我国卫生政策与体系研究科研项目及经费现状分析

目的：描述我国卫生政策与体系研究领域科研项目及经费现状,分析存在的问题,为促进研究能力提高提供建议。方法：通过问卷调查和关键人物深度访谈,从科研项目数量及分布、主题情况等方面进行分析。通过公开资料梳理,从项目数量与分布、主题情况等方面对国家自然科学基金的资助情况进行分析。结果：2015—2017年平均每个机构每年开展科研项目26.25项,涉及主题为卫生筹资、服务提供、卫生人力等;平均每个机构每年的科研经费为529.00万元;63.16%的研究机构来自国内的经费资助多于来自国际的经费资助,政府来源经费占全部经费比例为44.23%;财务管理方面,科研经费通常由上一级机构的财务管理部门通过预决算机制进行管理。2008—2017年,共有116家机构获得国家自然科学基金资助,平均每个机构获得项目数为4.81项、所获得资助金额为169.06万元,主要研究为卫生服务提供相关主题。结论：我国卫生政策与体系研究科研项目数量及经费快速增长,但主要集中于发达地区的研究机构,存在地区不平衡现象;国际资助呈现下降趋势,国内来源占比越来越高;经费管理机制在逐步调整,但不同机构落实方面存在差异。     

E-health: implementation and evaluation research in Scotland -- a scoping exercise

We searched the National Research Register (NRR) to identify funded research in Scotland (or in collaboration with a Scottish partner) in the area of implementation and evaluation of e-health services. A total of 61 research projects were identified which had been funded since 1 January 1995. These projects shared almost 7 million pound of funding (1 pound is $1.9 or 1.3 euro), the main funding sources being the Scottish Government and the European Union. Based on the projects reviewed, the majority of e-health research in Scotland was being conducted within the communication systems domain. Most of the research was being conducted at a single centre: only 14 studies (23%) were multisite. Future collaboration between these researchers, involving larger scale funding bids, may increase the quantity of e-health implementation and evaluation research.     

Promoting the social value of research in Kenya: examining the practical aspects of collaborative partnerships using an ethical framework

The ethics of research continue to attract considerable debate, particularly when that research is sponsored by partners from the North and carried out in the South. Ethical research should contribute to social value in the country where research is being carried out, but there is significant debate around how this might be achieved and who is responsible. The literature suggests that researchers might employ two inter-related strategies to maximise social value: collaborative partnerships with policy makers and communities from the outset of research, and dissemination of research results to participants, policy makers and implementers once the research is over. These areas have received relatively little empirical attention. In this study, we carried out 40 in-depth interviews to explore the role of collaborative partnerships in health research priority setting, and the way in which research findings are disseminated to aid policy making and implementation in Kenya. Interviewees included policy makers, researchers, policy implementers and representatives of organisations funding health reforms in Kenya. Two policy issues were drawn upon as tracers wherever possible: (1) the introduction of Artemesinin-based Combination Therapies (ACTs), an anti-malarial treatment policy; and (2) Haemophilus influenzae (Hib) vaccine for the prevention of pneumococcal diseases among children. The findings point to significant gaps in the 'research to policy to practice' pathway, particularly for national research institutions with a focus on clinical/biomedical research. These gaps reflect poorly effective partnerships among stakeholders and limit the potential social value of much research. While more investment is needed to establish strong structures for promoting and directing collaboration and partnership, how to target this investment is not entirely clear, especially in the context of the considerable power of the global health agenda and the research financing tied to it.     

卫生研发活动经费流向调查指标与监测体系

在提高卫生研发活动资源配置效率日益成为全球卫生科技发展热点的情况下,掌握研发活动经费流向情况是改善资源配置效率的重要前提。以往关于卫生研发经费流向情况的信息十分缺乏,系统地追踪全球卫生研发经费流向情况是一个长期的目标。本就卫生研发活动经费调查在世界范围内所进行的情况,以及实施调查涉及的概念、分类指标进行概述。同时,就我国卫生研发经费调查的现状进行分析,并对建立我国卫生研发活动监测体系给予政策建议。     

Funding for rural health research from the Australian Research Council: A missed opportunity?

Objective:  To determine the number of projects, and level of funding, for rural health research from the Australian Research Council (ARC).
Design:  Analyses of ARC searchable datasets of completed, and new and ongoing projects from 2001 to 2008.
Main outcome measures:  Number of rural health research projects as a proportion of total funding; level of funding for rural health research projects as a proportion of total funding.
Results:  Only 46 of 6498 ARC completed projects were classified as rural health research projects. This represents 0.7% of the total number of projects, and 0.39% of the total funding allocated. Only 25 of 4659 ARC new and ongoing projects were classified as rural health research projects. This represents 0.54% of the total number of projects, and 0.27% of the total funding allocated. None of the 832 completed fellowships were classified as rural health. Only five (0.52%) of the 953 new and ongoing fellowships were classified as rural health.
Conclusions:  The level of under-funding for rural health research could be partially addressed by directing applications towards the ARC, in addition to the National Health and Medical Research Council. With a few exceptions, rural health researchers are not yet competitive in the national funding arena.     

