Public funding supports basic research, clinical trials, regulatory assessment and post-market evidence generation for many medicines. This investment, which is present throughout the development process, remains largely invisible in price negotiations and decisions on access conditions.
We discussed this lack of transparency in Who Pays, Who Benefits — and Who Knows?, a webinar we organised a few months ago. The event featured Claudia Wild, from the Austrian Institute for Health Technology Assessment and Transparency International Healthcare; Roz Scourse, from Médecins Sans Frontières; and Megan Whiteman, from Public Citizen. Jaime Manzano and Adrián Alonso, from our organisation, moderated the discussion.
The document we are now publishing brings together the webinar’s main conclusions. One is that public support is present throughout almost the entire drug development lifecycle. The European HI-PRIX project has identified public funding across eight different phases, from early research to clinical trials, regulatory approval and post-market evidence generation. The literature reviewed by the project found that public-sector institutions contributed to approximately 42%-50% of all biologics and more than 90% of drug target research.
This investment often remains hidden when companies justify high prices by referring to research and development costs. Available estimates of the cost of developing a new medicine range from US$43.4 million to US$4.2 billion. This nearly 100-fold difference makes it impossible to know how much was actually invested and what share was covered by the public sector.
Publishing these costs is possible. Médecins Sans Frontières calculated that TB-PRACTECAL, a trial evaluating shorter, all-oral regimens for drug-resistant tuberculosis, cost €33.9 million. The organisation broke the expenditure down into 27 cost items and has developed a tool that other organisations can use to record and publish the costs of their clinical trials following the same model.
The MVA-BN mpox vaccine illustrates the consequences of failing to attach conditions to public funding. Its development drew on decades of publicly funded research, and the US government provided Bavarian Nordic with more than US$2.3 billion. When the mpox emergency affected Central and West Africa in 2024 and 2025, price and limited resources restricted access. Africa CDC estimated that up to ten million doses could be needed, yet only around five million were ultimately acquired through purchases and donations.
The issue is not only how much public money is invested, but what society receives in return. Funding agreements can include transparency requirements, reasonable pricing conditions and commitments covering licensing, technology transfer, regulatory registration and supply in the countries where products are needed.
Europe now has several opportunities to move in this direction. The negotiated text of the EU Pharmaceutical Directive introduces an obligation to disclose any public financial support received during the development of a medicine. Its impact will depend on common reporting standards, publicly accessible information and mechanisms to verify compliance. Negotiations on the next Horizon Europe programme also provide an opportunity to link public funding to transparency and access conditions from the earliest stages of a project.
Knowing who financed an innovation, how much it cost to develop and under what terms it moved into private ownership is not an end in itself. Public authorities need this information to negotiate prices, secure a fair return on public investment and ensure that medicines reach the people who need them.
For a more detailed analysis, the document brings together the main ideas, evidence and examples discussed during the webinar. You can download it here.
