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    • br Introduction Despite documented complexities with epidemi

    2018-11-13


    Introduction Despite documented complexities with epidemiological definitions and clinical diagnosis (Scott et al., 2012), the global burden of pneumonia, including healthcare-associated and ventilator-associated pneumonia, clearly remains significant. Estimates from the Global Burden of Disease Study 2013 (GBD 2013) suggested that although mortality from the main pneumonia-causing pathogens was decreasing worldwide, there were still at least 785,000 deaths globally from pneumococcal pneumonia, respiratory syncytial virus and Haemophilus influenzae pneumonia in 2013 with much of this burden in low- and middle-income countries (GBD 2013 Mortality and Causes of Death Collaborators, 2014), although other analyses considered mortality to be greater (Kovacs et al., 2015). In GBD 2013 figures, there were a further 105,000 deaths from influenza, where pneumonia is a significant secondary complication from primary infection, and an estimated 2 million deaths from lower respiratory tract infections of unknown aetiology (GBD 2013 Mortality and Causes of Death Collaborators, 2014). The GBD study also attributed 76.7 million disability-adjusted life-years (DALYs) to pneumonia and pneumococcal disease in 2010, again with the poorest sectors of society bearing the majority of this burden (Murray et al., 2012). Though there is an increasing prevalence of non-communicable disease and injuries in middle and lower-income countries (GBD 2013 Mortality and Causes of Death Collaborators, 2014), projections from the World Health Organization (WHO) estimate deaths from lower respiratory tract infections will remain among the top 4 leading causes of deaths in 2015 and 2030 (World Health Organization, 2013a). Part of the solution to overcoming these challenges is to invest in research. The UK is consistently rated among the top three investors in neglected disease research (Policy Cures, 2014a), and UK-based authors are generally prolific at contributing to the published evidence NSC59984 Supplier (Yao et al., 2014). Thus the activity of UK institutions is likely to be of significant national and international importance. The Research Investments in Global Health study (ResIn, www.researchinvestments.org) has previously reported on infectious disease research investments awarded to UK institutions between 1997 and 2010 (Head et al., 2013), also specifically highlighting the limited and fractured nature of pneumonia and pneumococcal research (Head et al., 2014a,b). There is a paucity in the systematic tracking of global investments in health research and development (R&D), with noted mismatches between the global burden of pneumonia and research investment (Rudan et al., 2011), and only one study of limited scope highlighting product and technology-related R&D of bacterial pneumonia in low-income settings (Policy Cures, 2014b).
    Results Total research funding for all infectious diseases awarded to UK institutions between 2011 and 2013 was £917.0 million across 1232 awards (Table 1). Of this, £145.2 million (15.8%) and 219 awards (17.8%) were related to respiratory infections. Pneumonia and pneumococcal research received £28.8 million (3.1% of total and 19.9% of respiratory infections funding) across 35 awards (2.8% of total and 16.0% of respiratory infections) (Table 1). By comparison across 2011–2013, tuberculosis received £71.1 million (7.8% of total and 49.0% of respiratory infections funding) from 83 awards (37.9% of respiratory infections) and influenza received £39.1 million (4.3% of total and 26.9% of respiratory infections funding) across 53 awards (24.2% of respiratory infections). These findings represent an approximately three-fold total and proportional increase from 1997 to 2010, where we reported that pneumonia-related research represented 6.6% of all respiratory infections and 1.1% of all infectious disease research funding (Head et al., 2014b). Total funding for pneumonia across the three-year period of 2011–2013 is greater than total funding across the fourteen year period of 1997–2010, with mean annual pneumonia funding in this update time period is £9.6 million compared with £2.0 million previously. The mean annual number of awards has increased slightly from 7 to 12 and the median award size has increased from £137,389 to £335,210 (Interquartile range £196,000–642,463). Similarly, the total annual investment in infectious disease research has increased by 64.6% in the period 2011–2013, compared with 1997–2010, despite similar numbers of awards. Investment and year were moderately correlated (rho 0.6152, p=0.0086), research output and year were strongly correlated (rho 0.9798, p=0.0001) and investment was moderately correlated with research output (rho 0.6107, p=0.0092).