A recent article in the Australian Journal of Rural Health (Vol 26, Issue 2, April 2018) makes the case that, at 2.4 per cent by value of the National Health and Medical Research Council total in 2014, the amount of research aimed specifically to deliver health benefits to Australians living in rural and remote areas is low given the health status and health service deficits faced by the 30 per cent of the population who live there.
Issues relating to health research in Australia were the subject of discussion at Senate Estimates on Tuesday 29 May 2018. This bloggpiece consists of a summary of some of the numbers and other facts from that discussion, sourced from the Hansard record.
In the period 2018-19 to 2021-22, the four years of forward estimates, some $6 billion is to be committed by the Australian Government for health and medical research. The main programs through which this money will be allocated are the National Health and Medical Research Council (NHMRC) (around $800m per year), the Medical Research Future Fund (c.$500m a year), and the Biomedical Translation Fund (c. $60m a year).
It would be interesting to compare this amount funded directly through the Federal health budget with the total through the private sector – dominated, presumably, by the pharmaceutical companies – and through other sources such as hospitals, State budgets and specific health condition interest groups (the Heart Foundation, for example).
The discussion at Estimates referred to the fact that many people in the research community are unclear about how funds in the Medical Research Future Fund (MRFF) are being disbursed.
Historically there has been a considerable amount of investigator-driven research funded by the NHMRC. The MRFF, on the other hand, is “priority setting research” and can fill gaps that are identified. The priorities are determined by the Government, through the Minister of the day and advice received by them. The Act requires the MRFF Board to consult with the community and the sector about its priorities.
"The Australian Medical Research and Innovation Strategy 2016–2021 was prepared by Australian Medical Research Advisory Board. It sets out the vision, aims, objectives, impact measurement and strategic platforms of the MRFF. The strategic platforms provide a framework for identifying MRFF priorities."
The first disbursements from MRFF were in 2016-17 and were for one year only. The next batch, announced in the 2018-19 Budget, are for four to five years.
There has been criticism of the relatively small amount allocated to research related to illness prevention, both within the MRFF envelope and in the overall health research effort. It has been suggested that as little as one per cent of the total health research allocation has been directed at prevention which, if true, would reflect poorly on the priorities in place.
At Estimates the Health Department referred to a number of grants for what could be considered ‘illness prevention’, including to the Australian Prevention Partnership Centre, some mental health research, Keeping Australians out of Hospital, Maternal Health in the First 2,000 days, the Advanced Health Research and Translation Centres, and the Centres for Innovation in Regional Health. These last are obviously of particular interest to the rural health sector.
"The aim of the Centres for Innovation in Regional Health (CIRH) initiative is to encourage leadership in health research and translation of direct relevance and benefit to regional and remote areas of Australia." "To achieve recognition as a CIRH, groups are required to demonstrate competitiveness at the highest international levels across all relevant areas of health care."
In 2017 the NHMRC recognised two groups in the CIRH program: the Central Australia Academic Health Science Centre and NSW Regional Health Partners.
Departmental officers spoke at Estimates of there being two main problems along the research pipeline. One is where a researcher or a team has a great idea but does not have the funds or the resources to prove the idea, to bring it to ‘proof of concept’ and start it down the pathway to trials. The other is where the idea has been proven through trials and the need is commercial energy and capital to bring the concept to market.
This second is where the Biomedical Translation Fund (BTF) fits in: it is designed to stimulate the venture capital sector and increase Australia’s ability to invest in good-quality late-stage research.
The BTF is leveraged 50:50 with private capital. It was announced in December 2015 under the National Innovation and Science Strategy and, after the identification of three fund managers, began operation in January 2017. The fund managers search out deals for advanced commercial-ready health and medical research innovations. To date there have been nine deals at a total value of about $42 million.
It has been suggested that if all goes well the health and medical sector could be the source of 28,000 new jobs, 130 new clinical trials, and a 50 per cent increase in exports. To hit all the desirable targets will require a suitably trained health research workforce and the MRFF is helping with this. It is working with the NHMRC to ensure there are more fellowships available to attract Australians into health and medical research.
Let’s hope the individuals and agencies involved have at least a third of an eye on the special opportunities and challenges in rural Australia.