The Need for GlobaI Collaboration and Coordination in Research for Health

1. The Need for GlobaI Collaboration and Coordination in Research for Health Prof Anthony Mbewu BA MBBS MD FRCP FMASSAf Executive Director Global Forum for Health Research

2. Values The values imbuing global collaboration in research for health: Health as a human right : WHO Constitution 1948 : `The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.’ Equity as a principle : The 1990 Commission on Health Research for Development recognised the importance of health research for development The 1992 World Development Report emphasised the role of health in development Research as a vital tool : The 1996 Ad Hoc Committee on Health Research for Future Intervention Options showed that 90% of global health research expenditure is on problems that affect 10% the world`s population; and recommended the formation of the Global Forum : 1998

3. GLOBAL HEALTH National Health : National Health Indicators (encompassing local health inequities) Global Health : Global Health Indicators (encompassing national and regional health inequities) Human solidarity Health as a global public good – rather than a traded commodity Health as a human right Global Health Governance Universal coverage Research for health - $ 160 billion : inequity Social determinants of health

4. Global Research for Health Expenditure Tracking resources for research for health Monitoring Financial Flows for Health Research 2008 Global Forum for Health Research, Geneva

5. STRATEGIC OBJECTIVES Logicframework of the mission of the Global Forum for HealthResearch : 1. Identifying Gaps and Priorities 2. PromotingResearch for Health 3. Facilitating Translation of Research intoHealth

6. The Spectrum of Research for Health Biomedical research Health policy and Systems research Social science and behavioural research Operational research Basic research: physical and biological sciences including chemistry, pharmacology, toxicology, genetics, etc Research on policy formulation, relationship to evidence, prioritization, etc Research on social and behavioural factors influencing health and their relation to equity, access, lifestyle and health-seeking behaviours, etc Research on factors affecting functioning of programmes, effectiveness of targeting, impact on behaviour, disease burdens and public health, etc Research on health systems management, functions, efficiency, effectiveness, system factors affecting access scale-up, monitoring and evaluation, etc R&D for drugs, vaccines, diagnostics, appliances, etc Understanding the biological nature of diseases; creating products to prevent or treat disease states Understanding how to test, scale-up and follow through the introduction of interventions and optimize their benefits Multidisciplinarity Global collaboration Exchanges of Faculty and student Building individual and istitutional capacity (cf EDCTP)

7. Health sector Other sectors Research system Health research system Innovation system National Global

8. Health Priorities Development • Their own health priorities • Identified by their own institutions and constituencies • In a systematic fashion (combined approach matrix etc) • Essential National Health Research : country specific global specific • Burden of disease – DALYs - mortality and morbidity • Also prioritise according to likely impact • Especially critical in resource-poor settings • Cost effectiveness analysis

9. Health Priorities of Developing Countries HIV and AIDS Tuberculosis Pneumonia Cardiovascular Disease Tobacco-related Disease Violence and Injury Alcohol-related Disease Obesity and Overweight Diarrhoeal Diseases Also : Health Systems Health Promotion Health Economics and Health Policy

10. Research Translation Research makes no difference to health unless it is translated GRIPPPP : Getting Research results Into : Policy Practice Promotion and Product

11. Fragmentation in international effort ….

12. Changing Global Architecture of Research and Innovation for Health • Increasing participation by LMICs in global health research • Especially ‘innovative developing countries’ (IDCs) • South no longer grateful recipients of R&D done in the North • Of $30 billion spent on global health research in 1986, only $1.6 billion (5%) was spent in developing countries • In 2008 IDCs alone spent $2.6 billion on R&D

13. Changing Global Architecture of Research and Innovation for Health • $2.5 billion spent on R&D for neglected diseases in 2008 ($20.7 billion on communicable diseases in HIC and LMICs) • Of $950 million spent by HIC on R&D in LMICs, only $150 million was actually transferred to LMICs • In 1986 LMICs contributed only $15 million to multilaterals such as GFATM, International Financing Facility for Immunisation etc • In 2010 LMICs contribute hundreds of millions of dollars to multilaterals and regional assistance

14. Changing Global Architecture of Research and Innovation for Health • In 1986 Foundations spent $50 million on diseases in LMICs; now Gates alone spends $1-2 billion • Private and NFPs in 2005 spent 8% ($12.2 billion) of the $160 billion global spend on R&D • HIV/AIDS : $2.9 billion out of the $18.7 billion public sector expenditure • Communicable disease : accounted for 74/665 drugs in development by top 10 pharma companies in 2008 (NCD : 409)

