Medical research responds better to disease burden and health shocks, yet global disparities persist

Medical research remains concentrated in high-income settings, raising concerns about alignment with global health needs. Yet systematic evidence on how research responds to both disease burden and acute health shocks across geography and time remains limited. We analyze global research, disease burden and outbreak event history across 204 countries and territories and 15 major disease groups from 1990 to 2021. Research responsiveness to domestic disease burden has more than doubled since 1990, but major gaps persist: maternal–neonatal, nutritional and many infectious diseases remain under-studied, and lower-income countries contribute disproportionately as research settings rather than authors. Funding priorities help explain these patterns. Removing philanthropic-funded research reduces estimated responsiveness growth in lower-income countries by nearly 40%, whereas corporate funding remains focused on profitable chronic diseases. Using an event-study design based on WHO outbreak alerts, we show that health shocks trigger rapid and durable increases in research attention. These responses are substantially stronger in the 2010s than in the 1990s, with response magnitudes shaped in part by digital connectivity, population structure and research capacity. These findings highlight the need for sustained monitoring and intentional funding strategies to better align research with shifting global health risks.