What are Australia’s core competencies and competitive advantages in medical research?

Professor John McCallum

Head, Research Translation Group, NHMRC25 September 2014

Competent NHMRC Research Public Support• 2,216 Project Grants

• 68 Program Grants

• 43 Development Grants

• 69 NHMRC Partnerships for Better Health – Partnership Projects

• 2 Partnership Centres

• 427 NHMRC Fellowships – 81 Senior Principal Research Fellows

– 99 Principal Research Fellows

– 247 Senior Research Fellows

• 257 Career Development Award Fellowships

– 125 Biomedical

– 56 Clinical

– 11 Industry

– 1 Part-time Employment

– 64 Population Health

• 376 Early Career Fellowships in Australia

– 146 Biomedical

– 56 Clinical

– 6 Primary Health

– 64 Part-time Employment

– 20 Indigenous Health

– 84 Population Health

• 218 Early Career Fellowships overseas– 155 Biomedical

– 25 Clinical

– 15 Overseas Exchange (Inserm and Aust/China)

– 23 Population Health

• 340 Scholarships– 46 Biomedical

– 167 Medical/Dental

– 13 Primary Health

– 14 Indigenous Health

– 100 Population Health

Increasing Number NHMRC Project Grant applications: total, fundable and funded rates, years 2000-2013

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

400

800

1200

1600

2000

2400

2800

3200

3600

4000

30% 23% 23% 22% 22% 21%21% 27% 27% 23% 23% 23% 21% 17%

37% 36% 34% 34% 36%40%

42% 48% 49%

58% 46%52% 52% 55%

33%41% 43% 44% 42%

39%

37%

25%24%

19% 30%

25%27%

28%

Year of Application

Nu

mb

er

of

Ap

plic

ati

on

s

Funded

Fundable, but not funded

Not fund-able

Project Grants 2005-2014: average grant size

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014$0

$100,000

$200,000

$300,000

$400,000

$500,000

$600,000

$700,000

$476,075$472,694

$526,397$538,951$583,724$572,057

$548,132$589,918

$626,345$649,524

Year funding commences

Funded Project Grants 2011 – 2013 application year

Broad Research Areas

2011 2012 2013

# of Apps

Funded Grants

Funded Rate %

# of Apps

Funded Grants

Funded Rate %

# of Apps

Funded Grants

Funded Rate %

Basic Science 1721 437 25.40% 1896 431 22.7% 2024 384 19.0%

Clinical Medicine and Science

1173 232 19.80% 1199 208 17.3% 1285 197 15.3%

Health Services Research

132 22 16.70% 112 26 23.2% 145 20 13.8%

Public Health 343 80 23.30% 363 66 18.2% 367 45 12.3%

Total 3369 771 22.9% 3570 731 20.5% 3821 646 16.9%

This data includes applications that were submitted to the NHMRC for peer review but were for funding for another agency / organisation (e.g. Cancer Australia, Cancer Council)

Basic Science Clinical Science

Health Services Research Public Health

App Year mean mean mean mean2001 2.1 2.9 3.1 3.42004 2.3 3.2 3.7 42007 2.5 3.5 4.6 4.42010 2.4 3.6 5 4.72013 2.6 3.9 5.4 5.1

Increasing multidisciplinary, team approachesCI #’s, project grants

• More CIs on PHR and HSR applications, progressive increases in all areas, more marked in HSR and PHR

Support for teams of high-calibre researchers to pursue broad-based, multidisciplinary, collaborative research• 251 applications have been received since 2003• 132 were funded – funded rate of 52.5%

Analysis shows that most Program Grants cover more than one Broad Research Area (BRA).The data presented is by the primary Broad Research Area as indicated by the applicant.

