WHO: 'Fragile state' of world pandemic preparedness due in part to poor R&D distribution among nations

Global preparedness for the next pandemic is being hampered in part by unequal distribution of research and development efforts among low-, middle- and high-income countries, a new report from the World Health Organization (WHO) shows.

In its 2023 Report on the State of the World’s Preparedness, an annual overview of how well United Nations member countries are faring when it comes to getting ready for the next pandemic, the WHO’s Global Preparedness Monitoring Board, or GPMB, noted that the vast majority of biomedical research, development and manufacturing takes place in a handful of wealthy countries.

“Limited national and regional R&D leave countries dependent on a global system that cannot ensure innovation is delivered equitably,” the report said. “Global coordination of pandemic-related R&D is weak.”

The GPMB measures progress on pandemic preparedness using the GPMB Monitoring Framework, which looks at 30 indicators linked with pandemic response across several broader sectors. Within “R&D and Access to Medical Countermeasures,” the organization measures global R&D coordination, R&D capacity building, coordination during emergencies, regional manufacturing capacity and national R&D innovation.

Global R&D coordination was one of the weakest areas of pandemic preparedness overall, the report said. And, while the other indicators within the greater R&D sector have improved since last year’s assessment, they remain classified as “Insufficient/Incomplete” based on the organization’s standards.

One of the starkest figures from the report is on the concentration of research and development spending among nations. Just 10 countries account for 80% of the nearly $1.7 trillion invested, according to the report, which cited a database last updated in July 2023 and overseen by Springer Nature. Meanwhile, the same database shows that only 3% of that spending is going to pathogens the GPMB has outlined as R&D Blueprint Pathogens, diseases the organization believes pose a serious public health risk.

The GPMB report points a finger at philanthropic and government funders that are unwilling to share resources, even in a crisis, according to the report. Philanthropic organizations are “reluctant to give up autonomy in how they set their own priorities,” the report said, while government research funding is “largely directed towards narrow definitions of national self-interest” when it comes to putting money toward research and development investments for health emergencies.

“Funders are largely concentrated in high-income countries and governance of R&D initiatives is not inclusive of low- and middle-income countries,” the report said.

Vaccine manufacturing, too, is concentrated in only a few regions, the organization wrote. Most facilities are in North America, Europe and Southeast Asia, leaving Africa and the Middle East with relatively lower capacity. 

While initiatives have been launched to boost vaccine manufacturing in parts of the world with low capacity, the organization noted that they are “fragile.”

“There is already evidence that interest is waning as the crisis in COVID-19 vaccine supply has faded from view,” the GPMB said in the report.

To ameliorate these problems, the GPMB called on nations and institutions to boost regional ecosystems for research and development, noting that the building of baseline manufacturing capabilities for vaccines, therapies, oxygen and diagnostic tools as well as surveillance systems should be part of a “global approach that promotes strategic coherence and coordination.” Other components of the effort include building regional markets for vaccines, regulatory coordination across countries and sharing information between them, the report said.

“In addition, creating a more sustainable R&D ecosystem will require strengthening the capacity and role of low- and middle-income countries, including by improving financing of R&D, workforce retention and capacity to implement technology transfers,” the GPMB wrote.