Discussion

A high-level view of global funding for neglected disease R&D suggests that the situation has largely remained the same over the last five years. Funding peaked in 2018, and since then, it has experienced a mostly gentle decline – largely due to increased global inflation eroding its buying power.

Beneath the surface, however, much has changed. By integrating funding data from the G-FINDER survey with our pipeline tracking and forward-looking funding announcements from the Compass project, we are gaining a clearer understanding of shifts in funders' priorities and how they align with real-world events.

We see funders adjusting their strategies in response to developments like product approvals, often leading to reduced funding. Sometimes, these shifts are driven by the progress of promising products, such as the M72 TB vaccine, entering their expensive late-stage trials. And other times, as with the rapid rise in private sector dengue drug development, they are due to a literal shift in the global climate making a previously overlooked disease seem much closer to home. With overall funding stagnant or declining, prioritising one area means another will be deprioritised or sometimes even forgotten: after several years of decline, funding for trachoma R&D fell to zero in 2023 after averaging $2.6m a year in the decade before 2021. It joined yaws and mycetoma on the list of the most neglected of the neglected diseases – those receiving well under a million dollars a year in R&D funding.

Also increasingly neglected is funding for vaccine R&D; its fall driven by successful trials for malaria and unsuccessful ones for HIV.

Some kind of setting priorities is not only wise but essential. While every area of unmet need represents a valuable investment, not all can be given equal priority. There is no single solution to unlock unlimited – or even sufficient – global funding. Smart choices need to be made.

In this section, we try to separate the signal of strategic shifts in global funding from the noise of the random changes in funding we observe every year. We show how the pipeline helps explain some, but not all, of what funders are choosing to focus on and argue that priority setting needs to be backed by the right data to maximise its impact.