Copyright: Knowledge Utilization Research Center Chapter 3 How Global Health Research Strengthens Research in Countries Knowledge Utilization Research Center

Copyright: Knowledge Utilization Research Center Dr Reza Majdzadeh Epidemiologist Knowledge Utilization Research Center; Tehran University of Medical Sciences 2 /46

Imbalances- 1  Gaps and imbalances as characterized by the '10/90' where only 10% of resources are spent on research into 90% of the world's health problems.  2:1 ratio in R&D funding allocated to non- communicable diseases (NCDs) and communicable diseases (CDs) respectively. Copyright: Knowledge Utilization Research Center3

Imbalances- 2  USA: Of 2,900 medicines in development in 2008, 750 (25%) of the compounds were cancer drugs, 312 (10%) for heart disease and stroke and 109 (3.7%) for HIV/AIDS.  Within the private not-for-profit sector, noncommunicable diseases are also widely covered by charity funding, while communicable disease funding remains almost exclusively in the realm of private foundations. Copyright: Knowledge Utilization Research Center4

Imbalances- 3  The above findings partially explains the fact that of the 1,556 new drugs developed between , only 21 (1.3%) were for tropical infectious diseases of the developing world.  Research portfolios must be more balanced and should include support not just for generation of new knowledge but for utilization of existing interventions, i.e. 'implementation research' referred to previously. Copyright: Knowledge Utilization Research Center5

Imbalances- 4  A survey of the major health research funders in the UK, for example, found that health services research received only between % of all the research grants awarded. Copyright: Knowledge Utilization Research Center6

Imbalances- 5  WHO spent approximately $215 million on research through its involvement in more than 60 research networks and partnerships. Based on DALYs, it was also estimated that 84% of the funding is in communicable, maternal, perinatal and nutritional diseases (40% of DALYs) and 4% is allocated to noncommunicable diseases (48% of DALYs). Copyright: Knowledge Utilization Research Center7

Imbalances- 7  An imbalance can be seen in the types of research being supported. In a survey of 140 major funders of health research globally, it was shown that most research is being done on developing new interventions rather than research to make better use of existing interventions.  A survey of the major health research funders in the UK, for example, found that health services research received only between % of all the research grants awarded. Copyright: Knowledge Utilization Research Center8

Imbalances- 8 Copyright: Knowledge Utilization Research Center9

Imbalances- 9 Copyright: Knowledge Utilization Research Center10

 Global Strategy and Plan of Action (GSPA) in Public Health, Innovation and Intellectual Property is expected to address such inequities.  Importantly, the GSPA will be implemented; 'transfer of technology', 'application and management of intellectual property (IP)', 'promoting sustainable financing mechanisms' and 'establishing monitoring and reporting systems’. Copyright: Knowledge Utilization Research Center11

 The Consultative Expert Working Group for Innovative Financing of R&D (CEWG) has been convened to make recommendations on some future innovations in the financing of health R&D. It is expected to complete its work in Copyright: Knowledge Utilization Research Center12

 US NIH has recently announced that it is providing a royalty free license for patents on darunavir (an antiretroviral drug) to the Medicines Patent Pool.  This a welcome political statement that the Obama Administration recognizes the importance of a competitive supply of low cost generic medicines in the struggle to make AIDS treatment more sustainable. Copyright: Knowledge Utilization Research Center13

 In another recent example of a partnership to facilitate access to medicines in developing countries, a collaboration between a manufacturer and an NGO successfully provided access to treatment for a life- threatening condition, chronic myeloid leukaemia (CML) to eligible patients in 80 countries worldwide. Copyright: Knowledge Utilization Research Center14

 Trade-Related Aspects of Intellectual Property Rights (TRIPS) Copyright: Knowledge Utilization Research Center15

Gaining public trust I Copyright: Knowledge Utilization Research Center16

 Ten years after the completion of the draft sequence of the of the human genome, and rapid conceptual and technological advances in genomics and DNA sequencing technologies, we have witnessed, for example, the development of biobanks, many of which have been established in developing countries and bring with it complex ethical questions. Copyright: Knowledge Utilization Research Center17

 Other ethical and regulatory challenges are linked with novel cutting edge technologies with important implications for health such as stem cell research, nanotechnology and synthetic biology. As the first patient enters a trial to test the use of stem cells in treating spinal injury, major concerns are also being expressed globally about ethical and regulatory issues around the testing of these relatively unproven medical technology, as well as related areas of human cell and tissue transplantation. Copyright: Knowledge Utilization Research Center18

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 In July 2002, for example, only 250 peer-reviewed open access journals existed. In 2010 this number has increased to nearly 3000, representing approximately 18% of all journals.  WHO's HINARI initiative, enabling developing country researchers full text access to more than 7,000 journals, has been mentioned previously. Copyright: Knowledge Utilization Research Center20

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 In 2008, the WHO and the Wellcome Trust initiated discussions about the development of a Code of Conduct on the sharing of data of public health importance. Copyright: Knowledge Utilization Research Center22

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(1) the proliferation of initiatives and the 'dream' of coordination'; (2) overemphasis on new players rather than reforming and strengthening existing institutions; (3) donor influence on priority setting and their lack of accountability; (4) the rhetoric of health (research) systems; (5) going around government; (6) channeling funds through organizations in the developed world; (7) linking health (research) to broader issues affecting human security and development. Copyright: Knowledge Utilization Research Center28

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