The ripple effect: how global health R&D delivers for everyone

Global health R&D^[1] delivers extraordinary returns for everyone. It saves lives, strengthens economies, and accelerates scientific progress in ways that benefit people in both low- and middle-income countries (LMICs) and high-income countries (HICs). This report builds on a growing body of evidence, including our May 2024 findings showing that every $1 invested in neglected disease R&D generates $405 in societal return.

Between 2000 and 2040, biomedical innovations targeting neglected diseases are projected to save more than 40 million lives and avert 2.83 billion DALYs, generating $49.7 trillion in net societal benefits. Consistent with where the burden of neglected disease falls most heavily, the majority of this impact is concentrated in sub-Saharan Africa and South and Southeast Asia. However, these investments also generate significant health and economic returns in HICs.

Global health innovation is a shared engine of resilience, prosperity, and progress.

In an era of increasing fiscal pressure, where rising defence spending is putting pressure on official development assistance (ODA) budgets and public funding for medical research, it is essential to understand the full value of global health R&D to both LMICs and HICs. Investments by HICs in R&D for neglected and emerging diseases and women’s health are often guided by a sense of global solidarity and shared responsibility. But, beyond these motivations, they are also smart, strategic choices – supporting high-quality job creation, fuelling GDP growth, and strengthening public health systems everywhere.  These investments stimulate innovation ecosystems, sustain biomedical industries, and build preparedness platforms that benefit populations globally.

At Impact Global Health, we have consistently demonstrated the life-saving value of biomedical innovation for LMICs. With this report, we broaden our lens to show how smart, sustained investments in global health R&D create returns that are truly global – delivering health and economic progress for HICs. We examine how much government funding from HICs has gone to global health R&D, how much of it stays within HICs, and the macroeconomic and scientific gains it leads to. We then explore the link between R&D and real-world impact, spotlighting case studies that show how innovations developed for LMICs have gone on to help HIC populations, proving that smart, sustained investment pays dividends globally and locally.

^{[1] In this report ‘global health R&D’ means funding for biopharmaceutical research and development targeting neglected and emerging infectious diseases and women’s health. See our survey scope and methodology for specific details of the diseases, products and conditions included.}

How much have HICs invested in global health R&D?

Data from our annual G-FINDER survey, shows that a total of $71 billion^[1] has been invested by 44 HIC governments in global health R&D^[2] between 2007-2023, representing 66% of total global investment, with most of the remainder coming from the private sector and from large health-focused philanthropic organisations like the Gates Foundation and Wellcome. Inflation-adjusted annual investment increased gradually between 2007 and 2019, rising by an average of $179 million per year. In 2020, funding surged by $4.5 billion (a 97% increase) in response to the COVID-19 pandemic. This elevated level of investment was sustained into 2021 but has declined in subsequent years – though it remains above pre-pandemic levels.

Which global health areas do HICs governments fund?

Since 2007, using the scope, data, and definitions from the G-FINDER survey, the majority of HIC funding has been directed toward neglected diseases (NDs), which received 63% of total investment. Emerging infectious diseases (EIDs) accounted for 33%, while only a small fraction – 2% – was invested in sexual and reproductive health (SRH). However, these figures are shaped by the gradual expansion of our survey scope over time: NDs have been included since the survey’s inception in 2007; EIDs, beginning with Ebola, were added starting in 2014; and SRH was introduced in 2018. When we limit the analysis to data from 2018 onward, during which, aside from COVID-19, the survey scope has remained relatively stable – the distribution shifts: EIDs represent 53% of HIC funding, NDs 40%, and SRH 4%.

How much of this funding stays within HICs?

Of the $71 billion, 90% ($64 billion) remained in HICs, and most remained within its country of origin: 76% of all HIC funding went to recipients in the same country that provided it. Cross border funding flows between HICs and, especially, funding from the European Commission to EU member states, meant that some countries received more funding than they themselves provided.

