Canadian Tuberculosis R&D Funding in 2019
Highlights from the Treatment Action Group Tuberculosis Research Funding Report
By Adam R. Houston and Lena Faust
The Treatment Action Group (TAG)’s recently released report on tuberculosis (TB) research funding highlights the continued gap in spending on TB research, which continues to fall far behind the annual target of US$2 billion set at the 2018 United Nations High-Level Meeting on TB. It would be possible to meet this funding target if countries dedicated their “fair share” to TB research, defined as each country spending at least 0.1% of its total research spending on TB research. Unfortunately, only 3 countries (the UK, the Philippines, and New Zealand) have met this goal of contributing their fair share so far.
Where does Canada stand?
With Canada’s TB research funding for 2019 totalling just under US$ 19.3 million, Canada met 76% of its 2019 fair share target of US$ 25,300,000 (see Figure 1). This places Canada behind the UK, the Philippines, and New Zealand (which met their fair share targets), as well as behind the United States, which spent 89% of its fair share on TB research. No other countries reached 75% of their fair share targets. Thus, Canada has room for improvement, but although not meeting its fair share, it is among the global leaders in working towards this goal. These dual themes of leadership and of falling short of commitments can both be used in advocacy.
Figure 1. Canadian Funding for Tuberculosis R&D, by Research Category, 2019
* Fair share target defined as at least 0.1% of overall R&D spending going to TB research. For Canada, the 2019 fair share target is 25,300,000 USD. Overall spending on TB research was therefore 6.02 million USD (24%) below this target.
As evident from Figure 1, the majority of Canadian TB funding (over 15 million USD) is currently going towards operational research, whilst only 1.40 million USD is going to basic science. Even less is spent on R&D for TB drugs, vaccines and diagnostics (only 1.02, 0.89 and 0.47 million USD, respectively). There is an urgent need to increase funding for TB drugs, vaccines and diagnostics in particular, as the TB field continues to lag deplorably far behind in these areas. As an example, in the TB field today, we continue to use a 100-year-old vaccine of variable effectiveness, whilst multiple effective COVID-19 vaccines were produced within just 1 year of the identification of SARS-CoV-2. This highlights that it is crucial to build political will to finance and advance TB research in these key areas.
Canada’s two largest TB research funders were Global Affairs Canada (GAC) and the Canadian Institutes of Health Research (CIHR) (see Table 1). Although GAC contributed only to operational research, CIHR funding covered several categories, including basic science, diagnostics, drugs, vaccines and operational research.
Table 1: Canadian Sources of TB R&D Funding, 2019 (From TAG Report)
One issue worth exploring further is coordination. As this table shows, multiple Canadian entities contributed to research, but what is unclear, not only from the TAG Report but also Canadian sources, is how well these efforts are coordinated. Lastly, the TAG Report also offers some information on particular areas of TB R&D. For instance, the Public Health Agency of Canada was ranked number 17 in global funders for Paediatric TB R&D; however, this still amounted to less than 1% of global funding, once again providing both grounds for congratulations and for continued improvement. As recent studies confirm, paediatric formulations have been identified as a particular concern in Canada, where Health Canada neither offers any separate or substantially incentivised regulatory pathways for paediatric medicines nor requires that drug manufacturers provide paediatric-specific data unless they are pursuing a paediatric indication. This offers an example of an important Canadian issue that deserves more attention.