A healthy society is a disaster resilient society

Disasters are usually measured by the number of deaths, injuries and damage to property that they cause. But, do these measures truly express the magnitude of damage to people’s health and quality of life?

In 2011, the earthquake that struck the Pacific coast of Tōhoku, with a magnitude of 9.0 (Mw), was the largest to ever hit Japan and the fourth most powerful in recorded history. Strong national building codes protected most of the buildings in Japan from this devastating earthquake and saved many lives as a result, but the people affected by that disaster still suffer from chronic illnesses, mental problems, loss of family and exposure to nuclear power plant accidents—most notably Fukushima, which continues to pose contamination risks due to the severe infrastructure damage it incurred during the earthquake. The public health situation of a community is a key factor in measuring their resilience against disasters, and accordingly, the strengthening of mental and physical health must be made a priority when looking to curb the risks posed such disasters in the future.

On the other side, the process of rebuilding after a disaster is just as important as the capacity and resilience building processes that happen prior to a disaster. Health professionals have an important role to play in facilitating mutual, cooperative relationships with non-health professionals as they work together to help rebuild communities. Specialists, such as those involved in disaster medicine, need to forge partnerships with general health providers to create a unified approach to community resilience and rebuilding programs. The role the health professional plays is not only important in the acute response to injuries caused by disasters, but also in preparedness work, which is crucial to later making an efficient response to any disaster.

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In Japan, for example, nation-wide disaster medical response systems have saved many lives.  With the Tōhoku earthquake in 2011, systems such as disaster-base hospitals, disaster medical assistant teams (DMAT), staging care units (SCU), wide-area transportation systems, emergency medical information systems (EMIS) and disaster medical-public health coordinators worked efficiently in the immediate aftermath of the earthquake, saving countless lives and limiting the impact of the disaster.

Despite these efforts, however, the medical and public health needs of the affected people exceeded the relief capacities in place at the time and, indeed, for several months after the event. Mental health problems including post-traumatic stress disorder (PTSD), depression and alcoholism are still huge problems in those affected, and it will take years to find solutions to these issues. Medical and public health preparedness should be emphasized and prioritized in order to build resilience to disasters in the form of long-running, systematized global health programs.

During the International Symposium for Disaster Medicine and Public Health Management that took place last May, scientists and experts in disaster medicine and public health reached a consensus that health concerns should be imperative in the formulation of disaster risk reduction interventions. Prioritization of the people’s mental and physical health in the process of disaster risk reduction should be in included in frameworks and policy at all levels. Preparation for people who need special assistance, such as those with disabilities, children and women, elderly people, people with chronic illnesses, foreigners and travelers, cannot be made without their own participation in the process of disaster risk reduction planning. 

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To achieve the above, education and training of general health-care providers and the continued development of the field of disaster medicine and public health are the only methods that will lead to long-lasting implementation.

All of this has been in the spotlight at the 3rd World Conference for Disaster Risk Reduction taking place in Sendai, Japan earlier this month. The Hyogo Framework for Action (HFA), endorsed by the UN General Assembly in 2005 to make the world more disaster resilient, will be revised in Sendai to reflect the post-2015 development agenda and give greater emphasis to the health of those vulnerable to the risk of natural disasters. The original HFA did not do enough to influence the design of existing national social protection mechanisms, particularly with regard to health programs and education schemes, which are crucial to building resilience to disasters. The new framework HFA framework under discussion in Sendai is meant to cover the next 20-30 years and will be expanded to include such important areas of social protection, like heath and education, effectively leading to the scaling-up of disaster resilience before disasters hit.

We, as health professionals, are striving to strengthen community resilience to disasters through the improvement of physical and mental health services. To do this, health professionals must be regarded as a key stakeholder working in concert with other professionals in the field of disaster risk reduction.

Shinichi Egawa (Tohoku University)

 

COHRED’s take on Prof. Egawa’s excellent contribution

In this guest post, Shinichi Egawa—Division of International Cooperation for Disaster Medicine, International Research Institute of Disaster Science (IRIDeS), Tohoku University—writes about disaster resilience as a necessary trait of ‘healthy’ societies. Governments across the globe are scaling up their combined efforts to reduce the risk of natural disasters. What role can evidenced-based health research, innovations and findings play in shaping local, regional and global Disaster Risk Reduction (DRR) responses? How can we change from ‘disaster preparedness’ to ‘increasing community resilience’? How can public, private and non-profit interactions be streamlined to increase efficiency and impact and reduce duplication? How can we optimize technology and human resource development in early warning, mitigation and post-disaster response? These and other key issues will be under the spotlight at the forthcoming Forum 2015 in Manila, Philippines, for which Prof. Egawa is part of the DRR scientific committee. COHRED firmly believes research and innovation are key to make societies healthy and thus, as Prof. Egawa maintains in his post, disaster-resilient. We therefore aim to stimulate widespread discussion on specific recommendations to strengthen national (health) research and innovation systems to make societies in low- and middle-income countries (LMICs) more resilient after natural hazards/disasters and adaptable to climate changes. Everyone interested in helping to develop the research and innovation systems of LMICs to become more disaster resilient – should be in Manila in August!

Carel IJsselmuiden (COHRED)

Social determinants of health at the Global Forum on Research and Innovation for Health 2015

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SPEED READ

 – Health is heavily determined by the conditions in which people are born, grow, live, work and age, and these, in turn, are shaped by the distribution of money, power and resources at local, national and global levels. These factors are usually referred to as social determinants of health.

– The Council on Health Research for Development (COHRED) and its partners will host the Global Forum on Research and Innovation for Health (Forum 2015) in Manila, from 24-27 August 2015.

– Social determinants of health cut across many of Forum 2015 themes. In particular, they play a critical role in some of the topics that lay at the core of the programme, namely food safety and security, health in mega-cities and disaster risk reduction.

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As world leaders shift their focus to the post-2015 Sustainable Development Goals, it is important not only to understand the impact of research and innovation on health in relation to broad development objectives, but also, it is critically important to emphasize the role that research and innovation can have in reducing health inequities.

Social determinants of health (SDH) are mostly responsible for health inequities. In other words, health is heavily determined by the conditions in which people are born, grow, live, work and age, and these, in turn, are shaped by the distribution of money, power and resources at local, national and global levels. The role of research and innovation in addressing SDH and promoting health equity has been emphasized by WHO’s Commission on Social Determinants of Health, which in 2008 published the report Closing the gap in a generation: Health equity through action on the social determinants of health: “[I]t is through the democratic processes of civil society participation and public policy-making, supported at the regional and global levels, backed by the research on what works for health equity, and with the collaboration of private actors, that real action for health equity is possible” .

With this in mind, COHRED, in partnership with the Philippine Department of Health and Philippine Department of Science and Technology, will host the Global Forum on Research and Innovation for Health (Forum 2015) in Manila, from 24-27 August 2015. Forum 2015 provides a platform where low and middle-income countries take prime position in defining the global health research agenda, in presenting solutions and in creating effective partnerships for action.