Lessons for general vaccinology research from attempts to develop an HIV vaccine

In the past when large investments have been made in tackling narrow scientific challenges, the enormous expansion in our knowledge in one small area has had a spill-over effect on research and treatment of other diseases. The large investment in HIV vaccine development in recent years has the potential for such an effect on vaccine development for other diseases. HIV vaccine developers have experienced repeated failure using the standard approaches to vaccine development. This has forced them to consider immune responses in greater depth and detail. It has led to a recognition of the importance of epitopic specificity in both antibody and T cell responses. Also, it has led to an understanding of the importance of affinity maturation in antibody responses and the quality of T cell responses in T cell-mediated immunity. It has advanced the development of many novel vaccine vectors and vehicles that are now available for use in other vaccines. Further, it has focused attention on the impact of research funding mechanisms and community engagement on vaccine development. These developments and considerations have implications for vaccinology more generally. Some suggestions are made for investigators working on other “hard-to-develop” vaccines.     

European Union and EDCTP strategy in the global context: recommendations for preventive HIV/AIDS vaccines research

The European Commission (EC) has strong commitments and recognises the need to continue to ensure that HIV/AIDS research efforts receive global attention. The EC is facing this challenge in a global context and has made substantial investments together with European Developing Countries Clinical Trial Partnership (EDCTP) to formulate a program for the accomplishment of a scientific strategic plan promoting the European/African HIV vaccine development approach. The EC and EDCTP has convened a number of meetings by experts in basic and clinical virology, immunology, epidemiology, as well as industrial and regulatory representatives. The remit of the committee of experts was to define (1) objective criteria for selection of HIV candidates; (2) to determine criteria for selection of sites for clinical trials in Europe and Africa. The resulting consensus paper will guide the EC and EDCTP in developing HIV vaccine strategy and recommendations.     

Mapping global health research investments, time for new thinking - A Babel Fish for research data

ABSTRACT: Today we have an incomplete picture of how much the world is spending on health and disease-related research and development (R&D). As such it is difficult to align, or even begin to coordinate, health R&D investments with international public health priorities.Current efforts to track and map global health research investments are complex, resource-intensive, and caveat-laden. An ideal situation would be for all research funding to be classified using a set of common standards and definitions. However, the adoption of such a standard by everyone is not a realistic, pragmatic or even necessary goal.It is time for new thinking informed by the innovations in automated online translation - e.g. Yahoo's Babel Fish. We propose a feasibility study to develop a system that can translate and map the diverse research classification systems into a common standard, allowing the targeting of scarce research investments to where they are needed most.     

Assembling a global vaccine development pipeline for infectious diseases in the developing world

Commercial realities have drastically reduced private investment in the development of new public health tools, but increased awareness of this situation has resulted in the emergence of a variety of research-based, nonprofit organizations. We reviewed current vaccine developments and developed a framework for efficient research and development investments in this area. We have identified several key "push" and "pull" forces within the vaccine research and product development environment and have examined their impacts on the process. These forces affect the global vaccine pipeline, which is composed of all individual vaccine initiatives and global partnerships (i.e., stakeholders), All of these research and development stakeholders must work together to establish and promote a global, sustainable research and development pipeline that delivers optimal vaccines and immunization technologies.     

The cost-effectiveness of vaccinating pregnant women against seasonal influenza in England and Wales

We assessed the cost-effectiveness of vaccinating pregnant women against seasonal influenza in England and Wales, taking into account the timing of vaccination relative to both the influenza season and trimester of pregnancy. Women were assumed to be vaccinated in their second or third trimester. Vaccination between September and December was found to have an incremental cost-effectiveness ratio of £23,000 per quality adjusted life year (QALY) (95% CI £10,000-£140,000) if it is assumed that infants are partially protected through their mothers, and of £28,000 per QALY gained (95% CI £13,000-£200,000) if infants are not protected. If some vaccine protection lasts for a second season, then the ratio is only £15,000 per QALY gained (95% CI £6,000-£93,000). Most of the benefit of vaccination is in preventing symptomatic episodes, regardless of health care resource use. Extending vaccination beyond December is unlikely to be cost-effective unless there is good protection into a second influenza season. Key sources of uncertainty are the cost of vaccine delivery and the quality of life detriment due to a clinically apparent episode of confirmed influenza. The cost of vaccine purchase itself is relatively low.     

