Public funding

Governments provided a record low 63% of global funding, mostly due to big cuts from the US, that record funding from India could not come close to offsetting.

The world’s governments invested $2,622m in neglected disease basic research and product development in 2023. This represented another small drop – of around $100m, or 4% – after the record fall in 2022 and the fourth consecutive year of declining public funding. This has left the public sector $580m (18%) below its 2019 peak – 8% below its average over the previous decade – and responsible for a record low 63% of global funding.

The decline in overall public sector funding was driven by further drops in contributions from high-income countries (HICs), which fell by another 4% ($113m) to $2,465. This left HICs responsible for 94% of global public funding, a little below last year’s level (94.6%) and their average over the preceding decade (94.4%).

A sharp drop in funding from the US government, which continued to contribute 80% of the high-income country total, was more than enough to account for the fall in HIC public funding. US public funding fell by 6% ($120m) to $1,968m – leaving it more than $100m below its ten-year average – because of cuts from multiple US government agencies. The DOD’s funding fell to an all-time low of $75m (down $29m, -28%), with almost half of this drop due to a sudden halt to its HIV/AIDS vaccine R&D (down from $13m in 2022, and from $36m in 2021). The CDC’s tuberculosis funding also fell to zero, down from $9.1m in 2022, leaving its overall contributions to neglected disease R&D at just $0.3m (down $13m, -98%), a far cry from its yearly average of over $20m over the past decade. The US NIH’s funding fell for a fourth consecutive year, dropping to $1,827m (down $76m, -4%), though the NIH alone continued to contribute 74% of total public HIC funding. And neglected disease funding from USAID fell again, albeit by a more modest $2.6m (-4%) after last year’s $21m drop.

Alongside a drop in funding from the US, there were much smaller cuts from each of the next three largest public funders: the European Commission (EC), the UK and Germany. The fall in EC funding was just $4.2m (-2%) – much smaller than the cuts it made in 2022. After a rebound in 2022, the UK’s funding dropped back to its 2021 record-low of $88m (down $7.6m, -8%). While reduced FCDO funding is mostly responsible for the long-term decline in UK government funding, this year’s fall was largely the result of record-low funding from the MRC. Funding from Germany declined again, though much more slowly than last year, falling by $4.1m (-8%) to $45m – half of what it was in 2021.

There were also large proportional drops in funding from Australia (down $7.5m, -22%) and Switzerland (down $5.6m, -33%). Funding from the Australian DFAT dropped to zero in 2023 after it made contributions of $11m in 2021 and $2.6m in 2022. Both this year’s and last year’s declines reflect the gap between the conclusion of its previous round of PDP funding and the commencement of the new one, which will distribute a total of $75m between 2024 and 2028. The fall in Swiss funding was the result of steep reductions in funding from the SNSF, which fell by more than half to $5.0m (down $5.4m, -52%), its lowest level since 2009.

In contrast to the falls in funding from multiple public HIC countries, funding from Japan rose fourfold to $28m (up $21m, 314%). This year’s rise and last year’s slightly smaller decline were both driven by the regular two-year cycles in Japan’s core funding to the GHIT fund. France’s funding more than doubled to $29m (up $16m, 127%), two-thirds of which was due to record funding from the ANR across several diseases.

Public funding from low- and middle-income countries (LMICs) totalled $113m in 2023, a rise of $22m (up 24% – or 20% if we adjust for a slight increase in survey participation) which left it just below its peak, and 16% above its long-term average.

Basically, all of the net growth in funding can be attributed to a sudden rebound in India’s spending, which rose by $21m (32%) to a record $89m after having declined at least a little in each of the past three years. This left India responsible for a record 78% of LMIC R&D funding, compared to an average of 68% over the previous decade. Net contributions from other LMIC governments remained essentially unchanged at $24m, with a $2.5m (21%) increase in funding from Brazil – again the second largest contributor – basically offset by a $2.3m (-29%) decrease from South Africa – the third largest.

The rise in Indian funding was mainly due to jumps in funding from the ICMR (up $15m, 29%) and the DBT ($12m, 384%). The ICMR’s funding rebounded to $68m following three years of decline, leaving it just below its 2017 peak. It increased its contributions across almost all its target diseases, headlined by substantial increases for tuberculosis (up $4.6m, 34%) and kinetoplastid diseases (up $3.1m, 71%). The Indian DBT’s funding also rose to its second-highest level ever, at $15m, with most of the increase directed to tuberculosis basic research. These rises offset falls from BIRAC (down $2.1m, -48%) and the Department of Science and Technology (down $3.5m, -61%).

The one-fifth increase in funding from Brazil (up $2.5m, 21% to $15m) was mostly an artefact of improved data collection, though the similarly-sized fall from South Africa (down $2.3m, -29%) was, sadly, genuine – a result of cuts from both the South African DSI and MRC.

LMIC governments remain much more heavily focused than other funders on basic research, which received 57% of their funds in 2023, compared to just 18% for other funders. In 2023, their funding for basic & early-stage research rose to $87m (up $22m, 33%), capturing a record 77% of public LMIC funding. Partly as a result of this focus on basic research, the share of funding they commit to clinical development is much lower than other funders’ – 6% compared to 26% across all other sectors. These gaps are smaller but still striking if we instead compare LMIC governments only to those in high-income countries.

Table 3. Top public R&D funders 2014-2023

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Funding from multilaterals declined for a second consecutive year from their record high in 2021, dropping by a further $12m (-21%) to $44m. While this drop was smaller than last year’s, it still brought funding to its lowest point since 2015, sitting at two-thirds of its ten-year average and well under half of its 2021 peak.

More than half of this fall was driven by Unitaid (down $6.8m, -14%) – as always by far the largest multilateral funder, responsible for 95% of the 2023 total. Funding from CARB-X also fell, reflecting cuts to its Salmonella and rheumatic fever vaccine programmes. This left CARB-X only narrowly the second largest multilateral funder and took its funding to a low of just $0.9m in 2023 (down $4.0m, -81%), just 7% of its 2020 peak. After recent declines, funding from the only two other significant multilateral contributors – the Task Force for Global Health and Grand Challenges Canada – rebounded slightly. However, the World Bank, last year's third-largest multilateral contributor, provided no funding at all for the first time since 2014.

Absolute funding can be a misleading measure of public investment in neglected disease R&D as it can understate the relative contributions of smaller and lower-income countries. For this reason, we also analyse countries’ investments as a proportion of their gross domestic product (GDP).

The US remained the top funder by share of GDP in 2023, devoting $7.07 per $100k of its GDP to R&D for neglected diseases, down slightly from 2022. They were followed by the UK at $2.61 per $100k, with India close behind at $2.46 per $100k. Both the US and UK have seen their funding relative to GDP fall over the past few years, the US dropping from $9.02 in 2020 to this year’s $7.07 per $100k and the UK from $6.90 to just $2.61.

Conversely, there were three countries outside the top 12 largest funders which appear here when ranked by their contributions relative to GDP: Sweden (fourth highest by GDP and thirteenth largest funder overall), South Africa (fifth highest by GDP and seventeenth overall), and Colombia (twelfth by GDP and twentieth overall).

Figure 4. Public R&D funding by GDP 2023^*

_{(A value of 10 is equivalent to an investment of 0.01% of GDP)}

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