[Researcher Comment] UK research funding for infectious diseases inconsistent with global burden of disease

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Study author Mr. Michael Head talks to 2 Minute Medicine: Network Manager, Infectious Disease Research Network at University College London

“Our study tracks translational infectious disease research spending to identify trends in spending on R &D. Tracking the source of the funding provides a useful starting point for students and early career researchers to maximize their chances of obtaining funding. We hope our findings will allow for more informed debate on the allocation of research funds in infectious disease, what diseases and types of research may have been under-funded, and developing continuous rigorous methods for tracking R&D spending. Our findings will be of interest to high-level policy departments, both in the UK and internationally.”

Key study points:

1. The correlation of infectious disease research spending in the United Kingdom (UK) with global burden of disease was modest in 2004 but projected to weaken in 2008.
2. Research in various areas of infectious disease (syphilis, gonorrhea, gastrointestinal infections, antimicrobial resistance, and certain neglected tropical diseases such as trachoma) is underfunded relative to each disease’s contribution to the global burden of disease.

Primer: In recent years, global health statistics have shifted from focusing on morbidity to a more comprehensive measure, the disability-adjusted life year (DALY) (1). The World Health Organization (WHO) uses DALYs to define the global burden of disease (GBD) as the worldwide death and loss of health directly related to diseases, injuries, and risk factors.

To some extent, the GBD should help set global health priorities, such as the allocation of research funding. Theoretically, health conditions responsible for a greater loss of DALYs should be higher priority for research funding than conditions associated with lower DALYs. This relationship has only been examined recently, and there is still a lack of public information on how infectious disease research in particular is funded – especially pharmaceutical company-sponsored research. However, we do know that some tropical diseases have been neglected since GBD research began in the 1990s (2). Likewise, in 2011 PLOS One published a review that showed that the majority of the variance in funding is attributable to factors other than the GBD and that certain conditions associated with higher DALYs (depression, injuries, and COPD) were underfunded (3). Further, research in 1999 indicated that the NIH overfunded diseases such as breast cancer while underfunding diseases such as COPD (4).

In addition to the variance in research spending not attributable to GBD, there are also ethical and policy questions to consider. For example, how might a lack of research funding for certain diseases widen health inequalities? Do advocacy groups unfairly influence funders’ priorities? Is there is a responsibility of researchers and clinicians to focus on research (and in turn, on policymakers and organizations to fund research) that has the greatest impact?

The present study examines funding for infectious disease-related research in the UK to assess trends in spending compared to disease-specific GBD to inform patterns in research investment.

Background reading:

1. World Health Organization – Global Burden of Disease (GBD)
2. Measuring the Burden of Neglected Tropical Diseases: The Global Burden of Disease Framework
3. NIH Disease Funding Levels and Burden of Disease
4. The Relation between Funding by the National Institutes of Health and the Burden of Disease

This [case] study analyzed 6,170 infectious disease-related research projects funded in the UK from 1997-2010 to examine relationships between research funding and GBD based on DALYs.

Specific diseases that were underfunded relative to their contribution to GBD included syphilis, gonorrhea, and trachoma; disease systems that were underfunded included gastrointestinal infections, antimicrobial resistance, and a subset of neglected tropical diseases. Diseases that were overfunded relative to their contribution to GBD included hepatitis C, African trypanosomiasis, leishmaniasis, and malaria. Analysis of 2004 spending showed a modest correlation between disease-specific research funding and disease-specific DALYs (r=0.5720); the same analysis yielded a weaker correlation in 2008 spending (r=0.3203).

In sum: Infectious disease research funding in the UK currently has a modest correlation with GBD, but is projected to decrease. The findings of this work are roughly equivalent to what previous studies have found in US NIH-based funding. However, we should not expect nor necessarily desire a perfect correlation, as this would neglect other important factors such as quality and feasibility of research proposals. Additionally, the lack of publicly accessible data from pharmaceutical companies conducting research makes the funding analysis incomplete.

These limitations highlight a few unanswered ethical and policy questions that are relevant to international health policy: (1) What should the responsibility of pharmaceutical companies be to providing open access to research funding reports, and what kind of mechanisms should be used to ensure compliance? (2) What qualifies as the “right” infectious disease research to fund, and is it being funded? If not, what steps must be taken to change what is being funded to what ought to be funded?

Click to read the study in The Lancet Infectious Diseases

Click to read an accompanying editorial in The Lancet Infectious Diseases

By [CH] and [LH]

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