HR_forum logo+dates and placeOver the course of three days, Forum 2015 will use informative and interactive discussions, workshops, networking sessions and activities to allow participants to interact, inspire, learn and partner to increase their own impact. This event will bring together all stakeholders who play a role in making research and innovation benefit health, equity and development. This includes high-level representatives from government, business, non-profits, international organizations, academic and research institutions and social entrepreneurs among others.

The programme for this event will be built around two major pillars showcasing: (1) key concepts needed to improve the efficiency and effectiveness of research and innovation for health and development, as well as (2) ways that research and innovation contribute to solutions to important global health and development challenges faced by low and middle income countries today.

Forum 2015 programme pillars and themes

I. Increasing the Effectiveness of Research and Innovation for Health:
• Social accountability
• Increasing investments
• Country-driven capacity building

II. The role of Research and Innovation:
• Food safety and security
• Health in mega-cities
• Disaster risk reduction

Clearly, social determinants of health cut across many of these themes, but in particular, they play a critical role in the second pillar of this year’s programme, under the themes of food safety and security, health in mega-cities and disaster risk reduction.

For example, the objective of food security is not only to facilitate the accessibility of nutritious and sufficient food for people, but also to provide economic and physical access to food for socially vulnerable groups. Sessions under Forum 2015’s food safety and security theme will focus on research and innovation in scientific, economic, rights-based, and commercial terms to ensure new solutions and scale up existing efforts, to ensure that food and water remain – and become – accessible and affordable to all. Social determinants in this theme reveal themselves in choices taken in agricultural production, access and distribution of food, and even dietary habits and safety standards, which all vary by region and population.

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The rise of mega-cities creates a range of health challenges, both new and old – from the rise of NCDs and return of infectious disease, to traffic related accidents and mental health issues. These issues are shaped by social determinants including housing conditions, unsafe water sources and poor air quality, to poverty, marginalization and limited access to basic healthcare.

With regards to disasters, there is wide international agreement that efforts to reduce disaster risks and increase resilience must be systematically integrated into national policies, plans and practices. As governments all over the globe are taking initiatives to reduce their risks, sessions under the disaster risk reduction theme in Forum 2015 will examine issues related to vulnerable populations who disproportionately bear the brunt of that risk, along with the range of socio-economic factors that influence the health disparities that arise between these vulnerable groups and the general population.

While it is clear that social determinants affect the disparate health outcomes of population groups in relation to food security, health in mega-cities, and vulnerability to disaster, SDH research, as well as the need for high quality research on SDH, could appear throughout the Forum 2015 programme.

Forum 2015 encourages participation by all as the meeting programme spans a wide range of topics and input is welcome in form of organized session proposals and abstracts, also on how to feature SDH more prominently in the programme this year in Manila.

Anthony Nguyen and Charlie Kent (COHRED)

COHRED Fairness Index: Where there is need for best practices in health research collaborations

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SPEED READ

– The field of international health research partnerships is vast and mostly unstructured with gaps that often leave the expectations of actors in international collaborative partnerships unattended. Every year significant amount of global expenditure is drawn towards improving global health through partnerships and yet there are prominent North-South discrepencies in health related benefit sharing around the globe. Evidence has increasingly shown that North-South research partnerships have been plagued by inequity and unfair practices, including the use of Southern research resources to serve Northern priorities. As a result, decades of global support for health research in low and middle-income countries (LIMCs) have not substantially improved the systems that countries need to prioritize, conduct, commission, partner or finance research and to translate results into effective policy, practice and products.

– Availability of global health funds and resources is not adequate to resolve the issue. This is becoming an increasingly accepted vision of many researchers in LMICs who now have a focus on ‘ownership’ and demand for a ‘change in approach’. Indeed, increased involvement of LMICs in their national research and innovation agenda is a pre-requisite for making country-led strategies in health happen and for addressing local priority problems especially those that are not funded by global health funds. Such increased involvement has been an enabling factor for many emerging markets such as India, China as well as Thailand and now the Philippines and South Africa to poise for on-going growth, leveraging this capacity to become globally competitive and to support their own economies through research and innovation.

– It is often challenging for a single institution especially in a LMIC to rise and expand without support from global research and partnerships. To learn from China where according to the World Bank, all Millennium Development Goals are within reach, the country has made promising progress in this direction by holding majority of partnership stakes at all times for amelioration of its national business, research, drug and vaccine production.

– In spite of these efforts, several LMICs lag behind in their ability to sufficiently reap the benefits from research and innovation partnerships for system building and enhancing their economic activity. A crucial bottleneck is that bulk of these benefits finds its way into high-income countries and institutions. In 2005, the economic impact of global health activity in Washington State was such that it bolstered its taxes, jobs and social development. This clearly illustrates how global health research is not merely about global health but also about reinforcement of economic activity, employment and growth – sadly a benefit package streaming into high-income countries.

– The COHRED Fairness Index seeks to change this by proposing a certification mechanism that will encourage a fairer distribution of all benefits of research and innovation – not just products, but also measurable impacts on the economy and system building in LMICs. And ultimately, it intends to increase research and innovation capacity for global health by building up research and innovation systems everywhere – especially in LMICs.

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North-South research partnerships: building on equitable foundations

Years of global support for health in LMICs, has made it clear that international aid from governments, research institutions, for-profit enterprises, non-profit organisations, research sponsors and donors in high-income countries have helped LMICs achieve access to improved health care services and even products. And yet these countries are still seeking to achieve autonomy in priority setting and in aligning their research results and outcomes with their regional policies.

One of the major setbacks of continued donor dependency of LMICs is that they have not been able to address building the relevant capacity required to deal with their own health needs. Indeed, if the guiding principle that health is a public good and that all partners should share the burden and benefits of doing research for health equally, then the choice of identified priorities as areas of work and the investment in local research capacity must become equally important.

Building an environment where equitable research partnerships can flourish is possible. Human Heredity and Health in Africa (H3Africa) research, for example, is a framework aimed at fostering the study of the complex interplay between environmental and genetic factors by investigating   disease susceptibility and drug responses in African populations. Founded by the Wellcome Trust and the National Institutes of Health, H3Africa research initiative spurred from concerns over inequality and exploitation, and strives to place “a firm focus on African leadership and capacity building as guiding principles for African genomics research,” with grants awarded to, and managed by, African scientists and institutions.

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Shaping a useful tool…

In line with this, the Council on Health Research for Development (COHRED) has embarked on the development of a standard: the COHRED Fairness Index (CFI) that would serve as a certification mechanism by providing guidelines for best practices in international collaborative partnerships in research for health. The CFI will not be about ‘naming and shaming’ but rather a mechanism that would encourage improvement of practices in international collaborative research partnerships for health. The CFI will thus include indicators, a measurement process, and a reporting system that is independent, transparent and that can address the key problems, potentials and challenges of collaborative research partnerships. Increased capacity of LMICs to perform research, enhanced ownership of data and results, reduction of harm of research to people, and reduction of reputational risk to all partners in the research process are a few examples of the ultimate impact of the implementation and use of the CFI.

