investment as a % GDP
A-2 National R&D for health as % GDP
A-3 National R&D for health as % national health investments
A-4 National R&D for health as % total R&D

B High-income countries
B-1 Gap between actual ODA and commitment to invest 0.7% of GNI on ODA
B-2 Gap between actual annual increase in ODA and commitment to double aid
between 2005 and 2010 - an extra $50 billion worldwide and $25 billion for Africa
B-3 Gap between actual ODA investments in R&D for health and target to invest 5% of
health ODA in R&D for health

C Low- and Middle-income Countries

C-1 Gap between actual investments in health and target to spend 15% of domestic
public spending on health
C-2 Gap between actual investments in R&D for health and target to spend 2% of
national health budgets on health research

D Global Health Initiatives and development agencies

D-1 Gap between actual investments and target to invest 5% of overall health
investment portfolios of Global Health Initiatives and development agencies to
support research capacity of countries, dissemination of research findings, and
management of knowledge.
because health equity is a priority
 1. Development cooperation (ODA)

Targets

1970 UN, 2002 Monterrey

0.7% of GNP/GNI on ODA

2005 Gleneagles G8 Summit

Doubling of aid by 2010:
-an extra $50 billion per year worldwide and
$25 billion per year for Africa, compared with 2004

because health equity is a priority

 US$ billions

10
12
14

0
2
4
6
8
France

Germany

UnitedKingdom

Netherlands

Italy

Sweden

Spain

Norway

Denmark

Belgium

Switzerland

Austria
Net ODA (2002)

Finland

Ireland

Portugal

Greece
ODA spending by country

UnitedStates

Japan

Canada

Australia

New_Zealand
because health equity is a priority
Development cooperation (ODA)
Central government

Bilateral ODA Multilateral ODA

Other government Ministries UN Agencies

agencies (host country, Development cooperation Voluntary The World Bank Group
transitional developing agencies contributions Regional Development Banks
countries) Specialized research agencies EC

Intramural Intramural researchers Intramural researchers

researchers

Universities
Research institutions
Research councils
Nongovernmental organizations
Foundations/charities/trusts
Companies
Partnerships/Initiatives
Public-private partnerships

Researchers worldwide
 DAC members’ total ODA from 1980
in 2006 US$ and as a share of GNI

ODA as a % of GNI ODA (2006 US$ billion)

0.50 100

0.40 80

ODA (2006 US$ billion)

ODA as % of GNI

0.30 60

0.20 40

0.10 20

0.00 0
1980 1985 1990 1995 2000 2005

Global Forum for Health Research, Monitoring Financial Flows for Health Research, 2008
because health equity is a priority
OECD 2005: www.oecd.org/dataoecd/34/26/36418606.pdf
because health equity is a priority
Comparison of 2005 ODA to the 0.7% of GNI target, for the G7 Countries

Canada
ODA below target
Italy Gap to target 0.7% GNI

France

Germany

United Kingdom

Japan

United States

0 10 20 30 40 50 60 70 80 90
ODA (actual and target), in billions US$

Global Forum for Health Research, Monitoring Financial Flows for Health Research, 2008
because health equity is a priority
Quality-adjusted aid

Commitment to Development Index 2007

www.cgdev.org
because health equity is a priority
 Aid flows

2002
$58 billion total aid flows from rich countries to poor ones

2000 - 2002 new aid project commitments

Mozambique 1,413
India 1,339
China 1,328
Tanzania 1,371

2003
Tanzania declared a four-month “mission holiday”,
receiving only the most urgent visits by donors
Foreign Policy, Ranking the Rich 2004

because health equity is a priority

Bilateral Donor Support to Tanzania, 2000-2002

Foreign Policy, Ranking the Rich 2004

because health equity is a priority
 Paris Declaration on Aid Effectiveness
Ownership, Harmonisation, Alignment, Results and Mutual Accountability
High Level Forum, Paris: 28 February – 2 March 2005