Only around 10% of funding flows directly from HIC governments to LMICs.^[3] South Africa is by far the largest recipient of this direct funding, receiving 33% of the total, with the next largest recipients – Costa Rica, Brazil, Uganda, Peru and Gambia – all receiving 5% each.

The small share of funding going directly to LMICs reinforces the importance of the role played by Product Development Partnerships (PDPs) and  intermediary organisations like the European and Developing Countries Clinical Trials Partnership (EDCTP) and the Coalition for Epidemic Preparedness Innovations (CEPI) which, together, receive 15% of HIC public funding and channel a larger share of it – about 22% of the total – onward to the LMICs in which they work.

Why does most funding remain in HICs?

There are several structural reasons why the majority of global health R&D funding from HICs remains within their borders. Much of this investment is routed through domestic institutions (including universities, government research agencies, and non-profit organisations), that already have the infrastructure, capacity, and track record to receive and manage large-scale public grants. Procurement rules, risk assessments, and reporting standards often favour established entities within donor countries, creating additional barriers to fund disbursement beyond HICs. Eligibility requirements further reinforce this pattern by mandating or strongly encouraging the involvement of researchers or institutions based in the funding country. For example, funding from the US (with partial exceptions from institutions like the NIH Fogarty International Center), the UK, and the European Commission often requires or promotes collaborations between a HIC-based researcher and an LMIC-based partner. While this can facilitate cross-regional exchange, it also structurally embeds funding flows within HIC systems.

In many cases, HIC governments fund research and product development with a global mandate but contract it out to domestic entities. These institutions may collaborate internationally or develop tools for diseases primarily affecting LMICs, but the funding itself remains in the originating country - along with associated jobs, infrastructure investment, and indirect economic benefit. This is particularly the case for basic research, which is the focus of the US National Institutes of Health (NIH), comfortably the largest single funder of global health R&D. Because basic research doesn’t involve testing medicines on patients it can, and typically does, take place at universities and research institutions in the funding nation.

At the same time, some LMIC institutions face challenges in meeting donor requirements for grant-making, limiting their eligibility for direct funding. While there has been sustained investment in this area – including long-standing efforts such as Wellcome’s support to KEMRI since the 1960s and UKCDR's initiatives to strengthen research capacity in LMICs – continued efforts remain critical. Continued investments in LMIC R&D ecosystems is essential to build the capacity, governance, and partnerships needed for a more geographically inclusive and resilient R&D ecosystem.

^{[1] All our monetary figures are quoted in inflation-adjusted 2024 US dollars, with funding in other currencies converted at average 2024 exchange rates.}

^{[2] By which we mean funding for biopharmaceutical research and development targeting neglected and emerging infectious diseases and women’s health.}

^{[3] We assume that funding with no specified recipient matches the distribution of the funding we do know about, so that the vast majority stay in HICs. See Appendix for details.}

Our research shows that the vast majority – 90% – of funding from HIC governments into global health R&D goes to HIC institutions, although those institutions may then further flow funding or goods onto LMICs. This funding fuels local economies, boosting GDP and creating high-quality research jobs that ripple into other sectors. Far from being an undisputed global public good, government investment in global health R&D catalyses private sector investment and sparks innovation, with patents and scientific breakthroughs multiplying long after the initial funding is gone. Drawing on a thorough review of the academic and other literature, we identified the economic multipliers applicable to each of the countries covered by our G-FINDER survey data to estimate the economic and scientific returns to HICs of two decades of global health R&D investment.