Using a rigorous methodology, the development of the CFI started in early 2014 and its design is the result of a multi-sector consultation approach involving a Technical Working Group (TWG) with 30 representative key stakeholders from NGOs, international organizations, philanthropies, donors, the public and private sector as well as academic institutions. The input received from these key stakeholders in global research and innovation has been consolidated into a report, The COHRED Fairness Index Global Consultation Document. It formulates the outcomes of the consultation and is structured to give an overview of the scope of the CFI, its operational model as well its potential application and uptake by end users. The report is open for comments and contributions from the public until 27 March 2015. The purpose of this global consultation phase is to give every stakeholder outside of the CFI Technical Working Group an opportunity to steer certain aspects of the CFI according to their relevant expertise and needs.

Fair Not Unfair Sticky Note

 

…and making research and innovation work for everyone!

All such input will be invaluable for helping us revise the report, improving the alignment of the principles and scope of the CFI with the real needs of all stakeholders, and making it certain that the new version of the CFI receives broad approval. In April 2015, the Fourth COHRED Colloquium will bring together 80-100 key representatives of different stakeholder groups during a 2-day meeting at the Wellcome Trust in London. The results of the first global consultation will be presented at this meeting. Over the next 6 months, COHRED’s core writing group and Technical Working Group will then prepare an update of this document. Because COHRED seeks to institutionalise fair and equitable practices in international partnerships in research for health, we have decided to prioritize a part of our efforts on developing opportunities for meaningful endorsements or sponsorships to collaboratively sustain and strengthen an inclusive framework where all stakeholders of the CFI feel engaged and own the CFI experience (more information on endorsement or sponsorship for the CFI can be obtained by contacting musolino@cohred.org).

Finally, it is expected that the CFI will be inaugurated before the end of 2015. The pre-launch of the CFI is scheduled this year in August at the Global Forum on Research and Innovation for Health 2015 in Manila, Philippines. With its implementation in January 2016, we hope the CFI will serve its stakeholders to add value to specific areas of operation in research for health allowing to improve the alignment of interests of all partners in global health research in the first instance, and in the long run to increase the capacity of LMICs, to optimize the use of research to improve health, reduce inequity and finally stimulate socio-economic development.

Najia Musolino and Janis K. Lazdins-Helds

Universal Health Coverage: the right path towards equity and development

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SPEED READ

– A large global coalition of more than 500 organizations from over 100 countries, has marked 12 December 2014 as the first-ever Universal Health Coverage Day, to reaffirm that health is a right, not a privilege, and that access to quality health care should never depend on where you live, how much money you have or your race, gender or age.

– Investing in health is a wise choice. Indeed, making universal health coverage a priority for all nations could be the cornerstone of the post-2015 sustainable development agenda and a powerful driver of economic growth in low- and middle-income countries.

– The Council on Health Research for Development (COHRED) proudly supports UHC Day and actively works on a number of activities at the global scale, all aimed at contributing to UHC through making the most out of the impact of research and innovation on the health and development problems of people in developing countries.

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Health is a right, not a privilege

“Health for all, everywhere”. Simple and linear as it may sound, attaining this is indeed a formidable challenge. Each year 1 billion people can’t afford a doctor, pay for medicines or access other essential care, and another 100 million fall into poverty trying to access it. In Africa and Southeast Asia, for example, nearly a third of households have to borrow money or sell assets to pay for health care.

Taking action to rapidly change this grim reality, on 12 December 2012, the United Nations unanimously endorsed Universal Health Coverage (UHC), declaring that everyone, everywhere, has the right to access the quality health services they need without facing financial hardship. Shortly after, Margaret Chan, Director General of the World Health Organization stated that, “Universal health coverage (is) the single most powerful concept that public health has to offer. It is inclusive. It unifies services and delivers them in a comprehensive and integrated way, based on primary health care.”

Responding to that historic call, a global coalition of more than 500 organizations from over 100 countries is now marking 12 December 2014 as the first-ever UHC Day. Spearheaded by The Rockefeller Foundation and WHO, this coalition is stepping up to reaffirm that health is a right, not a privilege, and that access to quality health care should never depend on where you live, how much money you have or your race, gender or age.

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Looking ahead, wisely: invest in health!

Making UHC a priority for all nations is not only a matter of justice and human rights. Rather, it could be the cornerstone of the post-2015 sustainable development agenda and a powerful driver of economic growth in low- and middle-income countries (LMICs). Health improvements drove a quarter of full income growth in developing countries between 2000 and 2011. At this rate of return, every US$1 invested in health would produce US$9-US$20 of growth in full income over the next 20 years.

To revisit the case for health investment, an independent commission of 25 renowned economists and global health experts from around the world came together from December 2012 to July 2013. The commission’s report, “Global Health 2035: A World Converging within a Generation”, was published in The Lancet on December 3, 2013 and launched on the same day at events in London, Tunis, and Johannesburg. The report clearly states that there is an enormous payoff from investing in health, and specifically makes the case that:

– the returns on investing in health are even greater than previously estimated;

– within a generation—by 2035—the world could achieve a “grand convergence,” bringing preventable infectious, maternal and child deaths down to universally low levels;

– taxes and subsidies are a powerful and underused lever for curbing non-communicable diseases and injuries;

– progressive universalism, a pathway to UHC that targets the poor from the outset, is an efficient way to achieve health and financial protection. Although some might believe that UHC is costly, studies consistently show that, when well-managed to provide quality care, it delivers better health outcomes at lower costs.

Thus, there is now widespread agreement that health may transform communities, economies and nations. But to tap into such a potential for development, the way that health care is financed and delivered must change, to be more equitable and more effective. Costs must be shared among the entire population through pre-payment and risk-pooling, rather than shouldered by the sick, and access must be based on need and unrelated to ability to pay.

Benefits can be almost immediate. If out-of-pocket spending for health services is eliminated or even reduced, money that families have to spend on health can now be spent on sending a child to school, starting a business or coping with an emergency. More broadly, UHC policies create resilient health systems: in times of distress, they mitigate shocks to people’s lives and livelihoods; in times of calm, they improve a community’s social cohesion and economic productivity.

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Adding the COHRED touch

COHRED proudly supports UHC Day. Delivering sustainable solutions to the health and development problems of people living in LMICs will require more than tackling health financing. If the medicines, health workers and health facilities do not exist, for example, it will be impossible to move toward UHC. In other words, strengthening health systems will be the key to ensure health for everyone and everywhere.

COHRED’s strong belief is that research and innovation play a crucial role in speeding up progress towards sustainable solutions to the health and development problems of people in LMICs. Either through enabling developing countries to identify their own national research priorities, or by providing leadership and effective solutions to support countries to build their own research and innovation systems for health and development, COHRED works actively to deliver UHC.

Last year, the WHO’s annual World Health Report was focused on “Research for universal health coverage”, remarking that UHC, with full access to high-quality services for prevention, treatment and financial risk protection, “cannot be achieved without the evidence provided by scientific research”. In the report, several examples of COHRED’s work are cited. These include Health Research Web, a global platform for information and interaction on health research for development, and RHInnO Ethics, a platform for research ethics review management.

