Impacts of the CIHR Institute of Infection and Immunity 2000-2008

A Report prepared for the Institute by Mark Bisby and Michelle Campbell

Ottawa, February 2009

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Table of Contents

Summary

Introduction
The CIHR Institute of Infection and Immunity
Goals of this assessent

1. Changes to the I&I Research Agenda
Building foresight capacity and responsiveness to emerging issues
Creating strategic initiatives – but is there a need?
Creating strategic initiatives – and do they work?
III's impact on the Infection & Immunity (I&I) agenda
III agenda: where next?
Summary

2. Changes in how research is done
How to encourage collaboration
Forced marriage, fast divorce?
Teams – what's in it for science?
Encouraging risk and innovation
Summary

3. Changes in who is doing I&I research
Expanding the scope of the I&I portfolio
Opportunities for new researchers
Forming a new kind of trainee
Building capacity in emerging areas
The rich get richer?
Summary

4. Changes in how I&I research is funded in Canada
The CIHR and III budgets
Allocating the research investment
Impact on other funding sources
Summary

5. Changes in partnering
A leader in partnerships
What attracts partners to III?
Key lessons learned from partnerships
Bureaucracy and coordination
Summary

6. Changes in how I&I research is being used
Changes in the advancement of knowledge
Changing roles in knowledge translation
Linkage & exchange
Creating new products and services
Role and effects in the policy and practice environment
Changes in public awareness of health research and its benefits
Summary

7. Where to now?

Endnotes
Appendix A: Additional data and analysis
Appendix B: List of key informants

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Summary

The CIHR Institute of Infection and Immunity (III) is one of CIHR's 13 Institutes launched in 2000. Unlike some Institutes, III did not have to start from scratch: it inherited well-established research communities in both immunology and infectious diseases, strong in biomedical science, but less well-represented in the themes of health services and population health research.

III's task was thus to introduce a multi-thematic approach to infection and immunity (I&I) research by encouraging the existing biomedical community to participate, recruiting researchers from the under-represented themes, building capacity in weak areas, and involving the necessary stakeholders to achieve its goals. Early in its history III faced the critical challenges of a research response to major public health issues: Walkerton, SARS, and Avian Flu. Nevertheless, these were extraordinary opportunities for the Institute to build its reputation with stakeholders and demonstrate the value of the CIHR model.

III is approaching a critical transition as its founding Scientific Director (SD) completes his term. We were asked by III to look at how the Institute has had an impact on research and the research community in the areas of infection and immunity, and identify those III activities that have had the greatest impact. We often found it helpful to take as a baseline the imagined impact of the simple continuation of a better-funded MRC, and consider the potential value-added of III.

To obtain the information on which we have based this report, we interviewed over 40 key informants who have interacted significantly with III; we surveyed information about III from the websites of the Institute, CIHR, and approximately 100 other organizations; and we used several grant, financial, publication and citation databases to obtain quantitative data.

1. Changes to the I&I research agenda

III has had valuable impacts on the I&I research agenda in ways that would not have been possible for MRC. Through efforts to convene researchers and research users across disciplines, III has galvanized the research community to respond to challenges and opportunities in under-researched and emerging areas by carefully and selectively investing its strategic research budget. Evidence suggests that III's strategic initiatives address clear needs which are not responsive to traditional funding modes, attract quality researchers, and achieve their goals of building capacity and activity in the targeted areas. III has also helped researchers identify and resolve real-world problems of importance to Canadians and the users of I&I research.

It will be difficult for III to have significant impact on the overall I&I agenda, however, as long as its funding and direct influence extends to only 3.7% of CIHR's total investment in I&I research.

2. Changes in how research is done

The comments of the key respondents were quite different from the long-held and supposedly widespread concern among health researchers about the quality of research being undertaken within strategic research programs. Projects funded by III strategic research initiatives are perceived, by those involved at any stage of the process, as: (i) mobilizing novel multi-disciplinary teams; (ii) pursuing multi-dimensional questions at national and international levels; (iii) increasing appetite for risk-taking and consequent potential for innovation and breakthroughs; and (iv) providing greater impetus for translation of results. The question raised by respondents was not whether strategic initiatives have any value, but rather whether they will prove to be the major source of innovative research in the future. This assessment implies a remarkable impact of III on the culture of I&I research.

