The Ripple Effect 3.0: deepening the case for the domestic benefits of global health R&D
By Impact Global Health 18 June 2026
Context
Every breakthrough in global health sends ripples that reach far beyond borders. In an era of fiscal tightening and inward-facing policy priorities, investments in global health R&D are under increasing pressure. Yet, these investments are among the most powerful drivers of innovation, economic growth, and resilience – not just for low- and middle-income countries (LMICs), but for high-income countries (HICs) as well. In the Ripple Effect project 1.0, Impact Global Health demonstrated that $71 billion in global health R&D funding from 2007-2023 catalysed $511 billion in GDP growth, created 643,000 jobs, and 20,000 patents in HICs, a multiplier effect proving that global health investment drives domestic prosperity as well as global health outcomes. Building on this, the Ripple Effect 2.0 examined this dynamic through case studies of innovations initially developed for LMIC needs that later delivered measurable health and economic benefits in HICs. Now, the Ripple Effect 3.0 project extends this work by applying the same approach to five additional products, further strengthening the evidence base.
This executive briefing highlights findings from five case studies: Arexvy (an RSV vaccine powered by the AS01 malaria-derived adjuvant), DFMO (a sleeping sickness drug repurposed to treat paediatric neuroblastoma), the single-dose HPV vaccine schedule (adopted by HICs based on evidence generated in LMICs), Rotarix (a rotavirus vaccine developed with a South-first strategy), and M72/AS01E (a promising new tuberculosis vaccine candidate). The brief provides quantitative, country-specific evidence of how these global health innovations improve health outcomes and deliver economic value across the US, UK, Japan and Europe.
Key findings
The five global health innovations analysed in The Ripple Effect 3.0 – Arexvy, M72, DFMO, one-dose HPV vaccination, and Rotarix – are projected to deliver substantial health and economic benefits in high-income countries by 2050. Together with the case studies featured in Ripple Effect 2.0, they illustrate the many ways in which investments in global health R&D generate returns far beyond their original purpose.
Some innovations provide a platform for several different innovations, such as the AS01 adjuvant, initially developed for a malaria vaccine and now used to protect older adults against shingles and RSV, while also supporting the first new tuberculosis vaccine candidate in a century. Rotarix, for its part, was originally conceived as a ‘South-first’ vaccine to address severe diarrhoeal disease in countries such as Mexico and Brazil before becoming part of routine childhood immunisation programmes across many high-income countries. Similarly, evidence generated in LMICs showed that a single dose of the HPV vaccine provides long-lasting protection, helping to reshape immunisation strategies worldwide. Global health innovations can also be repurposed for new indications, as seen with DFMO, which evolved from a treatment for sleeping sickness into a therapy for childhood cancer, and the BCG TB vaccine, which is now used to treat bladder cancer. Finally, some innovations represent reverse innovation, where lessons and technologies developed to address challenges in resource-constrained settings inform solutions in high-income countries, such as the Jada System for postpartum haemorrhage. Collectively, these examples demonstrate that global health R&D creates a cycle of shared innovation and mutual benefit, generating health, economic, and societal returns across countries, populations, and disease areas.
These innovations deliver clear health improvements and economic returns
Selected country-level examples illustrate the scale and diversity of these benefits:
- United Kingdom: approximately 1.3 million rotavirus cases averted through routine child immunisation with Rotarix, generating over $500 million in projected savings for the NHS.
- European Union: around 7.4 million cases of respiratory syncytial virus acute respiratory infection (RSV-ARI) averted through vaccination with Arexvy, resulting in approximately $4.7 billion in health system savings.
- United States: an estimated 700 additional cervical cancer cases averted through the adoption of a one-dose HPV vaccination schedule, generating $38 million in health system savings and a further $6.3 billion in programme delivery cost savings.
- Japan: approximately 172,000 tuberculosis cases averted following the introduction of the M72/AS01E vaccine, resulting in around $2 billion in health system savings.