Reaffirming its own commitment to contributing to UHC through research and innovation, COHRED is currently seeding the future, by shaping novel groundbreaking initiatives. In April 2015, the COHRED Fairness Index (CFI) will be officially presented in London. CFI is designed to provide an assessment tool to stakeholders to measure and report vital information that reflects their performance with respect to transparency, level of engagement, accountability and equity in their collaborations. The aim is to encourage good practices in North-South health research collaborations, for the benefit of health development and innovation in LMICs. Furthermore, COHRED and its partners are gearing up for the Global Forum on Research and Innovation for Health 2015, “People at the Center of Health Research and Innovation”. Planned for August 2015 in Manila, Philippines, Forum 2015 will bring together all stakeholders who have a part in making research and innovation benefit health, equity and development. Finally on stage as leading role actors of their own future, LMICs will take prime position in defining the global health research agenda that better suits their needs, in presenting solutions and in creating effective partnerships for action.

Universal health coverage is the final destination of a journey the World cannot afford to delay. Many paths lead to that destination. COHRED is making its way with determination and optimism about the impact of its global action.

Anthony Nguyen and Carel IJsselmuiden

Fostering sustainable investment in research for health

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SPEED READ

– The Council on Health Research for Development (COHRED) and its partners have recently held an international meeting aimed at identifying opportunities, possible solutions and strategies for moving towards sustainable investment in research for health in low- and middle-income countries.

– The final meeting report offers an overview of innovative financing mechanisms for health research and development, also commenting on the relevance and feasibility of applying such mechanisms in low resource contexts. Recommendations for taking steps towards developing integrated innovation systems, shifting from funding to investment, and engaging in advocacy for research for health financing have also been issued.

– The creation of an ‘African research space’ was recognised as a major driver for optimising African research development while maximising local and global investments. To support this, COHRED has recently launched COHRED Africa in Gaborone, Botswana. COHRED Africa expects to make its technical, advocacy and think tank contributions to science and innovation for health in Africa – and, where appropriate, globally as well.

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Financing health research in a changing landscape

“Healthcare demands in Africa are changing. Ensuring access to clean water and sanitation, battling ongoing communicable diseases and stemming the tide of preventable deaths still dominate the healthcare agenda in many countries. However, the incidence of chronic disease is rising fast, creating a new matrix of challenges for Africa’s healthcare workers, policy makers and donors.” These words, from a recent Economist Intelligence Unit’s report on the future of healthcare in Africa, give a precise idea of the challenges African countries, and more in general low- and middle-income countries (LMICs), will have to face in order to tackle the public health needs of an ever-growing population.

As most stakeholders agree, for health systems in LMICs to be able to cope with existing and future challenges, it is of absolute importance to increase investments in research and development (R&D). But who should pay for health-related R&D in Africa and LMICs? How to mobilise research funding? Can innovative financing mechanisms be identified to help meeting the growing health burden through investing in R&D?

To address these crucial issues, last June, in the framework of the seventh EDCTP Forum in Berlin, Germany, COHRED, in partnership with the West African Health Organisation (WAHO) and the New Partnership for Africa’s Development (NEPAD) Agency, held a meeting on “Sustainable Investment in Research for Health”. Attended by 35 participants from both the public and private sectors and representing European and African institutions, the meeting aimed at identifying opportunities, possible solutions and strategies for moving towards sustainable investment in research for health.

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Integrated innovation systems must be in place

“To help reduce the burden of disease, meet constitutional obligations and spur economic growth, African countries need to increase their investments in health research and innovation”, recently remarked John Ouma-Mugabe, Professor of Science and Innovation Policy at the University of Pretoria, South Africa, in a policy brief.

However, most African countries still rely heavily on external donors and partnerships to fund local research, with the result that research activities do not necessarily respond to development needs of local population but rather of those inhabiting developed countries. In addition, the volume of R&D is significantly insufficient. To break this dependence-poor R&D budget loop and to focus efforts and resources on domestic health demands and priorities, African countries will need to promote innovation, attract investments, and raise funds. Tapping into the possibilities offered by innovative financing mechanisms to either mobilise new revenue or improve the use of existing funds, will certainly play a pivotal role in addressing such complex problems.

Besides overviewing innovative financing mechanisms and assessing the relevance and feasibility of applying such mechanisms in low resource contexts, meeting participants discussed in depth aspects seen as essential for creating the environment in which research financing can happen and the funds eventually raised be spent in a productive way. Accordingly, the issuing meeting report carries recommendations for taking steps towards developing integrated innovation systems, shifting from funding to investment, and engaging in advocacy for research for health financing.

Highlighted actions that should be taken around these issues include, but are not limited to, foster political will and interest through understanding what priorities governments have and showing how research can respond to these; show the actual investments made in research to demonstrate tangible return on investment; create integrated research and innovation platforms to make efficient use of existing resources and thereby incentivise investment; strengthen accountability and transparency to attract potential investors through strong financial and administrative systems; engage the media as an advocate by maximising opportunities to communicate research findings through research-savvy journalists and media-savvy researchers; widen the scope of the audience to include, for example, a range of stakeholders and sectors, such as finance, business, information technology and so on, showing return on investment and thus making health research attractive to all.

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Jacintha Toohey (above), Policy Project Adviser COHRED, and Carel IJsselmuiden (down), Executive Director, The COHRED Group, at the launch of COHRED Africa in Gaborone, Botswana,6 November 2014

Towards an ‘African research space’

Another key point discussed at length during the Berlin meeting was centered on the recognition that moving towards a shared research space would have the benefit of optimising African research development while maximising local and global investments. Although it is still a matter of discussion whether creation of this space – either in the form of a network, an organisation, or a virtual space – should be first implemented at a regional level or immediately be continent-wide, a number of steps were identified as critical in its creation:

– Map the landscape to understand what is already in place and how it can be utilised or improved.

– Harmonise stewardship through tapping into regional leadership bodies and establishing common regulation processes and research agendas.

– Engage all stakeholders through open dialogue and continuous feedback, both during the creation of this space and its operation.

– Secure consistent funding by identifying a range of funding mechanisms to ensure sustainability of the research space.

– Leverage Africa’s potential by creating a strong cohesive whole to stimulate innovation and give it an equal place at the global table.

To support this, COHRED itself has formally launched COHRED Africa in Gaborone, Botswana, three years after appointing the first staff. COHRED Africa is the basis for all our work done in Africa – but – also it will have its own expertise to contribute to COHRED’s global clients and activities. In the company of high level representatives of Botswana, Swaziland, Malawi, Kenya and the African Development Bank, many colleagues with whom COHRED has worked over the years and continues to do so, key partners such as the EDCTP and Pfizer, COHRED Africa expects to make its technical, advocacy and think tank contributions to science and innovation for health in Africa – and, where appropriate, globally as well.

Sylvia de Haan and Carel IJsselmuiden

Note: find below a few examples of the press coverage on the launch of COHRED Africa and relevant discussion

Invest in research to attract funding, African governments told

Scientists contest the value of research

COHRED Africa office prioritises research ethics

Fair research partnerships: being clear over data access, control and ownership

COHRED’s Fair Research Contracting (FRC) Initiative, aimed at identifying best practices for negotiating equitable collaborative research partnerships that could help build sustainable research and innovation systems in low- and middle-income countries, continues to stir interest and to generate positive feedback. Recently, we have received a query via Twitter from Maternova Research, a non-profit affiliate of Maternova, which provides us the opportunity of remarking some important issues.

