1. Setting Country-specific TB r&d funding targets
Treatment action group (TAG)
October 2017
Prepared by Safiqa Khimani

2. Why is setting country-specific targets important?
Allow public resource tracking and create accountability for commitments on TB R&D funding to be announced at the Ministerial Conference / UN High Level Meeting on TB
Reify the $9 billion goal between 2016 and 2020
Leverage new funding sources based on countries’ capacity to fund
Focus on deliverables to catalyze progress

3. past efforts to set targets (1 of 3)
Overall target set with each country determining their own national plan
Pros:
Cons:
Buy in from countries
Public declaration
Legally binding
Need political will to do so
No specific funding targets
Calculated R&D expenditure for countries based on their incidence rate of TB, the national budget and GDP per capita, and the size of the national treatment program
Pros:
Cons:
Incorporates considerations of disease burden
Integrates return on investment as an argument to increase funding
Requires modelers due to complicated methodology
Difficult to explain to policymakers

4. past efforts to set targets (2 of 3)
Request for BRICS countries to triple funding and wealthy donor countries to double existing contributions
Pros:
Cons:
Simple request from activists
Intelligible to policymakers
Catchy campaign slogan
No specific overall goal
Does not work well for countries with unknown current TB R&D funding levels
Allocates a certain investment by U.S. agencies to contribute to the overall increase in funding while keeping pace with biomedical inflation
Pros:
Cons:
Highly consistent, transparent methodology
Targets available for contributing U.S. agencies
Only applicable for countries whose TB R&D spending and biomedical research inflation are known
Only applicable for countries with adequate current funding levels

5. past efforts to set targets (3 of 3)
Outlines targets for the G20 countries using each country’s portion of total GDP spent on R&D overall and accounting for past trends in R&D spending
Pros:
Cons:
Can ensure total sums to the already-set target (i.e. $9B in the Global Plan to End TB)
Applicable for countries with GERD data even if current TB spending is unknown
Accounts for private sector/ philanthropic contributions to overall target by calculating public funding to fill gap left
Slightly complicated methodology
Difficult to explain to policymakers
GERD data not available for every target country
Less comprehensive (G20 only)
Proposes for consideration targets for government-funded health research of all kinds: developing countries with potential research capacity should aim to commit 0.05−0.1% of GDP; developed countries should aim to commit 0.15−0.2% of GDP
Pros:
Cons:
Clear, simple methodology
Target varies on countries' development status
WHO Consultative Expert Working Group on R&D carries weight
Weak language--"should aim to”
Unclear how to translate to TB given low spending in endemic and non-endemic countries alike
How to define “potential research capacity”?

6. GDP versus Annual Average GERD
China EU
Japan
Germany
South Korea UK
Mexico
Indonesia

7. Methodology (1 of 3) Three criteria for countries chosen:
1. G20 countries
2. WHO-listed high-burden countries
3. Top richest countries* (based on GDP per capita)
*Only those classified as independent countries. This excludes any countries that are dependent or are declared territory of another country.
With the overlap between the three groups, the total number of countries included is 62 countries.
The targets were determined by a calculated percentage of GERD spent on TB specifically. To obtain this percentage, the annual target computed from the target set forth by the Stop TB Partnership ($8.836B) was divided by the sum of average annual GERD for all 62 countries.
Sources for GERD data: UNESCO Statistics and World Bank project database
Gross Domestic Expenditure on Research and Development (GERD): all expenditure (whether direct R&D activities or in support of R&D initiatives) spent on research and development in a country during a given period of time

8. Methodology (2 of 3)
Some countries' GERD data were not available on the UNESCO Statistics site
The EU GERD data was calculated based on data presented on the Eurostat R&D expenditure site, which stated GERD for 2015, a 4.4% increase from the previous year (2014), and expenditure that was equivalent to that of the US for 2013.
Annual GERD for these countries was created using a composite comparator based on an average of GERD for the countries with UNESCO GERD data in the same income status bracket and on the same continent as the country with missing data, then pro-rated for GDP
Papua New Guinea was missing GERD data but there were no other countries of the same income status in Oceania, so we used a composite comparator of countries of the same income status in Asia.

9. Methodology (3 of 3) Legend: Bold = HBC Top GDP per capita
Country with missing GERD data
Income Status
Continent
GDP of country with missing GERD data (2015)
Overall GERD spending pro-rated for GDP
Angola
Lower middle Income
Africa
102,962,245,247
1,528,506,910
Bangladesh
Lower middle income
Asia
195,078,561,219
2,708,292,814
Brunei Darassalam
High income
12,930,394,938
Central African Republic
Low income
1,583,776,760
13,708,362
Congo
8,553,154,506
126,974,268
DR Congo
36,188,521,107
313,229,345
DPR Korea
16,120,000,000
120,183,628
Hong Kong SAR, China
309,403,880,389
10,054,441,207
Liberia
Upper middle income
2,034,000,000
28,307,785
Myanmar
62,600,906,116
869,093,883
Nigeria
481,066,152,870
7,141,578,324
Papua New Guinea
16,928,680,397
235,022,358
Sierra Leone
4,251,779,857
36,801,234
Zambia
21,154,394,546
314,043,640
Zimbabwe
16,072,380,200
139,114,309

