Better data and monitoring needed to close the gap in health research for poor countries
A new article in the Lancet has called for better data to help guide investments in R&D toward the health needs of low- and middle-income countries. The authors from 13 global and research institutions in Europe and the US describe how a global health observatory could provide this and the scale of the challenges to do this.
"A global observatory on health R&D would be helpful and ultimately enable adequate financing for priority areas, aid efficient use and targeting of low resources, and improve investment decisions through avoidance of duplication and improvement in coordination."
Findings show a persistent imbalance between R&D investments and needs-based priorities as measured by all R&D indicators (research inputs, processes, and outputs). R&D investments in neglected disease research account for only 1% of overall health R&D investments; proportions of ongoing clinical trials addressing diseases mostly affecting people in poor countries are low; and the geographical distributions of health R&D investments, clinical trial research, and health research publications are heavily skewed towards high-income countries.
The authors, which include TDR’s Robert Terry who worked on this in the World Health Organization (WHO) before moving to TDR’s knowledge management, propose a set of health R&D indicators to allow for better monitoring and analysis of existing priorities and of countries' performance. Although efforts are underway to better align classification systems across countries and new initiatives to map existing classification systems to a common standard are in development, no international standards for health R&D classification yet exist.
Data for health R&D investments were found for only 37% of all countries. Data availability for this indicator was particularly poor for low to middle upper-middle-income countries (as low as 14%) and was much better for high-income countries (72%).
Although clinical trials registration is now broadly considered an ethical and scientific responsibility, caveats remain in the enforcement of trial registration, mainly in low- and middle-income countries.
The authors call attention to the inadequate investment in R&D to address the specific health problems of poor populations. This well-recognised investment deficit formed the background to the work of the WHO Consultative Expert Working Group on Research and Development: Financing and Coordination, and the process that preceded it including an international commission and several year-long multilateral negotiations. The group's report, which is being discussed by the governing bodies of WHO, recommends a new approach to global health R&D that involves the implementation of three elements focused on meeting the R&D needs of low-income and middle-income countries: guarantee of sustainable financing; coordination of global efforts; and provision of functions to monitor and inform the research processes in the form of a global observatory on health R&D.
The authors conclude that a global observatory on health R&D would be helpful and ultimately enable adequate financing for priority areas, aid efficient use and targeting of low resources, and improve investment decisions through avoidance of duplication and improvement in coordination. Increased transparency would enable countries to be accountable for public investments in health R&D and make knowledge more widely available so that researchers can more easily identify research projects that are similar to their own and make incremental improvements to existing research. Recent negotiations at WHO suggest that member states are supportive of a global observatory on health R&D, and the authors recommend that these plans be implemented now to secure a sustainable solution for regular mapping of health R&D.
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