Health R&D spending for major Western countries appears to have slowed, while emerging market economies China and South Korea continue to accelerate investment, and has Japan. Flat growth in the U.S. looks even worse when adjusted for inflation (see "Facing Reality," A5). In Germany and France, two of the largest economies in Europe, the average annual growth rate in government budget appropriations or outlays for R&D (GBAORD) in health grew 6-8% over 2000-09, then slowed to 2%.

In the U.K., health GBAORD has grown 7% per year from 2000 to 2010. At the end of 2011, the government said it would continue to increase spending in the life sciences, including £1 billion ($1.6 billion) to be invested in 2012 by the Medical Research Council and Biotechnology and Biological Sciences Research Council, and nearly £1 billion ($1.6 billion) invested annually in the health research and NHS research infrastructure. South Korea's GBAORD has grown 12% annually over the past three years. Japan's grew 5% over 2000-09 then accelerated to 9%. GBAORD data are not available for China. In the Aug. 23 New England Journal of Medicine, authors from the Robert Wood Johnson Foundation Clinical Scholars Program and colleagues estimated Chinese government medical research expenditures increased 67% to $567 million in 2010. According to ChinaBio LLC President Greg Scott, the government has committed more than $3 billion to new medicine R&D as part of its 2011-2015 plan.

Spending by philanthropies the Howard Hughes Medical Institute and the Wellcome Trust also has slowed or declined. Since the 2008/09 financial crisis, HHMI's endowment has declined, while Wellcome's endowment is basically unchanged. GBAORD figures from the Organization for Economic Co-operation and Development (OECD) for selected countries are charted against the NIH budget. GBAORD figures focus on the socio-economic objective of "health" but may under-represent basic life science research spending due to the classification system used by OECD. All figures are adjusted for purchasing power parity (PPP). (A) 2011 GBAORD data for U.K. not available; (B) Charitable funding committed each year; (C) Annual cash disbursements; Sources: NIH; OECD; HHMI; Wellcome Trust