The value of vaccines: what to do in the face of funding cuts which put decades of progress at risk

Vaccines are among the most effective tools in public health, saving millions of lives and preventing the spread of infectious diseases. Yet, despite their proven benefits and return on investment, funding for the research, development, and distribution of vaccines is under threat. Significant cuts by major global health donors, including the US and UK governments, could have dire consequences for immunisation efforts worldwide.

At the Global Vaccine and Immunization Research Forum (GVIRF) in Brazil last month, I presented the impact of global health vaccine R&D investment, highlighting both the progress made and the challenges ahead.

In the global health landscape that we track via G-FINDER, funding for vaccine R&D can be grouped into four buckets:

• COVID-19 and other coronaviruses – $1.5 billion in 2023 (and at least $4 billion in 2020)
• Neglected infectious diseases – $1.1 billion in 2023
• Emerging infectious diseases (excluding coronaviruses) – $185 million in 2023 ($1.7 billion including COVID-related R&D)
• Sexual & reproductive health –$150 million in 2023

As can be seen in Figure 1, the COVID-19 pandemic led to an unprecedented surge in funding for coronavirus-related vaccine development. However, this has come at the cost of non-coronavirus vaccine R&D, which has declined by more than 20% compared to pre-pandemic levels.

 Figure 1: Vaccine R&D investment by disease

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Source: G-FINDER

Coronaviral diseases aside, vaccine R&D for global health is dominated by HIV vaccine research, although this has been declining in both absolute terms and as a share of total funding, accelerated recently by multiple late-stage clinical trial setbacks.

And indeed funding for vaccine R&D overall—excluding the recent response to COVID-19—has been declining in relative terms for the last decade. In 2015, at the peak of the response to the West African Ebola outbreak, vaccine R&D accounted for 40% of all global health R&D investment. By 2023, this had fallen to just a quarter.

Figure 2: Share of global health R&D going to different product types

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Source: G-FINDER; excludes coronavirus

Sustained investment in global health R&D delivers incredible returns, and vaccines are some of the best investments of all. Last year, we reported on the impact of the last two decades of investment in R&D for neglected diseases and showed that the products developed from this investment will save 40.7 million lives by 2040.

Figure 3: Deaths and DALYs averted by disease 2000-2040

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When we calculate the economic activity generated by a healthy population who are not losing years to disability and illness, the savings to the healthcare systems, and the jobs generated by an active R&D industry, the net societal benefits run into the trillions of dollars. Globally, the total societal return from global health R&D is estimated at $405 for every $1 invested.

These numbers underscore the economic and societal value of sustained investment in vaccine R&D. However, the benefits of these investments take time to materialise—over 70% of the projected health and economic impact from the last 20 years of investment hasn’t yet happened, but rather will be realised between now and 2040.

To understand the potential cost if the necessary investment isn’t forthcoming, we can look to malaria and the contrasting timelines of the two novel vaccines just now being introduced.

Figure 4: Comparative timeline of RTS,S and R21: Phase III commencement to product introduction

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While the availability of funding was far from the only issue influencing the time it took for the RTS,S vaccine to proceed from Phase III trials to introduction at scale, the picture in the absence of sufficient funding to conclude pivotal trials and support timely large-scale introduction looks much more like RTS,S than R21. Our modelling shows that if RTS,S had advanced as quickly as R21, an additional two million lives could have been saved over the decade, resulting in an estimated economic benefit in the trillions.

Figure 5: Estimating the benefit of an accelerated introduction of RTS,S

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Leading investors in global health R&D—the US and UK governments—are cutting their foreign aid and global health budgets, with major implications for vaccine development and distribution efforts worldwide. Excluding coronaviruses, annual investment in vaccine R&D for global health is around $1.5bn; 59% of this funding comes from the US government. Three of the top six funders of non-COVID vaccine R&D are US government agencies, with the National Institutes of Health (NIH) alone contributing over 50% of global investment. It is not yet clear just how severe and sustained the cuts to this investment will be, but we should prepare for them to be significant. Known job cuts across the Department of Health and Human Services—in which NIH sits—already exceed 20,000, and the list of recently terminated NIH grants already tops 40 pages.

On the access front, the Trump administration has terminated its financial support for Gavi, the Vaccine Alliance, who have said that a reduction in their US funding could lead to over 1 million preventable deaths, and has shuttered USAID, with all of the flow-on effects for vaccine distribution and immunisation programmes that that entails.

The future of vaccine R&D depends on strategic investment, innovation, and global collaboration. We should, however, prepare for a scenario where significantly lower public funding continues. The message from other potential global health R&D funders is that they can’t fill the gap that is likely to exist, that they therefore need to identify which part of the gap they may try to fill, and that we may never be able to return to the levels of funding seen before. Collectively we must look anew at funding models, incentives, and mechanisms to see where we best have leverage, and look to funders who have not yet been investing in this space. Included in this is an opportunity to redistribute decision-making power away from the global north, and the potential role of governments and industry in Brazil, India, South Africa, China and beyond is significant.

At Impact Global Health we aim to make a compelling case for funders to come to the table and identify where can they invest for impact.