Joshua R. Ehrlich, University of Michigan
Recently, a middle-aged woman came to see me in my ophthalmology clinic because her eyes felt gritty and uncomfortable. She had seen another doctor a month earlier who diagnosed her with eyelid inflammation and wrote her a prescription.
As I examined her eyes, she mentioned in passing the prescription medication she’d been using – ivermectin. This was the first I’d heard of this drug being used for itchy, uncomfortable eyes. I knew researchers had studied and rejected ivermectin as a cure for COVID-19, and that the medication is to treat onchocerciasis, a condition more commonly known as river blindness that is mostly seen in rural sub-Saharan Africa.
River blindness is caused by a parasitic worm that’s transmitted when people are bitten repeatedly by infected blackflies. A long neglected tropical disease, it’s mostly known for causing severe skin disfigurement and permanent blindness. So why was this patient with itchy eyes in the U.S. using the same drug used to kill a blinding parasitic worm?
This is just one instance where decades of investment and collaboration to fight a disease that affects the global poor had yielded an unexpected benefit – a treatment for eyelid inflammation, dry eyes and rosacea.
This medicine is just one data point in a pattern worth billions of dollars.
As a population health researcher, I see firsthand the benefits of investment in global health research. Global health research has a long history of producing treatments, knowledge and economic benefits that advantage wealthy countries in unexpected ways.
Economic investments paying off
Global health research – whether it’s vaccine and drug development, large-scale population data collection or comparative policy studies – demands considerable investment. The results consistently show this investment is one that makes good economic sense.
A 2012 report from the U.S. National Institutes of Health estimated that every US$1 the agency invests in global health research will have a return on investment of $2.21 and that each research grant creates seven American jobs.
This report has proved to be true. Between 2008 and 2024, U.S. governmental institutions like the NIH spent around $46 billion in three key global health areas – neglected diseases, emerging infectious diseases, and sexual and reproductive health – an investment that catalyzed $104 billion in economic activity and created 600,000 jobs in the U.S.
Beyond the economics
The benefits of global health research go far beyond economic gains. This work also improves health and medicine in the U.S. and worldwide. As I saw in my own clinic, research into a disease half a world away led to treatment for a patient in the U.S. – and this is not unusual.
The nonprofit research organization Impact Global Health tracks what it calls innovation spillover. It details a host of global health research innovations that have led to health and economic benefits in the U.S. and other high-income countries. From COVID-19 tests to vaccines for HPV and rotavirus, to breast cancer risk reduction and pediatric cancer treatments, the direct benefits are impressive.
One example is a research partnership from the 1980s between GlaxoSmithKline and the Walter Reed Army Institute of Research that yielded a lifesaving malaria vaccine. That vaccine now prevents up to 1 in 8 childhood deaths in malaria-affected areas of sub-Saharan Africa.
On top of that, the technology behind that malaria vaccine is also the basis for the shingles and RSV vaccines used in the U.S. and globally. The shingles vaccine alone is expected to prevent over 9 million cases of shingles in the U.S. and save the healthcare system $55 billion by 2050.
An even older example of this innovation spillover is the tuberculosis vaccine. Over 100 years ago, French scientists developed a vaccine for tuberculosis, a lung infection that still kills over 1 million people each year, 80% of them in low- and middle-income countries.
As it happens, in 1990 the U.S. Food and Drug Administration approved the medication used in the tuberculosis vaccine as a treatment for bladder cancer. Researchers estimate this medication will prevent more than 300,000 cancers from recurring and save nearly 100,000 lives and nearly $12 billion in the U.S. by 2050.
Improving the healthcare system itself
Beyond essential medications, global health research also produces vital and actionable knowledge about healthcare delivery. Studying the health of populations around the world can provide unique insights that researchers can use to improve care in the U.S. and strengthen its healthcare system.
Most Americans, regardless of political beliefs, are dissatisfied with the U.S. healthcare system. Many other wealthy countries spend less money to get better outcomes – fewer premature deaths, longer health and life expectancies, more equitable access to care and so on. U.S. researchers have been studying those countries to understand what works about their systems and what doesn’t to inform ways to improve American healthcare.
One example of this is Washington state, which borrowed key lessons from Germany’s experience with long-term care to design the first publicly operated long-term care insurance program in the U.S. This program, Washington Cares, is funded through a small payroll tax of less than 0.6% of wages and can be used to cover long-term care costs such as home care, installing ramps or grab bars, compensating informal caregivers, and nursing home expenses.
Economists estimate that unpaid caregivers in the U.S. provide care valued in the trillions of dollars per year. A robust long-term care system could enable caregivers to make larger contributions to the formal economy. This would be a boon for the U.S. economy as the American population ages.
Looking forward
Proposed cuts to NIH’s 2027 budget threaten to undermine the benefits of global health research. In a time when many Americans feel overwhelmed with the cost of living, it may be tempting to consider cutting research aimed at helping people outside the U.S.
But looking at the data, I believe the kind of global health research the NIH funds is giving Americans a big bang for their buck. Any investment that yields these kinds of financial returns, while also delivering new drugs, vaccines and useful knowledge, seems worth holding onto. Global health research is an area where the U.S. can do well by doing good.
Joshua R. Ehrlich, Associate professor, University of Michigan
This article is republished from The Conversation under a Creative Commons license. Read the original article.
