The 'big three' – HIV, TB & malaria

HIV R&D fell to a record low, while both TB and malaria saw increased funding

Global funding for HIV R&D totalled $1,269m in 2023. This was a decrease of 11% (down $143m) from 2022, leaving funding at an all-time low, 28% below its 2019 peak, following significant decreases from the two top funders: industry and the US NIH.

As in all previous years, the majority of funding went to vaccine R&D ($671m, 53%), followed by basic research ($211m, 17%) and drugs ($188m, 15%). Funding fell across all product areas except for diagnostics, headlined by a further $58m (-23%) reduction in drug R&D, which is now down more than $120m from its 2021 peak.

Essentially all LMIC-targeted HIV drug investment came from just three funders – industry, US NIH and the Gates Foundation. It was steep cuts in industry’s drug funding (down $52m, -32%) that were responsible for most of this year’s sharp decline. This reduction in private sector drug R&D followed two years of record-breaking investment, and was partly due to the discontinuation of a daily oral candidate.

Funding for microbicide R&D fell steeply again (down $18m, -46%), dropping to $21m, well over 90% below its 2008 peak, as the remaining pool of microbicide funders shrank to just three organisations – US NIH, Irish Aid and Grand Challenges Canada. We cover the long-term reduction in microbicide funding, and its partial replacement by multipurpose prevention technologies, in the Discussion.

All three of the largest funders of HIV R&D made significant changes in 2023, which collectively contributed to the record low in overall HIV R&D funding. Industry investment fell by a third (down $75m, -35%), with cuts to both drugs and vaccines, to just over half of its 2021 peak. We consider industry’s gradual shift away from HIV vaccine R&D in more detail in the Discussion. Funding from US NIH fell across almost all product categories (down $55m, -6%), to its lowest level since 2017, while funding from the Gates Foundation rebounded from a historic low (up $12m, 10%). Higher Gates funding was driven by increased vaccine clinical development (up $14m, 157%), most of which went to IAVI and the Collaboration for AIDS Vaccine Discovery network (CAVD), and to industry for human cytomegalovirus-vectored vaccines.

Funding for tuberculosis rebounded by 9% ($69m) in 2023 to reach $806m, restoring it to just above its 2021 level and taking it to its second highest level on record. The overall increase in funding was driven by a $59m (62%) rise in vaccine R&D, which, building on last year’s growth, reached a record $154m. Diagnostics funding rebounded, rising by $17m (26%) to $82m, its second highest level ever.

While the US NIH remained the largest funder of tuberculosis R&D overall – as it has been every year since 2007 – its funding declined for the fourth consecutive year. Meanwhile the Gates Foundation, the second largest funder, increased its funding by $61m (38%), helping drive the big increases in vaccines and diagnostics. The increases in the Gates Foundation’s vaccine funding, which has more than doubled over the last two years, went mostly to the Gates Medical Research Institute (MRI) towards the development of the M72/AS01E TB vaccine through Phase III – forming part of its 3.5-year overall funding commitment for TB (see Future Funding box). The Gates Foundation's increased investment is offsetting declines elsewhere and emphasises the growing role of private philanthropy in TB research.

In 2023, global funding for malaria basic research and product development reached $690 million, reflecting a 9% ($60 million) increase from the previous year. Almost half of this rise, however, was due to new participants in the G-FINDER survey. Funding from ongoing survey participants grew by a more modest 5% – still an encouraging shift after four years of declining funding. Despite the uptick, funding remains at its second-lowest level in the past decade.

Over 90% of the funding from new survey participants was directed towards the clinical development of P. falciparum vaccines. Consequently, measured funding for vaccine R&D rose to its highest level in four years, at $148m (up $36m, 32%), partly reversing the downward trend from its peak in 2017. Funding from the Gates Foundation for vaccine R&D also rebounded (up $15m, 186% from 2022), with the additional funding mainly channelled to the Gates Medical Research Institute. Biologics funding nearly halved to $15m (down $12m, -45%) after last year’s sudden spike, with both rise and fall also driven by the Gates Foundation. Funding for the remaining product areas remained comparatively stable. Diagnostics received the smallest share of funding ($14m, 2%), with funding sitting at 60% of its long-term average due to the gradual disappearance of funding from the UK FCDO, DHSC and Gates Ventures.