Overall Funding in 2021
In 2021, total funding for HIV prevention R&D increased 12.5 percent (US$140 million) from the previous year, rising to US$1.25 billion. Funding increased for R&D focused on PrEP, VMMC, TasP and female condoms. During the same period, microbicide funding saw a 20 percent decline, and preventive HIV vaccine research declined 4 percent. The decline in microbicide funding reflects, in part, the impact of closure of the Microbicides Trials Network.
In addition, a number of donors have expanded the definition of “PrEP R&D” to incorporate all antiretroviral (ARV)-based prevention options, including investments that might have previously been coded as microbicides. The combined 2021 investments for microbicides and PrEP increased 53 percent in aggregate.
Preventive HIV vaccines, as the focus of 63.5 percent of total prevention research investment in 2021, continued to make up the lion’s share of overall HIV prevention funding. Yet preventive HIV vaccines in 2021 comprised a lower percentage of total prevention funding than in any prior year. The increase in total prevention funding in 2021 was fueled instead by increases in PrEP and TasP funding. The relative proportion of PrEP funding, at 21 percent of overall HIV prevention funding in 2021, has risen consistently since 2012 when the first PrEP indication TDF/FTC was approved by the US Food and Drug Administration.
US and European Public Sector Funding
Both public sector investment and philanthropic investment as a percentage of total investment remained the same in 2021, at 81 percent and at 12 percent, respectively. North America, principally the United States Government, made up the bulk of public sector funding in 2021 at US$1.08 billion (86 percent), while the European region came in second at US$161 million (13 percent). Other regions contributed US$13 million which constituted one percent of the cumulative public sector funding.
US public sector investment as a whole increased from US$857 million to US$922 million in 2021. In particular, US public investment in PrEP and TasP substantially increased in 2021 over 2020. European public sector funding increased to US$81.3 million. Europe saw increases in all areas of prevention research except, like the US, in microbicides.
Global philanthropic funding levels increased 16 percent in 2021 to US$150 million, up from US$127 in 2020. The Bill and Melinda Gates Foundation (BMGF) remains the largest philanthropic funder equaling 97 percent of philanthropic funding and 12 percent of total prevention R&D funding.