Maternova tweet

In a collaborative research partnership researchers should always consider the legal, ethical and practical implications for the data access, control and ownership. Research data, can often be referred to under the concept of Intellectual Property Rights. Thus, while some contracts may have specific terms and conditions pertaining to data rights, others may refer to data access under the general clause of Intellectual property rights. Negotiating data access and publication rights is an important and complex issue with some funding institutions placing restrictions such as exclusive ownership and access to research project data. Indeed, the landscape of intellectual property is broad and most often partners in health research lack the tools or strategies to make appropriate decisions that fit a rational engagement.

COHRED’s FRC Initiative aims to encourage research partners to carefully consider how they intend to approach the issue of data rights (often termed data ownership, data sharing or data access) from the outset when negotiating with a collaborative research partnership. While there exists a wealth of literature and some institutions have gone as far as developing template clauses for data rights, we encourage researchers to take the step insofar as it means to address complex issues early on in the research contracting process and not necessarily sign template contracts provided by funding institutions. COHRED’s FRC encourages that such clauses fit the disparate needs of the partner in research. The FRC initiative supports fairer research principles and practice and the maintenance of data integrity. Therefore, issues such as who will own and have access to research data/outputs in research collaborations context are very important.

Depending on the kind of research conducted, data can be varied and thus research partners would need to carefully consider how they wish to make it available for future use, for further research, to others or public benefit. Thus a carefully tailored data access/sharing clause is key.  The difficulty arises when some institutions have specified data sharing policies and the recipient funding institutions find themselves limited in negotiating around such clauses in a contract and as a result feel obliged to sign contracts at the cost of losing the funding where the research data or outputs are owned exclusively by the funding institution. Thus the implication is that data ownership is restricted and may not be freely available for further use in other research undertakings. In such cases, an in depth evidence based analysis can be made to demonstrate that the needs for access to data is the core for the accomplishment of fair research outputs. Under such circumstances, gaps in the clauses need to be filled to ensure that the partner in question has access to essential data.

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Image from “Kofi’s Cheese Project”, a cartoon produced to disseminate the FRC project outputs (http://www.cohred.org/frc/)

We can’t say with certainty that there is one particular template that sets out the best boilerplate language for data access and publication rights. However, there are a number of resources that we have developed to help research partners think through similar issues before signing off on a research contract as well as the types of factors that need to be considered in the negotiation process. This is particularly the case when a funding institution provides a template agreement, which could well be negotiated for more equitable terms. This would go a long way in strengthening global collaborations in health research partnerships.

The FRC Initiative addresses some key challenges relating to Intellectual Property, research costing, technology transfer, the legislative context and data sharing in the health research context. In addition to this we have developed 5 key guidance notes and a guidance booklet to assist in the ‘soft’ skills of negotiation (how to engage with your negotiation partner to get the best results for your organization). These materials aim to assist research-based organisations (who may not have specialist research contracting departments or have a lack of access to legal expertise) to get greater benefit from collaborative research activities about the issues in research contracting, particularly inequitable research collaborative contracting arrangements.

We would like to refer you to our website, where we offer useful guidance on research for health contracting. In particular, we would suggest you to go through the guidance note ‘3’ entitled ‘Ownership & Sharing of Data & Samples’. Also, please check page 17-21 of the FRC document entitled ‘Where there is no lawyer: Guidance for fairer contract negotiation in collaborative research partnerships’. In addition to this, WIPO, the Wellcome Trust, the National Institutes of Health and INDEPTH are typical examples of organisations that have developed extensive policy guidelines on access to research data, outputs and resources.

Jacintha Toohey (COHRED)

 

Note: for other useful links and for reading through sample clauses in research contracts, please go here

Making the case for research and innovation for health in the post-2015 development agenda

In this guest post, Claire Wingfield—product development policy officer at PATH—writes about a new paper exploring why research and development (R&D) of high-priority health tools for diseases and conditions affecting low- and middle-income countries (LMICs) should be a critical component of the post-2015 development agenda.

A dearth of adequate health technologies and interventions targeting poverty-related diseases—like HIV/AIDS, malaria, tuberculosis, and neglected tropical diseases—means that millions of people in LMICs continue to die each year from preventable and treatable diseases and conditions. Progress on developing new interventions targeting the health priorities of LMICs has faltered because these diseases occur almost exclusively among the world’s poorest and most marginalized populations. Thus, there is little or no perceived commercial market encouraging companies to develop products targeting LMICs. Because the health burden imposed by poverty and social vulnerability remains far too high, achieving health for all is one major goal of the post-2015 development agenda.

In a new paper—developed by the Council on Health Research for Development, the Global Health Technologies Coalition, the International AIDS Vaccine Initiative, and PATH—the authors make the case for the inclusion of research and innovation for health as a central component of the post-2015 development agenda. The paper describes the impact that increased investments in R&D and innovation for health—particularly for the world’s poorest—have had in contributing to progress toward achieving the Millennium Development Goals (MDGs)—particularly for MDGs 4 (reduce child mortality), 5 (improve maternal health), and 6 (combat HIV/AIDS, malaria, and other diseases).

Credit: PATH/Gabe Bienczycki
Credit: PATH/Gabe Bienczycki

These investments have helped to create an enabling environment for research in and for the benefit of LMICs by increasing demand for new health technologies, expanding coverage of proven interventions, and strengthening the innovation infrastructure in these countries. Building on the work of The Lancet Commission on Investing in Health—a group of renowned economists and global health experts—the paper discusses the need for increased R&D investments by all countries to achieve the dramatic health gains envisioned in the post-2015 agenda.

Adequate levels of investment, as suggested by The Lancet Commission, are critical for spurring the development of new health tools, provided they align with financing needs in R&D—notably predictability and flexibility. But even that sort of investment alone does not guarantee more products, and it does not drive innovation toward the right type of products—those that are suitable, acceptable, affordable, and accessible to populations most in need. It is essential, therefore, that indicators for R&D for health tools that primarily affect LMICs address a comprehensive set of outcomes including financing needs, infrastructure and human resources needs, enabling policies, necessary partnerships, capacity strengthening, and access requirements.

Because poor health and disability contribute substantially to poverty, research and innovation for health is linked to improving economic prosperity and is critical to eradicating poverty. Therefore, it must be continuously prioritized within the post-2015 development agenda. Ultimately, the success or failure of the post-2015 agenda relies just as much on how the goals and targets are implemented as it does on how progress will be measured. Thus any research and innovation indicators measuring progress against the goals and targets outlined in the post-2015 agenda must also increase accountability of researchers, governments, and funders, and inform research processes. Inclusion of research and innovation for health must facilitate an enabling environment for research and innovation in LMICs and encourage endemic countries to set and pursue a domestically-driven health research agenda.