Investitionstätigkeit und Investitionsrückstand als Risikofaktoren für die Hochschulmedizin?

University medicine in Germany requires significantly higher funding and investment because its tasks not only include health care but also research and teaching. However, over recent decades less and less funding compared to the development of the turnover has been available. This trend is due to decreasing public funding. The diminishing funding has caused a major backlog of investment at German university hospitals. The first part of the article summarizes the investments policies at university hospitals and other hospitals. The second part describes the investment needs in university medicine and exposes risk factors for research, education and health care due to the process of investment planning and realization. Goal-oriented solutions are shown to facilitate investments. The third part discusses several risks caused by insufficient investments in university medicine. There are special risks for research, teaching, and the capacity for innovation in university medicine besides economical and medical risks. Some policies and financial strategies to overcome the backlog in investments are presented. After a summary, the article concludes with some practical examples of further measures to ensure sustainable funding.     

Toward more specific and transparent research and development costs: The case of seasonal influenza vaccines

Background

The ability to calculate the development costs for specific medicines and vaccines is important to inform investments in innovation. Unfortunately, the literature is predominated by non-reproducible studies only measuring aggregate level drug research and development (R&D) costs. We describe methodology that improves the transparency and reproducibility of primary indication expected R&D expenditures.

Methods

We used publically accessible clinical trial data to investigate the fate of all seasonal influenza vaccine candidates that entered clinical development post year 2000. We calculated development times and probabilities of success for these candidates through the various phases of clinical development. Clinical trial cost data obtained from university based clinical researchers were used to estimate the costs of each phase of development. The cost of preclinical development was estimated using published literature.

Results

A vaccine candidate entering pre-clinical development in 2011 would be expected to achieve licensure in 2022; all costs are reported in 2022 Canadian dollars (CAD). After applying a 9% cost of capital, the capitalized total R&D expenditure amounts to $474.88 million CAD.

Conclusion

Clinical development costs for vaccines and drugs can be estimated with increased specificity and transparency using public sources of data. The robustness of these estimates will only increase over time due to public disclosure incentives first introduced in the late 1990s. However, preclinical development costs remain difficult to estimate from public data.     

Status of vaccine research and development for Helicobacter pylori

Gastric adenocarcinoma is globally the third leading cause of death due to malignancy, with the bulk of this disease burden being suffered by low and middle income countries (LMIC), especially in Asia. The majority of these cancers develop as a result of a chronic gastritis that arises in response to infection with the stomach-dwelling bacterium, Helicobacter pylori. A vaccine against this pathogen would therefore be a powerful tool for preventing gastric adenocarcinoma. However, notwithstanding a proof-of-concept that vaccination can protect children from acquisition of H. pylori infection, there are currently no advanced vaccine candidates with only a single vaccine in Phase I clinical trial. Further, the development of a vaccine against H. pylori is not a current strategic priority of major pharmaceutical companies despite the large global disease burden. Given the involvement of such companies is likely to be critical for late stage development, there is therefore a need for an increased appreciation of the burden of this disease in LMIC and more investment to reinvigorate research in H. pylori vaccine Research and Development.     

Systematic analysis of funding awarded for norovirus research to institutions in the United Kingdom, 1997–2010

Objectives

Norovirus infections pose great economic and disease burden to health systems around the world. This study quantifies the investments in norovirus research awarded to UK institutions over a 14-year time period.

Design

A systematic analysis of public and philanthropic infectious disease research investments awarded to UK institutions between 1997 and 2010.

Participants

None

Setting

UK institutions carrying out infectious disease research.

Main outcome measures

Total funding for infectious disease research, total funding for norovirus research, position of norovirus research along the R&D value chain.

Results

The total dataset consisted of 6165 studies with sum funding of £2.6 billion. Twelve norovirus studies were identified with a total funding of £5.1 million, 0.2% of the total dataset. Of these, eight were categorized as pre-clinical, three as intervention studies and one as implementation research. Median funding was £200,620.

Conclusions

Research funding for norovirus infections in the UK appears to be unacceptably low, given the burden of disease and disability produced by these infections. There is a clear need for new research initiatives along the R&D value chain: from pre-clinical through to implementation research, including trials to assess cost-effectiveness of infection control policies as well as clinical, public health and environmental interventions in hospitals, congregate settings and in the community.     

