Diseases with little funding – leprosy, bacterial pneumonia & meningitis, cryptococcal meningitis, rheumatic fever & histoplasmosis

By Impact Global Health 29 January 2025

10 min read
Neglected DiseasesBacterial pneumonia & meningitisCryptococcal meningitisHistoplasmosis

Overview

There was record funding for leprosy and at least some growth for almost all the others; but bacterial pneumonia & meningitis funding fell to a record low

This section covers the diseases receiving between $2.5m and $20m in R&D funding in 2023. Together, they received just 1.3% of global funding, or by way of comparison, just over 4% of the funding allocated to HIV alone.

Leprosy

Global funding for leprosy R&D reached a new peak of $19m in 2023, jumping by almost 40% (up $5.3m) from the previous year in its third consecutive year of growth.

As in 2022, more than 60% of this rise was driven by increased drug R&D funding from industry (up $3.4m, 60%), focused on the late-stage clinical testing of Bedaquiline, while much of the remaining increase was due to an increase in basic research funding from the Indian ICMR. Over the last three years, industry has provided a total of almost $17m for leprosy drug R&D, more than triple its overall investment in leprosy over the previous 14 years. In 2023, it accounted for nearly half of all global leprosy R&D funding.

Rising drug funding from industry cemented an overall shift towards drug R&D, which accounted for a record 59% of global leprosy funding in 2023, up from less than half a percent a decade earlier. Industry has also driven a big rise in clinical development funding, which accounted for a little over half ($11m) of the 2023 total, 95% of it for drugs.

Most of the remaining funding went to basic research ($7.0m, 36% of the total), which rebounded very slightly (up $0.5m, 8%) following three years of decline, thanks to a near-record $3.4m from the Indian ICMR. This trend suggests a promising trajectory for drug breakthroughs but may also raise questions about the balance of investment across other critical areas, such as diagnostics and prevention, which remain essential for long-term leprosy control and eradication.

Pipeline Updates

American Leprosy Missions announced the start of a Phase Ib trial for LepVax, the first vaccine developed specifically for leprosy and the only candidate in clinical development. LepVax is being investigated for both the treatment and prevention of leprosy in trials led by Fiocruz in Brazil.

Bacterial pneumonia & meningitis

Global investment in bacterial pneumonia & meningitis R&D – a two-disease group covering funding for both S. pneumoniae and N. meningitidis – totalled just $19m, dropping by close to two-thirds (down $30m, -61%). This was the fifth consecutive decrease, and took investment to its lowest ever recorded, at around a quarter of its ten-year average.

Funding for pneumonia R&D fell by two-thirds (down $27m, -66% to $14m) and investment for meningitis fell by a third (down $2.6m, -35% to $4.9m), both reaching record lows. Despite the larger drop in pneumonia funding, it continued to receive around three times as much funding as meningitis.

Pneumonia funding fell across all product areas except for diagnostics, as all six of 2022’s top funders reduced their contributions. Industry’s pneumonia vaccine funding fell by $20m (-96%) following the positive conclusion of a Phase III trial in infants of a 14-valent pneumococcal conjugate vaccine. Sharp declines in early-stage vaccine funding from the US NIH (down $4.8m, -96%) and post-registration studies sponsored by the Gates Foundation (down $3.3m, -52%) pushed pneumonia vaccine R&D down even further.

Pneumonia diagnostics was the only area to record an increase, jumping 262% (up $1.7m) thanks to new investments from the Gates Foundation ($0.9m) and Australian NHMRC ($0.2m) and the US NIH (up $0.4m, 70%) including funding for the development of a breath-based test designed for both diagnosis and antibiotic resistance profiling.

The pool of meningitis R&D funders fell by half in 2023, leaving just three: the Gates Foundation, the US NIH and MSF, as industry funding fell to nothing (down $2.8m) following the positive conclusion of a Phase III trial of pentavalent conjugate vaccine. A small drop from the Gates Foundation (down $0.4m, -24%) also contributed to the record-low funding for meningitis vaccine R&D

The small amount of diagnostics funding for meningitis fell by over a quarter (down $0.1m, -29%) as MSF, the sole funder, disbursed a smaller amount for the ongoing development of DiaTropix rapid diagnostic tests.

