Medical research responds better to disease burden and health shocks, yet global disparities persist

Medical research responds better to disease burden and health shocks, yet global disparities persist | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Medical research responds better to disease burden and health shocks, yet global disparities persist Hongyu Zhou, Prashant Garg, Thiemo Fetzer This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8568102/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Medical research remains concentrated in high-income settings, raising concerns about alignment with global health needs. Yet systematic evidence on how research responds to both disease burden and acute health shocks across geography and time remains limited. We analyze global research, disease burden and outbreak event history across 204 countries and territories and 15 major disease groups from 1990 to 2021. Research responsiveness to domestic disease burden has more than doubled since 1990, but major gaps persist: maternal–neonatal, nutritional and many infectious diseases remain under-studied, and lower-income countries contribute disproportionately as research settings rather than authors. Funding priorities help explain these patterns. Removing philanthropic-funded research reduces estimated responsiveness growth in lower-income countries by nearly 40%, whereas corporate funding remains focused on profitable chronic diseases. Using an event-study design based on WHO outbreak alerts, we show that health shocks trigger rapid and durable increases in research attention. These responses are substantially stronger in the 2010s than in the 1990s, with response magnitudes shaped in part by digital connectivity, population structure and research capacity. These findings highlight the need for sustained monitoring and intentional funding strategies to better align research with shifting global health risks. Scientific community and society/Developing world Scientific community and society/Scientific community/Publishing Health sciences/Medical research Scientific community and society/Social sciences Full Text Additional Declarations There is NO Competing Interest. Supplementary Files supplemental.pdf Supplementary Information Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8568102","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":573861764,"identity":"1f31b60f-3fb0-4026-81ea-4c65cc579678","order_by":0,"name":"Hongyu Zhou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAArUlEQVRIiWNgGAWjYBACAwYeIFkB4UiQoOUMyVoY20jRYs5/9uBj3nn3EvsbmA/e5mGwyyOoxbLhXLIx77bixBkH2JKteRiSiwk77GCPmTTvtoTEDQw8ZtI8DAcSGwhqOQxUyTsHpIX/G5FajoG0NIBtYSNSyxkeY8M5xxKMZxxmM7acY5BMhJbzZwwfvKlJkO1vb354402FHWEtCMAMNoF49aNgFIyCUTAK8AAAM6401nXHW44AAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-8250-5875","institution":"Renmin University of China","correspondingAuthor":true,"prefix":"","firstName":"Hongyu","middleName":"","lastName":"Zhou","suffix":""},{"id":573861765,"identity":"20ac4f12-7a30-4dea-a6ab-0d2b21a744ee","order_by":1,"name":"Prashant Garg","email":"","orcid":"","institution":"Imperial College London","correspondingAuthor":false,"prefix":"","firstName":"Prashant","middleName":"","lastName":"Garg","suffix":""},{"id":573861766,"identity":"c5e73f7f-0f6a-4b57-ba4a-ea1fe05e1781","order_by":2,"name":"Thiemo Fetzer","email":"","orcid":"","institution":"University of Warwick and University of Bonn","correspondingAuthor":false,"prefix":"","firstName":"Thiemo","middleName":"","lastName":"Fetzer","suffix":""}],"badges":[],"createdAt":"2026-01-10 12:00:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8568102/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8568102/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":100394791,"identity":"9c3a3a1a-9e3d-4007-95b9-501820f1c2fc","added_by":"auto","created_at":"2026-01-16 11:34:42","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2916478,"visible":true,"origin":"","legend":"Article File","description":"","filename":"mainnaturemed.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8568102/v1_covered_80ac59f8-3ff8-4a7d-ae1c-3bf08db30e22.pdf"},{"id":100144752,"identity":"6b3d4cfa-1819-4a2b-8ebb-70ab68bfe36a","added_by":"auto","created_at":"2026-01-13 12:17:32","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":10859441,"visible":true,"origin":"","legend":"Supplementary Information","description":"","filename":"supplemental.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8568102/v1/289cf53ba33e721c33542625.pdf"}],"financialInterests":"There is \u003cb\u003eNO\u003c/b\u003e Competing Interest.","formattedTitle":"Medical research responds better to disease burden and health shocks, yet global disparities persist","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8568102/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8568102/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Medical research remains concentrated in high-income settings, raising concerns about alignment with global health needs. 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