Credit: PATH/Evelyn Hockstein
Credit: PATH/Evelyn Hockstein

The post-2015 development agenda is an opportunity for LMICs to set their own health agendas and research priorities and to assert their leadership in strengthening the R&D landscape focused on the needs of the poorest and most marginalized populations. Therefore, it is essential that there is broad agreement among all of the relevant stakeholders that research and innovation for health—which includes the scaling up of proven health interventions as well as the development of new and improved high-priority health technologies—is critical to meeting the ambitious goals of eradicating poverty and ensuring sustainable development for all within a generation.

In support of the inclusion of research and innovation for health in the post-2015 agenda, over 150 organizations and individuals recently signed a petition to United Nations (UN) Secretary General Ban Ki-moon and Member States urging the UN to keep the research, development, and delivery of new and improved health tools for diseases and conditions impacting LMICs at the heart of the post-2015 development agenda. It is our hope that the Members States and other UN officials shaping the agenda will head this call.

Claire Wingfield (PATH)

 

Note: From the September issue of TDR news: “We are making good progress in a number of key initiatives with partners. For example, we’ve worked with COHRED, the Council on Health Research for Development, to develop a new internet platform that lists training opportunities and other important research management information in West Africa. West Africa Health Research Web (WAHRWeb) is a database and an announcement platform for research capacity training opportunities like ethics, grant writing, and clinical trials management for the 15 countries of the West African Health Organization (WAHO).”

Ebola virus outbreak: building national research capacity is key to prevention

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SPEED READ #

– The worst outbreak of Ebola virus disease ever is causing havoc in West Africa, with death toll exceeding a thousand people. Accounting for the potential further spreading of the disease and its high mortality rate (55-60% in this outbreak), WHO declared the outbreak a “public health emergency of international concern”.

– Certainly not a top global health priority before, Ebola has been largely ignored, with no investment in research or treatment really made, despite the fact that it has been around for some 40 years.

– The only sustainable long way out is the development of local research and innovation systems for health, in the framework of global research partnership. The Council on Health Research for Development (COHRED) wants to call to action African countries to step up to the ‘research and innovation table’ by developing their own capacity, build funding lines for health research and innovation, and begin regional and international collaboration on the basis of their own priorities. This will help prevent not only Ebola, but also many other conditions prevalent in low- and middle-income countries that are not priorities in ‘Global Health’, therefore do not really attract attention and funding, and so will need to be covered by countries themselves.

# see Notes at the end of post for updates and further information 

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Ebola strikes back

The worst outbreak of Ebola virus disease since the first appearance of this foe in 1976 in the Democratic Republic of Congo and in Sudan, is currently on stage. At the time of this writing, some 3069 suspect cases with 1552 deaths have been reported by the World Health Organization (WHO), of which 1752 cases and 897 deaths have been laboratory confirmed to be Ebola. First hitting the remote south-eastern forest region of Guéckédou in Guinea at the end of last year, it did not take much for the infection to spread to Guinea’s capital Conakry and then to neighbouring Liberia and Sierra Leone. More recently, Nigeria has also reported several suspect cases and at least six deaths, and infected people leaving the epicentre area have travelled as far as Saudi Arabia, Spain, Turkey and the United States. Accounting for the potential further spreading of the disease and its high mortality rate (55-60% in this outbreak), on 8 August 2014 WHO declared the outbreak a “public health emergency of international concern.

Although it has been around for some 40 years now, not much is known about Ebola virus, its origin, ecology, and transmission. Evidence has accumulated suggesting that fruit bats are the likely natural reservoir for Ebola virus, but humans can become infected upon close contact with a number of other animals, including chimpanzees and monkeys. Human-to-human transmission occurs from direct contact with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids. There is currently no specific treatment to cure the disease, although several drugs are under development. Patients are (or should be) kept in isolation and given intensive supportive care.

2014 Ebola outbreak in West Africa. The putative first virus introduction and epicenter are in the vicinity of the town of Guéckédou in the Guinea southeastern forest region. Source: Centers for Disease Control and Prevention
2014 Ebola outbreak in West Africa. The putative first virus introduction and epicenter are in the vicinity of the town of Guéckédou in the Guinea southeastern forest region. Source: Centers for Disease Control and Prevention

Research is key to prevention

“The precise factors that result in an Ebola virus outbreak remain unknown, but a broad examination of the complex and interwoven ecology and socioeconomics may help us better understand what has already happened and be on the lookout for what might happen next, including determining regions and populations at risk,” recently wrote Daniel Bausch and Lara Schwarz in a PLoS Neglected Tropical Diseases’ editorial. “Although the focus is often on the rapidity and efficacy of the short-term international response, attention to these admittedly challenging underlying factors will be required for long-term prevention and control,” these authors continued.

Most likely, the relationship between Ebola and underdevelopment has played a major role in the outbreak emergence. Although rich in natural resources, Guinea is one of the poorest countries in the world, and precarious living conditions might well have caused people in search of food and wood in the forest to come into contact with infected animals, favouring viral spillover. The effect of environmental change on Ebola outbreak in West Africa and disease dynamics is another obscure issue. “So intriguing puzzles remain. Untangling these – through research that combines environmental, epidemiological, virological, veterinary, and social science with local knowledge – will be key to predicting and preventing future outbreaks of Ebola – in this and other regions,” remarked Melissa Leach.

So, consensus is growing around a pivotal point: research is needed in order to prevent even more devastating Ebola outbreaks in the future. And the Ebola story that is hitting worldwide headlines nowadays might serve as a paradigm for many other conditions prevalent in low- and middle-income countries (LMICs), but that in a shrinking world might rapidly become of international concern. Ebola has been largely ignored, with no investment in research or treatment really made, because a few hundred cases in a tropical country are not enough to end up on the ‘global health priority’ list. On the other hand, the failing status of health system in the outbreak region has been known and described for many years. In other words, nothing is new in this outbreak other than its magnitude and spread beyond West Africa.

What is the long way out? The answer lies in the development of local research and innovation systems for health, in the framework of global research partnership. Building national research capacity in LMICs will help improve health systems–not only for Ebola, but for a number of other ailments that are, or might become tomorrow, ‘under the radar’ globally speaking–through health systems research. Strengthening health systems in LMICs will also help to address questions that are locally relevant but do not show up in global ‘burden of disease’ statistics, possibly tapping into local knowledge and experiences, as suggested for Ebola. Finally, this approach can create innovative environments for global health because new researchers, new innovators, new business get active in global health research and innovation, attracting investments and spurring international collaborations.

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A call to action

COHRED expresses the deepest condolences to all who lost family and friends, and countries who lost citizens to a neglected disease that has caused epidemics since four decades.

 COHRED’s work is totally relevant to the future prevention of this condition, both in terms of building national capacity in this region for ‘health systems research’ and in terms of making sure that countries for whom this is a priority will actually treat it like a research priority, unlike the rest of the world who pays attention because it now spreads outside a well-contained area. In the medium-to-long term, developing such research capacity can potentially lead to innovation capacity, in which solutions to priority problems come from the countries where the priorities are.