^{Note: For more details on the individual studies and impact multipliers considered, and why we selected the ones we did, please refer to the Appendix.}

Economic activity generated

Investment in research doesn’t stop at the lab – it triggers spending and growth in adjacent sectors, rippling through the economy. Comparing the economic impact of government R&D spending across countries is no easy task. Studies vary widely in their methods, definitions of economic activity, and the types of R&D they assess, making direct comparisons tricky. Still, looking at the high-quality studies most applicable to our data, we found that each dollar invested in R&D returns somewhere between 5.70 and 10.20 to the economy.^[1]

Based on these estimates, the $64 billion in R&D funding retained by HICs would be expected to generate around $511 billion in economic activity, within plausible alternative estimates ranging from $365 billion at the low end to as much as $658 billion on the high end. The US alone is projected to generate $387 billion in economic impact from its R&D investments. For ‘Team Europe’ – EU Member States along with the European Commission itself – the figure is almost $57 billion. Much of that return has already been realised during the period from 2007-2023 in which the spending took place, but it also has a long tail. A not-insignificant share of that benefit will continue to accrue over the coming decade, continuing to drive economic growth.

Jobs created

Funding brings higher levels of economic activity that bring more jobs. These jobs, themselves, stimulate more economic activity. While it is comparatively easy to measure the extra jobs created directly in the R&D sector – scientists, technicians, biosecurity officers – it is much more difficult to precisely estimate how many extra jobs the ripples from these new projects create across the whole economy – for delivery drivers, in nearby cafes and for the makers of safety equipment.

The studies underpinning our assessment suggest that every $1 million invested in health R&D generates around 2.7 direct jobs in the research sector, the scientists, lab technicians, and security staff we talked about above. But the ripple effects extend much further. These direct jobs fuel demand across other sectors, from construction and equipment manufacturing and even food services and local retail, ultimately supporting something like ten jobs per $1 million invested across the wider economy. This means, very roughly, that each extra job in R&D leads to a little over two additional jobs in other sectors, either servicing the R&D industry or based on the additional demand from its employees.

Applied to the $64 billion invested globally in health R&D, this equates to approximately 172,000 direct jobs and around 643,000 total jobs. These are often referred to as ‘indirect and induced’ jobs – created through the spending power and economic activity of those directly employed in R&D.

Private sector investment catalysed

Research shows that government spending on R&D doesn’t ‘crowd out’ private investment by soaking up the limited resources available for R&D, but instead ‘crowds it in’ by providing a steady stream of new ideas on which the private sector can capitalise on. Take the example of developing a novel drug for a neglected disease: the high risks, long development timelines, and (often) low prospective returns can deter private investors. In such cases, government grants provide essential funding to move projects through the riskiest early clinical phases. This public investment can then attract additional private capital to complete product development once government funding has supplied proof-of-concept. Public funding can also strengthen innovation networks – whether directly, through public-private partnerships, or indirectly because of researchers moving from academia to pharma companies.

This catalytic effect tends to play out over time. The literature distinguishes between short-term and long-term leverage effects: in the short term (typically within a year) government investment often triggers an immediate stimulus in private R&D spending. The long-term effect, which is harder to study, reflects the cumulative impact usually over a decade or more as sustained public investment continues to draw in private capital. Overall, most estimates suggest that around 60% of the private sector response happens within the first three years.

The effect of public R&D on the private sector varies widely by country, shaped by existing patterns of industry and their links to the government. A cross-country analysis shows the US, UK, Japan, and Germany consistently outperform the OECD average in leveraging public investment to crowd-in private capital. In the US, every public dollar invested returns between $0.85 and $1.25 in private R&D within a year – and eventually up to $7.36. The UK sees similar gains, with £0.73 to £1.03 in the short term and up to £4.02 in the long term. Germany and Japan also show strong results, each exceeding the OECD average of a 1:0.67 multiplier in the short-term and 1:3.72 long-term.

Assuming similar dynamics in global health, we estimate that the $64 billion invested by HIC governments has already catalysed around $62 billion in private R&D, with the potential to grow to $359 billion over the coming decade.

Patents filed

It’s hard to pin down exactly how many patents will result from global health R&D investment. The patenting process is slow, and organisations that are already good at innovating tend to both receive more funding and file more patents, so it can be difficult to determine whether extra funding is the cause or the effect of an organisation’s ability to generate new ideas. Still, two studies using sophisticated statistical methods estimate the amount of funding needed to generate an additional patent at between $2.6 million and $3.8 million. Meanwhile, data from the EU’s Horizon 2020 programme suggests a much higher figure (over €20 million per patent) by dividing its total investment by the number of patents filed so far – likely an underestimate since many projects were still ongoing when the evaluation took place and does not include patents filed by organisation not directly funded through horizon projects.   Research suggests that, for every patent induced by targeted R&D funding, as many as three patents may be generated in other technologies by other firms.

