Enhancing Health Research Funding: Commitments and Aspirations

1. 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

2. The spectrum of health research for development Biomedical research Health policy and systems research Social sciences and behavioural research Operational research Understanding the biological nature of diseases; creating products to prevent or treat disease states Understanding how to test, scale-up and follow through the introduction of interventions and optimize their benefits Innovation Impact

3. Resources for health R&D are situated in the • domains of: • development cooperation (ODA) • 2. health • 3. research

4. 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 • 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

5. 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.

6. 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

7. 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.

8. 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

9. ODA spending by country

10. Intramural researchers Intramural researchers Intramural researchers Researchers worldwide Development cooperation (ODA) Central government Bilateral ODA Multilateral ODA Other government agencies (host country, transitional developing countries) Ministries Development cooperation agencies Specialized research agencies UN Agencies The World Bank Group Regional Development Banks EC Voluntary contributions Universities Research institutions Research councils Nongovernmental organizations Foundations/charities/trusts Companies Partnerships/Initiatives Public-private partnerships

11. DAC members’ total ODA from 1980 in 2006 US$ and as a share of GNI Global Forum for Health Research, Monitoring Financial Flows for Health Research, 2008

12. OECD 2005: www.oecd.org/dataoecd/34/26/36418606.pdf

13. Comparison of 2005 ODA to the 0.7% of GNI target, for the G7 Countries Global Forum for Health Research, Monitoring Financial Flows for Health Research, 2008

14. Quality-adjusted aid Commitment to Development Index 2007 www.cgdev.org

15. 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

16. Bilateral Donor Support to Tanzania, 2000-2002 Foreign Policy, Ranking the Rich 2004

17. Paris Declaration on Aid EffectivenessOwnership, Harmonisation, Alignment, Results and Mutual AccountabilityHigh 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: • Strengthening partner countries’ national development strategies and associated operational frameworks • 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

18. Economist 11 October 2008

19. 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

20. 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

21. 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

22. 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

23. 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

24. 2. Health World health expenditures: US$ 4.4 trillion in 2005 www.who.int/nha/pie_chart_%202005.pdf

25. Health expenditures: 2003

26. 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.

27. 2. Health Targets 2001 Abuja Declarationon HIV/AIDS, TB and other related infectious diseases 15% of domestic public spending to go on health

29. 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

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

31. Strength of investments in health R&D (2005) 2% target for LMICs

32. Global health R&D expenditures Global Forum for Health Research, Monitoring Financial Flows for Health Research, 2008

33. Group I Communicable, maternal, perinatal and nutritional conditions 100 % Group 2 Non-communicable diseases 90 80 70 Group 3 Injuries 60 50 40 30 20 10 0 AFRO AMRO EMRO EURO SEARO WPRO Globalization of disease burdens Deaths by cause and WHO region, 2002

34. '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

35. '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 ¨ • Malaria 1 272 ¨ • Childhood diseases 1 124 ¨ • STIs (excluding HIV) 180 ¨ • Meningitis 173 ¨ • (Other) Tropical Diseases 129 ¨ • Hepatitis B 103 ¨ • Hepatitis C 54 ¨ • Dengue 19 ¨ • Japanese encephalitis 14 ¨ • Intestinal nematodes 12 ¨ • Leprosy 6 ¨ African trypanosomiaisis Chagas Disease Leishmaniasis Leprosy Lymphatic filariasis Onchocerciasis Schistosomiasis

36. ‘Very neglected diseases' Total Gates Foundation Grants by Disease (to 2005)

37. Fragmentation in international effort ….

38. 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

39. Chronic diseases: the new epidemicCancer, 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

40. 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)

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

42. Chronic diseases: the new epidemicCancer, 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

43. Global health R&D expenditures Global Forum for Health Research, Monitoring Financial Flows for Health Research, 2008

44. Global health R&D expenditures 180 HICs 98% USA 47% NCDs > 90% 160.3 160 140 51% private HICs 95% USA 53% NIH 43% of global publicR&D, of which NCDs 50-60% 120 41% public 100 Health R&D expenditure 8% not 80 for profit 60 HICs 96% NCDs ?% 40 20 0 1986 1992 1998 2001 2003 2005 Year Global Forum for Health Research, Monitoring Financial Flows for Health Research, 2008