Talent at Risk: The Crisis Facing Global Health Research and What Can Be Done

For three decades, the world has made historic progress against HIV/AIDS, tuberculosis, malaria, polio, and malnutrition. Behind every vaccine, diagnostic, and treatment is a small, highly specialised "discovery workforce" of scientists and researchers. Our analysis finds that this workforce is now dangerously fragile — and that the threat is less about attracting talent than keeping it.

85% of people who enter these key discovery roles leave within five years. Around 10% move to better-funded disease areas such as cancer or influenza, but more than twice as many leave for the private sector, where pay and job security are far higher. In fact, more workers exit these roles to join Merck alone than move into cancer research. For those who stay, up to 44% of research time is lost to grant-writing, compliance, and operational tasks that don't require their expertise.

These pressures are being compounded by shocks to the research environment: threats to indirect cost rates, the closure of USAID, and acute financial strain on the very institutions that anchor the pipeline. The system is also strikingly concentrated — half of the global discovery workforce trained at just 1.8% of US institutions, and 12 universities alone produce a fifth of it. Disruption to a handful of campuses could reverberate across the entire field.

The central message is one of cautious optimism. We can still train enough scientists; the challenge is retaining them and freeing them to do science rather than paperwork. It sets out six concrete interventions — from cutting administrative burden and protecting research infrastructure to closing the early-career "conversion gap" and broadening the talent pipeline — that could break the cycle before it tips into irreversible decline.