Make global health research equitable, urges fair initiative

When WHO director general Tedros Adhanom Ghebreyesus, declared in January that the world was “on the brink of a catastrophic moral failure” because of the unequal international distribution of Covid-19 vaccines, this was an alarming but not altogether unfamiliar warning for many developing countries.

In all health areas, poorer nations are being left behind, and research has not been immune from this trend. By the last count, there were some eight million active researchers worldwide.  However, there is still a huge global disparity, with OECD countries counting 50 times more researchers per million inhabitants than least developed countries.

An initiative led by The Council on Health Research and Development (COHRED), headquartered in Geneva, has been attempting to bridge the gap and tackle inequalities in global health partnerships.

Championing equitable health. With its global implementation in 2018, the Research Fairness Initiative “was developed out of the understanding and realisation that there’s an imbalance that exists within research partnerships,” Kirsty Kaiser, an implementation manager at COHRED, told Geneva Solutions. “COHRED focuses on trying to improve research for low-middle income countries by addressing some of the bottlenecks that exist.”

Covid-19 has shone a light on those bottlenecks, highlighting “the really big problem that exists not only in terms of research but also in terms of things like vaccine access and health system capacity,” said Kaiser.

Despite the emphasis on international collaboration at the beginning of the pandemic, the race by countries to claim doses of the coronavirus vaccines for their own populations is creating deep inequalities and putting those promises of global solidarity to the test. This has also impacted the field of research.  “We started to see it was very much focused on the global north or in high income countries and global south countries were very much left out of that industry,” Kaiser said.

One of the reasons was that poorer countries did not have the staff and funding necessary to carry out the initial research, “and there’s always a danger when that happens that they get further left behind,” she added.

Unfair partnerships. Research partnerships continue to be formed against the backdrop of inequitable conditions as wealthy countries with the best equipped institutions have the upper hand for research funding - a pool already difficult to access for low-middle economies to access, Kaiser continues. These ‘global north’ countries then dictate the goals and terms of research partnerships, goals that may not necessarily benefit all.

A study of Angolan and Mozambican health academics’ experiences of north-south partnerships, for example, found that “power and resource imbalances can lead to serious ethical challenges … including exploitation or “tokenism” within the partnership.”

While low- to middle income countries are playing an increasing role, the distribution of research worldwide remains highly unequal. According to a UN report, OECD countries have about 3,500 researchers per million inhabitants, while in the least developed countries there are only about 66 researchers per million inhabitants.

“That low number of researchers, coupled with a lack of science tradition and funding and little access to published science, seriously hampers research systems in the global South,” the 2019 Global Sustainable Development report said.

The initiative thus offers an organisation learning tool designed to help stakeholders in research to assess their current partnerships, helping these organisations strategise towards being more equitable partners over time.

To do so, the RFI requires partner institutions to report on their policies and practices in relation to 15 topics that deal with three main domains: fairness of opportunity, which happens before the research, a fair process which is the research process itself, and fairness sharing of benefits, outcomes and costs.

Some organisations have already published RFI reports, including the  World Health Organization Special Programme for Research and Training in Tropical Diseases (WHO TDR), and the Swiss Tropical and Public Health Institute (Swiss TPH), an institution invested in the research, education and services field of global health.

Swiss TPH, for example, reported in their work on fair process that they hire locally, creating opportunities whilst also minimising research costs.

Having strong research frameworks in place will address the gaps in health systems while making them more capable of addressing major global health problems such as Ebola, HIV/AIDS, and the Zika Virus, says Kaiser.

Inequalities exposed. Health systems around the world are being dealt serious blows with major impacts on the capacity to deliver essential health services. This was highlighted in a recent survey published by the World Health Organization, which revealed that 90 per cent of 105 countries experienced major disruptions with low-middle income countries reporting the greatest difficulties.

"The survey shines a light on the cracks in our health systems, but it also serves to inform new strategies to improve healthcare provision during the pandemic and beyond,” said Dr Tedros Adhanom Ghebreyesus, WHO director-general. “Covid-19 should be a lesson to all countries that health is not an ‘either-or’ equation. We must better prepare for emergencies but also keep investing in health systems that fully respond to people’s needs throughout the life course.”

Based in South Africa, Kaiser told Geneva Solutions that “for a few weeks our system was completely overwhelmed because we did not have the capacity to deal with a pandemic.” These interruptions were further exacerbated when the new variant of the virus – the 501Y.V2 started spreading at the end of last year completely overwhelming the country’s health systems.

It is no surprise that the development for the Covid-19 vaccines, for example, have been concentrated in the ‘global north.’ Although poorer countries are the beneficiaries of the global solidarity programme Covax, the technology and know-how is still limited to richer countries.

Created through wide consultation, the goal is that the adoption of the RFI  will become the norm by organisations to adequately address the systemic inequalities in global health research. With 10 registered users so far, COHRED has deemed 2021 the year of equitable partnerships, hoping that by supporting research efforts, it can lessen the disparities between rich and poor countries.