Using the $3.2 million estimate (the average from the two non-EU studies), global health R&D investments from HICs could yield around 20,000 patents – driving innovation not just in health but across the wider economy.

^{[1] At the lower end of the estimated return range is the European Commission’s evaluation of the Horizon 2020 programme, which suggests that every euro invested will generate roughly five euros in economic benefits to EU citizens by 2040. At the higher end is a study by Ciaffi et al., which analysed the macroeconomic effects of public investment in innovation across 15 OECD countries between 1981 and 2017. Using sophisticated ‘Structural Vector Autoregression’ (SVAR) models, the researchers isolated the effects of unexpected government spending shocks and estimated that R&D investment yields a return of 6.26 times the additional investment in the first year, rising to a peak multiplier of 10.33 by the fourth year. Sitting between these two is a study from University College London, which also applied SVAR models to quarterly U.S. data from 1947 to 2017. Focusing on ’mission-oriented‘ innovation spending, the study found that every dollar invested in civil R&D sectors (such as health, energy, and space) can generate up to $7.76 in national output. While these studies do not focus exclusively on biomedical R&D, they offer a useful proxy for its effects on the economy.}

The benefits of global health innovations don’t stop at borders, or for the purposes or geographies for which they are originally intended. Many innovations initially developed, trialled, or approved for LMICs have ultimately benefited populations in HICs in various ways: including faster and more cost-effective vaccine development, stronger pandemic preparedness, rapid point-of-care diagnostics to reduce waiting times, and broader access to technologies such as affordable and long-acting contraceptives now also used in high-income settings.

Examples of innovations that delivered dual benefits

This list of 22 innovations (alphabetically ordered) illustrates the broader health, economic and societal benefits of investing in global health R&D, spanning neglected diseases, emerging infectious diseases, and sexual & reproductive health.

Open to enlarge

^{Note: We reviewed academic and grey literature using specific search terms and inclusion criteria to map innovations with these dual benefits and leveraged our in-house expertise. Our inclusion criteria are defined by the G-FINDER survey scope, which has restrictions around certain products. There are more products than those we have listed that have dual benefits, but these do not feature here due to our scope, for example the AS04 vaccine adjuvant developed for a Hepatitis B vaccine is excluded because Hepatitis B vaccines are not in the G-FINDER scope. See the Appendix for more details.}

Case studies

The current global health R&D system has delivered extraordinary life-saving innovations, health, economic and scientific benefits globally. HICs have seen significant benefits which they can continue to reap given the concentration of infrastructure and expertise developed over many years in these countries – if governments sustain their investment and the private sector is stimulated to co-invest.  

Whilst the concentration of R&D investment in HICs has delivered significant returns, this model is reaching its limits. The next phase of global health R&D requires a deliberate transition toward more distributed capacity, not despite the economic benefits to HICs, but to sustain and amplify them. It is in the interests of both HIC and LMIC governments to strengthen this ecosystem further.

Empowering LMICs through investment in local and regional R&D

LMIC governments have a pivotal role to play in shaping a more resilient and equitable global R&D ecosystem. The evidence is clear: investing in health R&D delivers not only better health outcomes but also catalyses economic growth, industrial development, and scientific advancement. To fully realise these benefits, LMICs must prioritise investment in infrastructure and capacity building including:

• Building and maintaining research infrastructure and biomanufacturing capacity to enable local and regional product development and scale-up.
• Investing in human capital through sustained support for STEM education, clinical trial expertise, and leadership in scientific research.
• Strengthening regulatory systems and ethical review mechanisms to ensure that research is safe, efficient, and globally interoperable.
• Developing innovation-friendly policies and governance structures that support knowledge transfer, data stewardship, public-private cooperation, public procurement, and local ownership of research agendas.

