The 10 largest public and philanthropic funders of health research in the world: what they fund and how they distribute their funds

After the 10 largest funding organizations of health research were identified, data were collected on their funding patterns and funding distribution mechanisms. For each organization, data were collected on:

Funding for operational expenditures was excluded.

Finally, we denoted whether funding organizations used a classification system to classify funding to various health areas and whether they reported statistics on funding for various research types (e.g. biomedical research, clinical research, epidemiological research or health systems research [35]) and recipient countries or regions.

All data were collected from online reporting databases, annual reports, official websites, or other information sources. After this, each funder was invited to participate in an interview. Before the interview, a document with collected data was made available to a representative of the funder. Before and during the interviews, representatives were asked to add, amend or confirm the data.

First, there is considerable diversity between funding organizations in terms of what they fund and how they distribute those funds. This begs the question: do some funding distribution models have more impact than others? The impact of different approaches to funding health research is regularly discussed in the literature, for example, for intramural versus extramural funding [23], for targeted versus untargeted funding [37], for ‘people grants’ versus project grants [36, 38], for small grants versus large grants [10], and for competitive versus non-competitive research funding [39]. However, comparative evaluations of the impact of various funding models are scarce [10, 23, 38], even though approaches to measure the impact of health research are available [40]. An exception has been the recent comparisons of ‘people grants’ versus projects grants in the United States, which compared HHMI with NIH researchers and NIH Pioneer Awards with NIH project grants [36, 41‐43]. These comparisons have led the NIH to consider a broad shift toward ‘people grants’, demonstrating the value and potential impact of such evaluations [36]. Evaluations of this kind provide new insights when comparing funding models across funding organizations, but given the different contexts in which funders operate, comparing the impact of different models within one funding organization is perhaps particularly valuable and should become more common practice.

There is also a need for more debate about where the power to decide priorities for publicly funded health research should lie (with parliaments, ministries, funding agencies, or independent committees of experts). Such debate is needed because there are finite resources for investing in health research and thus priorities need to be set using fair and legitimate methods and using the best possible evidence [44]. In practice, public sector health research funding decisions are not only made on the basis of what research is needed, but are regularly influenced by other factors, such as political interests, advocacy and lobbying [2]. Thus, there is a need for transparency on who makes those decisions and to debate who should make them [2, 13, 45‐47]. Analysis of funding organizations’ priority setting processes was not part of this study (see Limitations) but deserves to be a more frequent subject of research studies in the future.

Second, to enable evaluation and debates as noted above, it is necessary to have a map of the health research funding landscape: to know who the main funders of health research are, what they fund, and how they decide what gets funded [2, 6‐11, 13]. Yet, this study shows that these data are often not available. Through our study, we did not find a list of all public or philanthropic health research funders worldwide that included their annual health research expenditures (Additional file 1). Therefore, we have now established such a list ourselves at www.​healthresearchfu​nders.​org. On this website, we provide access to the data collected for this article and to information on more than 200 other public and philanthropic funders of health research that we have added to this website since the mapping for this article was completed.

Besides the absence of a global listing of funding organizations, we found that data on organizations’ funding patterns and funding distribution mechanisms are often not available, and when they are, they are difficult to aggregate, owing to differences in funders’ data classification systems. Notably, we only collected these data for the 10 largest funding organizations of health research. The absence of such information, and the difficulties in aggregating the data across funders, are likely to be more prominent when smaller funders are also included. There is currently no consensus on a framework for producing descriptive data on funders’ funding patterns (both in terms of health areas and research types) nor on a framework for describing their funding distribution mechanisms [6, 8, 37]. In this article, we have proposed three frameworks for reporting data on health research funding: for reporting data on funding distribution mechanisms (Table 4), for reporting data on funding patterns in terms of health problems (the Global Burden of Disease classification [34]), and for reporting data on funding patterns in terms of research types (biomedical research, clinical research, epidemiological research or health systems research, as proposed by Frenk [35]). The adoption of standards for reporting funding data, including guidance on what data classification systems to use, by funding organizations, for example through collaborative initiatives such as the Heads of International Research Organizations, would substantially improve the quality and comparability of reported funding data [9].

Funding organizations are starting to support the goal of transparency and are increasingly recognizing the problems noted above and addressing them. At the 2014 World Health Summit in Berlin, several major funders of health research expressed interest to work together toward developing a common approach for mapping health research funding flows [12]. Another good example of a multi-funder collaboration to increase insight in health research investments is the World RePORT website [48]. On a national level, the United Kingdom has led the way in terms of harmonized reporting by showing it is feasible to collect comparable data on health research funding from all major public funding bodies and charities in a country [22]. Besides initiatives from funders themselves, there are also several promising initiatives from other parties to address the lack of data on global health research funding [1, 16, 49‐51]. The recent decision to establish a Global Observatory on Health R&D at WHO in particular may help to improve transparency in this area [1].

Finally, we note that the mapping conducted for this article has had several limitations. First, we have excluded funding organizations in the private for-profit sector (these are listed elsewhere [30]). Second, national systems for funding health research vary. In many countries, a large amount of health funding is dispersed directly from governments to universities or research institutes via block grants. We excluded these block grants and therefore the public funding organizations that we report on do not all contribute the same share of all health research that is publicly funded in a country. Third, we had to make several generalizations in order to be able to report data across funders that were diverse in their funding distribution mechanisms and reporting systems. For instance, what we have termed ‘targeted’ research funding, is a grey area that ranges from broad prioritized research areas to specific research topics or questions [52]. Also, funders reported on their expenditures on health research in various formats. Although we have kept track of these varying reporting formats, they decrease comparability across funders. Fourth, we would have liked to exclude overhead costs within project funding (not operational costs of the funder, which we did exclude where possible, but overhead costs of the research organization), to measure only the amount of funding that went to research, but this was not feasible because it was mostly not reported. Fifth, our proposed framework for reporting on funders’ funding distribution mechanisms (Table 4) lacks detail. It would have been interesting to also report on more detailed mechanisms, such as funders’ grants for businesses and PDPs/PPPs, but we did not include such analyses because of a lack of comparable data across funders. Sixth, funding organizations frequently make adaptations to their funding strategies, and therefore our findings should be viewed as a snapshot of funders’ expenditures, funding distribution mechanisms and funding patterns during the time of our data collection [53]. Seventh, in addition to reporting about funding organizations’ funding distribution mechanisms and patterns, we would have liked to report on funding organizations’ priority setting processes as part of this work (another important aspect of how funders decide what gets funded). However, we found that priority setting processes were generally not well-described and highly variable across funders, making it difficult to analyse and report our data. It deserves recommendation that such an analysis is conducted in the future, but the development of a framework for assessing priority setting processes at funders is needed first, potentially based on existing guidance for health research priority setting [44]. Lastly, and most importantly, our search strategy was limited in scope (see for more detail Additional file 1), was aimed only at finding the 10 largest funding organizations of health research in the world, and detailed data were only collected for those 10 organizations.