Cryptococcal meningitis

With funding from the UK’s NHS and MRC essentially unchanged at a total of $1.7m, the small increase in funding was due to a rebound in funding from the US NIH, which had fallen in each of the previous three years. The rise in NIH funding went to drug R&D, which, in line with previous years, represented 90% of both the NIH’s contributions (which totalled $6.2m) and overall global funding ($7.8m). The net increase in NIH funding was thanks to new funding for a Phase III trial studying encochleated oral amphotericin for the treatment of HIV-related cryptococcal meningitis, contributing to a record $4.6m (65%) of funding going to clinical development.

Funding for cryptococcal meningitis biologics remained essentially unchanged at $0.8m, all of which came from the US NIH.

New Developments

Early US NIH cryptococcal meningitis funding data for 2024 show no further funding for the Phase III oral amphotericin trial which drove the 2023 increase following the trials conclusion in early 2024.

This suggests that overall funding fell in 2024, with the potential to rebound in 2025 when new Phase II/III trials are scheduled to begin.

Rheumatic fever

Funding for rheumatic fever vaccine R&D – the only product area included in the survey – was $4.9m in 2023, a 40% increase on 2022, when funding fell by more than 80% to just $3.5m. The 2022 drop, though, followed a surge in funding between 2019 and 2021 which saw average funding rise to $21m, compared to just $2.4m prior to 2019. The end result is a level of funding far below its recent peak, but still safely above its longer-term average.

The high level of 2019-21 funding was mostly driven by major contributions from two organisations: the Australian Medical Research Future Foundation, which invested in the Telethon Kids Institute's Strep A vaccine; and CARB-X, which provided funding to GSK-Bio and Vaxcyte towards their Strep A vaccines. Neither of these organisations have provided any funding over the last two years.

Instead, the partial bounce back in 2023 was thanks to record contributions from the US NIH, which saw its funding nearly quadruple from last year’s record low of $0.6m to $2.8m – 57% of the 2023 total. Early indications suggest that the rise in NIH funding persisted into 2024. Most of the remaining 2023 funding was provided by the Leducq Foundation ($1.8m, 36%), which began funding rheumatic fever in 2022 via the Telethon Kids Institute

Histoplasmosis

In 2023, the fourth year of its inclusion in the G-FINDER report, histoplasmosis R&D received $3.8m, a very slight rebound of $0.2k (6%) from last year’s record low.

New Developments

Preliminary 2024 histoplasmosis funding data from the US NIH – responsible for more than 95% of 2023’s funding – suggest that its contributions declined in 2024, falling from $3.7m to an estimated $2.8m. Without offsetting increases from other funders (or additional grants yet to be recorded by the NIH) this would leave histoplasmosis funding well below 2022’s record low.

With drug funding again largely unchanged at around $100k, the small increase was split relatively evenly between basic research and diagnostics. Basic research ($3.6m in 2023) continued to receive the vast majority of overall funding. This reflects the focus of the US NIH, which again provided well over 95% of global funding and which again directed over 95% of its funding to basic research.

The slight increase in histoplasmosis diagnostic funding – still well below its 2020 peak of $0.5m – was mostly due to newcomer French ANRS ($22k) and a resumption in funding from the NIH ($51k) aimed at aggregating industry efforts to leverage dual-iDDS probe technology.

Figure 6: Diseases with little funding - leprosy, pneumonia & meningitis, cryptococcal meningitis, rheumatic fever & histoplasmosis

Leprosy

Leprosy 2023 top funders
Top funders
Leprosy 2023 funding by product
Funding by product
Leprosy 2023 pipeline candidates
Pipeline candidates

Bacterial pneumonia & meningitis

Bacterial pneumonia & meningitis 2023 top funders
Top funders
Bacterial pneumonia & meningitis 2023 funding by product
Funding by product
Bacterial pneumonia & meningitis pipeline candidates
Pipeline candidates

Cryptococcal meningitis

Cryptococcal meningitis 2023 top funders
Top funders
Cryptococcal meningitis 2023 funding by product
Funding by product
Cryptococcal meningitis 2023 pipeline candidates
Pipeline candidates

Rheumatic fever

Rheumatic fever 2023 top funders
Top funders
Rheumatic fever 2023 funding by product
Funding by product
Rheumatic fever 2023 pipeline candidates
Pipeline candidates

Histoplasmosis

Histo 2023 top funders
Top funders
Histo 2023 funding by product
Funding by product
Histo 2023 pipeline candidates
Pipeline candidates

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