While Ebola virus is now under the spotlight, COHRED wants to call to action African countries (and other LMICs) to step up to the ‘research and innovation table’ by developing their own capacity, build funding lines for health research and innovation, and begin regional (and international) collaboration on the basis of their own priorities. Looking beyond the immediate horizon and, say, Ebola, this effort must comprise all major reasons for morbidity and mortality in LMICs, most of which are not priorities in ‘Global Health’, therefore do not really attract attention and funding, and so will need to be covered by countries themselves.

This is where COHRED can add value, with our ‘technical support’, ‘practical tools’, and ‘global action’ that support LMICs to build their own research and innovation systems for health, aiming at locally relevant, sustainable systems, not only to fight Ebola, but to tackle all health problems facing countries.

Carel IJsselmuiden and Gerald Keusch

 

Note: The devastating Ebola outbreak has been recently featured in the September issue of TDR news.

Note: “There’s never been a big market for Ebola vaccines,”…..that’s why  Ebola Vaccine, Ready for Test, Sat on the Shelf…..until now!

Note: Since the appearance of our post on the necessity of fighting Ebola by building national health research capacity, others have shared this view in the ongoing public debate. Here follows what recently expressed on the topic by South Africa Science and Technology Minister Naledi Pandor (the original press release can be found here):

Urgent need to build research capacity in Africa

20-10-2014

Pretoria – Science and Technology Minister Naledi Pandor says the Ebola outbreak in West Africa has illustrated the urgent need to accelerate focused investment in research in Africa.

This as the world is grappling with containing the virus that is devastating West Africa, with a death toll standing at over 4 000 currently. Most of the victims are in Guinea, Liberia and Sierra Leone.

Speaking at the European Organization for Nuclear Research (CERN) celebration of 60 years of peace and development in New York on Monday, Minister Pandor said science has been a significant contributor to social development in many parts of the world, citing breakthroughs to eradicate diseases such as polio and smallpox as a result of drug and vaccine development. 

“It is imperative for Africa’s scientists to work in Africa if they are to support development on the continent, if they are to play a role in smooth technology transfer and if they are to drive innovation,” the Minister said, citing the example of the Square Kilometre Array, which was resulting in brain gain for Africa for the first time in four decades.

Sub-Saharan Africa contributes about 2.3 percent of world’s Gross Domestic Product, but is responsible for only 0.4 percent of global expenditure on research and development. With 13.4 percent of the world’s population, it is home to only 1.1 percent of the world’s scientific researchers. 

Minister Pandor said it was thus logical to propose that focused, well-designed investment in science and innovation could offer Africa new opportunities for development in a range of sectors, as African countries were the major consumers of products of advanced scientific discovery.  

“Building world-class research infrastructure was one of the pillars for building competitive, knowledge-based activities to attract the best human capital resources,” she said. 

The Minister added that she was pleased by the significant contribution CERN had made to increasing world knowledge in new areas of scientific research.  

“We are pleased that several African countries have scientists who have participated in the Large Hadron Collider (LHC) research initiatives and we congratulate the leadership of CERN, who have been true world scientists seeking to attract scholars from the global community to the LHC,” she said. 

The CERN event celebrates the values of science and promotes the role of science in international debates and decision-making, and it actively supports science, technology, engineering and mathematics education.

Other speakers included Ban Ki-moon (UN Secretary-General), Prof. Carlo Rubbia (Nobel Physics Prize winner and former Director-General of CERN) and Kofi Annan (Nobel Peace Prize winner and former UN Secretary-General).

Research for Health must stay at the heart of the post-2015 Sustainable Development Framework

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SPEED READ

– Work on outlining the post-2015 development agenda is coming to an end. The UN 68th General Assembly will meet in New York in September to define a set of Sustainable Development Goals (SDGs).

– “Ensure healthy lives and promote well-being for all at all ages,” reads proposed SDG 3. However, where does research for health stand in the new framework’s draft?

– To make sure that research, development, and delivery of new and improved health tools are kept at the heart of the post-2015 development agenda, the Council on Health Research for Development (COHRED) teamed up with the Global Health Technologies Coalition (GHTC) and the International AIDS Vaccine Initiative (IAVI) to address an appeal to Secretary General Ban Ki-Moon and Member States of the UN.

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Looking beyond 2015

While the current Millennium Development Goals expire next year, work on outlining the post-2015 development agenda is brewing up. The UN 68th General Assembly will meet in New York in September to define a set of Sustainable Development Goals (SDGs) to focus on in the 15 years to come. The new “Sustainable Development Framework 2015-2030” is the result of a lengthy process. In particular, the proposal on SDGs was prepared by a 30-member Open Working Group (OWG), established under mandate by the Rio+20 Outcome document in June 2012. The OWG final report lays out some 169 targets spread across 17 SDGs that range from ending poverty in all its forms everywhere to strengthening the means of implementation and revitalize the global partnership for sustainable development.

Despite the considerable efforts deployed so far and the undeniable progress done in the process of arriving at this new post-2015 framework, however, many observers fear that to ensure “healthy lives at all ages”, one of the key goals currently envisioned in the development framework, a more explicit and full support to health research and related policies and capacity building will be needed in the final discussion.

To make sure that research, development, and delivery of new and improved health tools are kept at the heart of the post-2015 development agenda, COHRED teamed up with GHTC and IAVI to address an appeal to Secretary General Ban Ki-Moon and Member States of the UN.

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The appeal

We, the below signatory organizations request that the UN fully supports in the post-2015 SDG-Framework the research, development, and delivery of new and improved medicines, vaccines, and other health tools for the diseases and health conditions that predominantly affect low- and middle-income countries as well as marginalized, vulnerable populations globally.

Thanks to the leadership of the UN and investments by Member States, the current Millennium Development Goals have made major contributions to improving the health and lives of millions of people around the world. A sustained focus on some of the greatest global health challenges has led to enormous progress in many areas, including significant improvements in the development and delivery of health tools such as drugs to treat HIV/AIDS, tuberculosis (TB) and malaria. Efforts to tackle diseases have also helped underpin progress in other important areas, such as gender equality, child mortality, and maternal health. Millions of lives have been saved.

However, major challenges remain, and the health burden imposed by poverty remains far too high. In this context, it is essential that the post-2015 development agenda retains a strong focus on eliminating poverty-related diseases and conditions. The post-2015 agenda must build on previous achievements to ensure that healthy lives and access to health services can be achieved in an equitable and sustainable way, leaving no one behind. This means ensuring universal access to proven health interventions. But it also means developing and delivering new health technologies which can help address the shortcomings of existing interventions and sustainably reduce morbidity and mortality over the longer term. This will require continued support for the research, development, and delivery of new tools to combat major epidemics like HIV/AIDS, TB, and malaria, as well as other poverty-related diseases and conditions ranging from neglected tropical diseases to reproductive, maternal, and child health. Continuous investment of human and financial resources in science, technology, and innovation is essential to achieve both economic and social development for all.

We are encouraged by the current inclusion of the need to support the development of new medicines and vaccines for diseases particularly affecting developing countries in the Zero Draft document of the Sustainable Development Goals. Concern remains, however, about the omission of medical devices and diagnostics which also contribute to improving health outcomes, the lack of clarity on how this effort will be funded, and how supporting policies, incentives, capacity building, collaboration, and knowledge and technology sharing will be defined and implemented.

