Financing global health R&DFinancing global health R&D is but one of many issues in the global development agenda that the international community will debate in a series of major international events this year. In September in New York, international leaders will agree to the agenda that will follow the Millennium Development Goals. In December, the world will descend on Paris to try to reach an agreement on limiting the impact of climate change.

And, a couple of weeks ago, Addis Ababa played host to the 3rd international Financing for Development Conference – and financing global health R&D was one of the hot topics during the week.

To give us an insight into some of the key issues around global health and financing global health R&D, we spoke with Dr. Marco Schäferhoff, Associate Director of Associate Director at SEEK Development, based in Berlin.

Dr. Schäferhoff works with the Lancet Commission on Investing in Health. He is one of the authors of a recent study, “How much donor financing for health is channelled to global versus country-specific aid functions,” published in The Lancet.

The study is the first in-depth assessment of how donor funding is spent on global versus country-specific functions of health, and introduces new definition of global health financing that combines conventionally reported official development assistance for health with spending by countries on pharmaceutical R&D for neglected diseases. We spoke to Dr. Schäferhoff about the impact of the Ebola crisis, the needs for financing global health R&D, and what’s next for donor funding for global health.

The Ebola Crisis and the Sustainable Development Goals

In your article, you talk about the impact of the Ebola crisis on the global health community. What did it reveal about the state of global health financing?

Dr. Marco Schäferhoff (MS):  First of all, the slow global response to the Ebola crisis in West Africa exposed the weaknesses of the global health system to a major global health crisis, especially the inability to react rapidly but also the lack of surge capacity for health crises. However, it also illustrates that

important gaps exist in donor financing for key global functions, such as outbreak preparedness and response, leadership for global health, and R&D for diseases of poverty.

The crisis explicitly confirmed that leadership and stewardship, which is one of the main functions in global health, is extremely underfunded. The subsequent conversation over the WHO’s slow response to the Ebola crisis, especially given that the WHO has a core mandate to organize a coordinated response, must be discussed bearing in mind that the WHO’s budget for outbreak and crisis response has reduced by nearly 50% from 2012-13 to 2014-15.

Financing global health R&DThere has been a lot of emphasis on data as being an important part of getting the SDG agenda right. Can you explain a little why you and your colleagues decided to expand your conception of ODA to ODA+?

MS: Simply put, we coined the term health official development assistance plus (ODA+) in order to present a more comprehensive picture of donors’ efforts to support research and development. The returns on investing in R&D are some of the largest of all investment opportunities in global health, and yet, global health R&D for neglected diseases is underfunded and lacks a comprehensive database. By including additional public financing for R&D for neglected diseases, we took a first attempt at better calculating the amount of public funding currently being spent, which reveals how financing for global functions goes beyond the public development agencies and departments. Going into the Sustainable Development Goals (SDG) agenda, we hope that this reshapes how policymakers approach and measure their support to global health.

Financing global health R&D

Something that we were obviously pleased to see – given that we have been advocating it at the EU level – was the importance you place on global health R&D in the broader health agenda. Just why is increased funding for R&D so important for global health?

MS: There is an urgent need to scale up R&D for neglected diseases and improve access to new technologies and pharmaceutical products. Millions of people in low- and middle-income countries continue to die from diseases that could be addressed by large-scale investments in R&D. With respect to the development of drugs, vaccines and other technologies, such as diagnostic tests, for neglected diseases, it is gratifying to see that funding has increased in recent—but donor funding for this R&D is still too little.

Stronger investments in R&D for new health technologies are one of the most effective ways to improve global health. This has been emphasized by the Lancet Commission on Investing in Health (CIH).

Financing global health R&DFrom your analysis of ODA+, do you think that sufficient funding is being made available from donors to fund the kind of breakthroughs we need in health R&D to fight diseases of poverty?