There is growing recognition that we need to rethink how global health R&D is financed. To fully unlock the potential of LMICs in global health R&D, financing models must evolve to be more responsive to today’s realities. Traditional funding approaches, largely driven by public and philanthropic institutions in HICs, have underwritten many successes, but often concentrate resources in a limited number of geographies and institutions, limiting opportunities for local leadership.

A more sustainable and inclusive R&D system will require a rebalancing of risk, responsibility, and return. This means:

• Expanding matched co-funding mechanisms that catalyse domestic investment from LMIC governments.
• Deploying blended finance instruments that use public or philanthropic capital to crowd in private investment.
• Channelling more funding directly to LMIC institutions.
• Reforming existing funding flows to prioritise long-term capacity-building, not just product delivery.

PDPs: critical to strengthen the future R&D ecosystem

PDPs are among the most effective vehicles for delivering affordable, context-appropriate technologies. Data also show that a significant share of PDP funding (78%) remains in HICs. This highlights an opportunity to better align these partnerships with long-term capacity goals in LMICs. To do so, PDPs need not only increased funding, but also the flexibility to invest in strengthening local research infrastructure, workforce development, and regulatory systems. Currently, many PDPs face constraints due to narrowly scoped funding, limiting their ability to contribute to broader ecosystem-building, a challenge often described as the ‘unfunded mandate’ of PDPs. Funders should seize the opportunity to fund these ‘unfunded mandates’: the cross-cutting functions that fall outside traditional product budgets but are vital for building local R&D ecosystems. This includes support for LMIC-led trials, technology transfer, regulatory harmonisation, and regional leadership. By empowering PDPs to take on these roles, donors can help shift the model from one-way technology transfer to true partnership anchored in resilient, locally driven innovation systems.

These approaches are not about shifting funding away from high-performing institutions in HICs. They are about broadening the base, designing financing models that build strength across more geographies, ensure the durability of R&D pipelines, and create greater shared value.

For donors, now is the time for strategic, forward-looking investments which can help build a more distributed and resilient R&D ecosystem: one that protects hard-won gains, accelerates local innovation, and ensures that the benefits of global health research are more equitably shared.

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Calculating funding flows

To calculate the flow of funding between different HICs, we used the G-FINDER survey data set for 2007-2023. For funding provided directly to product developers (as opposed to funding provided to intermediaries like PDPs, CEPI or the EDCTP) we used the G-FINDER recipient country. For direct funding for which no recipient nation was specified (around 10% of the total) we assumed that it followed the pattern of destination-specific funding, with 98% flowing to HIC recipients, with a geographical distribution mirroring the distribution of destination-specific funding.

For funding provided to (almost exclusively HIC-based) intermediary organisations like the EDCTP, we pro-rated the share of funding ultimately flowing to HICs based on the geographical distribution of funding provided by intermediaries, excluding destination unspecified funding from our analysis. This calculation resulted in our assigning 78% of funding to intermediaries to HICs, with that funding allocated as being received by the intermediary’s home country.

This outcome of this process suggested that 95% of HIC public global health R&D funding ultimately ends up in HICs. We viewed this figure as inflated because of its complete reliance on product developers’ home countries, ignoring the possibility of formal subcontracts or informal resource expenditures in LMICs by HIC-based institutions. Since none of this secondary funding flow is captured in the G-FINDER survey – though an indicative review of NIH subawards to LMICs identified only a relatively low level of formal NIH funding to LMIC-based recipients – we opted to lower our estimate of HIC recipient share from 95% to a relatively arbitrary figure of 90% to correct for this overestimation and to reflect our uncertainty about the exact figure. G-FINDER based funding flows from and two individual HICs were reduced by 5.3% to reflect this lower estimate of HIC recipient share.