As organizations working to save lives and improve health, we urge you to commit explicit and full support to health research and related policies and capacity building as a core component of a new, post-2015 agenda for equitable health and sustainable development for all. We ask that you press Member States to offer similar support, and to formally assess how to measure progress towards this goal, and how to fully and sustainably finance and enable the research, development, and delivery of essential new and improved health tools.

PATHMVI

A bigger role for science

It is not only the commitment to research for health that needs to be reinforced. Apparently, the recommended SDGs contain several other science-related issues that require attention. According to a recent SciDev.Net article, “[m]any of the quantified targets based on scientific evidence that appeared in earlier documents that laid out the SDGs have been replaced by blanks or removed entirely in the final document”. In other words, science experts fear that by approving a final resolution with vaguely indicated targets will permit politicians to adjust following efforts on the basis of economic convenience rather than scientific evidence. “For example, in April, possible climate change targets included an explicit two degrees Celsius limit, and dates for when carbon emissions should be arrested and reduced. The current outcome document is silent on these issues,” continues the SciDev.Net article.

 Carel IJsselmuiden

Kofi’s Cheese Project: Tools for negotiating fairer research partnerships

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SPEED READ

– The Council on Health Research for Development (COHRED) today launched Phase 2 of its Fair Research Contracting (FRC) Initiative, aimed at identifying best practices for negotiating equitable collaborative research partnerships that could help build sustainable research and innovation systems in low- and middle-income countries (LMICs).

– Phase 2 outputs include guidance notes presented in a checklist format to allow researchers to work through key issues within important areas of research contracting; a guidance booklet aimed at addressing the ‘softer’ skills of negotiation, in order to prepare those inexperienced in research contracting for the reality of the negotiating process; and a cartoon entitled Kofi’s cheese project.

– “This new guidance provides straightforward advice about steps to take to make sure that the opportunities which collaborative health research presents to institutions are maximised, especially where contracting capacity is limited or absent”, said Danny Edwards, Programme Manager, Fair Research Contracting Initiative.

– Plans are underway for COHRED Colloquium 4, at the Wellcome Trust, London, United Kingdom, in the near future, which will look at designing a Fairness index for International Collaborative Health Research. The Colloquium is co-hosted by the Wellcome Trust.

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Getting to fairer research contracts 2.0

Collaborative health research has grown significantly in recent years, not only in terms of quantity, but also as for complexity of study design and geographical distribution. This has increasingly involved multi-centre collaboration, with research institutions based in high-income countries (HICs) seeking to establish partnerships with institutions in LMICs. But while HIC partners are usually fully aware of intellectual property rights and know how to maximize the benefit of research for their institutions, such knowledge is less present in LMICs generally, and in Africa particularly. This asymmetry can severely limit LMICs’ power to negotiate favourable contracts and achieve equitable allocation of benefits of research to participating institutions and individuals. Consequently, international research partnerships risk missing opportunities to build research and innovation capacity and national development.

Last year, about this time, COHRED launched a new guidance document on fair contract negotiation in collaborative research partnerships, thanks to funding from the NWO Science for Global Development Programme (WOTRO). This was part of a broader initiative aimed at identifying best practices for the research contracting (negotiation) process that could help build sustainable research and innovation in LMICs. The guidance was developed particularly for contexts where there may be no lawyer or legal expertise, or where these might be present but associated with limited capacity.

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Although “[t]he issue of inequitable research partnerships is not new …… previous work has not addressed the crucial role that equitable contracts play in defining the nature of research collaborations, in building the foundations for successful long-term partnerships, and in enhancing the research systems of LMICs. The essential difference in our guidance document is that it attempts to shift control over negotiating research benefits to the LMIC partner, instead of reliance on the good intentions of the high income country partner,” wrote COHRED’s Debbie Marais and Carel IJsselmuiden in the Lancet Global Health blog.

Following the great success of the guidance, COHRED FRC Initiative is now entering ‘Phase 2’.

New FRC tools launched in June

With the support of the Doris Duke Charitable Foundation, five more accessible guidance notes have been established in a checklist format, to allow researchers in organisations with limited contracting capacity to systematically work through the key issues involved in the key problematic areas of research contracting:

  • Fair research contracting
  • Intellectual property
  • Data ownership
  • Technology transfer and system optimisation
  • Indirect costs

Each of these guidance notes includes key questions to consider, a case study, a list of relevant tips/lessons, and an indication of where to look for additional information.

“This new guidance provides straightforward advice about steps to take to make sure that the opportunities which collaborative health research presents to institutions are maximised, especially where contracting capacity is limited or absent”, said Danny Edwards, Programme Manager, Fair Research Contracting Initiative.

Another practical output of the second FRC phase has been the development of a guidance booklet aimed at addressing the ‘softer’ skills of negotiation, presented through a series of vignettes/case studies to prepare those inexperienced in research contracting for the reality of the negotiating process. This new enabling document is organized to cover the three stages of the negotiation process, based upon the lifecycle of a research contract: pre-contract negotiations, contract, and post-contract.

“We also wanted to provide guidance to assist in the ‘softer’ skills of negotiation – how to engage with your negotiation partner to get the best results for your organisation. To us, and to researchers we spoke to, this was viewed as just as important as understanding the technicalities of a research contract,” said Jacintha Toohey, Project Assistant on the Fair Research Contracting Initiative.

The guidance booklet frames the issue like this within the introduction:  “Key to understanding negotiation is appreciating that: Simply because something arrives in a pro-forma contract, it does not mean it is non-negotiable. With the right approach, many things can be negotiated; A mutually beneficial relationship means that partners enter negotiations with mutual respect and balanced power. This is particularly important when partners might appear to be different levels of bargaining power.”

Last but by no means least; a super nice cartoon – the story of Kofi the mouse and its cheese project – has been produced to disseminate the project outputs even further. The rationale for this choice is grounded on the increasing use of cartoons as a winning communication strategy to effectively convey ‘serious’ messages to a more diverse audience.

What next?

This new set of guidance is just the next step in the Fair Research Contracting Initiative’s plans. In the next phase, we will be transforming our contracting support into a web-based decision support system. In the meantime, we welcome feedback on how we can further improve these tools.

In addition, plans are well underway for COHRED Colloquium 4, at the Wellcome Trust, London, to be held in London, United Kingdom, in the near future, which will look at designing a Fairness index for International Collaborative Health Research. The Colloquium is co-hosted by the Wellcome Trust.

Colloquium 4 will bring together decision-makers from all the sectors engaged in global research and innovation for health to design an innovative research-based index to boost multi-stakeholder research collaborations by taking into account the expectations of fairness of all the partners.

Regrettably, now that this ‘finish line’ has been reached, Danny Edwards is now moving on from this project to take on a fresh challenge at another organisation. Golbahar Pahlavan has joined COHRED in the meantime, and will be looking after Colloquium 4 amongst other responsibilities. Jacintha Toohey will continue to work and support the team in helping to make research contracts fairer.

Danny Edwards, Golbahar Pahlavan, Jacintha Toohey and Carel IJsselmuiden