Program Grants: applications 2011 to 2013

2011 2012 2013

Broad Research Area # Apps #

Grants Funded Rate %

# Apps

# Grants

Funded Rate %

# Apps #

Grants Funded Rate %

Basic Science 8 6 75.0 7 2 28.6 10 4 40.0

Clinical Medicine and Science 5 2 40.0 8 7 87.5 8 4 50.0

Public Health 2 1 50.0 3 1 33.3 6 3 50.0

Health Services Research 0   0  0 0   0 0 0 0  0

Total 15 9 60.0 18 10 55.6 24 11 45.8

NHMRC Research Fellowships: commencing 2012-2014

Broad Research Area2012 2013 2014

# Apps

# Grants

Funded Rate %

# Apps

# Grants

Funded Rate %

# Apps # Grants Funded

Rate %

Basic Science 131 49 37.4 112 48 42.9 128 43 33.6

Clinical Medicine and Science 54 23 42.6 35 17 48.6 55 17 30.9

Health Services Research 8 2 25.0 5 3 60.0 11 3 27.3

Public Health 29 13 44.8 32 17 53.1 47 15 31.9

Total 222 87 39.2 184 85 46.2 241 78 32.4

Note: Data covers application years 2011 to 2013

Early Career Fellowships

4,193 applications received between 2004-2013,

1,279 funded – funded rate of 30.5%

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Number of Apps. 345 370 404 443 433 389 433 390 463 523

Number Funded 112 133 141 137 131 117 121 131 128 128

Funded Rate 32.5% 35.9% 34.9% 30.9% 30.3% 30.1% 27.9% 33.6% 27.6% 24.5%

Summary funding for major schemes2013 application year

National Total

NHMRC Funding Scheme # Apps # Funded Funded Rate

Project Grants 3821 646 16.9%

Program Grants 24 11 45.8%

Centres of Research Excellence 74 15 20.3%

Partnership Projects 51 22 43.1%

Development Grants 111 24 21.6%

Postgraduate Scholarships 222 108 48.6%

Early Career Fellowships 523 128 24.5%

Career Development Fellowships 308 60 19.5%

Practitioner Fellowships 57 16 28.1%

NHMRC Research Fellowships 241 78 32.4%

Advantages: Australia’s strong publication performanceNHMRC Bibliometric Report 2005 - 2009

An Analysis of all Australian publications indexed in Thomson Reuters’ Web of Science database• NHMRC-supported publications

– more than 30% total (26% in 2002-2006)– relative citation impact 60% higher than the world average– 40% involved international collaborations– 2.8% in top 1 % cited papers world-wide.

Strategic Review of Health and Medical Research | Full Report | February 2013 p13

Australia isn’t a laggard in commercialisation activity and success

Strategic Review of Health and Medical Research | Full Report | February 2013 p14

Healthy, wealthy & affordable: How research improves Australia’s health

The sector must provide value for public money & support & actively promote this

NHMRC Initiatives: (1) Development Grants

40 completed grants surveyed in a review:

– 85% reached complete or partial proof of concept at completion of the grant;

– 80% had secured a commercial partner (mostly Australian biotech firms);

– 55% are currently under some form of possible commercial development; and

– 6 have resulted in product to market or are awaiting regulatory approval

Independent, commissioned assessment of the outcomes from NHMRC Development Grants, available from

http://www.nhmrc.gov.au/_files_nhmrc/file/media/media/rel12/nhmrc_development_grants_review_april_public_121122.pdf

Initiative (2): Research Translation FacultyOver 2,800 Faculty members.

