Global research needs transnational funding

There is increasing recognition that challenges such as climate change and chronic diseases require research on a global scale, but with many different national funding agencies involved, the calls for proposals often do not meet the needs of cross-border researchers, according to Irene Papanicolas, professor of health services at Brown University.

Papanicolas is director of the Center for Health System Sustainability, launched last month to help countries learn from one another, by leveraging patient-level data to produce comparative insights and policy recommendations, in order to optimise patient care and build resilient and sustainable health systems.

The centre is host to the International Collaborative on Costs, Outcomes and Needs in Care, a partnership of 15 collaborators from North America, Europe and Asia Pacific that carries out comparative health systems research. "The current funding model doesn't always work for collaboratives like ours,” Papanicolas told Science|Business.

Of course, there are efforts to simplify international science – such as €61 million in new climate grants announced yesterday by eight national funding agencies. But generally, finding sources from which all the partners can get funding is difficult because calls in global health research are often limited to funding partnerships in a specific and limited number of countries. 

EU grants are one case in point, since they primarily fund European research priorities and international partners are not always allowed to take leading roles in consortia.

The low number of call for proposals able to fund all the countries involved delays research and slows the partnership’s efforts, said Papanicolas.

In particular, what’s missing is funding to build the infrastructure required to harmonise data from existing national sources. This means upfront investment is needed before research can begin to compare how high income countries manage their healthcare systems and to understand which policies are successful – and which are not.

Apart from slowing down much needed research, the lack of flexible cross-border grants can also influence the shape of a project and how it is conducted. 

"You see relatively more comparative work done through surveys, which can be hosted in one institution" said Papanicolas. "We don't use other data sources, like claims data or linked surveys to claims, to do comparative research as often, because it requires multiple researchers in different countries to access the data.”

In fact, even with formal partnerships which include careful data use agreements, patient data from administrative or registry records cannot leave most countries.

“This changes the type of work we can do and the questions we can answer," Papanicolas said.

Limited funding opportunities

The shortage of funding is a structural problem that is tied to the fact that the money comes from public sources, and researchers need to justify why they need to collaborate with peers in other countries.

"A lot of research funding comes from taxpayer money. And therefore, it's mostly geared to funding institutions within the country," said Papanicolas. 

This creates pressure on researchers who want to do cross-country data comparisons to keep the number of international collaborators, and the budget, low. 

"There's a trade off between the countries you want to compare, the questions you want to ask, and who and what is fundable," said Papanicolas. 

And while countries share the problems of ageing populations, chronic disease and expensive new treatments that threaten the sustainability of healthcare systems, they may still have different priorities when it comes to addressing them. As a results, it can be challenging to find a consensus on broad cross-border joint research.

To get the funds researchers often have to identify common challenges, rather than focus on comparisons to provide insights on a priority for a single country.

Charitable funding

Charities are key funders of cross country health research. As one example, the Novo Nordisk Foundation, the Wellcome Trust, and the Gates Foundation recently committed $100 million each to support research and development into global health challenges that disproportionately affect the world’s poorest communities.

But in the case of developing capacities for international comparisons or health system measurement in rich nations, the number of foundations offering grant funding is very small.

In the case of Brown’s Center for Health System Sustainability, the US Commonwealth Fund and the UK Health Foundation have financed and supported the International Collaborative.

International EU schemes

In 2015, former research commissioner Carlos Moedas set three goals for EU research and innovation policy: open innovation, open science and open to the world.

But since then concerns over intellectual property theft and the rising technological might and competitive threat from China and other countries has muddied the waters.

In 2021, Brussels presented a new global research agenda, which signalled a more cautious approach to cooperation with foreign science powers, while at the same time pledging to reinvigorate research ties with the US.

Recently, Horizon Europe widened its international reach with association deals with the UK, New Zealand, South Korea and Canada.

In February, Marc Lemaître, director general for research and innovation, backed the call to give newly associated countries more say over governance of the next research programme, FP10, which is due to start in 2028.

As things stand, despite paying into the budget, associated countries do not get a vote when deciding on Horizon Europe work programmes.

Outside the EU

In 2016, an intergovernmental organisation set up by Brazil, Russia, India, China, South Africa, Iran, Egypt, Ethiopia, and the United Arab Emirates launched a research and innovation scheme, called the BRICS STI Framework Programme.

Despite the similar language, compared to Horizon Europe, the sums involved to date have been modest. The pilot call was worth around $80 million, with eight national funding agencies and ministries chipping in $10 million each.