Key Findings

KEY FINDINGS

We analyzed U.S. government FY 2007 research funding by CDC, DOD, NIH, and USAID on African sleeping sickness, Buruli ulcer, Chagas disease, cholera, dengue, leishmaniasis, malaria, and tuberculosis (TB). We evaluated agency-specific spending across diseases and by research activity. Data were adjusted to ensure that funding for projects that involved multiple diseases was counted only once. This section discusses the impact of that adjustment.

Total Spending across Agencies

Total spending across all study areas was approximately $366 million.
- NIH accounted for approximately 78 percent of total spending.
- Of the remaining agencies, DOD accounted for 12 percent of total spending, CDC for 6 percent, and USAID for approximately 4 percent.

Research funding exceeded $100 million for only two of the eight diseases.

Research on TB and malaria was funded at nearly the same level, with TB receiving nearly $133 million and malaria receiving about $130 million.
Research funding was less than $50 million for each of the remaining six diseases.
Malaria and TB each received about 36 percent of the total funding. Dengue received 12 percent. The remaining five diseases, African sleeping sickness, Buruli ulcer, Chagas disease, cholera, and leishmaniasis, each received less than 10 percent of total funding.

All of the agencies were involved in research on multiple diseases, particularly diseases with the greatest level of funding. However, for half of the diseases in this study, NIH was the only agency engaging in research on that disease.

All agencies funded research on malaria.
NIH and CDC funded research on dengue, leishmaniasis, and TB. USAID funded research on TB but not dengue and leishmaniasis. DOD funded research on dengue and leishmaniasis but not TB.
NIH was the only agency conducting research on African sleeping sickness, Buruli ulcer, Chagas disease, and cholera.

Spending by Type of Research Activity

Overall Spending by Research Category
While there was some activity in all research categories, earlier stage research received the largest portion of funding by far.
“Basic Research” was the activity that received the most funding (about 35 percent), with “Product Discovery and Preclinical Product Development” receiving the next largest percentage (approximately 33 percent).
No other research area received more than 10 percent of funding.
- “Clinical Product Development and Related Clinical Research” received just over 8 percent of funding.
- The remaining areas, “Implementation/Operational Research,” “Epidemiology Research,” and “Education, Training, and Capacity Building” each received between 4 and 6 percent of funding.
- 7.5 percent of total funding could not be classified. All of that funding was from NIH and could not be placed into a research category because there was insufficient information available to permit classification (for example, if an abstract was missing and the project title was not descriptive enough to permit classification). This represented about 5.8 percent of all of the NIH projects that we reviewed.

Spending by Research Category within the Agencies

The allocation of each agency’s spending by research category to some extent reflected the unique strengths of each agency.
NIH was the only agency that provided funding for all research activities. “Basic Research” was the most heavily funded and accounted for 43 percent of total NIH spending.
DOD and USAID spent the majority of their research funds on “Product Discovery and Preclinical Product Development” and “Clinical Product Development and Related Clinical Research.”
- About 67 percent of DOD research spending was classified as “Product Discovery and Preclinical Product Development,” and almost 24 percent was classified as “Clinical Product Development and Related Clinical Research.”
- About 29 percent of USAID research spending was classified as “Product Discovery and Preclinical Product Development,” while nearly 55 percent was classified as “Clinical Product Development and Related Clinical Research.”
Of the four agencies, CDC spent the largest percentage on “Implementation/Operational Research,” which accounted for 61 percent of total CDC spending.

Spending by Research Category across the Agencies

Although NIH allocated the largest amount of money to research on the diseases included in our study, looking at all the agencies, it did not account for the largest percentage of spending in all categories.
Across research categories, NIH accounted for by far the largest percentage of funding for four of the six categories: “Basic Research” (accounting for nearly 95 percent of the total spending in that category); “Product Discovery and Preclinical Product Development” (about 72 percent); “Epidemiology Research” (about 87 percent); and “Education, Training, and Capacity Building” (nearly 81 percent).
Funding for “Clinical Product Development and Related Clinical Research” was the most evenly distributed across the agencies, with DOD, NIH, and USAID each funding more than 25 percent of the research in that category.
“Implementation and Operational Research” was heavily concentrated at CDC, which accounted for nearly 84 percent of research funding in that category.

Spending by Disease

Spending varied tremendously across diseases. The widest range of research activities was performed on those diseases that had the greatest total funding.
Only four diseases had funded activity in all research categories: dengue, leishmaniasis, malaria, and TB.
For the remaining four diseases, activity was heavily concentrated in early stage or epidemiological research.
- For African sleeping sickness, Chagas disease, and cholera, at least 50 percent of funding was classified as “Basic Research.”
- Almost 58 percent of the funding for Buruli ulcer was classified as “Epidemiology Research.”
For all but two of the diseases studied, leishmaniasis and malaria, less than 10 percent of spending was classified as “Clinical Product Development and Related Clinical Research.”
“Implementation/Operational Research” and “Education, Training, and Capacity Building” accounted for less than 10 percent of funding for all diseases.

Adjustments for Double-Counting

All agencies except NIH provided directly to us data that were already adjusted for double-counting of multi-disease research.14 For NIH data, we made adjustments for double-counting based on a review of NIH projects (see our abridged Methodology on page 7 and the full Methodology in Appendix I on page 33 for more details about this process.) This section outlines the impact of those adjustments to the NIH data.

Table 5 shows the extent of our adjustments for double-counting for multi-disease projects by comparing unadjusted funding (i.e., total spending when double-counting of multi-disease awards was not taken into account) to adjusted funding (i.e., total spending after subtracting double-counting of multi-disease awards). Our adjustments of NIH data for double-counting of multi-disease research reduced the total amount spent on all eight diseases by more than $110 million, which is 28 percent of unadjusted funding.

For all diseases except Buruli ulcer and cholera, controlling for multi-disease projects reduced research funding by between 25 and 50 percent.
TB had the largest dollar adjustment—nearly $45 million, or nearly 28 percent of unadjusted TB spending. Malaria was second, with just under $30 million, or nearly 25 percent of unadjusted spending.
Chagas disease and dengue had more than $10 million in double-counted multi-disease research. Leishmaniasis had slightly less—around $9 million.
African sleeping sickness and cholera had, respectively, nearly $5 million and about $1 million in double-counted multi-disease research.
The U.S. government is funding only $656,000 in research on Buruli ulcer, and none of this funding is related to multi-disease research.

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