Why global health R&D is one of the smartest investments governments can make

At a time when governments are under intense fiscal pressure – juggling rising defence spending, ageing populations, and growing health threats – choices about public investment matter more than ever. One area that is often framed as altruistic, but in fact delivers strong domestic returns, is global health R&D. Global health R&D is typically justified on moral grounds: saving lives, reducing inequities, and tackling diseases that disproportionately affect low- and middle-income countries (LMICs). These motivations remain essential. But they are not the whole story.

In The Ripple Effect report, we show that global health R&D also delivers tangible economic, scientific, and security benefits to the countries that fund it. And the evidence is striking. Between 2007 and 2023, high-income country (HIC) governments invested $71 billion in global health R&D. Of this, $64 billion stayed within HICs – generating an estimated $511 billion in GDP growth, supporting 643,000 jobs and creating close to 20,000 patents.

When governments invest in global health R&D, much of that funding does not disappear overseas. Instead, it largely flows through domestic institutions, which support skilled employment, sustain innovation ecosystems, and generate spillovers across the wider economy.

A powerful – yet often overlooked – argument for investing in global health R&D lies in its spillover effects. Research initially focused on diseases prevalent in LMICs has repeatedly produced innovations that were later adapted, repurposed, or scaled to deliver benefits well beyond their original therapeutic areas and geographies. We have identified at least 22 such innovations that have generated significant health and economic benefits in HICs. One example is the AS01 adjuvant, originally developed for the RTS,S malaria vaccine, which later enabled shingles and RSV vaccines widely used in HICs. We have estimated that by 2050, Shingrix alone is expected to avert nearly 32 million cases across HIC markets (e.g. EU, UK, Japan, and the US), generating $72 billion in health-system savings – of which $55 billion would occur in the US alone. Similarly, the BCG vaccine, first developed for tuberculosis, is now used as a treatment for bladder cancer in HICs and is expected to save close to 300,000 lives and nearly $15 billion in health-system costs by 2050. Crucially, these spillovers do not just improve health outcomes or reduce costs; they also strengthen the foundations of national and global health security.

The COVID-19 pandemic provides a clear illustration of this. Platforms and tools originally developed for other diseases such as malaria (ChAdOx1), tuberculosis (GeneXpert), and Ebola (rVSV-based vaccines) were rapidly mobilised to respond to an entirely new virus – shortening development timelines and accelerating access to vaccines, diagnostics, and treatments.

What COVID-19 ultimately revealed is that preparedness is cumulative. It validated decades of long-term investment in global health research and reinforced a critical lesson: preparedness cannot be switched on in an emergency – it must be built steadily over time. The tools needed to confront the next health crisis depend on the investments made today.

While the current global health R&D system has delivered extraordinary results, it remains heavily concentrated in HICs. This concentration builds on deep expertise and infrastructure that already exist, but it also creates vulnerabilities. A more distributed global R&D ecosystem – one that builds research capacity, leadership, and manufacturing capability closer to where disease burdens are highest – would strengthen the system. It would improve the speed and relevance of innovation, support economic development in LMICs, and enhance global preparedness by broadening the base of scientific capability.

This shift is not about diverting resources away from successful institutions in HICs. It is about complementing them – designing financing models that encourage co-investment, crowd in private capital, and support long-term capacity alongside product development. Product Development Partnerships (PDPs) also have a critical role to play. Despite their central contribution to recent breakthroughs, many PDPs face constraints from narrowly scoped funding that limits investment in local research infrastructure, workforce development, and regulatory systems. Addressing this 'unfunded mandate' is essential if the global health R&D ecosystem is to evolve in a way that is both equitable and resilient.

Looking forward, the question is not whether governments can afford to invest in global health R&D. The evidence suggests they cannot afford not to. These investments save lives, strengthen economies, and reduce future risk – at home as well as abroad. Cutting back may offer short-term fiscal relief, but it carries long-term costs that far outweigh any immediate savings.