15. Changing Global Architecture of the Biopharmaceutical Industry • India : from reverse engineering to fully integrated biopharma industry (Serum Institute etc) • South Africa : designed and tested a novel HIV vaccine to phase I stage • PDPs : $584 million (30% of grant funding for R&D on neglected diseases in 2007)

18. Science is increasingly global International co-authorship (% total) Source: Global Science and Innovation Forum, 2006

19. The Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property May 2008, Resolution WHA61.21 ‘...securing an enhanced and sustainable basis for needs-driven, essential health research and development relevant to diseases that disproportionately affect developing countries’ : – prioritizing research and development needs; – promoting research and development; – building and improving innovative capacity; – transfer of technology; – application and management of intellectual property; – improving delivery and access; – ensuring sustainable financing mechanisms; – establishing monitoring and reporting systems.

20. Element 2: Actions to promote research and development (2.1) support governments to develop or improve national health research programmes and establish, where appropriate, strategic research networks to facilitate better coordination of stakeholders in this area (a) promote cooperation between private and public sectors on research and development (b) provide support for national health research programmes in developing countries through political action and, where feasible and appropriate, long-term funding (c) support governments in establishing health-related innovation in developing countries.

21. Element 2: Actions to promote research and Development (2.2) promote upstream research and product development in developing countries (a) support discovery science, including where feasible and appropriate, voluntary open-source methods, in order to develop a sustainable portfolio of new products (b) promote and improve accessibility to compound libraries through voluntary means, provide technical support to developing countries and promote access to drug leads identified through the screening of compound libraries

22. Element 2: Actions to promote research and Development (2.3) improving cooperation, participation and coordination of health and biomedical research and development (a) stimulate and improve global cooperation and coordination in research and development, in order to optimize resources (b) enhance existing fora and examine the need for new mechanisms, in order to improve the coordination and sharing of information on research and development activities (d) support active participation of developing countries in building technological capacity (e) promote the active participation of developing countries in the innovation process.

23. Element 2: Actions to promote research and Development (2.4) Promoting greater access to knowledge and technology relevant to meet public health needs of developing countries (a) promote the creation and development of accessible public health libraries in order to enhance availability and use of relevant publications by universities, institutes and technical centers, especially in developing countries (b) promote public access to the results of government funded research, by strongly encouraging that all investigators funded by governments submit to an open access database an electronic version of their final, peer- reviewed manuscripts

24. Element 3: Building and improving innovative capacity There is a need to frame and develop and support effective policies that promote the development of capacities in developing countries related to health innovation. Key areas for investment are capacities relating to science and technology, local production of pharmaceuticals, clinical trials, regulation, intellectual property and traditional medicine. (paragraph 31)

25. Element 4: Transfer of technology 4.1 promoting transfer of technology and the production of health products in developing countries 4.2 supporting improved collaboration and coordination of technology transfer for health products, bearing in mind different levels of development 4.3 developing possible new mechanisms to promote transfer of and access to key health-related technologies

27. Conclusions • Research and innovation key to equity and development • Collaboration and coordination essential for the success and impact of research and innovation • Collaboration within equal partnerships with • bilateral exchange of students and faculty • Institutional capacity building key for sustainable national research and innovation systems • Collaborations should build the capacity of universties, science councils, and academies of science • Build the capacity of civil society and NGOs to participate in research

28. Conclusions • Invest in infrastructure to support research : ICT, new technologies, buildings and laboratories • Partnerships should include ‘new donors’ in ‘innovative developing countries’ • Invest in research management, drug regulatory authorities, ethics committees, innovation and technology managers, IP management etc • Multidisciplinarity is vital • Invest across the value chain from basic science...... • Developing countries should invest equivalent of 2% of health budget on research for health • Donors should spend 15% of health sector budget on research for health

29. Conclusions • Foster south-south collaboration • Collaborations should include the private sector in HICs as partners; and also the nascent private sector in LMICs • Rigorous and ethical management of IP • MTAs : tissues, genomes, • Biodiversity : developing countries must benefit • Share data generated through research – including private sector clinical trials etc • Recommendations of Commission on Macroeconomics and Health for a Global Health Research Fund? • Innovative Financing Mechanisms for research for health