Exploring Why Global Health Needs Are Unmet by Public Research Efforts: The Potential Influences of Geography, Industry, and Publication Incentives

It has been well established that research is not addressing health needs in a balanced way: much more research is conducted on diseases with more burden in high income countries than those with more burden, especially prevalent in lower income countries. In this study we document the persistence of these imbalances using WHO data on Global Burden of Disease against bibliometric information as a proxy for research efforts: we find that, in relative terms, diseases which are more prevalent in high income countries generate ten-fold more research attention than those in low income countries. Next, we investigate some of the potential drivers for these imbalances. First, we look at the geographical distribution of disease burden and research. We observe that countries steer their research priorities according to national health needs while also contributing somewhat to global needs. Since research output is heavily concentrated (about 80%) in high income countries, this results in a relative lack of attention to diseases in lower income countries. However, a novel finding is that diseases with a similar burden in high- and middle-income countries are also under-researched, even in relation to their burden in both high- and middle-income countries. Second, we find that disease focus of global industrial R&D is very similar to the disease focus of public research, suggesting that public and industrial priorities are coupled. Third, we look into publication journal and citation patterns across diseases to inquire into the influence of academic prestige and evaluation practices. No bias is found in representation of diseases among the 25% most prestigious journals. However, in middle income countries, citation rates are found to substantially decrease for diseases most prevalent in low and middle income countries, which may constitute a disincentive to address them. We discuss how all three driving factors can potentially affect the relative lack of response of research to global health needs. Finally, we also make publicly available the correspondence table between WHO ICD-10 disease definitions and PubMed MeSH descriptors.