A Prize for Repurposing Drugs for Neglected Diseases

More than one billion people are affected by poverty-related and neglected diseases (PRNDs), including the 21 recognized neglected tropical diseases, as well as HIV/AIDS, tuberculosis, and malaria. These diseases cause avoidable illness and death, reduce schooling and labor productivity, and impose large economic costs. Yet funding for PRND research and development (R&D) remains far below need. In 2024, R&D funding was still more than $1 billion below its 2018 peak. At the same time, thousands of FDA-approved drugs already exist and some may hold promise as treatments for PRNDs. But without a viable commercial market, no one has a strong financial incentive to find out.

One solution is to create the missing incentive. A prize could reward innovators that discover and prove an existing drug can treat a PRND. This philanthropy-funded prize could catalyze the search for underexplored treatments and generate large welfare gains for people who have been underserved by the existing market. Because these drugs have already undergone safety testing and accumulated real-world data, the path to identifying promising candidates may be faster and less risky than for entirely new compounds. And when a widely used drug is successfully repurposed, patients can often access it more quickly through existing supply chains and, if it is off patent, at lower cost.

Repurposing is not hypothetical. Doxycycline, originally developed as an antibiotic, was later found to treat filarial diseases such as river blindness and lymphatic filariasis by targeting the bacteria required for the parasite to survive. Clinical studies show that a six-week course can sterilize adult female worms and kill a substantial share of adult worms. Doxycycline illustrates the broader point that existing drugs can generate clinical value when applied to diseases they were not originally designed to treat.

So why does this not happen more often? The first reason is the familiar market failure associated with PRNDs themselves. These diseases affect the world’s poorest people, who cannot afford to pay high enough prices to offset the costs of discovering and testing new drugs. Also, even global health donors can be tempted to bargain down prices once a drug’s use for PRNDs is proven—promoting access but weakening incentives for drug development. For these reasons, firms have little financial incentive to invest in pharmaceutical R&D for PRNDs and total investment remains far below what the disease burden warrants (see Figure 1).

Figure 1. Cancer and Alzheimer’s disease receive many times more R&D spending per disability-adjusted life year (DALY) than poverty-related and neglected diseases (PRNDs)

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Source: Center for Global Development analysis, 2026. R&D spending data for cancer and Alzheimer's disease is not comprehensive. R&D spending for cancer is sourced from the National Institutes for Health, 2024 and Bloomberg, 2024. R&D spending for Alzheimer’s is sourced from National Institutes for Health, 2024, Alzheimer’s Association, 2021, Alzheimer’s Association, 2024, and Horizon Europe research programme, 2020. R&D spending data for dengue, HIV/AIDS, tuberculosis, schistosomiasis, and malaria are sourced from Our World in Data, 2023. All monetary values are expressed in 2026 US dollars. Disability-adjusted life year data comes from the Institute for Health Metrics and Evaluation, 2023.

Another reason investment is low is specific to repurposing existing drugs. Incentives to discover new uses are often weak, especially once a drug is off patent and no single firm can easily capture much of the upside. Yet proving that a drug works for a new disease can still require expensive clinical trials, regulatory work, and coordination with health systems. The result is an additional market failure: society would benefit from knowing whether existing drugs can treat PRNDs, but no individual actor has a strong incentive to generate that evidence.

Existing funding tools do not fully solve these problems. The US Priority Review Voucher program, for example, can reward companies a transferable voucher roughly equivalent to $100 million that develop new drugs for neglected tropical diseases, but it excludes drug repurposing. Grant funding, by organizations like the Drugs for Neglected Diseases Initiative and Coefficient Giving, has driven important progress but has structural limits. Grants only induce effort from teams funders select in advance and tend to favor applicants already working in the space.

A prize could complement grants by creating a standing reward for anyone who succeeds. That would broaden the search beyond the usual applicants, encouraging researchers, nonprofits, and companies with relevant data or expertise to pursue promising repurposing leads across a wide range of possible drug-disease combinations they might otherwise ignore.

This prize, funded by a philanthropic funder or donor consortium, could offer a reward to any organization that demonstrates, through a credible clinical trial, that an existing drug provides meaningful benefit for an eligible PRND. To be credible, the prize would need a few elements specified in advance:

1. A reward large enough to spur investment – we estimate roughly $30-$50 million per successful drug-disease pairing.
2. A requirement that winning treatments improve on standard of care – through better efficacy, safety, ease of delivery, suitability for low-resource settings, or stronger overall value for patients and health systems.
3. A cost-effectiveness threshold – to ensure the prize supports sufficiently high-value opportunities, payments could be tied to expected health impact or conditioned on clearing a pre-specified cost-effectiveness bar.
4. Access conditions – winning the prize could require companies to make successful treatments available on terms that support broad access in the settings where they are most needed.

Repurposing is a promising, under-supported opportunity for funders seeking to accelerate progress. A philanthropically-funded prize for drug repurposing is not a complete solution, and it should complement, not replace, traditional grant funding and broader investments in global health. Still, a prize for drug repurposing is a practical, high-upside bet: it could create the missing market signal, reward the search for overlooked treatments, and help ensure that affordable medicines are not missed simply because no one had an incentive to find them.