Report highlights a ‘second valley of death’ threatening to keep developed malaria products from reaching those most in need
London and Washington, DC (19 June 2018)—A new report on the state of funding of malaria research and development (R&D) globally shows that funding for basic research and product development falls short of the need.
“Right now, annual investments in basic research and product development for malaria are about US $100 million less than what is required to meet funding targets,” said David C. Kaslow, MD, Vice President of Essential Medicines at PATH. “We see evidence of this shortfall across malaria R&D. In addition to that gap, however, we now face a ‘second valley of death’—not enough resources to move products through development, all the way to impact.”
The report, Bridging the gaps in malaria R&D: An analysis of funding—from basic research and product development to research for implementation, combines original research with regularly reported data on funding for basic research and product development. It is the first time a report has quantified the funds not only devoted to initial product development but to the additional research to improve access to those prevention or treatment products. This research for implementation included implementation research, operational research, and health systems research.
The report spotlights the results of a pilot survey of leading funders of malaria R&D covering a three-year period, 2014–2016. It found that research for implementation comprised 16% of total average annual malaria R&D investments of $673 million, averaging $107 million annually.
“Research for implementation is critical to controlling malaria and meeting elimination targets,” said John Reeder, PhD, Director of TDR, the Special Programme for Research and Training in Tropical Diseases based at the World Health Organization (WHO). Numerous policies and strategies have recommended research to determine which interventions and combinations are best suited in specific areas. The report, Bridging the gaps in malaria R&D, is the first attempt to document how well funding supports those strategies and commitments.
The report showed that investments in basic research and product development over the same three-year period averaged $215 million, annually, for drug development (32% of total malaria R&D); $142 million for vaccine development (21%); $135 million for basic research (20%); $35.3 million for vector control products (5%); and $19 million for diagnostics (3%).
While funding for most areas of malaria R&D has tended to fluctuate since an earlier edition of the report was published in the mid-2000s, diagnostic development has seen relatively sustained increases since 2007–2008, when funding was under $10 million. [All funding data in the new study are reported in 2016 US dollars.]
“To get a clearer picture of malaria research data gaps, and to save more lives, we need funders, especially donor governments, to improve and simplify standards for tracking their investments,” said James Whiting, Executive Director of Malaria No More UK.
The report was developed by PATH, TDR, and Malaria No More UK, with input from WHO’s Global Malaria Programme (WHO/GMP), the Foundation for Innovative New Diagnostics (FIND), Medicines for Malaria Venture (MMV), and the International Vector Control Consortium (IVCC). Policy Cures Research provided data on financial resource flows and also conducted the pilot survey to derive an initial estimate of investments in research for implementation.
The WHO’s World Malaria Report 2017 raised concerns worldwide when it showed that the total number of estimated malaria cases rose in 2016 by 5 million over the previous year. Of the 21 countries that had been on track to eliminate malaria by 2020, 5 countries reported an increase of more than 100 cases in 2016 compared with 2015.
These rises in malaria cases were not uniform and have prompted malaria experts to recommend a more customized approach—one that ensures that available tools are used to maximum effect. In the absence of data on investments in research for implementation, however, it has not been possible to assess whether funding levels are consistent with the priority assigned to it by leading funders, or if the funding allocated is sufficient.
The 20 organizations surveyed regarding research for implementation funding are a subset of the 187 participants in the annual G-FINDER surveys on basic research and product development. They were asked to provide funding data for the years 2014–2016.
Those conducting the study found challenges in collecting data on research for implementation, which has not received the same attention as basic research and product development has received in the annual G-FINDER reports published since 2008. Consequently, few organizations have had systems in place to separate these funding data from other funding data, including data on overall malaria R&D funding.
The report makes three overarching recommendations on basic research and product development in malaria, and five additional recommendations specific to research for implementation.
Overarching recommendations from the report:
- Improve coordination across intervention areas (from basic through implementation research). Product developers must work together to ensure that next-generation interventions will fit together seamlessly.
- Develop more innovative funding approaches. New types and approaches of funding mechanisms and incentives are clearly needed.
- Continue existing tracking of funding flows and strengthen systems to address data gaps. Key stakeholders, including those who have experience tracking resource flows and conducting research, should work together—in particular, on research for implementation.
Key research for implementation topics recommended for discussion:
A. Agree to definitions and a core data set to track research for implementation. The use of a range of definitions complicates and, in some cases, prevents tracking and analysis into funding flows. Few funders are doing this, and many who would like to do this do not have the systems or personnel to do it.
B. Determine how to collect data on research for implementation funding at the institutional, national, and subnational levels. This survey has been limited to a subset of organizations. However, there is a deep well of research to be mined at the local level that is necessary to complete the full picture.
C. Investigate the value of tracking funding for training and capacity building for research for implementation. Several organizations provided funding for building this capacity, yet this report (and others) have identified gaps in research capacity. Can the tracking of funding for training be useful for funders and program planners?
D. Review diagonal versus horizontal research for implementation. How can the outcomes of research for implementation be shared across health systems so that the learnings do not remain siloed within a particular disease area or type of intervention?
E. Consider a funding target for research for implementation as part of any elimination or control program. The goal would be to increase funding to the areas with the greatest gaps, not to reallocate from within the current funding pool.
Bridging the Gaps in malaria R&D: An analysis of funding—from basic research and product development to research for implementation will be presented first at an event in London on June 19, 2018, organized by the UK All-Party Parliamentary Group on Malaria & Neglected Tropical Diseases.
The development of this report was undertaken by PATH, the Special Programme for Research and Training in Tropical Diseases, and Malaria No More UK, in collaboration with the Foundation for Innovative New Diagnostics, Innovative Vector Control Consortium, Medicines for Malaria Venture, and the World Health Organization’s Global Malaria Programme. Data collection was completed by Policy Cures Research.
Support for the development and dissemination of the report was provided by the Bill & Melinda Gates Foundation and the ExxonMobil Foundation. The views expressed in the report or related materials are solely those of the authors and do not necessarily reflect the views of the funders.
PATH is the leader in global health innovation. An international nonprofit organization, PATH saves lives and improves health, especially among women and children. PATH accelerates innovation across five platforms—vaccines, drugs, diagnostics, devices, and system and service innovations—that harness our entrepreneurial insight, scientific and public health expertise, and passion for health equity. By mobilizing partners around the world, PATH takes innovation to scale, working alongside countries primarily in Africa and Asia to tackle their greatest health needs. With these key partners, PATH delivers measurable results that disrupt the cycle of poor health. Learn more at www.path.org.
MALARIA NO MORE is a UK charity determined to end malaria by inspiring the UK public, businesses and government to fight for a malaria-free world. www.malarianomore.org.uk / @malarianomoreuk
TDR the Special Programme for Research and Training in Tropical Diseases (TDR) is a global programme of scientific collaboration established in 1975. Its focus is to improve the health and well-being of people burdened by infectious diseases of poverty through research and innovation. TDR is hosted at the World Health Organization (WHO), and is sponsored by the United Nations Children’s Fund (UNICEF), the United Nations Development Programme (UNDP), the World Bank and WHO.
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