We reaffirm the commitments made at Rome to harmonise and align aid delivery….
especially in the following areas:
i. Strengthening partner countries’ national development strategies and associated
operational frameworks
ii. Increasing alignment of aid with partner countries’ priorities, systems and procedures
and helping to strengthen their capacities.
iii. Enhancing donors’ and partner countries’ respective accountability to their citizens and
parliaments for their development policies, strategies and performance.
iv. Eliminating duplication of efforts and rationalising donor activities to make them as cost-
effective as possible.
v. Reforming and simplifying donor policies and procedures to encourage collaborative
behaviour and progressive alignment with partner countries’ priorities, systems and
procedures.
vi. Defining measures and standards of performance and accountability of partner country
systems in public financial management, procurement, fiduciary safeguards and
environmental assessments, in line with broadly accepted good practices and their quick
and widespread application.

www.oecd.org/dataoecd/11/41/34428351.pdf

because health equity is a priority

Economist 11 October 2008

because health equity is a priority

UN chief urges donors to honour aid pledges despite financial
crisis
UN Secretary-General Ban Ki-moon expressed deep concern on Tuesday at
the continuing financial crisis, urging donor countries to honour their
commitments to helping the world's poorest people despite difficulties
caused by the crisis.

Echoing a similar concern raised by World Bank President Robert Zoellick,

Ban stressed that leaders of the Group of Eight industrialized countries had
committed to providing annually 50 billion U.S. dollars for the purpose of
helping developing countries in the 2005 Gleneagles summit.

"Now because of all this changing prices, it has gone up to at least 62 billion
dollars now," Ban said. "First of all, G8 countries should implement their
commitment."

Xinhua, 8 October 2008

because health equity is a priority

What happens to aid following financial crises…

David Roodman, Center for Global Development, 13 October 2008.

http://blogs.cgdev.org/globaldevelopment/2008/10/history_says_financial_crisis.php

because health equity is a priority

What happens to aid following financial crises…

David Roodman, Center for Global Development, 13 October 2008.

http://blogs.cgdev.org/globaldevelopment/2008/10/history_says_financial_crisis.php

because health equity is a priority

 Total Health ODA 2001-2006

OECD-DAC Database: ‘Health ODA’ aggregates three Creditor Reporting System sectors:
(1) Health (2) Population Policies/Programmes & Reproductive Health (3) Water Supply/Sanitation
Kaiser Family Foundation www.kff.org/hivaids/upload/7679_02.pdf

because health equity is a priority

 Health ODA Commitments by Major Sub-Sector, 2006

2.8% of total health ODA

4.4% of (1) and (2)

OECD-DAC Database: ‘Health ODA’ aggregates three Creditor Reporting System sectors:
(1) Health (2) Population Policies/Programmes & Reproductive Health (3) Water Supply/Sanitation
Kaiser Family Foundation www.kff.org/hivaids/upload/7679_02.pdf

because health equity is a priority

 2. Health
World health expenditures: US$ 4.4 trillion in 2005

because health equity is a priority

www.who.int/nha/pie_chart_%202005.pdf
 US$ billions

1000
1200
1400
1600
1800

200
400
600
800

0
Germany

France

United Kingdom

Italy

Spain

Netherlands

Belgium

Poland

Switzerland

Sweden

Greece

Austria

Portugal

Norway

Denmark
Total Expenditure on Health 2003

Czech Republic

Hungary

Romania

Finland

Ireland
Health expenditures: 2003

Slovenia

Iceland

Slovak_Republic

United_States

Japan

Canada

Australia

New_Zealand
because health equity is a priority
 Land area

www.worldmapper.org

Public health spending

Territory size shows the
proportion of worldwide
spending on public
health services that is
spent there. This
spending is measured in
purchasing power parity.
 2. Health

Targets

2001 Abuja Declaration on HIV/AIDS, TB and other

related infectious diseases
15% of domestic public spending to go on health

because health equity is a priority

 Zambia

Tunis ia

Sudan

Senegal

Niger ia

Mozambique

Mali

Libyan Ar ab J amahir iya

Kenya

Ghana

Ethiopia

Egypt

Côte d'Ivoir e

Cape Ver de

Bots wana

Alger ia

0 2 4 6 8 10 12 14 16 18
Health as % governm ent expenditure 2003

because health equity is a priority

 3. Research
Targets
2002 European Union
Spend total of 3% of GDP on R&D by 2010

2003 African Union/NEPAD

Increase public spending on R&D to at least 1% of GDP
within five years

1990 Commission on Health Research for Development

2% of national health budgets of LMICs and 5% of aid for
the health sector from development aid agencies should
be earmarked for research and research capacity
strengthening

because health equity is a priority

Health R&D and national R&D as a % of GDP (2005)
AU 1% target EU 3% target
1.1 1.1

