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Tapping the power of small institutions: is that enough?

The commentary by Keusch and Medlin on a virtual global health research network provides food for thought on an interesting concept — one that has a real chance of coming to life, thanks largely to the electronic communication systems that the world now has at its disposal.

The views expressed by the authors are noble, the justification is sound, and the intention is virtuous. But the description of the network's actual purpose lacked the punch the rest of the commentary exhibited. Furthermore, it is hard to fathom how many of the poorer countries will fulfil the criteria of participation in the proposed network, which include "an assured national source of funding [for health research], scientific autonomy in priority setting… an independent peer-review system, [and] a long and consistent history of scientific accomplishment".

Another major concern among the less developed countries is the detrimental fall-out (particularly on health) of the current trends and policies of international trade, including intellectual property rights, and the overwhelming dominance of "mega" research institutes in the West — just some of the thorny issues of globalisation. Some sceptics may wonder if the suggested health research network will suffer under such pressures, with research priorities being dictated by economic gains rather than health needs.

In terms of the practicalities of setting up their network, the authors are quick to point out that three kinds of resources are at the disposal of health research institutes: scientific capacity in the form of in-house expertise, determination of their own priorities and allocation of resources, and well-developed systems for funding and promoting best science (unfettered by political or other influences). This may be absolutely true from a developed country perspective. Sadly, the same cannot be said for most developing countries.

This leads to, perhaps, a more useful focus for the suggested network: instead of tapping the power of small institutions — which are often powerless to begin with — the philosophy should be turned around to target larger institutions. The real goal of such a network should be to offer preferential support to build the capacity of smaller institutes in developing countries, by linking them up with larger institutes (which are often the centres of excellence). Only when this happens, could a global health research network operate equitably.

Despite these weaknesses, the authors must be commended for the forceful manner in which they have stated the need to harness resources for health research. If implemented, the proposed network would undoubtedly strengthen efforts to attract more (financial) resources to this cause. At the same time, it is not entirely clear who the beneficiaries of this bounty would be, and how much would go to those who need it most.

Finally there is a danger that an initiative of this kind will be based largely upon discussions among the heads of international programmes of biomedical agencies in North America and Europe. It is paramount that planning should take into account views from Asia, Africa and Latin America. Only then can this truly be a global venture.

Dr M Abdur Rab, Regional Adviser, Research Policy and Cooperation, World Health Organisation, Regional Office for the Eastern Mediterranean, Egypt, 22 April 2003