Investing in Global health R&D delivers shared benefits
Taken together, these findings highlight a simple but powerful message: investments in global health R&D generate benefits far beyond their original purpose. By strengthening scientific networks, accelerating innovation, and enabling knowledge transfer, global health research creates substantial returns for high-income countries as well as LMICs.
Case studies
The AS01 adjuvant was created through global health research aimed at developing vaccines for malaria and was ultimately included in the first approved malaria vaccine, Mosquirix (RTS,S/AS01). Recognised as an adaptable platform technology, AS01 was subsequently incorporated into Arexvy – the world’s first approved RSV vaccine for older adults – where AS01E (a variant of the adjuvant) helps elicit a strong immune response against RSV lower respiratory tract disease.
Until 2023, no vaccine existed to protect older adults against RSV despite it causing an estimated 160,000 hospitalisations and up to 10,000 deaths annually among older adults in the US alone. Arexvy, approved in 2023 and now available in over 70 countries, addressed this long-standing gap, achieving over 80% efficacy against symptomatic RSV disease. The trajectory of AS01 – from malaria research to a platform now used across multiple vaccines – illustrates the multi-directional value of investments in global health R&D.
Health and economic impact in the EU, Japan, UK and USA
- By 2050, Arexvy is projected to prevent around 15 million RSV acute respiratory infection cases, save nearly 107,500 lives, and avert 1.3 million DALYs across the EU, UK, US, and Japan. The EU accounts for the largest share of cases averted, while Japan sees the most lives saved relative to its population.
- Arexvy delivers nearly $310 billion in societal value from healthy years gained and $20 billion in health-system cost savings. In the US, the vaccination programme recoups roughly 80 cents of every dollar spent through avoided healthcare costs alone – before accounting for the broader value of lives saved.
Why this matters for policymakers
Arexvy illustrates how a single adjuvant technology, originally developed to protect children from malaria can deliver major health and economic benefits for ageing populations in HICs decades after its initial development. The same AS01 platform now powers vaccines against malaria, shingles, RSV, and a promising TB candidate, demonstrating the extraordinary leverage of early-stage global health R&D investments.
Investments made to solve urgent global health challenges can continue to generate health and economic benefits long after their first application. As populations age, platform innovations such as AS01 play a critical role in translating early-stage global health research into long-term domestic value, making the case for sustained investment in global health R&D as a strategic, not merely humanitarian, priority.
HPV causes virtually all cases of cervical cancer, the fourth most common cancer in women, causing the deaths of 350,000 women every year, most in LMICs. The HPV vaccine has existed since 2006. The question of whether a single dose could suffice emerged from an observation in the Costa Rica HPV Vaccine Trial, which found that women who had received only one dose appeared just as protected as those who received three. Dedicated trials in Kenya, Tanzania and India confirmed the finding, leading the WHO to endorse a one-dose schedule for eligible individuals in 2022.
Health and economic impact in the EU, UK, US and Japan
- By 2070, a one-dose HPV vaccine schedule is projected to prevent an additional 2,700 cervical cancer cases, save almost 300 lives, and avert 12,700 DALYs across the UK, Europe, the US and Japan, compared to a two-dose schedule. More optimistic uptake scenarios could avert up to 14,300 additional cases.
- Switching to a one-dose schedule has the potential to generate $1.5 billion in societal gains and $68 million in health-system savings from averted cervical cancers, plus over $10 billion in delivery cost savings across the four markets, as administering one dose instead of two cuts procurement costs roughly in half.
Research conducted in LMICs did not just solve a problem in low-resource settings – it unlocked a simpler and more equitable path to cervical cancer elimination by increasing coverage while decreasing costs. A disease that kills 350,000 women annually is now likely within realistic reach of being eliminated, and that prospect owes as much to LMIC-driven research as to the vaccine itself.
Why this matters for policymakers
The HPV single-dose case demonstrates how global health R&D can stimulate high-impact opportunities beyond their original context, improving equity in health outcomes and efficiency simultaneously. For health systems already under fiscal pressure, the delivery cost savings alone – over $10 billion – represent precious resources that can be redirected to other priorities.
