Another Open Letter to the Minister of Health: Please Don’t Let Canadian Health Research Wither.
At the beginning of this Summer, the dire predicament of health research in Canada was detailed in an open letter co-signed by over 1300 researchers. The Minister of Health, Dr. Jane Philpott, convened an emergency meeting on July 13th to address the problems caused by changes enacted by the Canadian Institutes of Health Research, the government funded agency tasked with supporting this type of research. Sixty researchers and CIHR staff met in Ottawa to hammer out a list of recommendations to rescue the peer review process by which applications for funding of new ideas are vetted. The agency had rolled out a series of major changes that were characterized by many as a train wreck. Since the next funding competition was scheduled for this Fall, it was critical to prevent a similar calamity. As a result of the Ottawa meeting, assessment of grants submitted to this Fall’s competition should be improved. Two days after the meeting the outcomes of the previous competitions were announced (here and here). Just under 13% of submitted projects were funded, a historical low for the agency and well below the fraction that can be reliably ranked by peer review. Success rates (the percent of applications funded out of all applications submitted) are projected to fall further in the near future, possibly into single digits, leaving thousands of health researchers with no research funding. Why does this matter?
Like all countries, Canada faces challenges in ensuring the health of its citizens. A combination of demographics and increasing drug and provision costs has caused health to become by far the largest government expenditure (well over $200 billion in 2015). In contrast, we spend under $1 billion — less than half a percent of our healthcare budget — on health research. When CIHR was formed in 2000, the stated intent was for it to grow to 1% of health spending. In the US, the primary health research funder is the National Institutes of Health (NIH). Although the US has a population 10X that of Canada, the NIH budget is over 40X the size of that of CIHR. The US invests heavily on health research because it has consistently driven innovation and improved quality of life.
So why don’t we just let the rest of the world do the research, from which we can learn and apply the results?
First, much health research is conducted in academic health sciences centres across Canada. These places comprise teaching hospitals, clinics and other sites of care that, not coincidentally, are also among the most respected of our healthcare institutions and are largely responsible for training medical students. Research is core to these centres’ mission of providing the best possible health care today while also actively improving the quality, effectiveness, and efficiency of future care. As opportunities for research in Canada shrivel, many of these centres will lose their best scientists and clinicians to other countries. Second, we will not solve the impending tsunami of challenges to our healthcare system by waiting for other countries to develop and test solutions. In her recent speech at the Canadian Medical Association’s General Council, Minister Philpott named four ingredients of sustainable health care: prioritizing social determinants of health; upholding the Canada Health Act; strengthening primary care, including home care; and building patient-centred digital systems. Few solutions in these domains can be easily imported from elsewhere. Third, when health research happens elsewhere, any commercializable benefits accrue to foreign inventors instead of expanding and growing a promising sector of the Canadian economy. Fourth, scientists around the world are still working to understand our basic biology, let alone diseases. That’s a major reason so many drugs fail during development. Given some headlines, it is understandable to think we are on the cusp of curing cancer, Alzheimer’s and other diseases. While progress has been made, there remains so much more to be done. Canadian health researchers have historically punched above their weight, internationally. If our progress slows, new treatments and cures will fade even further into the distance.
The health research community realises there is a possibility that government will wait until CIHR gets its act together before considering new funding. This would be disastrous as many excellent research programs are on the brink of collapse. Scientists have already faced under-financing due to poor preparation and implementation of new CIHR funding processes, which has resulted in highly skilled staff and scientists losing their jobs and promising lines of research being brought to an abrupt halt. Students, seeing this uncertainty and lack of opportunities, are choosing other career options. Since training often takes longer than a decade, the consequences will be felt for many years.
So what is the solution when government confidence in CIHR is shaky, at best, and yet the agency is the primary means by which essential health research is supported? Allowing the agency to languish in its current state for another year will result in irrevocable damage to health research in Canada at a time when it is arguably most needed. The projected single digit success rates for the next CIHR competitions will be the last straw for hundreds of researchers. Government knows that CIHR doesn’t perform research itself: that is the function of scientists, researchers, clinicians, technicians and trainees across the country. Yet it is these bright, hardworking people — and, more importantly, the people across Canada who might have benefitted from their research — who will bear the brunt of a funding freeze. With the guidance of a working group of active researchers, CIHR has been restoring attributes associated with international gold standards of peer review. But no amount of improvement to such processes will substitute for the atrophy in funding (25% reduction in real terms since 2007). Our government must realise that it needs to invest substantive additional resources to health research, either under current agency leadership or under a new regime. The status quo is surely unthinkable — especially for a government known for its appreciation of scientific evidence, the potential of Canadian ingenuity and the impending need for better health solutions in our future.
Director of Research, Lunenfeld-Tanenbaum Research Institute
Assistant Professor, Laval University and national co-chair, Association of Canadian Early Career Health Researchers