Ic e la nd
S witze rla nd

1.0 1.0

0.9 0.9
S we de n
Expe nditure on health R&D as % of GDP

0.8 0.8

0.7 De nm a rk 0.7

0.6 US A 0.6

UK
0.5 Be lgium 0.5
S inga pore
C ana da

0.4 0.4
F ra nc e J apa n F inla nd
Aus tria Ge rm a ny

0.3 0.3
Ne the rla nd
Hunga ry
S pa in Ire la nd
Turke y Ita ly Norway
0.2 0.2
C ze c h R .
S outh Af ric a Kore a

P a na m a C uba P ortuga l
0.1 0.1
Arge ntina P oland
S lov a k R .
Gre e c e Me xic o Bra zil
Luxe m bourg
Trinidad R us s ia C hina
S lov e nia
0.0 0.0
0.0 1.0 2.0 3.0 4.0

To ta l e x pe nditure o n R&D a s % o f GDP

because health equity is a priority

Strength of investments in health R&D (2005)
Iceland
11

10

Sweden
Switzerland
9
Health R&D as % of national health expenditure

Denmark

UK
6

Belgium
5 Finland
Japan
Canada

4 USA
Turkey
Austria France Hungary
Israel
Germany
3 Netherland
Ireland Spain

Czech R. Norway Italy

Korea

2
2% target
South Af rica for LMICs
Cuba Panama
Poland
Venezuela
1 PortugalSlov akia
China India MexicoRomania
Brazil
Argentina
Russia Luxemb. Greece
Trinidad
Slov enia
0
0 5 10 15 20 25 30 35
because health equity is a priority
Health R&D as % of total R&D expenditure
 Global health R&D expenditures
180

160.3
160

140 51%
125.8 private
Health R&D expenditure

120
41%
105.9 48% public
private
100
48%
84.9 private 8%
45% not
80 48%
public for
private 44% profit

55.8 public
60 7%
not
45%
8% for
public
not profit
40
30 for
7% profit
not
20 for
profit

0
1986 1992 1998 2001 2003 2005
Year

Global Forum for Health Research, Monitoring Financial Flows for Health Research, 2008
because health equity is a priority
 Globalization of disease burdens
Deaths by cause and WHO region, 2002

100
% Group I
90
Communicable,
80
maternal,
perinatal and
70 nutritional
conditions
60

50 Group 2
Non-
40 communicable
diseases
30

20
Group 3
Injuries
10

0
AFRO AMRO EMRO EURO SEARO WPRO

because health equity is a priority

 'Neglected Diseases'

Diseases:
• that are significant sources of mortality and morbidity
• for which there are few or no adequate interventions
(that are relevant to large, affected populations)
• that attract relatively little R&D funding

because health equity is a priority

 'Neglected Diseases'

Mortality Estimates for 2002 (World Health Report 2004)

Infectious and Parasitic diseases 10 904 (000)
HIV/AIDS 2 777 ¨
Diarrhoeal diseases 1 798 ¨
Tuberculosis 1 566 ¨
African trypanosomiaisis
Malaria 1 272 ¨
Childhood diseases Chagas 1 124 ¨
Disease
STIs (excluding HIV) 180 ¨
Meningitis Leishmaniasis
173 ¨
(Other) Tropical Diseases Leprosy 129 ¨
Hepatitis B 103 ¨
Hepatitis C 54 ¨
Lymphatic filariasis
Dengue 19 ¨
Japanese encephalitis Onchocerciasis
14 ¨
Intestinal nematodes 12 ¨
Schistosomiasis
Leprosy 6 ¨

because health equity is a priority

Total Gates Foundation Grants by Disease (to 2005)

‘Very
neglected
diseases'

because health equity is a priority

Fragmentation in international effort ….