The only registered TB vaccine, BCG, is over a century old and offers little protection against pulmonary TB in adults – the form responsible for most deaths. In HICs, TB today is driven less by ongoing spread and more by a large silent reservoir of past infection, characterised as those with latent TB and more common among older adults and foreign-born populations. As immune systems weaken with age, dormant bacteria can reactivate – a risk a new vaccine candidate, M72/AS01E, is uniquely positioned to address.
M72/AS01E uses the same AS01E adjuvant developed through malaria vaccine research, paired with M72, a protein derived from two TB antigens. In 2019, a landmark trial across Kenya, South Africa and Zambia demonstrated approximately 50% efficacy in adults with latent TB infection – the first significant proof of TB vaccine efficacy in over a century. A pivotal Phase 3 trial launched in March 2024.
Health and economic impact in the EU, UK, US and Japan
- By 2050, M72/AS01E could prevent over 420,000 TB cases, save 52,000 lives, and avert nearly 764,000 DALYs across the EU, UK, US and Japan. Japan accounts for the largest share of lives saved, reflecting its higher TB incidence and case fatality rate among the four HIC markets.
- The societal value of 764,000 DALYs averted is estimated at $176 billion.
The 423,000 cases averted are projected to generate $5.6 billion in health-system cost savings. Crucially, for every dollar invested in vaccine delivery, health systems are estimated to save $28 in avoided treatment costs.
The story of AS01 and M72 illustrates how global health research works as a cycle of shared innovation and shared returns. An adjuvant developed to tackle malaria in low-income settings now underpins what could become the first new TB vaccine in over a century, demonstrating that investments made to address neglected diseases rarely stay contained to the populations they were first designed to help.
Why this matters for policymakers
If M72/AS01E succeeds in Phase 3 and gains approval, it could save tens of thousands of lives, ease significant pressure on health systems, and deliver returns of $28 saved per dollar invested – all from an adjuvant technology originally developed to fight malaria. The case for maintaining investment in neglected disease R&D has never been clearer.
DFMO (difluoromethylornithine) was briefly explored as a cancer treatment in the 1970s before severe side effects halted trials. A serendipitous discovery redirected it to treat African sleeping sickness (human African trypanosomiasis), where it proved so effective in late-stage cases it earned the nickname “the resurrection drug.” After a period as a hair removal cream, scientists found a new application: using DFMO to prevent paediatric neuroblastoma tumour regrowth rather than as a first-line treatment. By using much lower doses, the worst side effects were avoided. A 2020 study showed 4-year overall survival rose by 12 percentage points (to 96%) with DFMO, leading to FDA approval for paediatric neuroblastoma. The sleeping sickness chapter kept this compound alive long enough for its cancer application to be discovered.
Health and economic impact in the EU, Japan, UK and USA
- By 2050, DFMO could save the lives of more than 1,600 children across the UK and EU, averting almost 87,000 DALYs. Almost all beneficiaries are under five years of age, meaning each death averted translates into a large number of life years gained.
- The societal gains from 87,000 DALYs averted are valued at over $10 billion across the UK and EU. Because neuroblastoma is rare, DFMO’s aggregate impact is smaller than some innovations – but for the children who benefit and their families, the effect is profound.
DFMO illustrates how valuable treatments can emerge through non-linear development pathways, especially when neglected disease research keeps promising science in active use. Work originally redirected to an African sleeping sickness indication preserved and refined a drug that is now projected to save thousands of children’s lives in HICs.
Why this matters for policymakers
DFMO reinforces a core lesson of the Ripple Effect: global health R&D can preserve scientific options, create unexpected second uses, and deliver measurable health and economic value well beyond the populations it was originally developed to serve. Sustaining investment in neglected disease research is not only a humanitarian imperative – it is a source of future medical breakthroughs.