10. results

11. Annual TB R&D Funding Targets
Legend:
Bold = HBC
Italics = G20
Top GDP per capita
Countries would need to allocate % of their spending on R&D to TB specifically in order to reach the $8.836B global target for
Country
Annual TB R&D target (rounded, USD)
Angola
1,500,000
Argentina
4,800,000
Australia
21,200,000
Austria
11,300,000
Bangladesh
2,700,000
Belgium
10,900,000
Brazil
35,000,000
Brunei Darussalam
12,700,000
Cambodia
100,000
Canada
25,300,000
Central African Republic
13,000
China
305,600,000
Congo
Denmark
7,500,000
DR Congo
300,000
DPR Korea
Ethiopia
500,000
European Union
202,400,000
Finland
7,300,000
France
55,400,000
Germany
99,700,000
Country
Annual TB R&D target (rounded, USD)
Hong Kong SAR, China
9,900,000
Iceland
300,000
India
46,500,000
Indonesia
2,100,000
Ireland
3,300,000
Israel
10,700,000
Italy
27,500,000
Japan
154,900,000
Kenya
800,000
Lesotho
2,000
Liberia
28,000
Luxembourg
675,000
Mexico
10,300,000
Mozambique
100,000
Myanmar
900,000
Namibia
Netherlands
15,100,000
New Zealand
1,800,000
Nigeria
7,000,000
Norway
5,300,000
Country
Annual TB R&D target (rounded, USD)
Pakistan
2,400,000
Papua New Guinea
200,000
Philippines
700,000
Qatar
1,300,000
Russia
36,500,000
Saudi Arabia
11,900,000
Sierra Leone
36,000
Singapore
8,400,000
South Africa
4,600,000
South Korea
64,000,000
Sweden
13,700,000
Switzerland
13,400,000
Tanzania
500,000
Thailand
4,900,000
Turkey
12,500,000
U.A.E.
4,000,000
United Kingdom
40,400,000
United States
444,500,000
Vietnam
Zambia
300,000
Zimbabwe
100,000

12. TB R&D Funding Gap by country
Of countries that report TB R&D spending data, most must dramatically increase investments to meet targets. A higher rank indicates a country’s current spending is closer to meeting targets.
Country
Rank
Reported public TB R&D spending* (2016; USD)
Annual TB R&D target (USD)
Funding gap
Australia 7
$9,489,424
$21,200,000
$11,710,576
Brazil 18
$1,584,088
$35,000,000
$33,415,912
Canada 5
$16,898,180
$25,300,000
$8,401,820
China 24
$2,885,011
$305,600,000
$302,714,989
Denmark 25
$56,730
$7,500,000
$7,443,270
European Union 17
$23,575,253
$202,400,000
$178,824,747
France 22
$1,689,104
$55,400,000
$53,710,896
Germany 14
$14,820,938
$99,700,000
$84,879,062
Hong Kong SAR, China 23
$127,554
$9,900,000
$9,772,446
India 12
$14,768,283
$46,500,000
$31,731,717
Ireland 11
$1,110,380
$3,300,000
$2,189,620
Japan 21
$4,990,224
$154,900,000
$149,909,776
Mexico 19
$419,778
$10,300,000
$9,880,222
Netherlands 6
$9,858,859
$15,100,000
$5,241,141
New Zealand 10
$679,649
$1,800,000
$1,120,351
Norway 2
$5,503,497
$5,300,000 --
Philippines 9
$302,178
$700,000
$397,822
Singapore 15
$1,026,214
$8,400,000
$7,373,786
South Africa 1
$6,465,746
$4,600,000
South Korea 13
$12,359,135
$64,000,000
$51,640,865
Sweden 16
$1,606,583
$13,700,000
$12,093,417
Switzerland 8
$5,938,196
$13,400,000
$7,461,804
Thailand 20
$173,846
$4,900,000
$4,726,154
United Kingdom 4
$27,575,390
$40,400,000
$12,824,610
United States 3
$316,471,566
$444,500,000
$128,028,434
*Confidence is lower in the reported public spending for the following countries, since data were not reported for all institutions that may fund research: Brazil, China, Denmark, France, Hong Kong, Mexico, Singapore, Sweden, Thailand

13. Limitations
Not all countries had GERD data available for all years between 2010 and 2015
Use of comparators for countries with missing GERD data may under- or over-estimate a country’s capacity to spend on GERD, and the percentage which countries should be allocating towards TB R&D
Basing TB R&D targets on overall GERD spending lets countries underspending on research generally “get away easier”
The $8.836 billion target sets a ceiling on the total for country-specific funding targets, which may under- or over-estimate a country’s capacity to spend (e.g. U.K. comes in low)
Not all countries included (focus on G20, HBC, and wealthy countries)
Targets do not take into account disease burden or spending on healthcare
For determining TB R&D funding gap, not all countries report funding data and not all institutions are represented for countries that do report