Regional clinical research networks provide timely evidence to help emerging health policy. They deserve more support, says Jimmy Whitworth.
Global research and development into new products for neglected diseases was around US$2.5 billion in 2007, according to a recent survey by the Australia-based George Institute for International Health. This is a substantial sum, and represents a clear increase in activity in recent years.
But while many researchers across the world feel obliged to publish their results in high-impact scientific journals — to advance their academic career and access grants for further research — this can miss the point. All biomedical research should have the potential to improve health and stimulate changes in health policy and practice.
Easier said than done
Doing this is not as easy as it sounds. The policy process is neither simple nor linear and is influenced by many factors — the body of up-to-date research knowledge is just one of these. Policymakers rarely read scientific journals — so researchers need to use other more effective ways of communicating their findings. And even if a policy is decided, there is no guarantee that health workers will change their practice as a result.
Still, the long-sustained efforts of a research group in South-East Asia show that it is possible to ensure policymakers and health practitioners at least consider research findings.
Scientists at Mahidol University in Bangkok, Thailand and the University of Oxford in the United Kingdom began collaborating on tropical medicine research in 1979. Funded by the Wellcome Trust, this partnership has grown from a small unit studying snake bites and severe malaria into a major network for clinical research. It studies globally and regionally important infectious diseases, including bird flu, dengue, encephalitis, leptospirosis, malaria, melioidosis, meningitis, rickettsial diseases, tetanus, tuberculosis and typhoid.
The keys to success have included closely integrating local institutions, attracting high-calibre national and international staff, rapidly identifying and responding to diseases that threatenpublic health, high-quality studies of those diseases, developing research and institutional capacity, and translating the evidence of research into policy and practice.
The network has evolved gradually from its initial base in Bangkok through research collaborations in many countries, from India to Indonesia. Its partners include hospitals, institutions and universities. Capacity has been built by training clinical scientists at all levels and by building modern offices and laboratories, so improving clinical research infrastructure.
Multinational teams work together and, by collaborating with local institutional partners, they develop research strategies around local health priorities. These ensure relevant and timely outputs that can be quickly translated into national and international policy and practice. For example, clinical studies supported by the network have led to evidence-based national prescribing policies for typhoid and meliodosis.
Networks worth nurturing
The South-East Asia region is densely populated, with half the world's human population living within 3200 kilometres of Bangkok, often in close contact with domestic and wild animals. As the majority of emerging infectious diseases are thought to originate from animals, this is a prime breeding ground for epidemics and pandemics.
One very real example is the threat since 2003 of avian influenza mutating within the region to cause a human pandemic. The network's unit at the Hospital for Tropical Diseases in Ho Chi Minh City, in Vietnam, hasresponded by helping to establish and co-ordinate the South East Asia Influenza Clinical Research Network (SEAICRN). This conducts high quality multi-centre clinical research studies. It has regionalpartners in Indonesia, Singapore, Thailand and Vietnam as well as international partners including the National Institutes of Allergy and Infectious Disease, the University of Oxford, the Wellcome Trust and the WHO.
Such established, well-integrated and credible research groups can have a major influence on policy and practice. For example, the SEAICRN has been able to respond to the recent epidemic of swine flu by swiftly modifying its protocols in order to collect invaluable information about clinical management.
But these networks require sustained funding and support to maintain a central core platform for individual research projects. We must not overlook the importance of training individual scientists and building institutional research capacity alongside scientific research. Policymakers, donors and funders, institutions and scientists should be seizing the opportunity to support such south–south networking.
New initiatives, such as the South Asian Forum for Health Research (SAFHER), which fosters collaboration and partnership in health research, are developing. Governments and funders need to hear, support and nurture these local scientists and clinicians. These are the voices that know best what is wanted and needed.
Jimmy Whitworth is a clinician, working in international public health for the past 30 years. He oversees strategy and policy for health research in developing and restructuring countries at the Wellcome Trust, London.