III's impact has been to support and increase multidisciplinary collaborative research in the I&I research community. While it is still early days, these collaborations are generally real and sustained, and yield results. By attracting leading researchers, a broad swathe of the research community, diverse and appropriate stakeholders and partners to participate in agenda-setting and initiative development and review activities, III has made strategic team research not just respectable, but truly innovative.

3. Changes in who is doing I&I research

The important change since 2000 has been the attraction and support of new investigators in this field. This is an outcome both of overall CIHR funding increases and partnerships, and a deliberate strategy of III in the HIV/AIDS field.

The major impact of III has been to assist these new investigators to become established through: (a) grant funding that is targeted to them (Pilot Project grants and to a lesser extent bridge funding); and (b) the New Investigator Forums. It is unlikely that either of these amenities would have been available through MRC.

Many thought that the Strategic Training Initiatives in Health Research (STIHRs) funded by III were already having an important impact on the interdisciplinarity of both investigators and trainees associated with them, and expected greater impacts as the graduates of these training programs entered the research workforce.

Significant staff support can really help new teams come together and develop research programs in novel areas, but III's resources to provide this level of support are limited.

There were a number of discrepancies between perception and reality in this area, probably influenced by the notoriously low success rates in the open grants competition. In reality, young investigators in I&I research who receive New Investigator Awards are succeeding in securing operating funds. While established researchers have quite reasonably increased their funding as a result of CIHR's budget increases, they have not done so at the expense of the many new recruits to the field of I&I research.

4. Changes in how I&I research is funded in Canada

CIHR's investment in I&I has increased faster than its overall budget, appropriately, given the growing awareness since 2000 of Canada's vulnerability to infectious diseases and the need to boost Canadians' defences. However, III's strategic investments are so overshadowed by the 96% of funding that flows to I&I research through open competition that it is difficult to disentangle the impacts of III from those of CIHR.

The primary impact of III has therefore had to be catalytic, for example, by seeding neglected areas, developing international opportunities, and providing limited funding to allow high-quality research projects to proceed while re-applying for long-term CIHR funding.

A second important impact has been the involvement of funding partners and stakeholders in setting the Institute's research priorities. This has several mutual advantages: partnered research programs became increasingly relevant to actual needs, and uptake of results is more probable.

For their own part, funders are rising to the challenge of the new CIHR funding environment, and adapting their priorities in a variety of ways, including increasing the interdisciplinarity of their own funding programs. III has been able to link researchers with suitable funding partners, and other funders helped to prepare I&I researchers to be more competitive for large-scale CIHR funding.

5. Changes in partnering

III is considered an excellent and desirable partner, thanks to the expert knowledge, early and continued engagement, patience, flexibility and due diligence it brings to its partnerships. III has enhanced the positive perception of CIHR by partner organizations, in comparison to their sometimes jaundiced view of the former MRC.

The impacts of III's partnering efforts are widespread, though impossible to quantify. They include a research agenda more relevant to the real health problems of Canadians, a growing interest in the utility of health research among health agencies, improved representation in international initiatives, and an appreciation that CIHR, thanks to III's example, can respond rapidly to emerging health threats by mobilizing the expert health research community.

Despite efforts on all sides, there remain partnership issues for CIHR: the perceived rigid bureaucracy at CIHR headquarters, and a lack of coordination among the 13 Institutes.

6. Changes in how I&I research is being used

I&I research is improving in quality, relevance, availability, and ease of uptake and application, all of which are important steps towards increased research use.

The quantity and quality of I&I research has more than recovered from the budget cuts of the mid 1990s. Given III's small budget, these overall improvements are more likely attributable to the increase in CIHR's budget, not to mention a range of other major enhancements to the Canadian research environment since the 1990s. Nevertheless, the doubling of virology publications may be related to III's several priorities in this field.

The Institute's community is more aware and more willing to engage in KT activities, but seeks guidance and support as to how to go about it. Researchers are becoming more interested in orienting their programs to increase timely application of results, while provincial and federal health agencies trust III, and will rely on it again to provide research results to inform policy decisions. Receptor agencies may find it difficult to meet the demand to participate on research teams, especially within more targeted strategic initiatives.

Where III has excelled is at creating opportunities for linkage and exchange between researchers and research users, including other researchers, health practitioners and policy makers, and industry. There are many examples of policies, practices, products and services which are being developed as a result of projects created within III's strategic initiatives.