because health equity is a priority

 Diseases that disproportionately affect LMICs

• Type III
Overwhelmingly or exclusively incident in developing countries

• Type II
Incident in rich and poor countries but with a substantial
proportion of the cases in poor countries

• Type I
Incident in both rich and poor countries, with large numbers of
vulnerable populations in each

because health equity is a priority

 Chronic diseases: the new epidemic
Cancer, Diabetes, Heart Disease, Stroke, Mental/Neurological Conditions

• Becoming the dominant source of ill health and death in LMICs

* Driven by: poor diet, lack of physical activity, tobacco use

• 57 million deaths in 2003: 33 million attributed to chronic diseases

• 17 million attributed to cardiovascular disease

* 1/3 of these occurred in mid-aged people
* 1/3 occurred in China and India

• Estimated number of diabetics

India 32 million
China 21 million
USA 18 million
Indonesia 8 million

2000 global total: over 170 million

Estimated 2030 total: over 360 million
because health equity is a priority
 Obesity rate doubles in 10 years in China

• 60 million obese; 200 million

overweight

• 20 million have diabetes

• 160 million have high blood

pressure

First comprehensive Chinese

national survey on diet, nutrition
and disease; reported October
13, 2004 (270 000 adults
surveyed)

because health equity is a priority

 Death rate & ranking of 10 main diseases in China, 2004

City County
Rank Cause Death Rate % Cause Death Rate %
(1/100000) (1/100000)
1 Malignant Neoplasms 126.42 23.92 Malignant Neoplasms 119.66 23.70
2 Cerebrovascular 100.90 19.09 Cerebrovascular Disease 74.95 14.85
Disease
3 Heart Disease 99.36 18.80 Diseases of Respiratory 67.18 13.30
System
4 Disease of Respiratory 69.33 13.12 Heart Disease 63.36 12.54
System
5 Injury & Poisoning 31.14 5.89 Injury & Poisoning 33.50 6.63
6 Diseases of Digestive 17.13 3.24 Diseases of Digestive 14.21 2.81
System System
7 Endocrine, Nutritional & 14.91 2.82 Endocrine, Nutritional & 12.74 2.52
Metabolic Diseases Metabolic Diseases
8 Diseases of 9.52 1.81 Disease of Genitourinary 8.11 1.61
Genitourinary System System
9 Disease of Nervous 4.59 0.86 Disease Originating in 363.95 0.68
System the Perinatal Period
(1/100,000 live birth)
10 Disease Originating in 168.46 0.52 Pulmonary Tuberculosis 3.25 0.64
the Perinatal Period
 Chronic diseases: the new epidemic
Cancer, Diabetes, Heart Disease, Stroke, Mental/Neurological Conditions

Research agenda for NCDs

• relevant to health of the poor in LMICs
• Needs to include a wide range of research domains
* Effectiveness of existing (generic) drugs with different
genetic groups and in different settings
* New drugs that are cheaper/more appropriate for different
populations and settings
* Treatment regimes and health care systems
* Rapid, cheap, easy-to-use, robust diagnostics

because health equity is a priority

 Global health R&D expenditures
180

160.3
160

140 51%
125.8 private
Health R&D expenditure

120
41%
105.9 48% public
private
100
48%
84.9 private 8%
45% not
80 48%
public for
private 44% profit

55.8 public
60 7%
not
45%
8% for
public
not profit
40
30 for
7% profit
not
20 for
profit

0
1986 1992 1998 2001 2003 2005
Year

Global Forum for Health Research, Monitoring Financial Flows for Health Research, 2008
because health equity is a priority
 Global health R&D expenditures
180

160
HICs 98% 160.3

140 USA 47% 51%

private

NCDs > 90%

HICs 95%
Health R&D expenditure

120
41%
public
100 USA 53%
8%

80
NIH 43% not
for
profit
of global publicR&D, of which
60
NCDs 96%
HICs 50-60%
40
NCDs ?%
20

0
1986 1992 1998 2001 2003 2005
Year

Global Forum for Health Research, Monitoring Financial Flows for Health Research, 2008
because health equity is a priority
because health equity is a priority