Relative and absolute addressability of global disease burden in maternal and perinatal health by investment in R&D

Abstract

Summary Maternal and perinatal disease accounts for nearly 10% of the global burden of disease, with only modest progress towards achievement of the Millennium Development Goals. Despite a favourable new global health landscape in research and development (R&D) to produce new drugs for neglected diseases, R&D investment in maternal/perinatal health remains small and non‐strategic. Investment in obstetric R&D by industry or the not‐for‐profit sector has lagged behind other specialties, with the number of registered pipeline drugs only 1–5% that for other major disease areas. Using a Delphi exercise with maternal/perinatal experts in global and translational research, we estimate that equitable pharmaceutical R&D and public sector research funding over the next 10–20 years could avert 1.1% and 1.9% of the global disease burden, respectively. In contrast, optimal uptake of existing research would prevent 3.0%, justifying the current focus on health service provision. Although R&D predominantly occurs in high‐income countries, more than 98% of the estimated reduction in disease burden in this field would be in developing countries. We conclude that better pharmaceutical and public sector R&D would prevent around 1/3 and 2/3, respectively, of the disease burden addressable by optimal uptake of existing research. Strengthening R&D may be an important complementary strategy to health service provision to address global maternal and perinatal disease burden.

A systematic mapping of funders of maternal health intervention research 2000-2012

“…Though tracking research funding amounts and outputs is difficult [ 17 ], funding allocations for maternal health research are disproportionate to the burden of disease [ 18 , 19 ]. There were about half a million publications on health in LMICs between 2002 and 2011 [ 17 ], which dwarfs the 35,078 publications we located on maternal health in a similar period (before applying exclusion criteria).…”

Global priorities for research and the relative importance of different research outcomes: an international Delphi survey of malaria research experts

“…For instance, Fisk and colleagues used a Delphi exercise to assess absolute and relative government and charitable funding for maternal and peri-natal research in the UK and internationally [13]. In another study Fehr et al employed an expert Delphi survey technique to examine and understand experts’ opinions on causes for lack of treatment options for neglected diseases and on feasible measures to promote research and development [14].…”

Of silver bullets and red herrings: invited commentary to Fisk et al.

“…A 'red herring' is something that diverts attention from a topic or line of inquiry (Collins 2009). We believe that the main line of argument in the Viewpoint by Fisk et al (2011) Fisk et al do not challenge that health services in low-and middle-income countries need to be improved. But they anticipate new pharmaceutical products and diagnostic techniques which they imply will make independent contributions towards improving maternal and perinatal health -provided that there will be increased investment in R&D. We are not told what exactly these products will be like.…”

“…A ‘red herring’ is something that diverts attention from a topic or line of inquiry (Collins 2009). We believe that the main line of argument in the Viewpoint by Fisk et al. (2011) constitutes such a red herring.…”

“…We find ourselves on common ground with Fisk et al. when they state in their Viewpoint: ‘The case for improving service provision is overwhelming, given evidence that many women have inadequate access to even basic care.’ (Fisk et al. 2011).…”