1. Creating a Sustainable Health Research Enterprise in Canada Presentation to the Health Research Board of Ireland February 27, 2015 Alain Beaudet, MD, PhD President, Canadian Institutes of Health Research

2. CIHR was created to support health research excellence CIHR’s mandate is “to excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened Canadian health care system” CIHR was created in 2000 under the authority of the CIHR Act and reports to Parliament through the Minister of Health CIHR was created to transform health research in Canada by: funding more research on targeted priority areas building research capacity in under-developed areas, such as population health and health services research training the next generation of health researchers; and focusing on knowledge translation, so that the results of research are transformed into policies, practices, procedures, products and services for improved health outcomes and healthcare 2

3. CIHR’s Four Pillars 1.Biomedical3.Health Services 2.Clinical4.Population Health Ethics Knowledge Translation 3

4. Addressing Health Research Priorities through 13 Institutes CIHR is a unique model for health research With its 13 Institutes, CIHR has become a meeting ground for Canada’s health research community The model enables optimal use of existing knowledge to fill research gaps, maximize cooperation and minimize duplication Population and Public Health Gender and Health Aboriginal Peoples’ Health Health Services and Policy Research Genetics Infection and Immunity Nutrition, Metabolism and Diabetes Cancer Research Neurosciences, Mental Health and Addiction Aging Musculoskeletal Health and Arthritis Circulatory and Respiratory Health Human Development, Child and Youth Health 4

5. CIHR is a key player in the Federal Government’s S&T Structure Prime Minister Minister of HealthMinister of Industry Minister of State (Science and Technology) Other Cabinet Ministers Natural Resources Canada Fisheries and Oceans Canada Environment Canada Transport Canada Defence Research and Development Canada Agriculture and Agri-Food Canada National Defence Foreign Affairs, Trade and Development Industry Canada Health Canada Public Health Agency of Canada Canadian Institutes of Health Research Canadian Food Inspection Agency Canadian Foundation for Healthcare Improvement Statistics Canada National Research Council Genome Canada Canada Foundation for Innovation Social Sciences and Humanities Research Council Natural Sciences and Engineering Research Council Canadian Space Agency Departments with national laboratories Federal agencies conducting research Research funding agencies Foundations 5

6. The Financial Context CIHR’s Total Budget * Anticipated budget, including 2014-15 Supplementary Estimates C 6

7. CIHR investments and average relative citations index in medical research CIHR Investments 2000-2005 (Constant $) Average Relative Citations Index in Medical Research (2005-2010) 7

8. CIHR has maintained its competitiveness by leveraging investments from external partners 8 CIHR’s leveraged funds from formal partnership agreements (constant 2008-2009 $) 8

9. Bottom up Strategy: Investigator-Initiated (Open) Research Full spectrum of CIHR mandate Top Down Strategy: Priority-Drive (Strategic) Research Targeted to specified areas of health research and knowledge translation. These programs and initiatives are intended to: Focus on gaps in specific research areas and research communities or Leverage existing strengths for impact Open to all areas of health research and knowledge translation. This suite of programs is intended to: Capture excellence across all pillars Capture innovative/breakthrough research Improve sustainability of long-term research enterprise Integrate new talent Funding Tools: Investigator-Driven vs. Priority Driven 9

10. 10 Supporting health research through investigator- and priority-driven investments *Anticipated budget, including 2014-15 Supplementary Estimates C and adjustments to be provided by Treasury Board Figures in Euros based on current rate of exchange Investigator Initiated operating Support CIHR Budget 2014/15 = 712.67 million EUR* 10

11. Type of investments by pillar 11

12. CIHR has made progress in strengthening each of the four pillars Biomedical Clinical Health Systems / ServicesSocial / Cultural / Environmental and Population Health 12

13. Quality of the idea Feasibility and appropriateness of the approach Multidisciplinary committees Integration of results Best minds: Foundation Scheme Best ideas: Project Scheme Successful candidates selected Caliber of applicant Vision for program Quality of program Quality of environment Multidisciplinary committees Integration of results STAGE 1STAGE 2STAGE 3 STAGE 1 STAGE 2 Reform of CIHR’s granting system 13