Faculty Steering Groups continue to work on developing shortlisted Cases for Action as follows:

Steering Group Shortlisted Case for ActionArthritis and Musculoskeletal Conditions

Re-fracture prevention in patients with minimal trauma fracture/osteoporosis

Asthma Appropriate prescription and use of asthma medicationCardiovascular Disease and Stroke Appropriateness and performance in the management of CV

disorders in Australia Dementia Primary prevention of dementia using population strategies

and big data sources Diabetes Mellitus Prevention of Diabetes Mellitus Healthy Start for a Healthy Life Healthy Pregnancy Improving Care for Patients with Multiple and Complex Chronic Disease

Achieving safer and better chronic disease care for people with mental illness

Mental Health Embedding e-mental health services into practiceObesity Prevention of excess gestational and post-partum weight gainPrimary Health Care Improve assessment and management of absolute

cardiovascular disease risk

Initiative (3): NHMRC Advanced Health Research and

Translation Centres (applications close 30/9/14)Submitting groups should provide evidence of:1. Leadership in outstanding research- and evidence-based

clinical care, including for the most difficult clinical conditions,

2. Excellence in innovative biomedical, clinical, public health and health services research,

3. Programs and activities to accelerate research findings into health care and ways of bringing health care problems to the researchers,

4. Research-infused education and training,5. Health professional leaders who ensure that research

knowledge is translated into policies and practices locally, nationally and internationally,

6. Strong collaboration amongst the research, translation, patient care and education programs.

Application of Fundamental Knowledge

Fundamental Knowledge

Fundamental Knowledge

Application of Fundamental Knowledge

New Initiative

G7 - World Dementia Council

Key challenges• Improvements in

health and care

• Raising awareness and supporting dementia friendly communities

• Better research

Cure or modifying therapy by 2025 - target

Focused and coordinated Research: World Dementia Council Statement of Purpose (May, 2014)

• Current research and development is not making sufficiently rapid progress• Conventional drug development approaches have made limited headway• Our understanding of dementia and our diagnostic tools are still in their

infancy• There have been multiple clinical trial failures, often in the late stages of

development, at large cost to investors and the pharmaceutical industry• Too much experimental science is left on the laboratory shelf with no

prospect of financial support to enable further development• The current ratio of risk to reward in dementia research and development is

not attractive to investors• The lead times are long and the chances of failure are very high.

We need to change that equation – 2014 Budget funded a new NHMRC National Institute for Dementia Research ($200M) to prioritise and coordinate research.

Why Dementia?

• There are more than 332,000 Australians living with dementia which increases to 400,000 in less than ten years and, without a medical breakthrough, to be almost 900,000 by 2050

• Total direct health and aged care system expenditure on people with dementia was at least $4.9 billion in 2009-10 and by the 2060, to outstrip all other health conditions

• It is the most feared diseases with 71% of Australians 50 to 59 years worrying about contracting dementia, and 75% among those aged 60 and over

• 1.2 million Australians are involved in the care of a person with dementia• Australia faces a shortage of more than 150,000 paid and unpaid carers for

people with dementia by 2029• Dementia is the single greatest cause of disability in older Australians (aged

65 years or older) and the third leading cause of disability burden overall• Globally dementia care would be the 18th largest economy (in between

Turkey and Indonesia) and the largest world company with US$600bn turnover, larger than Walmart (US$414bn) and Exxon-Mobil ($311bn)

(4) National Institute of Dementia Research• Planning is well advanced for the establishment of an NHMRC National Institute of

Dementia Research with A$200m.• NHMRC Dementia Research Team Grants Scheme opened on 8 August 2014 and closes on 8

October 2014, providing up to $32.5 million over five years for large scale projects (up to five teams will each receive $6.5 million).

• Executed funding agreement with the Clem Jones Centre for Ageing Dementia Research in Brisbane, $9 million over four years.

• Commenced a stakeholder consultation project to identify national dementia research and translation priorities. Draft priority areas are expected to be identified by the end of 2014.

• This is a new Institute model for future NHMRC priority work and different compared to international examples like CIHR etc.

Prioritising and coordinating from the new National Institute will begin in early 2015

Further information available through NHMRC website: http://www.nhmrc.gov.au/research/boosting-dementia-research-initiative

Policy Issues

The Key Strategic Issues:

Flat forward funding after a decade of increases

Increasing applications & grant size, new medical schools, growing Universities/Institutes

Project rates already under 17% and must go lower with 5 year grants – 40% larger?

