Beyond DALY: public funding of health innovation in Brazil as a political strategy for equity in the Global South.

BACKGROUND

Disability-adjusted life years (DALYs) are widely used to prioritize public funding for science, technology and innovation (ST&I) in health. In universal systems such as Brazil's Unified Health System (SUS), however, allocation decisions may also incorporate broader political and social considerations.

OBJECTIVE

To assess whether Brazilian public ST&I funding for neglected tropical diseases (NTDs) and Zika (2006-2019) aligned with disease burden measured by DALYs, and to examine how observed funding patterns reflect political commitments to health equity and innovation in the Global South.

METHODS

Cross-sectional analysis of national research calls (2006-2019). Actual disbursements were compared with expected values proportional to the DALY distribution for each disease. Associations between DALYs and funding were evaluated using Spearman correlation.

RESULTS

High-burden diseases-including tuberculosis, Chagas disease and schistosomiasis-received less funding than expected, while Zika and leprosy obtained disproportionately higher investments. Overall, the correlation between DALYs and funding was weak and not statistically significant; a significant negative trend emerged within a subgroup of major NTDs.

CONCLUSIONS

DALYs did not operate as the sole criterion guiding Brazil's ST&I funding. Political urgency, social mobilization and SUS operational priorities influenced allocation, indicating that ST&I functions not only as a technical instrument but also as a political strategy to reduce health inequities and foster context‑appropriate innovation for vulnerable populations in the Global South.