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.