Canada and global health research: 2005 update

From a global perspective, large disparities persist between the focus of health research investments and the global burden of illness. Over the past four years, Canadian efforts to address these disparities have steadily increased. The objectives of this paper are to present these recent achievements and to highlight continuing challenges. We summarize the activities of two complementary Canadian initiatives, both aimed at increasing Canada's investment and involvement in global health research. They are the Global Health Research Initiative--a partnership involving four federal agencies; and the Canadian Coalition for Global Health Research--a not-for-profit membership organization. Several achievements include: increased investment in global health research; increased knowledge production and use through "South-Canada" partnerships; stronger advocacy and increased awareness; enhanced capacity development; and improved coordination and communication. Based on these achievements, important current and future challenges are identified. They include: more coherent resource allocation; more focussed health research priorities; and the need to maintain and build momentum.     

Applied public health research - falling through the cracks?

Background  

There is a degree of dissonance between the types of evaluative research required by organisations providing or commissioning health care, those recommended by organisations developing evidence-based guidance, and those which research funding bodies are prepared to support.     

External assistance to the health sector in developing countries: a detailed analysis, 1972-90.

This study, which was conducted for the World Bank''s World development report 1993: investing in health, provides an objective analysis of the external assistance to the health sector by quantifying in detail the sources and recipients of such assistance in 1990, by analysing time trends for external assistance to the health sector over the last two decades, and, to the extent possible, by describing the allocation of resources to specific activities in the health sector. The main findings of the study are that total external assistance to the health sector in 1990 was US$ 4800 million, or only 2.9% of total health expenditures in developing countries. After stagnation in real terms during the first half of the 1980s, health sector assistance has been increasing since 1986. Despite their small volume, external assistance at the margins may play a critical role in capital investment, research and strategic planning. The study confirms prior findings that health status variables per se are not related to the amount of aid received. Comparing investments to the burden of disease shows tremendous differences in the funding for different health problems. A number of conditions are comparatively under-financed, particularly noncommunicable diseases and injuries.     

An analysis of financial flows from the Brazilian Ministry of Health for research and development in 2003-2005 according to the National Agenda for Health Research Priorities

This study mapped the application of financing in research and development in health (R&D/H) by the Brazilian Ministry of Health in 2003-2005, according to the National Agenda for Health Research Priorities, created in 2004. The analysis was based on data from a study aimed primarily at measuring these investment flows during the same period. The calculations included only direct financing with actual outlays in research, including payroll expenditures. The studies were categorized according to the 24 sub-agendas of the national priority agenda by two independent researchers, and disagreements were resolved by consensus. Research and development expenditures in health totaled 409.7 million reais, concentrated mainly in the following sub-agendas: transmissible diseases, the health industry complex, clinical research, pharmaceutical care, and non-communicable diseases (79% of the total). All 24 sub-agendas received some financing during the period. The study established a baseline for subsequent evaluations of this financing instrument's inductive capacity and the relationship between R&D/H investments and the population's health needs.     

Assessing research impact: A framework and an evaluation of the Society of Family Planning Research Fund’s grantmaking (2007–2017)

The Society of Family Planning Research Fund (SFPRF) provides grants for research on abortion and contraception. In 2017, SFPRF conducted a retrospective evaluation of its investment in family planning research. Using a developmental evaluation approach, we created a framework for assessing research impact in family planning and applied it to an analysis of our grantmaking between 2007 and 2017. Our framework consists of 30 indicators of research impact, which span nine impact categories from building researchers’ capacity to influencing individuals, communities, and systems. Through application of this framework to our grantmaking, we learned that our grantmaking has helped build the research capacity of emerging and established family planning scholars and advance the field of family planning by supporting the creation of a robust scholarly evidence base. At the same time, we identified less evidence of impact on policy and practice. The results of this analysis directed SFPRF to move towards more focused funding opportunities, including longer-term and larger investments, and to prioritize partnerships between researchers and knowledge brokers.     

Ethiopia-Netherlands AIDS research project]

The 'Ethiopia-Netherlands AIDS Research Project' (ENARP), started in 1994, is a long-term collaboration between AIDS researchers in Amsterdam and the Ethiopian Health and Nutrition Research Institute in Addis Ababa. The ENARP's primary objectives include conducting studies on HIV and AIDS in Ethiopia, especially by means of some large-scale prospective cohort studies, training Ethiopian scientists in PhD programmes in epidemiology, immunology and virology and establishing a reference laboratory for HIV and AIDS in Ethiopia and neighbouring countries. External funding for ENARP amounts to 32 million Dutch guilders for two periods of four years and is being provided by the Dutch Government. ENARP is the largest third world biomedical project supported by the Dutch Government. In 2000 two Ethiopian students obtained their doctorates from the University of Amsterdam. Five new PhD students commenced their training in 1999. ENARP hopes to set up HIV-1 vaccine phase I and phase II trials in the near future.