The relative level of investment per death DALY or YLD

The relative level of investment per death, DALY or YLD for all infections combined consistently increased over time (Tables 2–4). When considering time points 2004, 2010 and 2013, the median investment by mortality observed was £17.20, but greatest in 2013 (£31.16). HIV and malaria investments were above the median level at each time point; tuberculosis was below the median level (Table 3, Fig. 3). Compared to mortality, little investment was directed towards cholera, syphilis and pneumonia. Vaccine-preventable diseases such as diphtheria, measles and pertussis were mostly ranked as poorly-invested, though their respective investment by mortality observed noticeably increased in 2013 as global burdens declined. The ‘investment per DALY observed’ metric (Table 4, Fig. 4) demonstrated similar findings to the mortality metric, with pneumonia appearing poorly-invested compared to other particularly high-burden infections such as malaria, and cholera, syphilis and pertussis also receiving little funding. Acute hepatitis C, African trypanosomiasis and purchase SCH527123 demonstrated the highest relative investment when compared to DALYs. Ranking infections by investment and disease burden in 2013, Table 5 describes how HIV (9th) and malaria (10th) were mid-ranking diseases, with tuberculosis (14th) and pneumonia (20th) ranked lower. Acute hepatitis C, African trypanosomiasis and leishmaniasis were the top three infections, and pertussis, cholera and syphilis the bottom three. Diphtheria was ranked in the lowest three when compared against mortality and DALYs, whilst gonorrhoea was ranked in the lowest three when compared against YLD.
Discussion We identified 7398 awards for infectious disease research awarded to UK institutions across the 17year time period of 1997–2013, with total funding of £3.7 billion. Relative to measures of investment compared to global mortality, DALYs and YLD, acute hepatitis C, trypanosomiasis and leishmaniasis rank highly whilst Shigellosis, pertussis, cholera and syphilis consistently rank lowest; tuberculosis typically ranked lower than HIV or malaria, and pneumonia appears to receive particularly low levels of investment compared to mortality and DALYs. The overall level of investment and the median investment by mortality, DALY and YLD observed increased in 2013 compared with previous time points, owing to both increases in research investment and decreases in the global burden of infectious disease. There are other published analyses that have similar aims in terms of considering investment and burden. Consideration of NIH funding in 2006 suggested a modest correlation with USA disease burden from 2004, (Gillum et al., 2011) with comparable findings in analyses from Australia (Mitchell et al., 2009) and Norway (Kinge et al., 2014), showing variable correlation depending upon the chosen burden metric and whether that metric considered national or global burden. Thus, policymakers have a decision to make about the extent to which there is targeting of investment on health burdens within their own country, and how much funding targets international priorities. These decisions will be driven to an extent by the remits of existing funding agencies, plus also the existing research expertise in the UK. Disease areas such as the NTDs appear well-funded here, relative to their global disease burden, and this is may be in part due to previous and ongoing excellent performance by individuals and institutions in addressing these areas. In terms of the location of research investment activity, the UK demonstrably provides greater relative international investment in nations where there are colonial ties (Fitchett et al., 2014c). It may be that other nations also favour countries in which they have historic connections (and there are good reasons for doing so, such as a common language or infrastructure requirements); however, this may also mean that some countries are neglected in terms of receiving research investment from which they could greatly benefit.