Rotarix is a live oral rotavirus vaccine developed by GSK using a deliberate “South-first” strategy – initially targeting middle-income countries such as Mexico and Brazil, where rotavirus mortality was much higher than in HICs. GSK carried out some of the largest vaccine trials in history in these settings, building a robust evidence base that later enabled widespread adoption in high-income health systems.
The UK adopted Rotarix in 2013. Data from the rollout showed case numbers fell by as much as 88% among vaccinated children under one, and by over 40% among unvaccinated over-65s – demonstrating how infant vaccination changes disease circulation across the whole community. Many EU countries have yet to adopt Rotarix universally, leaving a substantial preventable burden.
Health and economic impact in the EU and UK
- By 2050, the UK’s adoption of Rotarix will lead to over 1.2 million fewer rotavirus cases, prevent nearly 100 infant deaths, and avert over 75,000 DALYs. EU-wide adoption on the same timeline could avert 17 million cases, save over 1,000 lives, and deliver health gains worth more than $130 billion.
- Rotarix would deliver health gains valued at more than $22 billion in the UK alone, alongside health-system savings of $584 million. EU-wide adoption could generate $7 billion in health-system savings, with total societal impact exceeding $154 billion across both markets.
Rotarix illustrates how a South-first development strategy – driven by the disease burden where rotavirus mortality was greatest – generated evidence that proved equally valuable for high-income health systems. The same advantages that made Rotarix suited to LMIC environments (two-dose schedule, temperature tolerance, broad protection) also proved decisive for HIC adoption.
Why this matters for policymakers
Rotarix demonstrates that investment in global health R&D is not only a response to disease burden in LMICs – it creates practical, scalable innovations that strengthen health systems and deliver measurable health and economic value in HICs. EU member states that have not yet universally adopted Rotarix represent a concrete, near-term opportunity to capture these returns.
The research behind the numbers
Ripple Effect 3.0 combined desktop research, literature synthesis, and validated modelling techniques
- Quantify the health impact of each health innovation in HICs including lives saved, cases or recurrence averted, and averted disability-adjusted life years (DALYs).
- Estimate the economic benefit provided by each product in HICs by calculating the societal value of the health gains received by patients, along with an assessment of health system cost savings.
All our models draw on standardised inputs, including age-stratified epidemiological projections, population trends and national healthcare cost estimates. We estimate the burden of a disease on its sufferers and on the health care system in the absence of the modelled intervention and calculate annualised differences in outcomes based on central estimates of the products’ clinically demonstrated effectiveness, discounting the value of benefits delivered in the future. Additional life years lived as result of averted mortality – the key driver of overall benefit in most of our models – are calculated based on nation- and age-specific life expectancies, incorporating a linear trend capturing expected change in life expectancy over time.
Where relevant, we incorporate flow-on herd immunity effects of vaccination programmes, product-specific rates of waning efficacy over time and effects of averted mortality on life expectancy, with these parameters derived based on a review of the academic literature.
For further details on the key modelling assumptions for each case study please see: https://www.impactglobalhealth.org/insights/hubs/the-impact-of-global-health-rd-hub
Why it matters and implications for the future of R&D
The evidence demonstrates that investment in global health R&D represents a highly effective use of public resources, generating health, economic, and innovation gains in HICs as well as health and economic gains in LMICs. It also challenges the outdated notion that global health R&D is primarily an act of external assistance. Instead, it shows that these investments are a strategic asset: they protect lives, reduce pressure on health systems, strengthen scientific capability, and generate economic value both at home and across borders.
The next phase of global health R&D must focus on building resilient, distributed, and inclusive ecosystems. While HICs have historically concentrated R&D infrastructure and expertise, expanding support for LMIC-led research strengthens global preparedness, equity, and shared returns. This includes investments in research infrastructure, workforce development, regulatory systems, and platform technologies that can be adapted across multiple disease areas. Public and philanthropic funders should also leverage blended finance mechanisms to catalyse co-investment from domestic and private sectors, ensuring sustainable funding for long-term innovation pipelines. This is not only a matter of fairness; it is a matter of resilience. A more distributed R&D ecosystem reduces dependence on a small number of institutions and geographies, increases the speed and relevance of innovation, and creates stronger foundations for responding to both endemic diseases and future health threats.