14. Increasing success of pillars 2, 3, 4 researchers in CIHR investigator-initiated programs Distribution of Applications by Pillar Distribution of Applications by Pillar for Stage 1 of CIHR’s first Foundation Scheme competition Percent of Applications (%) BiomedicalClinicalHealth Systems/ Services Social/Cultural/ Environmental/ Population Health % of Successful Applications % of Submitted Applications Historical OOGP Data (% of Successful Applications) 14

15. Promising results from new/early career researchers in investigator-initiated programs 15

16. Canada excels in all health research sectors Less Specialized World Average More Specialized Specialization Index (SI) Less Impact World Average More Impact Average Relative Citations (ARC) Clinical Medicine Biomedical Research Biology Public Health and Health Services Psychology and Cognitive Sciences Source: The State of Science and Technology in Canada, 2012 16

17. The Canadian health system does not perform as well United-Kingdom 2 nd United States 7 th Netherlands 1 st Canada 6 th New-Zealand 5 th Germany 4 th Australia 3 rd Quality Care 2345176 Access 126.5345 Efficiency 3125467 Equity 1243657 Overall Ranking (2010) 1.00 - 2.332.34 - 4.664.67 to 7.00 Source: The Commonwealth Fund Despite the excellence of the Canadian health research, Canada faces a challenge in turning this powerful information into high-quality and cost-effective care 17

18. Canada is facing an increasing burden of diseases and increasing costs in the healthcare system Since 2000, health-care costs have more than doubled, surpassing the $200-billion mark in 2011 (including $50 billion of federal investments) The growing burden associated with aging will only exacerbate the financial pressure already experienced by governments Evidence shows that 50% of patients do not get treatments of proven effectiveness and up to 25% get care that is not needed or potentially harmful Identify gaps and inefficiencies in the health care system Develop, integrate and evaluate innovations that will improve the effectiveness of patient- and population-centered care Monitor the use and costs, and evaluate the impact of health and policy interventions The Issue The Solution 18

19. Giving ourselves the means Change the paradigm for the conduct of clinical, health services and policy research Leverage Canada’s unique data opportunities for research and a high performing learning health system 1 2 Collaborating on a national strategy that aims to ensure that the right patient receives the right intervention at the right time 19

20. Supporting and promoting comparative effectiveness research to evaluate the benefits and harms of current therapeutics and practices Developing implementation science to investigate and address major bottlenecks (e.g. social, behavioral, economic, management) that impede effective practice change Shifting from a researcher-driven to a health provider/patient-centered research agenda Strategy for Patient-Oriented Research: Objectives Strengthening clinical research to increase our capacity to evaluate health innovations (preventative, diagnostic, therapeutic; drugs, practices, devices) 20

21. Bridging the valleys of death Bridging Valley 1 by fostering public- private partnerships and by providing clinical validation of research results Bridging Valley 2 by ensuring that research results are integrated into the healthcare system Valley 1 Valley 2 Basic Biomedical Research Clinical Science & Knowledge Clinical Practice & Health-care Decision Making Discovery TranslationEvaluationImplementation 21

22. Strategy for Patient-Oriented Research: core elements Support for People and Patient-Oriented Research and Trials (SUPPORT) Units SPOR Networks Training and capacity development Improving the clinical trials environment Patient engagement 22

23. SPOR SUPPORT Units are provincial and/or regional centres providing support and expertise on data access, methodological and research services, knowledge translation, clinical trials and capacity development SPOR Networks represent national collaborations of decision-makers, health professionals, health researchers, patients and other stakeholders to generate research evidence and innovations designed to improve patient health and health care systems Regional SUPPORT Units and pan-Canadian Networks are core components of SPOR 23

24. Significant progress made to date on SPOR Approved - Total Investment = $247.1M / 5 years Under development – Estimated Investment = $131.2M / 5 years Status of the SUPPORT Units Business Plans (investments include CIHR and partner funding) Under discussion – Estimated Investment = $20M / 5 years Three SPOR Network Opportunities 1.SPOR Network in Youth and Adolescent Mental Health – ACCESS Canada 2.Pan-Canadian SPOR Network in Primary and Integrated Health Care Innovations 3.SPOR Networks in Chronic Disease 24

