Introduction Countries have traditionally been split into two major groups: developed or industrialized (“the North”) and developing or underdeveloped (“the South”). Several authors and organizations have challenged this classification to recognize countries that have reached an intermediate stage of social and economic development. As proposed by Morel and collaborators in 2005, the concept of Innovative Developing Countries (IDCs) defines a group of nations with impactful scientific programs. Here, IDCs are reexamined by a variety of metrics to highlight their role in health innovation through research and development (R&D) programs on neglected tropical diseases (NTDs) that also positively impact epidemic preparedness. Results To address the global changes due to expanding globalization we updated the original indicator of the number of USPTO patents deposited by individual countries per GDP and per capita to the number of international patents applications, related to applicant residence and deposited under the Patent Cooperation Treaty (PCT) per GNI (or GDP) and per capita. A comparison of the originally described ranking of top innovative countries to those in the present study revealed new members that updated the list of IDCs and showed a prominent role now played by China. Analyzing scientific publications in international journals since the introduction of the IDC concept in 2005 we found that IDCs do prioritize Neglected Tropical Diseases (NTDs) as an area of research. Finally we investigated the role of IDCs in two major public health emergencies between 2012 and 2016, the outbreaks of Ebola in West Africa and Zika in South America. An analysis of the co-authorship country networks demonstrated an important role for IDC infrastructure and personnel in the prevention and control of these epidemics. Discussion and conclusions Different techniques can be used to evaluate and measure innovative performance of countries. Country rankings published by traditional indexes, such as the Bloomberg Innovation Index (BII) and the Global Innovation Index (GII), only include high income economies among the top 20 performers. This is in sharp contrast to our approach, which identified 8-9 IDCs among the first 25 with China occupying the top position. Through an analysis of the pros and cons of the different methodologies, the IDC concept challenges more conventional approaches to address and estimate the innovative capacity of countries., Author summary Splitting countries into two groups—rich and poor; developed (the “North”) and developing (the “South”); leaders and followers—appears to us to be progressively more simplistic, unrealistic and a heritage from colonial times. Triggered by the first wave of globalization, the share of world income going to today’s wealthy nations soared from twenty to almost seventy percent between 1820 and 1990, a fact that supported and strengthened this dichotomic vision; however, the new globalization driven by information technology has propelled the rapid industrialization of several developing nations and simultaneous deindustrialization of developed nations, a phenomenon that has not yet been fully understood nor reflected in traditional economic indexes and analyses. In this article we revisit the 2005 concept of Innovative Developing Countries (IDCs) that points to the underrepresentation of IDCs in well-known innovation indexes and country ranks. Our analysis clearly shows a prominent role for IDCs in health innovation, research and development on NTDs and in epidemics preparedness, prevention and control.