Catherine Whicher is a graduate student of Global Health Policy at the London School of Hygiene and Tropical Medicine
Varoon Mathur is a Software Engineering/Data Science student at the University of British Columbia
Last week Universities Allied for Essential Medicines (UAEM) published the 2017 University Report Card for Global Equity in Biomedical Research, evaluating fifteen of Canada’s universities (U15) for their contributions to neglected health needs including biomedical research, equitable licensing, global health education, and transparency. This is the 5th iteration of the report card, but the first time UAEM focused exclusively on public research schools (and exclusively on Canada, for that matter). While there were some promising highlights of what our universities can do when they set themselves to it, overall it is clear that Canadian schools are failing to use their considerable power to address many neglected aspects of global health.
Much criticism in the media has focused on Big Pharma as the body responsible for high drug prices, the 10 million deaths each year due to lack of access to existing treatments, and the 1 billion worldwide suffering from neglected diseases. While the influence of Big Pharma is considerable, universities are the source of between one quarter and one third of all new medicine. Their licensing policies shape whether products developed in university labs ever reach the patients for whom they were intended. Despite this, and despite Canadian schools being public interest, largely publicly-funded institutions, only one – the University of British Columbia – has a global access licensing policy to ensure technologies developed at the school are made accessible worldwide.
While a global access licensing policy is important to any school’s commitment to equitable distribution of their technologies, this was not the only aspect on which UAEM evaluated the U15. Their methodology also included how schools used biomedical research funding from the Canadian Institutes of Health Research, The Natural Sciences and Engineering Research Council of Canada, and the Gates Foundation to address global health and neglected disease. Disappointingly, an average of only 5.7% of each university’s funding was dedicated to global health research, training, and collaboration. Merely 1.2% was dedicated on average to neglected diseases (as defined by the World Health Organization); neglected aspects of HIV/AIDS, TB, Malaria; or anti-microbial resistance. The consequences of failing to address neglected diseases were starkly evident during the 2014 Ebola crisis, and again in 2016 when the Zika virus spread across the Americas. Canadian universities cannot wait until the next neglected disease makes headlines, they must already be seeking answers.
The report card also looked at universities’ responsible publication practices including open access publishing and reporting of trial results, finding that 11 of the U15 schools have adopted or implemented a statement or policy on open access publishing. This is encouraging, as are those schools who are providing supporting funds such as the University of Ottawa. However, UAEM found summary results for an average of just 37.5% of completed clinical trials conducted by each university, searching through ClinicalTrials.gov and PubMed. Publication bias is an old problem, but public research institutions must be at the forefront of change to a more accountable system, and must enact policies to ensure their researchers submit summaries for all registered trials, as suggested by the authors of a recent CMAJ commentary.
These report cards are not published with the primary intention to name and shame each school for their poor performances, but rather to set the benchmark from which they must improve. UAEM was founded in 2001 after successfully lobbying Yale University to permit the generic production of an HIV/AIDS drug which they had licensed to Bristol-Myers Squibb. The subsequent 30-fold drop in price made the medicine affordable in Sub Saharan Africa at the peak of the epidemic’s crisis. The success of that first campaign – and the improvements seen at many universities across North America and Europe in the years since – showed that biomedical research universities have much untapped power to increase the availability and affordability of medicines.
BIAS TOWARDS APPLIED RESEARCH
This survey generated a “Canadian Report Card” on the attention different research-intensive universities give to global health, specifying tropical diseases such as malaria. It employed what were considered the “most significant sources of publicly-available data,” namely Canadian funding agencies. Also “an online questionnaire was developed with SurveyGizmo, and e-mailed to TTO officials, Administrators, Faculty and Staff best suited to provide the data.” We are not told how the “best suited” decisions were made, but I, for one, cannot recall being consulted.
The students who conducted the survey could not be expected to fully understand the nature of the research enterprise, yet they “hold public research universities,” some more than others, “to account.” The funding agencies and big pharma seem let off the hook. The latter, driven by the profit motive, tend to look for quick-fixes. Even though the Executive Director of the World Health Innovation Network sits on the Council of the CIHR, it is not obvious that the funding agencies think otherwise. But some global problems are not yet ready for remediation. The time is not ripe. We must do more basic research on the lower slopes before attempting the summit.
Here there is a major problem. Researchers who come to this conclusion and passionately want to solve global health problems must often manage with zero funding. I suspect that, as in the case of the two unfunded papers on malaria from Queen’s University that I published a decade ago (references below), much current Canadian research on global health failed to register with the survey.
Forsdyke, D. R. (2002) Trends Parasitol. 18, 411-418. Selective pressures that decrease synonymous mutations in Plasmodium falciparum.Paper Here .
Xue, H. Y. & Forsdyke, D. R. (2003) Mol. Biochem. Parasitol. 128, 21-32. Low complexity segments in Plasmodium falciparum proteins are primarily nucleic acid level adaptations. Paper Here .