25. The Issue:Despite its widespread use, there was surprisingly little evidence to support the use of surgery for treating osteoarthritis of the knee The Study: CIHR-funded researcher Dr. Alexandra Kirkley (University of Western Ontario) compared the outcome for patients who receive surgical versus non-surgical therapy for osteoarthritis of the knee The Results: Results suggested that the surgical treatment that was part of the normal process of care for osteoarthritis of the knee failed to show any benefit for patients These results are changing clinical practice around the world The total reduction in this surgery translates into national savings (in the US) of between $82 million and $138 million annually Evidence to improve the efficiency of the healthcare system 25

26. Evidence for better care and cost savings The Issue: In 2012, Canada ranked 27 th among OECD countries (out of 34 countries) in terms of lowest infant mortality rate (source: OECD) The Study: Dr. Shoo Lee, from Mount Sinai Hospital in Toronto developed a Canadian Neonatal Network and initiated a project aimed at reducing mortality, major morbidity, and hospital length of stay The Results: This project, which started as a pilot project in 12 sites, is now implemented in 30 hospitals and 17 universities across Canada Outcomes of the pilot project include: 30% decrease in hospital acquired infection 2 days average reduction in length of hospital stay $7-10 million annual cost savings 26

27. 27 CIHR’s strategic directions for the next five years Roadmap II’s strategic directions will guide efforts and investments to advance knowledge and capture innovation for better health and health care Promoting Excellence, Creativity and Breadth in Health Research and Knowledge Translation Mobilizing Health Research for Transformation and Impact Roadmap II Capturing Innovation to Produce Better Health and Health Care for Canadians Achieving Organizational Excellence Feeding the innovation pipeline Re-defining excellence in training Identifying research gaps and prioritizing needs Developing strategic initiatives Increasing capacity and impact 27

28. 28 CIHR is committed to supporting investigator-initiated research Supporting investigator-initiated ideas and research, from discovery to application Decreasing researcher burden with the implementation of the Foundation and Project Open funding schemes Improving the effectiveness, consistency, reliability, fairness and sustainability of peer review decisions through changes to peer review processes Ensuring the sustainability of the health research enterprise through the development of a national vision to position trainees for success in both academic and non- academic careers Staying the course on Investigator-Initiated Research EXCELLENCE Strategic Direction #1 Promoting excellence, creativity and breadth in health research and knowledge translation 28

29. 29 Maximizing the health, social and economic impact of research through targeted and partnered investments Enabling multidisciplinary research and increasing capacity to address complex research questions Focusing on critical health issues championed by Canadians Forging strategic alliances with new health and non- health partners Partnering to ramp up Priority-Driven Research Mobilizing health research for transformation and impact Strategic Direction #2 MOBILIZE Success in health innovation will be achieved through strategic alliances 29

30. Identified research priorities conform with those of major international research organizations Importance (%) 30

31. Roadmap Signature Initiatives Research Priority Areas Roadmap Signature Initiatives Pathways to Health Equity for Aboriginal Peoples Strategy for Patient-Oriented Research (SPOR) Personalized Medicine Community-Based Primary Health Care International Collaborative Research Strategy for Alzheimer’s Disease Inflammation in Chronic Disease Canadian Epigenetics, Environment and Health Research Consortium Evidence-Informed Health Care Priority-driven agenda is delivered through major research initiatives referred to as: Roadmap Signature Initiatives 31 Enhanced patient experiences and outcomes through health innovation Health and wellness for Aboriginal peoples A healthier future through preventive action Improved quality of life for persons living with chronic conditions 31

32. Valley 1 Valley 2 Basic Biomedical Research Clinical Science & Knowledge Clinical Practice & Health Decision Making Translational Continuum Community-based primary heath-care Personalized medicine Alzheimer’s disease and associated dementias Evidence- informed health-care Epigenetics Roadmap Signature Initiatives – Alignment with the Strategy for Patient Oriented Research 32

33. CIHR has initiated an in-depth review of the role and slate of Institutes to ensure that the current Institute Model is optimal for delivering on CIHR’s mandate and for enhancing the organization’s capacity for impact and transformation. From….To…. Addressing the needs of a specific community (a home for every researcher…) Mobilizing communities to focus on achieving greater impact Knowledge translation activities that focus on sharing the results of research with decision makers Involving patients and decision makers in the research process to accelerate change in policy and practice Inviting partners to co-fund research in gap areas that are of interest to them Working with partners to co- design and co-fund transformational initiatives CIHR’s changing role in the evolving Canadian research landscape 33