Of the global budget for health research, only 10% is spent on the disease burden of 90% of the world's population. Investments in international health research are lacking, hampering health of the poor in particular. Effective vaccines against the world killers HIV, malaria and tuberculosis still do not exist. However, besides scaling up research for new drugs and vaccines, research in health care systems are needed to understand the obstacles to implement new as well as existing interventions to prevent and combat the major health problems of those most in need. The task demands political and private sector commitment.