MS: Our analysis shows that donors do not give sufficient attention to R&D for poverty-related diseases and that they should spend more on R&D. We also refer to WHO’s Consultative Expert Working Group on R&D estimates which called for a doubling of current R&D expenditures in this area – from $3 billion to $6 billion –as did the CIH, mentioned previously. While our analysis suggests that there is still a long way to go to reach the $6 billion target, the $6 billion would still represent only 2–4% of total health R&D.

But insufficient donor financing is not the only challenge. Another problem is that investors often make investments independently of each other, resulting in a fragmented financing landscape for R&D that makes the introduction and scale up of new health technologies and products difficult.

The good news is that a number of new ideas were unveiled at the ‘Financing for Development’ conference in Addis Ababa that could go a long way in boosting R&D financing.

One example is the new Health Investors’ Platform for R&D, championed by PATH, the Gates Foundation, and members of the CIH. There is a recent article by Lawrence Summers and Gavin Yamey of the CIH, published as part of PATH’s Innovation Countdown 2030 Report released at Addis. The two authors make very clear that investors want more guidance on how to achieve maximum impact – for example, knowledge about the most promising candidates in the R&D pipeline – and that the provision of this knowledge as part of the health investors’ platform could be really game-changing.

Financing Global Health R&D – are we doing enough?

We have passed the first major milestone for the development agenda in the second half of 2015 – the Addis FFD conference. Looking at the broader SDG and financing agenda, do you think enough emphasis has been placed on the health R&D agenda by the international community? Do you think that donors are beginning to recognize the potential there for the fight against diseases of poverty?

Financing global health R&DMS: It is important to emphasize that there has been a lot of progress over the past 10 to 15 years when it comes to R&D for neglected and poverty-related diseases. Many product development partnerships emerged, and some innovative methods for R&D financing, such as advance market commitments for vaccines, were established. The need to facilitate R&D and to improve country access to new health technologies is also reflected in the draft SDGs (target 3B) – this also shows that the need for R&D is acknowledged.

But as already mentioned, we need more technological innovation and R&D funding.

Our data shows also that some donors have done better in this regard than others. In addition, it is likely that emerging economies will expand their health R&D budgets exponentially.

In your personal opinion, what would you like to see as the next major breakthrough development in global health?

There are many important R&D developments underway at the moment and I find it hard to pick one. I think that one important approach to answering this question is to conduct an explicit, transparent prioritization exercise.  PATH recently did this, with its Innovation Countdown 2030 project.  The project engaged R&D experts worldwide, using a Delphi method to rank the possibilities.  The result was a list of 30 innovations that could “bend the curve”, such as new formulations of oxytocin to treat post-partum bleeding, protective vaccines against malaria and HIV, and long-acting injectable antiretroviral drugs.

Overall, donor support will need to look different in the SDG era and there is huge opportunity for donors to show increased leadership in investing in underfunded key global functions of health.


Dr. Marco Schäferhoff

Dr. Marco Schäferhoff, Associate Director at SEEK Development (SEEK), leads SEEK’s Strategy, Policy and Performance unit and is an expert on global health strategy, policy and financing, and evaluations. Among other clients, Marco has supported the Global Fund, the Bill & Melinda Gates Foundation, the Partnership for Maternal, Newborn and Child Health, and UNAIDS. He also provides ongoing advice to the German government on its engagement with the Global Fund.

He currently works with the Lancet Commission on Investing in Health in translating its findings into actionable policy recommendations for donor and country governments. Recently, he also led a Norad-funded study estimating the effect of education on health, including cost-benefit and full-income analyses. He also managed the ‘Rethinking the Global Health Architecture’ project – a joint project with Chatham House, which was launched in September 2014 to catalyze a high quality dialogue among key stakeholders and decision-makers on the future of the global health system.

Marco has published a wide range of scientific contributions on international financing for health and development and transnational cooperation. He holds an advanced degree in Politics and a PhD in Political Science.

Images: DSW, 2015. Graphs and charts: copyright – The Lancet, 2015.