A CALL FOR ACTION TO STRENGTHEN HEALTH RESEARCH CAPACITY IN LOW AND MIDDLE INCOME COUNTRIES

progress due to lack of investment and political will.  More recent initiatives that are, at this point, largely led by African scientists include the European and Developing Countries Clinical Trials Partnership  (EDCTP) networks of excellence led by African scientists (http://www.edctp.org/), the Clinical Trials Partnership (25) and the Malaria Genomic Epidemiology Network (MalariaGEN-  http://www.malariagen.net/). In recent years,   global   and   regional   Information   networks   have developed with a goal of strengthening country level RCS in specific areas of concern – †††,‡‡‡,   §§§,   ****,††††, ‡‡‡‡,§§§§,*****, †††††, ‡‡‡‡‡, §§§§§.

Catalyzed by the business community, Product Development Partnerships (PDPs) such as Medicines for Malaria and the TB Alliance have grown. PDPs now manage 2/3 of the identified drug development projects for neglected diseases (26, 27). The MVP (Meningitis Vaccine Project) specifically for Africa involves academia, industry, local pharma in both developed and developing countries (ref:  www.meningvax.org).

TWAS, the academy of sciences for the developing world, has as its main mission the promotion of scientific excellence and capacity    in                     the                     South    for         science-based              sustainable development (http://twas.ictp.it/). In addition, global networks of academies of science (IAP- global network of science academies   http://www.interacademies.net/)  and  academies  of medicine        (Inter                       Academy                      Medical    Panel-IAMP- http://www.iamp-online.org/) promote the role of academies in providing evidence based advice to governments for health and science policy and strengthening national higher education and research systems  for health.

Continuing critiques of progress on health RCS note that some initiatives and programs are still uncoordinated. Many tend to stress only market-oriented aspects of medicine (e.g. laboratory methods, vaccinations, therapies), and many leave little infrastructure  behind  when  specific  program  funding  ends. Some  observe  that  much  of  the  international  research  in tropical diseases and genomics still involves data collected in the LMIC, transferred to the northern scientific site and published there without any built-in feedback to the country of origin (28,29). In several countries in sub-Saharan Africa, interventions are said to have failed to increase the quality and number of researchers and the productivity of research; to support   sustainable   local   institutions;   to   retain   human resources; and   to improve the interface between researchers and the public (30). Some countries bearing the greatest burden of   disease   may   suffer   from   lack   of   political   will   and government instability (31) and experience low public understanding of the importance of research investment (32).

While certain middle income countries, like Brazil, India and China are becoming world leaders in health research and innovation, few LMICs have reached a critical mass of faculty and   researchers.   Facilities   are   still   limited   and   many researchers suffer true intellectual isolation. These alarming conditions   contribute   to   the   brain   drain   of   promising researchers similar to that for health workers and physicians from  under-resourced,  poor  countries  to  wealthy  northern

countries (33,34,35,36). Some see limited epidemiological research capacity in Africa (37) as limiting the ability to fully assess health status and the results of interventions. Others cite weak  research  capacity in  disease  endemic  countries  as  the single most important rate limiting factor to achieving solutions to their health and development priorities and in moving ahead to complete the unfinished business of eliminating neglected tropical diseases that still affect millions of people (2, 13).

Why Act Now?

While in the 20th  century, there was a true health revolution with over thirty years of additional life expectancy achieved on average across the globe, new global health challenges for the 21st century face all countries.

For example:

• Emerging and drug resistant infections create greater risks whatever and wherever their origins due to the global transportation and trade, population migration, and climate change (38).
• Climate   change   and   its   human   health   effects, including  food  security  and  water  availability  are truly global problems0 (39, 40).
• All  regions  of  the  world  are  experiencing  both demographic and epidemiologic transition – longer life expectancy and the challenges of an aging population as well as an increase in non- communicable diseases (NCDs) worldwide, with the incidence of both growing fastest in LMICs.