Taken together, these findings point to a clear policy imperative: global health R&D is a strategic tool for economic security, health-system sustainability, and scientific leadership. Policymakers in donor countries should maintain and, where possible, expand funding, while fostering partnerships that empower LMIC institutions, amplify innovation, and ensure that the benefits of research are shared equitably across the globe. The choice facing funders is not only whether they can afford to invest in global health R&D, but also whether they can afford the long-term costs of allowing proven innovation pathways to weaken.
Calls to action
The new evidence from the five additional case studies presented here further buttresses our existing recommendations for the funders of global health R&D: now is the time to double down on global health R&D as a shared investment in prosperity, security, and resilience. At a moment when public budgets are under pressure and traditional aid narratives are increasingly contested, the case for global health R&D must be made not only on moral grounds, but also as a practical investment in domestic health, economic stability, and future preparedness.
- Sustain investments and reposition global health R&D as a strategic driver for growth
At a time of fiscal pressure and shifting geopolitical priorities, sustaining investments in global health R&D requires a clearer articulation of its domestic value. The evidence from The Ripple Effect shows that investments originally directed toward global health needs generate substantial health gains, cost savings, and economic value within high-income countries. Positioning global health R&D within broader economic, innovation, and security frameworks can help maintain continuity of investment even as traditional aid narratives come under strain. Funders should therefore move beyond defending global health R&D as a discretionary development spend and instead present it as part of a wider national interest agenda: one that supports health-system resilience, industrial competitiveness, scientific leadership, and preparedness for future biological threats. - Create financing approaches that protect innovation pipelines during transition
The global health R&D ecosystem is entering a period of heightened fragility. Avoiding long-term losses in innovation capacity will depend on financing approaches that provide predictability across the R&D lifecycle and support platform technologies with demonstrated spillover potential. The product pathways highlighted in The Ripple Effect 2.0 illustrate how early-stage investments can yield durable returns over decades, reinforcing the case for mechanisms that prioritise continuity and multi-year funding rather than short-term cycles. This is particularly important for products and platforms that may not offer immediate commercial returns but can generate significant downstream value for multiple populations, diseases, and markets. Funders should protect these pipelines from stop-start financing, which risks losing scientific talent, institutional memory, and promising candidates before their full value is realised. - Strengthen the enabling conditions for sustainable innovation ecosystems
Long-term returns from global health R&D depend on more than individual products. Economic and health gains are maximised when investments are accompanied by strong regulatory systems, skilled workforces, access to risk capital, and supportive policy environments. As demonstrated by the platform innovations in this report, these enabling conditions increase the likelihood that early research translates into scalable innovations with lasting domestic and global value. - Recognise the role of spillovers and repurposed products in health innovation
Biomedical R&D, particularly from the private sector, remains heavily concentrated in areas of highest burden to the richest countries, especially oncology. Fighting cancer is a worthwhile, but extremely crowded field, and the results presented here show that the next blockbuster cancer drug will not necessarily be discovered by looking for a cure for cancer. Innovation often emerges through unexpected pathways: technologies developed for one disease, geography, or population can later prove transformative elsewhere. The prevalence of spillovers and serendipity in R&D suggests a portfolio strategy for innovation, placing a large number of small bets in the hope of an unexpected payoff.
Funders should therefore resist overly narrow definitions of value that privilege only immediate, disease-specific, or market-ready outputs. The evidence from these case studies shows that global health R&D can generate returns far beyond its original purpose, including repurposed products, platform technologies, and scientific advances that benefit HICs and LMICs alike. Recognising this wider innovation dividend is essential to building a stronger, more resilient R&D ecosystem for the future.