Table 1 Summary of key findings and implications for policy

Background

Evaluating whether research aligns with the global burden of disease (GBD) is essential for equitable and effective scientific progress and improvement of human health. Tracking research–disease alignment over time reveals whether research priorities are adjusted to shifting health needs or reinforce persistent gaps. This study takes a global, longitudinal view to identify neglected areas, evolving trends and opportunities to shape a more responsive, inclusive research enterprise and evidence-based science policy.

Main findings and limitations

We use a triangulated approach, combining an LLM, international classification of disease codes and medical expert validation, to reveal that the divergence between research and disease burden has narrowed by 50% over the past two decades. This narrowing has been driven almost entirely by a shift in the GBD. We find a dichotomy of more local communicable diseases, which have seen a decline in divergence of about 75%, and more global noncommunicable diseases, which have seen a 25% increase in divergence, together yielding a halving (−75% + 25%) of the research–disease divergence since 1999. A forecasting of the divergence to 2050 shows that if this dichotomy is not addressed with a more aligned research enterprise, the divergence is likely to widen again. Accounting for a withdrawal of US public funding for international research would sharply accelerate a future widening of the divergence. The simulation of the future is limited by the inherent fragility of the global research enterprise.

Policy implications

The identified dichotomy calls for differentiated approaches:

• Global noncommunicable diseases affect populations worldwide, but most research is still concentrated in research-intensive countries. Policy action, like open science and data sharing mandates, is needed to make progress in aligning global research efforts with evolving disease burden. This will facilitate the acceleration of research in traditionally less research-intensive countries, which become increasingly affected by the burden of noncommunicable diseases.

• For more localized communicable diseases, it would be required to make a concerted effort to invest in locally led research capacity and equitable collaboration frameworks that avoid extractive practices (helicopter science) and build sustainable, research-informed responses to localized diseases.

In general, to more deliberately address research–disease divergences going forward, our findings underscore the importance of real-time monitoring to devise responsive funding strategies that should be coordinated by global bodies. This coordination should be strengthened through permanent governance mechanisms, especially secured funding and treaty-based commitments. Key research countries are integral to these efforts, yet a changing global policy and research landscape may jeopardize progress. For example: a potential withdrawal of US public funding for international research would affect communicable diseases such as HIV/AIDS, respiratory diseases and tuberculosis, as well as noncommunicable diseases, such as neurological diseases and substance use disorders. In the short term, countries with an established resource base in these diseases might compensate. In the long term, fragility should be offset by stability through greater global coordination. Longitudinal and granular data on the geography of disease and research, such as presented in this article, are essential to enable such increased coordination.