Activists claim that only 10 per cent of global health research is devoted to conditions that account for 90 per cent of the global disease burden – the so-called ‘10/90 Gap’. They argue that virtually all diseases prevalent in low income countries are ‘neglected’ and that the pharmaceutical industry has invested almost nothing in research and development (R&D) for these diseases.

Citing this alleged imbalance as justification, activists have been calling for a complete redesign of the current R&D paradigm in order to ensure that more attention is paid to these ‘neglected diseases’. This could include measures such as an ‘essential research obligation’ that would require companies to reinvest a percentage of pharmaceutical sales into R&D for neglected diseases, either directly or through public R&D programs.

But does such an imbalance really exist and what would be the effect of redesigning the R&D system? This paper investigates the realities of the 10/90 gap and its relation to the diseases of poverty.