Over the past 6 years, there has been a remarkable transformation in the health research enterprise in Canada. I will develop this further below. At the same time, there is currently considerable anxiety, much of which I share, within the research community. That anxiety is focused largely, although not exclusively, on the results to be released later this month for the September Open Grants Competition. As many of you know, it now seems almost certain that the success rate for this competition will be significantly lower than for previous open grant competitions.
Why, despite the unprecedented increases in CIHR's budget, are success rates for the September OGC going to be so low? There are two reasons: First, there are more researchers applying for more money. And second, without an increase in our base budget, CIHR will have less uncommitted funds to award to new grant applications.
I am very concerned about the impact this situation will have on all members of the research community - new investigators, mid-level established investigators and Canada's most senior researchers. And I am particularly concerned about the impact on new investigators who are at the beginning of their careers. These new investigators represent the future of health research in Canada. Failure to secure grant support for their research in those critical first years can have a lasting detrimental effect on their subsequent careers. Clearly, all of us need to think about how to improve the situation for the very group of investigators who are bringing their energy, superb training and new approaches to health research.
In this message, I would like to provide my perspectives on health research in Canada - past, present and future and how we can begin to approach the current funding crunch.
The Past 6 Years: A Quantitative Analysis
Since the final year of the Medical Research Council (1999), the CIHR base budget has grown from $289M in 1999-2000 to $723M in 2006-2007. This increase in funding for health research is virtually unequalled anywhere. The increase has meant that:
the total value of the Open Grants Competition (OGC) has more than doubled from $165M to $350M;
the number of investigators funded in the OGC has increased from approximately 2,100 (1999-2000) to 3,300 (2005-2006); and
the average value of an operating grant has increased from $81K (1999-2000) to $111K (2005-2006).
In addition to these increases, the support for training and career awards has also significantly increased. With the launch of the Strategic Training Initiative in Health Research (STIHR), the number of trainees funded directly by CIHR has increased by about 96%. Because the costs of supporting graduate students and postdoctoral fellows is a significant proportion of many research grants, the STIHR program also represents a significant increase in funds for research.
The reconfiguring of our career awards program by emphasizing the support of New Investigators, together with new funds, has meant that the investigators with CIHR Career awards has also increased from 422 to 665, an increase of 58%.
The growth of the 13 Institutes has also created new funding opportunities in strategic areas of research that align with the Institutes' individual and CIHR's overall strategic plans. These targeted areas of research, defined through extensive consultations with the 13 Institute Advisory Boards and the broader stakeholder communities, represents an entirely new approach to the setting and implementing of research priorities in Canada.
In total, the opportunities for targeted research support has increased from about $26M in 1999 to approximately $172M today.
Consistent with our Parliamentary mandate, we have also increased significantly the programs and funds for knowledge translation- the moving of research into products, practice, and policy. The Proof of Principle (PoP), Science to Business (S2B) Knowledge to Action, CAHRs and Partnerships for Health Systems Improvement programs all have created new opportunities for researchers from every pillar of health research to work with the users of research to move research findings produced in our universities and hospitals into practice and policy.
In addition to CIHR's own base budget, $516M in new partner funds, have been secured by the Institutes, for shared targeted objectives from 1999-2000 to 2005-2006.
In addition, the Federal Government has also introduced several important new programs, all designed to build research capacity - the Canada Foundation for Innovation, Indirect Costs, the Canada Research Chairs - that are bringing very significant and much-needed new support for infrastructure, start-up funds for new investigators, indirect costs for institutions and salary support for 700 health researchers. This new support also translates into hundreds of millions of dollars per year for health research.
Together, this increase in support has profoundly changed the environment for publicly funded health research in Canada from the dark days of the mid-1990s.
The Past 6 Years
But, as impressive as these numbers are, the qualitative changes are equally profound. CIHR is not simply a larger version of the MRC. Over the past 8 years, starting with the national discussion led by Dr. Henry Friesen, Canada has spearheaded a new vision for health research. That vision recognizes explicitly that the key to better health and the successful treatment of disease is simultaneously a biological, clinical, health system and population health challenge. The CIHR vision also explicitly recognizes that knowledge translation is also a necessary part of an integrated health research strategy for the 21st Century.
