Whose diseases matter? Parasitic and viral infections in the political economy of global health research.

Global health research agendas are shaped not only by epidemiological need but also by political, economic, and institutional priorities. This study examines the relationship between disease burden and research and development investment (R&D) for parasitic and viral infectious diseases over the period 2000-2023. We integrate data from the Global Burden of Disease Study (2000-2023) and the G-FINDER database (2007-2023) to compare prevalence and cumulative R&D funding across three panels: parasitic neglected tropical diseases (NTDs), viral NTDs, and selected high‑profile viral infections. Parasitic NTDs affected up to 30% of the global population in 2000 and remained above 10% in 2023, while viral NTDs stayed below 0.03%. The burden of parasitic NTDs was primarily in the Global South, with low prevalence in the Global North. R&D investment favored viral diseases, receiving about ten times more funding than parasitic diseases, which focused mainly on early-stage research. In contrast, viral diseases received support from early research through late-stage development, predominantly in the Global North. These findings highlight a misalignment between disease burden and R&D investment, reflecting systemic asymmetries in knowledge production and priority setting. Institutional frameworks, risk perceptions, and geopolitical contexts influence global health priorities. To effectively reshape global health, regions must enhance their capacity to set priorities based on their unique epidemiological realities. This shift is crucial for aligning research agendas with local health needs and addressing the systemic imbalances in global medical innovation.