More than 1.7 billion people worldwide suffer from ‘neglected diseases’ – illnesses rarely researched by the private sector because most of those affected are too poor to provide a market for new drugs, and over 1 billion of them are children (2,3). Furthermore, 10 million people die each year simply because they can’t access existing lifesaving medicines – often because those treatments are simply too expensive (4). With new global health challenges such as COVID-19, HIV/AIDS, antimicrobial resistance, the lack of transparency in research, including for clinical trials, and the lack of alternative models for efficient and sustainable innovation, the gap between vulnerable populations and affordable treatment threatens to widen even further. Furthermore, the COVID-19 pandemic largely showed the immense gaps between low- and middle-income countries (LMICs) and high-income countries (HICs) when it comes to sustaining a functioning healthcare system as well as massively vaccinating their population.

Universities can use their unique positions as public interest, largely publicly funded research institutions to address both of these challenges. By prioritizing research on global diseases neglected by for-profit research and development (R&D), they can pioneer new treatments that will benefit millions in LMICs. And by sharing their medical breakthroughs under open, non-exclusive licenses or licenses that promote lower prices for LMICs and for underserved populations in HICs, universities can help poor patients worldwide access new, lifesaving treatments. Universities can also play a critical role in educating their students and raising awareness within and outside of their campus about these issues in order to empower them to take on these global health challenges in their own work.

Some universities are already taking these steps – along with teaching students about the challenges of neglected disease innovation and treatment access. However, few have systematically tried to measure universities’ contributions in these vital areas. UAEM’s University Report Card fills that gap. The first iteration of the Report Card, released in 2013, evaluated both American and Canadian institutions together. However, major Canadian universities differ in key respects to their American counterparts in regard to biomedical research funding, which is why the 2017 iteration of the Report Card evaluated the Canadian and American universities separately. 

Compared to 2017, most universities have regressed in all sections, with access and empowerment receding the most. This indicates that universities invest fewer resources into offering global health-related courses and/or programs for students at all levels, disregarding the need to educate and raise awareness among our future leaders. This is accompanied by an overall decrease in access, with a reduction of universities signing non-exclusive licensing agreements, less trial data made public than ever before, and fewer publications in open-access format. The COVID-19 pandemic proved that publishing in open-access journals and sharing data and knowledge is more than possible and was highly incited, showing that universities make conscious choices to avoid doing so.