Too little cash has been raised for pandemic preparedness.
The entire donor investment in "cross-border externalities" - for example, preparing for the next disease outbreak and tackling antimicrobial resistance - came to around $1 billion in 2013. This was less than a third of the $3.4 billion needed for a pandemic preparedness system, according to estimates of the World Bank.
The analysis highlights another mismatch between spending and need - for research and development in neglected diseases.
This is just one of the "global public goods" and the World Health Organization says it needs $6 billion. However, spending in 2013 for all global public goods totalled around just $3 billion.
Additionally, the researchers examined country-specific funding by country income groups, finding that a third of aid was allocated to middle-income countries.
Former US Treasury Secretary Lawrence Summers, co-author of the report and professor of economics at Harvard University in Cambridge, MA, says:
"The best way for donors to improve the health of poor people in middle-income countries is to invest in research and development for neglected diseases, pandemic preparedness and other global functions of health."
He adds: "These investments will improve existing tools, lower drug prices, and increase global coordination to make it cheaper and more efficient for all countries to deliver health services to poor people."
The paper presents an expanded definition of official development assistance (ODA) for health. This is used to identify important underfunded areas.
The new approach has been developed by a group of leading global health experts and economists, led by Marco Schäferhoff, PhD, associate director of SEEK Development in Berlin, Germany.
It combines both financing officially reported as ODA for health, with additional spending on pharmaceutical research and development for neglected diseases, which disproportionately kill the world's poor.
Funding needs to be 'refocused'
Dr. Schäferhoff says: "We should be investing in essential global functions, as these investments would benefit poor people wherever they live, including the poor within middle-income countries.
"For example, countries like China and India would substantially benefit from market shaping to lower drug prices and increased international efforts to control multidrug resistance tuberculosis."
Dr. Schäferhoff adds:
"At the same time, health aid to the world's poorest countries must continue and donor countries should also ensure that vulnerable and marginalised populations in middle-income countries, such as ethnic minorities who suffer discrimination, refugees and people who inject drugs receive sufficient support."
The analysis estimates that just 21% ($4.7 billion of $22.0 billion) of the funding in 2013 was devoted to global functions to provide:
- Research on drugs, vaccines and diagnostics
- Preparing for the next disease outbreak and tackling antimicrobial resistance
- Providing global leadership and stewardship.
By contrast, funding for individual country support was $17.3 billion (79%).