Diseases with moderate funding – dengue, Salmonella, snakebite, hepatitis B & C

Increases for snakebite and dengue left them at or near record highs; Salmonella funding was the lowest in more than a decade

Funding for dengue R&D jumped by $29m (35%) to $113m, its second highest level on record and more than $20m above its average over the preceding half decade.

The increase was the result of another surge in industry funding, up a further $26m (56%) from last year's record high. Industry has now provided more R&D funding for dengue in the last three years ($152m) than it did over the first twelve years of the G-FINDER survey. Industry funding now dominates dengue R&D, with NIH contributions dropping to less than one-third of industry’s total in 2023. Funding from the US NIH has slumped in tandem with the rise in private sector investment, falling by a further $5.7m (-20%) in 2023 and by $50m (-69%) from its 2016 peak. After being the top funder of dengue R&D every year until 2022, NIH funding fell to less than a third of industry's total in 2023.

The rise in industry funding took dengue drug R&D to $81m – another record high, up $33m (66%) since 2022 and more than double its then-record 2021 level. The ongoing rise in drug funding has been accompanied by a gradual decline in basic research, down a further $2.2m (-10%) in 2023 and by two-thirds ($43m) from its 2016 peak. This shift from basic research to a mix of early- and late-stage drug R&D mirrors the changing of the guard in leading funders, from the basic research focused NIH to industry’s focus on product development.

Global funding for Salmonella R&D fell by $6.4m (-8%) to $78m in 2023, though nearly a third of the reduction was an artefact of missing data from the Indian private sector. This drop left Salmonella funding at roughly the level it had been in 2021, considerably below its three year peak between 2016 and 2018, when it averaged more than $100m per year.

Both typhoid & paratyphoid fever ($15m) and non-typhoidal Salmonella enterica (‘NTS’, $52m) received slightly less funding in 2023. Typhoid & paratyphoid fever continued to receive more than three times as much funding as NTS, despite NTS funding remaining close to last year’s record high.

Reduced funding from the US NIH – still the top overall Salmonella funder – was the main contributor to both reduced 2023 funding and the long term decline since 2016, driving the long term downward trend in basic research funding, which fell for the fifth consecutive year in 2023. The single biggest reduction in 2023 funding, though, was from CARB-X, the antimicrobial resistance-focused nonprofit. CARB-X had tripled its Salmonella vaccine funding – across both NTS and typhoid – to nearly $5m in 2022 before cutting it to below $1m in 2023 in what appears to be the result of front-loaded disbursements. CARB-X’s cuts drove a 9% ($4m) reduction in vaccine funding, which left industry (down $1.5m to $21m) responsible for more than half of global vaccine R&D, focusing on the clinical development of bivalent and trivalent combination vaccines.

Funding for snakebite envenoming (SBE) R&D grew for a fifth consecutive year (up $8.2m, 37%), to reach $31m in 2023. The ongoing growth enjoyed by SBE contrasts sharply with the overall stagnation in funding for other WHO neglected tropical diseases; but there remain concerns about the sustainability of the increased investment.

Almost all of the increase in 2023 was linked to drug development (up $8.5m, 68%), with a focus on clinical development (up $4.8m, 53%). This, in turn, is largely linked to investment in Ophirex’s broad-spectrum small molecule therapy, varespladib, which recently completed Phase II trials.

These trials were the beneficiary of both increased funding from the US DOD (up $4.0m, 58%) and first time self-funding from Ophirex, the developer, as well as the first recorded drug funding from the US NIH ($0.9m). After four years of growth, Wellcome’s SBE investment sputtered (down $1.1m, -12%) as their long-term funding programme gradually begins to approach its scheduled 2026 conclusion.

Funding for hepatitis B R&D was $25m in 2023, down almost a quarter from 2022's record high (down $7.7m, -24%), but still the second highest funding total since it was added to the survey in 2018. The entirety of the drop in overall hepatitis B funding was due to a decrease in funding for biologics, the sole recipient of the 2022 increase, leaving 2023 biologics funding still much higher than its average prior to 2022. Both the 2022 increase and 2023 drop in biologics funding were entirely due to changes in industry investment, which was again the leading source of funding in 2023 and which continued to focus exclusively on biologics R&D.

Despite the drop in industry’s biologics spending, still more than half of all hepatitis B funding in 2023 was for biologics (59%), with another 22% for drugs and the remainder divided between basic research (12%) and diagnostics (8%). Industry’s big bet on hepatitis B biologics demonstrates how radically private sector funding can reshape the product landscape.

The US NIH, which had been the top funder every year prior to 2022, remained in second place, but reduced its funding by $0.8m (-11%) to $5.8m, its lowest level since 2019. Of the 28% of 2023 funding reported as going towards clinical development, around nine-tenths went towards the development of biologics, including around half the overall funding from industry and from the EC – the third largest supporter of hepatitis B R&D behind industry and the NIH.

Global funding for hepatitis C rose by $5.0m (30%) to $21m, the highest total since 2019. This was its highest funding level since 2018, though still just over a third of its peak from a decade ago. This rebound in funding was driven by a record $17m (up $2.4m, 16%) in funding from the US NIH – the top funder in each of the last three years – and the resumption in funding from Unitaid, which had been absent in 2022 ($1.8m in 2023, down from $2.7m in 2021).

As in each of the past three years, vaccine R&D remained funders’ primary focus, rising by $3.7m (38%) to a record high $13m. This left vaccines responsible for nearly two-thirds of the total, compared to just 8% a decade earlier. The remaining funding was divided relatively evenly between diagnostics (basically stable at $4.8m, 23% of the total) and drug research $3.0m (14%), which rebounded (up $1.5m, 100%) from last year’s record low. The long term decline in drug R&D is the result of the continued absence of any funding from (traditionally drug focused) industry – which has provided no meaningful hepatitis C funding since its $40m spike in 2018.

Cuts to industry’s drug funding have also driven a steep decline in clinical development, which remained below $2m, two-thirds of which was for late-stage diagnostic development. This was close to last year’s record low, after having averaged more than ten times that amount each year between 2013 and 2018.