Bibliometric study of research and development for neglected diseases in the BRICS

Developed countries seem to play a leading role in RD for neglected diseases and the literature quantity is closely related to the investment. The amount of literature from America itself accounts for over 1/4 of the literature published worldwide, and is more than doubled the amount of literature from the BRICS. G-FIDER’s report shows that 3.2 billion US dollars was dedicated to neglected diseases in 2012, 63.2 % of all funding was from the public sector. About 95.9 % of public sector funds are from high-income countries (the first three are America, Britain and European Commission) and the funding from low- and middle-income countries (LMIC) is growing, though the amount is still very small. Among the five countries, only India and Brazil are on the list of top 12 funders and comes in seventh and eighth respectively [18]. Funding from India and Brazil totals 34.4 and 19.7 million US dollars (adjusted to 2007 US dollars) respectively, accounting for 1.7 % and 1.0 % of the total funding from the public sector. Funding from India, Brazil and South Africa account for almost 3/4 of the total funding from LMICs in 2013 [19]. China also published a lot of relevant literature, but its financial contribution seems quite small based on the G-FINDER report. The most probable cause might be incomplete information collection, as the data for China only covers funding for a few diseases, such as HIV/AIDS and helminthiasis.

With economic development and growing attention to healthcare, the investment from BRICS countries into RD for neglected diseases is rising, as shown by the increased scientific production. According to the database of the Word Bank, the gross domestic product (GDP) of the BRICS has been on a stable rise since 1980 [5]. The health expenditure per capita of the five countries has also been increasing consistently since 1995 [20]. The eight Millennium Development Goals (MDG) put forth in 2000 also push governments to act to improve health status, and of which the MDG 6 is regarding HIV/AIDS, malaria and tuberculosis. Public Health Innovation and Intellectual Property Rights presented at the 56^th World Health Assembly noted that RD in the pharmaceutical sector must address public health needs and not only potential market gains [21]. WHA61.21 was adopted to implement the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property and member states agreed in 2008 to promote new thinking on innovation and access to medicines, as well as establish an enhanced and sustainable basis for need-driven essential health RD relevant to diseases which disproportionately affect developing countries [22]. Our study also finds a rapid increase in literature since the beginning of 21^st century, which might be due to the attention to health and neglected diseases from the international community.

Unlike the global research focus, BRICS countries tend to focus on major causes of disease burden among the neglected diseases. Globally, HIV/AIDS is the top priority among neglected diseases and the amount of literature on its RD is much larger than that of the following parasitic disease (especially malaria) and tuberculosis. G-FINDER survey also reports that HIV/AIDS, malaria and tuberculosis receive the vast majority of global neglected disease RD funding [18]. It seems that the BRICS research hotspots are related to their disease burdens. According to data on the WHO’s Global Burden of Disease in 2012 [23], the first three causes among neglected diseases for disability-adjusted life-year (DALY) in BRICS countries include HIV/AIDS, parasitic and vector diseases, diarrhea and tuberculosis, which are exactly the hotspots found in the study. In total, 30 % of the children at risk of soil transmitted helminthiasis around the world are from the BRICS [24] and thus it is not strange that helminthiasis is an RD priority for the five countries. Except for Russia and South Africa; Brazil, India and China focus on one specific helminthiasis type which is highly consistent with their disease burden. Indian residents at risk of filariasis infection account for 50 % of the total population at risk, and filariasis is treated as a research focus by India [25]. Brazil and China both make schistosomiasis a priority, but they only attach importance to a specific epidemic type in their own country. The absolute number of leprosy patients in India is 87 000, which seems not to be very large, but it accounts for 41 % the global patients [26] and thus it is reasonable that leprosy is found as one hotspot. Russia has the least burden of neglected diseases among the five and the major cause for its DALY is chronic disease. Our research also finds the amount of Russia’s literature is much less than the others. New drugs developed by Russian enterprises are usually only put on the domestic market, which might also affect the literature publishing [7]. Since the research hotspots in the BRICS countries are not completely the same, they would benefit from each other for exchanging experience in the common research areas while sharing RD results for research foci peculiar to one country. Thus, BRICS countries can work together to better utilize RD resources and cure diseases that affect developing countries.

However, disease burden is not the only factor influencing the research hotspots. It is very interesting that HIV/AIDS is not one of the Indian RD hotspots even though the disease burden is very heavy [23]. The possible reason might be the Indian patent law, which allows for generic production of drugs under certain conditions. According to the law, Indian pharmaceutical factories are only allowed to continue the generic production of drugs brought to market before 1995. As for drugs introduced to India from 1995 to 2005, generic manufacturers can produce them as long as they pay “reasonable royalties” to the patent holders. Drugs introduced after 2005 can be generically produced only after the patents expire (last for 20 years). However, compulsory licensing can be used by India if necessary since the WTO’s decision of 30 August 2003 (Article 31bis of TRIPS) expands the potential use of compulsory licensing to allow the manufacture of generic versions of patented drugs for exports to least-developed countries [27, 28]. Most anti-retroviral drugs were introduced prior to 2005 and thus currently India is a major supplier of affordable generic anti-retroviral medicines to developing countries, which can bring in substantial profit. Besides, unlike other neglected disease that usually confined in certain areas, HIV/AIDS is a global issue. Almost all countries, especially developed countries, pay close attention to RD for HIV related products. In this case, India can have a free ride as the country can issue compulsory licenses to supply domestic markets or to produce for export, and India has experience in compulsory licensing [29].

As the results shown, a substantial majority of global studies as well as the investment were focused on HIV/AIDS, tuberculosis and malaria. China should conduct more studies on other neglected diseases for long-term benefits, not just three diseases that currently have gained close attention. In addition, China should not only focus on the major causes of disease burden for its own country, but also the diseases that mainly affect other developing countries. As the largest developing country, China should shoulder more responsibility in aiding other developing countries.