Curiosity and the eagerness to learn are inherent aspects of human nature, propelling individuals to seek answers to various phenomena they observe or experience. Through rigorous research, our world has undergone significant advancements across multiple fields compared to centuries ago. In fact, scientific research exhibits a positive correlation with the standard of living. Without it, human thriving would falter, and our progress would halt. While in theory, knowledge knows no borders and research should not be limited to a socioeconomic class, the reality contrasts the ideal, evident by the varying landscapes of research between low-income countries (LICs) and their higher-income counterparts.
High-income countries (HICs) have made significant investments in applied research, commonly recognized as research and development (R&D). R&D encompasses innovative activities undertaken by both private companies and the government to advance and discover new products and services, particularly in sectors such as pharmaceuticals and biotechnology. Recognizing the positive impact of R&D on the economy, HICs allocate substantial amounts of funds to this sector. As of 2020, global spending has reached $2.4 trillion. HICs typically invest approximately 3% of their gross domestic product (GDP) in R&D in contrast to the less than 0.5% invested by LICs. This significant disparity in R&D spending can be attributed to the challenges faced by LICs and their varying priorities due to their lower socioeconomic status.
As a result of poverty, LICs struggle with an array of stressors, including food insecurity, malnutrition, and a substantial disease burden. These challenges compel governments to allocate funds predominantly to essential needs, such as providing food, shelter, and medical treatments to citizens. Consequently, there is significantly less financial surplus available for investment in R&D.
Limited resources further add to the challenges faced by LICs, encompassing scarce funding and outdated technology. For instance, a 2021 study conducted on public health graduate students in Liberia revealed that, among 120 participants, 86% owned a computer. However, 18.4% and 39.4% experienced malfunctioning hardware and battery issues, respectively. The study also highlighted the students’ struggles with poor internet connectivity for approximately 3.4 days per week. Regarding technological knowledge, 47% of students reported never using analysis programs, while 46% had limited knowledge of statistical analysis. On a broader scale, LICs encounter obstacles such as limited access to grant opportunities, outdated laboratory equipment, the high cost and limited accessibility to lab reagents, and inadequate research salaries. Moreover, the funding landscape for cutting-edge research, particularly in R&D, relies heavily on contributions from private corporations, a crucial aspect lacking in many LICs. These limitations collectively impede the capacity of LICs to engage in cutting-edge research, thereby restricting progress across various scientific disciplines.
The lack of prioritization for R&D in LICs can also be traced back to the substantial disease burden they face. Poverty, coupled with issues like unclean water and inadequate sanitation, exposes citizens of LICs to an increased risk of infectious agents. Limited access to medical care and preventative measures exacerbates this vulnerability, leading to the outbreak of communicable diseases such as malaria, HIV, tuberculosis, and most recently COVID-19, in these regions. However, the challenges for LICs extend beyond communicable diseases, encompassing a concerning surge in morbidity and mortality rates due to non-communicable diseases such as hypertension, diabetes, and cancer – also prominent among low-income citizens in middle-income countries and HICs. Of concern, a study conducted by Bollyky et al. (2017) found LICs are underprepared for the shift to communicable diseases. This warrants the need for research initiatives to address both aspects of the disease burden. Additionally, the situation in LICs explains why research is focused on health rather than R&D.
Despite the numerous challenges, scientists in LICs strive to advance the scientific field. Nevertheless, prevalent bias impedes the broader impact of their research. This issue is highlighted by the findings of Harris et al. (2017), who conducted a blinded crossover study involving 347 English clinicians. The study revealed that research abstracts originating from LICs were perceived differently when the source was altered to indicate a HIC. Furthermore, a notable decrease is observed in the citation rates of publications from LICs compared to those from developed nations. This discrepancy not only reflects a potential bias in the acknowledgment of research contributions but also highlights the challenges faced by scientists in LICs in gaining recognition and impacting the global scientific community.
Besides the challenges, LICs offer significant research opportunities, especially in clinical settings. These include a diverse patient population and distinctive disease profiles, creating a platform for the development of new therapeutics. HICs possess robust research capacity, funding, and equipment, leading to increased international collaborations with LICs in global health research, benefiting both parties. However, several concerns have been raised, including ethical considerations and the potential for research outcomes to be skewed in favor of HICs. Regarding ethical considerations, the absence of regulatory frameworks poses a risk of exploiting unprotected populations. This issue can be addressed by involving local collaborators to protect the rights of participants. Concerning the potential skewing of research outcomes, HICs may lack insight into the infrastructure of LICs, leading to the development of applications or therapeutics that are impractical in LIC settings. Therefore, HICs must consider the feasibility of their research outcomes in LIC settings. This careful consideration ensures that both collaborative efforts contribute positively to global health without compromising ethical standards or feasible implementation in low-income settings.
In conclusion, the disparities in research landscapes between LICs and HICs are evident. Despite the challenges faced by LICs, such as limited resources, a substantial disease burden, and biased recognition of scientific contributions, these nations offer significant research opportunities, particularly in clinical settings. HICs, with their strong research capacity, funding, and equipment, engage in international collaborations with LICs, providing mutual benefits in global health research. However, ethical considerations and the potential for skewed research outcomes pose challenges. To address these issues, HICs must involve local collaborators and consider the feasibility of outcomes in LIC settings. The need for a more equitable global scientific community entails ongoing efforts to bridge the research gap and foster collaborative initiatives that benefit all nations.
Daniah Alkassab