Fellowship structures don’t match success rates

Institutional financial pressures

Significant research wastage

Medical Research Future Fund uncertainties?

Health and medical research (and health care sustainability) need active maintenance

‘Wastage’ in basic medical research:

• Poor reproducibility by industry 11-25% only of published research findings and few evaluations

• Only 6/53 of what were claimed as cancer breakthrough articles could be reproduced

• Only 20-25% findings published were in line with data in lab and only 37% had acceptable statistics

• Big problems with cell cultures: 10-20% of all cell cultures are HeLa cells infected, and 18-36% not the right cell line

• Projects change hypotheses and add findings with not in the final published story and repetition of work done elsewhere

+ Social Sciences and Arts need ‘bigger’ themes, Giddens ‘holistic view of modern societies’, more appeal to both sides of politics.

Research wastage must be reduced

2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 $-

$100,000.00

$200,000.00

$300,000.00

$400,000.00

$500,000.00

$600,000.00

$700,000.00

$800,000.00

$900,000.00

$703,065.00 $715,479.00 $746,075.00 $760,463.00 $774,227.00 $788,958.00 $804,165.00

Medical Research Endowment Account forward estimates

2014/15 Federal Budget – Summary

• Boosting dementia research ($200M)• Simplified and consistent health and medical

research ($9.9M)• Medical Research Future Fund ($20B)• Medical Research Endowment Account

– There are no significant changes to NHMRC’s Medical Research Endowment Account (MREA). MREA expenditure is expected to be greater than this year’s appropriation as we continue to draw down on the MREA balance.

Medical Research Future Fund

• The $20 billion capital protected Medical Research Future Fund will be created from 1 January 2015 – subject to Parliament

• The interest from the Fund, amounting to an estimated $1 billion a year when fully mature, will support basic, applied and translational research in priority clinical areas that will benefit patients.

• Initial funding will come from around $900 million in funds left after winding up the Health and Hospitals Fund and savings outlined in the Health Budget.

In the budget speech the Treasurer said:

“Tonight, I announce the Government’s commitment to build with your contributions, a $20 billion Medical Research Future Fund.

This fund will, within six years, be the biggest medical research endowment fund in the world.

Its funding of research will be in addition to existing levels of funding through the National Health and Medical Research Council.

The Medical Research Future Fund will receive all the savings from the introduction of a $7 Medicare co-contribution, modest changes to the Pharmaceutical Benefits Scheme and other responsible changes in this Health Budget, until the Fund reaches $20 billion”.

• Introduction

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Successes: There are 2500 employees at Cochlear Limited

Examples of good ‘public interest’ cost benefits:Professor Rachelle Buchbinder; Arthritis specialist (Monash University) shows that a procedure where bone cement is injected into a person’s vertebrae to try and fix painful spine fractures works no better at improving back pain than a sham procedure (NJEM 2009)

“This is another of numerous examples of promoting and using promising new treatment — before there is evidence of benefit from rigorous trials” – more to follow in genomic research?

Jeffery Braithwaite in The CareTrack study, identified in some areas of healthcare there is significant wastage, additional costs and, sometimes, unnecessary suffering. MJA 197(2) 16 July 2012: 100-105

- Over-prescription of antibiotics, particularly for sinus and throat infections, is a huge waste of money.- For surgical site infections, 84% of cases were administered antibiotics too late to prevent wound infections. - Surgical site infections currently cause much avoidable suffering and cost us $750,000 a day.

Is not the same old story for medical research?

We are c.2% of World research and punch above our weightMajor successes in commercialisationCompetent and improving public interest translation in Guidelines and de-investmentMedical Research Future Fund potential over the horizonWe need to talk up our performances and continue to give value from our current funding

Research help and funding inquiries:1800 500 983 – help@nhmrc.gov.au

www.nhmrc.gov.au13 000 NHMRC (13 000 64672)