Dominant Funders and Their Field-Wide Influence
As in past years, prevention research in 2021 continued to be concentrated in a small number of large investors. The US public sector, primarily the NIH and USAID, contributed 73 percent of all global funding (US$ 922 million out of US$1.25 billion). BMGF remained the principal philanthropic donor, accounting for 97 percent – US$147 million out of US$152 million — of all philanthropic investment.
Investments by the two leading donors — the US public sector and BMGF — combined accounted for US$1.06 billion, or 85 cents of every dollar spent. Diversifying the funding base is vital not only for the long-term sustainability of the field, but also to ensure that the research priorities are informed by a diversity of perspectives.
This year saw an increase in European funding from 17 funders which could bode well for diversifying prevention research funding in the future. The increase in European funding was propelled by increased investments, or returning funders, from public sector funders in Denmark, Germany, Ireland, the Netherlands, Norway and the United Kingdom. European philanthropic investments also increased for Wellcome Trust and the Children’s Investment Fund Foundation. Hopefully this trend will continue in subsequent years in the face of new European budgetary challenges posed by the COVID-19 pandemic, and the war in the Ukraine.
COVID-19 Related Impact to HIV Prevention R&D in 2021
Fifty-six percent of funders spanning nineteen countries surveyed by the Working Group provided insights on how the COVID-19 pandemic had impacted their HIV prevention projects in 2021. Respondents reported varied impact to their investment portfolio with some increasing and others decreasing investments, but almost all reported that COVID had not caused them to make new long-term shifts in their HIV prevention investment.
More than half of funders, however, reported that they experienced pragmatic challenges resulting from the COVID-19 pandemic. These challenges include: 1) delays in clinical trials due to COVID-19 restrictions in the trial environment, 2) shortages of bio-material resources redirected to support pandemic efforts; and 3) disruptions caused by administrative study protocol changes, ethics approvals, and timeline extensions.
Shift Toward PrEP, TasP and PVT
The most striking change in funding in 2021 was the shift from microbicides and PVT, toward PrEP, TasP and VMMC. Preventive HIV vaccines funding also decreased but continued to make up the bulk of overall HIV prevention funding at 64 percent. Investment by funders is heavily concentrated in preventive HIV vaccines representing 71.5 percent of total NIH’s investment in prevention research and 45 percent of investment by the BMGF.
At the same time, PrEP overtook microbicides by a large margin in 2021 for the first time. Yet, when PrEP and microbicide research investments are combined (as several donors now do), there was a 52 percent increase in this broad ARV-based prevention category. The shift toward TasP may reflect the acceleration of U=U strategies, as well as emerging new PrEP options.
While it is too early to infer a trend, at least in the short-term, funders seem to be focusing increasingly in areas of prevention research where effective options or strategies already exist that are open to improvement or evolution.
Decrease in the Number of Philanthropic Funders Engaged
Despite philanthropic funding levels increasing from US$127 million to US$151 in 2021, the decline in the number of philanthropic donors continued. The number of philanthropies responding with grants in HIV prevention research decreased from 9 to 6 in 2021. It is unclear whether this decline is due to a true shift in priorities, or year to year changes in funding cycles or other reporting vagaries. The Working Group will continue to track this metric.
Philanthropic investment in HIV cure research in 2021 was also limited to six philanthropies, but covering a smaller research portfolio. Independent philanthropic donors are essential to a vibrant funding base and could help improve the funding imbalance that currently afflicts the investment landscape.