Accordingly, as our overall budget has grown, CIHR has been expanding into all of these areas of research and into knowledge translation.
Figure 1 illustrates how this expansion across the 4 pillars of health research has played out over the past 6 years. Two things are clear from Figure 1: First, we are committed to broadening the definition of health research to include pillars 2-4. And secondly, all areas of health research have benefited very significantly as CIHR's budget has increased.
Figure 1 CIHR: Broadening the Mandate
This Canadian vision for health research has been applauded by others, as noted in the International Review Panel Report and most recently, in the recent review by Sir David Cooksey of the organization of funding for health research in the U.K.
I support this integrated vision for health research. It is both compelling and timely, and that is why, in large part, I accepted the position of President of CIHR in 2000. As I pointed out in my Address at the Inaugural meeting of the Canadian Academy of Health Sciences, I do not view our situation as a 'zero-sum' game. That is, I do not feel that, for example, funds that go to research on palliative care are funds that otherwise would have gone to systems biology.
The Challenge Today
As I noted at the beginning of this Message, CIHR is facing a double challenge - first, the unprecedented and rapid expansion of the health research community and second, decreasing amounts of in-year funds available to support new grant applications.
A. Increased Demand for Funds
The unprecedented expansion of health research capacity across Canada, fuelled by CFI, the CRC, the indirect costs program and new federal tax incentives for philanthropy, has resulted in a much-needed increase in health research capacity. For example, CFI's largest single sector of infrastructure investment has been in health research. This is not surprising. The growing complexity and sophistication of health research, as well as the development of entirely new fields of health research, has created exciting new opportunities for research and its application.Canada's 13 largest universities, and hence recipients of the majority of CIHR support, all have schools of health sciences and multiple affiliated teaching and research hospitals. These latter institutions have also been ambitiously expanding their capacity for research, fuelled by CFI, provincial governments and philanthropy. Together, these 13 universities and their affiliated hospitals number close to 50, virtually all of whom are expanding their research capacity.As I have visited campuses across Canada over the past 6 years, I have been impressed with the scope and the vision of first, the plans, then the buildings and now the outstanding investigators that have been and are being recruited to Canada.
Even without this increase in health research capacity, the broadening of our mandate, relative to the former MRC, has also translated into a significant increase every year in the number of investigators applying to CIHR for support.
The increasing complexity and nature of health research has also meant that the costs of carrying out internationally competitive research has gone up. The average value of an operating grant has increased from about $75,000 in 1999-2000 to $111,000 per year in 2005-2006. And if one compares just the grants in the biomedical sciences (which is largely what the MRC funded), the average grant has doubled from the $75,000 in 1999-2000 to about $150,000 in 2005-2006.In my view, these numbers should rise even further, but we have taken a balanced approach, weighing the need to fund at international levels against the desire and the imperative to fund as many outstanding investigators as possible across the country.
The recruitment of hundreds of new investigators, either following their postdoctoral training, or more senior investigators attracted to Canada by an exceptionally positive research and social climate, collectively represents the growth of a fantastic resource for our country - a growing pool of scientific talent that Canada will need to compete effectively in a world hypnotized by the rise of China and India. These scientists are exceptionally well trained, and ambitious. They are putting forward to CIHR's Grants Panels cutting edge, exciting research programs in numbers today that we didn't even begin to see when CIHR was launched in 2000.
B. Significant Decrease in Available Funds
Because research projects extend over several years, CIHR typically makes forward commitments of 3 to 5 years, with an average of around 4.2 years. However, CIHR receives annual appropriations from Parliament. Thus, in any given year, most of CIHR's funds are already committed and the amount of uncommitted funds available to fund new research projects is not the total budget, but only those funds that are being 'freed up' by expiring grants made 4-5 years ago and new funds received from Parliament. As CIHR's budget growth has slowed over the last few years, the uncommitted funds available to support new grants and awards have shrunk. For example, in the most recent competition of the Operating Grant program, it is estimated that the level of funds available will be approximately 30% less than in the previous year.