Applying multipliers

Drawing on a thorough review of the academic and grey literature, we identified the economic multipliers applicable to each of the countries covered by our G-FINDER data to estimate the economic and scientific returns of two decades of global health R&D investment from HICs. For each study included in the review, we listed the GDP, job creation, and private sector multipliers, where available, and assessed whether the study fell within the scope of our analysis. We conducted this structured review across published studies and institutional reports, focusing on methodological robustness, relevance to health R&D, funding type (government or philanthropy), and time horizon (short- vs long-term). Multipliers were deemed in scope if they reflected credible, health-relevant impacts of public investment; others were excluded or qualified based on limitations such as reliance on input-output/IMPLAN models or other methodological shortcomings. We added annotations to each entry describing assumptions, strengths, and methodological considerations, ensured consistency in units and definitions.

Except for private sector investment – where we identified robust country-specific multipliers – we applied a common multiplier (with a defined lower and upper bound) across countries. Figures reported in the main analysis reflect the midpoint of this range. For the private sector, one study was used to estimate both the short- and long-term effects of public R&D investment on private sector response. While not specific to health R&D, this study is the most robust and detailed available, distinguishing between short- and long-term effects across specific countries and the OECD. Its findings were nevertheless corroborated by other country- or region-specific studies to ensure their validity.

We followed a similar methodology to estimate how many patents will be filed in response to two decades of HIC investment in global health R&D. Very few studies have assessed the cost per patent, likely due to the lengthy patenting process and the issue of endogeneity: organisations that are more successful at innovation tend to receive more funding and also file more patents, making it difficult to isolate the causal impact of funding on innovation. While patents are not a perfect measure of innovation, they remain the best proxy currently available. We identified two studies that examined the impact of research funding on patent output, both of which used instrumental variable approaches to address endogeneity concerns. In addition, the evaluation of the Horizon 2020 programme provides some indication of patenting activity resulting from public investment. However, it is important to note that the goal of that evaluation was not to estimate the cost per patent, partly because insufficient time had passed since the programme’s end, with many projects still ongoing at the time of review. That said, we divided the total investment by the number of patents filed as of the evaluation to derive an indicative estimate of the cost per patent, which turned out to be nearly ten times higher than the estimates from the two other studies. The patent figures presented in the report use the midpoint of the two in-scope studies, while the exact values from each study are used to inform the range.

Literature review to identify innovations

Economic multipliers don’t capture all benefits of investment in global health R&D. We conducted a literature review of innovations intentionally developed/tested/scaled for LMICs that ended up benefiting HICs to demonstrate the broad benefits of investing in global health R&D.

To identify the innovations with dual benefits, we leveraged in-house expertise and conducted systematic searches of academic and grey literature. Search terms included: ("low- and middle-income countries" OR LMICs OR "developing countries") AND ("biomedical innovation" OR "health technology" OR "point-of-care" OR "device" OR "diagnostic" OR "medical" OR "vaccine" OR "drug" OR "vector control") AND ("reverse innovation" OR “reciprocal innovation” OR "technology transfer" OR "health security" OR "economic spillover" OR "scientific contribution" OR "economic benefit").

Innovations were included if there was clear evidence that the innovation was originally intended for neglected diseases, emerging infectious diseases or sexual & reproductive health issues as defined by the G-FINDER survey scope. This included being first approved for, or initially investigated for, one of these global health areas, or significant advancements in the innovation were conducted for one of these global health areas or targeting LMICs.

We identified 22 innovations that met the criteria, spanning neglected diseases, emerging infectious diseases or sexual & reproductive health issues and product types (drugs, vaccines, diagnostics and devices). Select innovations were grouped based on commonalities and presented as case studies in the report.

•       Vaccine adjuvants – AS01 and Matrix-M

•       Women’s health – Mirena

•       Innovations adapted for COVID-19 – ChAdOx1, SORMAS, remdesivir, GeneXpert, ERVEBO

•       Repurposing innovations – eflornithine, BCG, hydroxychloroquine