ideasIdea

Burden-weighted portfolio targets for every major cancer funder

Funders would publish how their spending compares with deaths and years of life lost per cancer, and commit to shift a fixed share of money each year towards the biggest gaps.

A burden-weighted formula sets a target share for each cancer type and each stage of the pipeline (prevention, detection, metastasis, delivery) using disability-adjusted life years and deaths from GLOBOCAN and the Global Burden of Disease study, adjusted by a tractability discount. Funders publish actual versus target and are held to a rebalancing rule of, for example, moving 10% of the discretionary portfolio per year towards under-funded areas. Analyses of NCI and UK spending have repeatedly shown lung, pancreatic, oesophageal, liver and stomach cancers receive far less per death than breast, leukaemia and prostate.

Hypothesis

If the five largest public and charitable funders adopt a published burden-weighted target with a 10% annual rebalancing rule, the ratio of research spend per death between the best- and worst-funded common cancers falls by at least half within five years, and grant applications in under-funded cancers rise in proportion.

Rationale

Portfolio targets work where they are transparent and measured: the UK Research Councils shifted spending towards dementia after a published burden comparison, and Gavi rebalanced vaccine investment using disease-burden weights. Peer review alone cannot rebalance because it scores proposals, not portfolios; the proposals that arrive already reflect where money has been.

What would test it

One funder pilots the formula on a defined pot (for example 20% of new awards) for three years, tracks application volume, success rates and quality scores by cancer, and compares the burden alignment of the pilot pot with the rest of its portfolio.

Maturity

speculative

Who has to act

policy

Cost to try

Small (under $1M)

Years to first evidence

Bottlenecks it attacks

Funding follows fashion, not burden · Money goes to the cancers and questions that are easy or popular, not the ones that kill most or where a dollar would do most.

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Burden-weighted portfolio targets for every major cancer funder

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bottlenecks