Urbanization is now a global phenomenon with over half the world’s population living in cities, with the most rapid urbanization in LMICs. Unique factors in the built and natural environments  of  cities  are  strongly  linked  to  respiratory diseases and changing patterns of disease transmission. Obesity related to poor diet and inadequate exercise are very prevalent in cities and increasing in all countries. Informal settlements and  migration  exacerbate  stress  and  mental  health  related health problems. Health disparities are often dramatic within cities and the need for science to inform action on these broad determinants of health has never been more urgent (41).

The fact that these challenges are shared lends a new urgency to the call for renewed  and more concerted national and global action to make RCS a priority in all countries and assure true partnerships that allow local scientists and researchers to participate in all phases of the process to address these shared global health problems. It is also important to encourage shared access to the enormous scientific opportunities available to tackle these problems in new ways through tools like genomics, molecular epidemiology, diagnostics using chip technology and efforts to create low-cost diagnostics suited to medical needs and social contexts in the developing world. In addition, all countries face the challenge of translating what is known into interventions that improve health by reaching the populations who need them most in a timely and cost-effective manner (27). The increased wealth of low and middle income nations also creates unprecedented opportunities for new research capabilities in the global South, and these countries must be included in future global discussions of health research and health research governance.

The  2012  World  Health  Assembly received  the  report  of  a WHO Expert Working Group on Research and Development: Coordination and Financing (CEWG) which has made recommendations for improvement in global health research and development priority setting and coordination as well as for targets for country investment in their own health RCS and for  donor  country  investment  in  the  research  capacity  of

LMICs (20). The recommendations in this report are still in active  discussion  by  WHO  member  states  and  may  come before the 2013 World Health Assembly in May 2013.

Recommendations for Academies

IAMP member Academies consist of national and international leaders of the academic and scientific communities with important access to policy makers and the public. They can use their unique position to draw attention to the need for a robust research capacity in their own countries, and join with other academies  at  the  regional  and  global  level  to  accelerate sustained leadership for and investment in effective health research systems to promote sustained social and economic development and innovation

At country level:

1. IAMP member academies should engage with country leadership
   and other stakeholders to assess the adequacy of current national research
   capacity and, based on the findings of that assessment, determine the most effective
   role they can play to support the development of research capacity that addresses the
   health and development needs of their country .
2. IAMP member academies should support appropriate priority setting for and investment in RCS,
   including the education and training of young investigators and supportive environments for their work,
   strong educational and research institutions that produce and
   host researchers to reverse brain drain and national health research policies and systems that support both.
3. IAMP member academies in countries that provide international development assistance (IDA) should engage with
   appropriate country leadership to promote meaningful and sustained investment in research,
   using a system’s approach to RCS, as a priority in their overall assistance programs
   to LMICs. At regional and global level IAMP member academies should work through regional and global networks of academies to:
4. Maintain an emphasis on RCS and actively engage in efforts to build the health research
   systems needed to effectively address global health challenges for the future in order to:
   • ensure that strengthening systems for health research is a fundamental component of all
     “health systems strengthening” initiatives and
     investments;
   • ensure that health RCS is included in all long term national, regional and global strategies to promote human and economic development and innovation and to reduce health disparities;
   • promote international and country level funding of health research that permits better understanding of and action on the broad determinants of health by being: less vertical, more long term and sustainable, more client oriented and more responsive to country and community health needs.
5. IAMP should join efforts to assure that the international scientific community and all stakeholders in global health are committed to initiating aligned, autonomous, sustainable, high- quality research partnerships by and with LMIC investigators. This could be achieved by:
   • including developing country partners in the governing boards of RCS initiatives and ensure their active participation in agenda setting and prioritization of activities funded by developed countries;
   • jointly developing codes of conduct to ensure equitable and sustainable partnerships between developed and developing country researchers;
   • supporting current efforts to develop frameworks for fair research contracting among north-south researchers;
   • supporting current global efforts to develop and promote principles and guidelines for research integrity (align with above)supporting and collaborating with pacesetting organizations and stakeholders in promoting RCS.
6. IAMP, working with its member academies at national level, should encourage the international community, the WHO and other stakeholders from LMICs as they discuss the report of the WHO CEWG, to develop consensus on a global instrument for and a target level of investment in RCS by donor countries and LMIC countries themselves and monitor progress on these commitments .