Taken together - the vastly increased demand for grant support and the projected 'hard landing' of our budget - have converged to create the current situation.
How should we react to the current situation? Both short and long term strategies are required if we are to sustain and enhance the momentum developed over the past 6 years.
From my perspective, there are several essential elements to this strategy for the future:
Excellence must be at the very core of everything we do. Excellence in the research that gets supported, excellence in how CIHR operates.
The emphasis must increasingly shift away from "inputs" and immediate outputs (e.g. number of grants funded, success rates, number of students trained) to the more downstream impacts of health research (e.g. new understanding of disease, improvements in treatment, containment of emerging new infections, environmental and psychosocial determinants of health and disease, successful new companies or licensing deals, reductions in wait times, new or improved diagnostic technologies). This is what the public is interested in.
Newly recruited outstanding young investigators expect to be funded. An approach is required that recognizes this and allows our best young people to demonstrate their potential.
Drawing the connection between taxpayers support for research and the resulting impacts of this research is everyone's responsibility. All of us - students, postdocs, research assistants, faculty, CIHR staff - have a tremendous opportunity to demonstrate to the Canadian public and to Parliamentarians the value of health research. The pilot projects that CIHR has carried out over the past few years - Café Scientifique, Media courses, public fora on a broad range of topics - have all been great successes. And I know that many universities, hospitals and individual researchers are also very committed to such activities.
Public engagement is essential for the future of what we all want to do: It hopefully will turn bright young people on to a career in research, it addresses the fears or misunderstandings of the public of what we are doing, it creates a strong political constituency to advocate on behalf of research, and it provides each of us with the opportunity to listen to what the public is thinking.
Although not immediately a budget issue, the changing nature of health research demands that we step back and take a high level look at peer review.
I have received many thoughtful comments and suggestions in response to my call for suggestions as to how CIHR should respond to the IRP Review and to the current financial situation.
Many of the comments have centered around the importance of the Open Grants Competition (OGC) and the need to increase further the size of the OGC. CIHR is fully committed to the OGC. That is why the single largest dollar increase in our budget has been to the OGC ($192M in 1999-2000; $350M in 2005-2006). But, as important and central as the OGC is to many researchers and to the advancement of research, the diversity of the research communities that CIHR now supports and the demands and needs of different health challenges and research opportunities, requires that CIHR offer a more complete menu of opportunities. For example, where there are clear research gaps or deficiencies that need to be addressed, Canada needs a proactive mechanism that encourages research in designated areas. Examples over the past 5 years include research on palliative care; the Collaborative Health Research Program with NSERC to encourage research that lies at the boundaries between the health and natural sciences; aboriginal health research; and the Regenerative and Nanomedicine initiative. There will also be circumstances, ranging from SARS to wait times, where the Canadian health research community has the opportunity to demonstrate the immediate impact that research can have on the health of Canadians.
Other suggestions have centered around the need to reduce the number of small Institute-led initiatives and explore new mechanisms to ensure that CIHR launches fewer, larger initiatives with greater potential for impact. We agree with this advice and are now actively discussing how best to do this.
Some people have suggested that we cut our administrative costs (the 'Operating Budget' in Ottawa speak). CIHR currently spends about 6% of our budget on administration. I am pleased to announce that, through cost-saving measures, $1M will be transferred from the 2006-2007 Operating Budget to Grants and Awards. It is also important to note that most of CIHR's Operating Budget costs are incurred in processing grant applications and to run the peer review process.
The Canadian health research community has a great story to tell Canadians and Parliamentarians. That story is not about falling success rates. That story is about new biological understanding of mechanisms of diseases like cancer, autism, and diabetes; about new approaches to therapy; about evidence-based changes in clinical practice; about research informing the development of health policy; about successful spin-off companies and licensing deals; and about research on human behaviour and health promotion.
There are great scientific and social challenges that lie ahead. The unsustainable rising costs of health care, the rapid aging of the Canadian population, the impact of environmental change and global warming on human health, the development of new tools to understand complex biological systems like the brain, and the need to understand the epidemic of obesity, are only a small number of examples that cry out for answers, answers that only health research can provide. These are the stories that need to be told to Parliamentarians.