London School of Hygiene & Tropical Medicine

UK funding for infectious diseases research is neglecting some of the diseases that result in the highest rates of death and disability, according to research published in The Lancet Infectious Diseases.

The research – carried out by researchers at the London School of Hygiene & Tropical Medicine, University College London and Imperial College - is the first ever detailed assessment of infectious diseases investments made by funding organisations to UK institutions. The study shows that gastrointestinal infections, antimicrobial resistance, and some neglected tropical diseases such as trachoma, the commonest infectious cause of blindness globally, receive particularly low levels of investment from UK funders, relative to the disability and death that they cause.

The UK is the second largest investor in global health worldwide. Between 1997 and 2010, non-commercial funders such as the Wellcome Trust and Medical Research Council (MRC) invested £2.6 billion in research into infectious diseases. Gastrointestinal diseases received just 9.7% (£254 million) of overall funding, despite being estimated to account for 22.2% of deaths due to infectious disease in 2004. By contrast, HIV, which causes a comparable number of deaths to gastrointestinal disease, received almost twice the amount of funding (£460 million or 17.7% of the overall amount) between 1997 and 2010. 

HIV, blood infections (such as malaria), and respiratory infections (such as tuberculosis) received the highest proportion of funding overall, with these three areas together receiving almost half (49.4%) of the total money invested in infectious diseases research during this period. HIV, respiratory infections, and blood infections are estimated to have contributed to 71.7% of the total deaths due to infectious disease in 2004, with the highest number of deaths due to respiratory infections, responsible for 43.5% of the total deaths in 2004, but receiving just 15.8% (£410 million) of the total UK research funding.

Antimicrobial resistance, described by WHO as "a global public health emergency affecting all countries", received just 3.7% (£96 million) of funding, although this is a rapidly growing problem globally. The researchers also identified low levels of investment in research specifically relating to infections in children and elderly people, with research covering infections in children receiving only 3.3% (£87.1 million) of total funding, and research into infections in elderly people receiving just 0.3% (£7.2 million) of total funding.

Joseph Fitchett, co-ordinator of the TB Centre at the London School of Hygiene & Tropical Medicine, who carried out the analysis, said: "The UK is clearly showing leadership by supporting cutting edge research in global health. But with limited resources for health research, it is imperative that we openly and rigorously document how our investments are spent. We need to avoid duplication of efforts, maximise our impact on human health, and identify ways forward to help us allocate resources equitably. Although opinions will vary on how we can best evaluate disease burden, what is clear from this research is the need for a clear and well-informed strategy to tackle the major problems facing public health today."

Lead author Michael Head, of University College London, said: "Infectious diseases account for 15 million deaths per year worldwide, and disproportionately affect young people, elderly people, and the poorest sections of society. The investments in research for these diseases must be allocated appropriately. Our data can help inform the decisions behind the allocations of funding and provide evidence for possible areas of under-investment that warrant further attention."*

The authors point out that a key limitation of their study is that it does not include analysis of funding from the UK pharmaceutical industry, thought to contribute considerable sums to research in this area, since the investments from these companies are not clearly documented because of commercial sensitivity.  

To assist policy makers, funding organisations, and other researchers, the authors will be making the full results of their study freely available online. They urge funding agencies to add to this resource by making their investment portfolios openly available.

Michael G Head, Joseph R Fitchett, Mary K Cooke, Fatima B Wurie, Andrew C Hayward, Rifat Atun, UK investments in global infectious disease research 1997–2010: a case study. Published online in The Lancet November 8 2012: http://dx.doi.org/10.1016/ S1473-3099(12)70261-X