Finally, III has been successful at conveying to the public both the nature of threats to public health and the importance of investing in research in order to mitigate them.

Introduction

The CIHR Institute of Infection and Immunity

The CIHR Institute of Infection and Immunity (III) is one of CIHR's 13 Institutes launched in 2000. Although all the Institutes shared the mandate of CIHR, each faced different initial challenges. Unlike some Institutes, III did not have to start from scratch: from CIHR's predecessor, the Medical Research Council (MRC), III inherited well-established and well-funded research communities in both immunology and infectious diseases. These researchers were particularly strong in biomedical science, but much less well-represented in the themes of health services and population health research.

A big challenge for III was thus to introduce a multi-thematic approach to infection and immunity (I&I) research by encouraging the existing biomedical community to participate, recruiting researchers from the under-represented themes, building capacity in weak areas, and involving the necessary stakeholders to achieve its goals. These changes were essential for III to contribute to CIHR's goal of "forging an integrated health research agenda across disciplines, sectors and regions that reflects the emerging health needs of Canadians and the evolution of the health system and supports health policy decision-making"¹.

III is unique among the institutes in two important ways: first, it manages substantial funds for targeted programs on behalf of CIHR, giving it a practical budget many times larger than the allocated strategic budget which all Institutes receive. Second, shortly after CIHR's launch, Canada faced a significant number of major health issues which became public and government priorities – the Walkerton water supply tragedy, SARS, and the potential Avian Flu pandemic – which all fell within III's mandate. These challenges were a trial-by-fire for III, but provided opportunities for the Institute to prove its value, build its reputation, and demonstrate the utility of the CIHR model.

CIHR's 2006 International Review reported favorably on III², noting that "The Scientific Director clearly leads by example and has the confidence of much of the community. This is an example where Knowledge Transfer has worked very well and has provided rapid responses to a range of public health requirements", and "On balance, … this Institute has been very successful". In preparation for that review, a 2005 EKOS survey of funded and non-funded health researchers found that 91% of researchers felt that III had been "very" or "to some extent" successful in influencing the research agenda within its mandate³.

Goals of this assessment

The Institute of Infection and Immunity is approaching a transition as its founding Scientific Director (SD) completes his term. At this critical juncture, we were asked to report on the outcomes and impacts of the Institute's activities since its inception, differentiated as much as possible from the impact of generally increased CIHR funding. We investigated the actions of the Institute's Director, Staff and Advisory Board, the role played by the research community, partners and stakeholders participating in III-sponsored research funding and other activities. We explored the vision and strategy of the institute, the research-facilitating activities that III has led and sponsored, the partnerships and collaborations fostered by III, the people and types of research funded by III strategic initiatives, and III's knowledge translation (KT) activities, including commercialization, and impacts on policy and practice.

In this assessment, attribution was a significant challenge. We were charged to focus on what the Institute has caused to change, rather than on how infection and immunity research has changed. The Institute is well-integrated into CIHR and benefits from the CIHR leadership, models and programs which have supported, catalyzed and enhanced the Institute's own activities. Neither data nor respondents always distinguished clearly between what was CIHR's and what was III's: rightly so, we think. Furthermore, there have been so many improvements since 2000 in support for I&I research, and the environment in which it takes place⁴, that it is difficult to attribute changes even to CIHR, let alone III, since the increase in the overall CIHR budget dwarfs the Institute's modest budget for strategic research.

Since we were both well acquainted with the workings of MRC in its last years of operation, we often found it helpful to take as a baseline the imagined impact of the simple continuation of a better-funded MRC, and consider the potential value-added of the CIHR model, using the III as an example.

We used several approaches to obtain the information on which we have based this report:

• We conducted a series of semi-structured interviews with key informants with a variety of roles and encounters with III (interviewees are listed in Appendix B). We sought to identify trends and changes that could be attributed to the III's own activities, and not to I&I funding in general; we thus selected informants with considerable interactions with III, and not a statistically significant sampling of the entire I&I research community. Later in our enquiry we also contacted others to address very specific issues that arose as we proceeded.
• We surveyed information about III (annual reports, newsletters, meeting proceedings, evaluation reports, strategic plans, press releases, etc.) from the websites of the Institute, CIHR, and approximately 100 other organizations, some selected because of their known role as partners with or stakeholders⁵ in III, others discovered through search engines.
• We used largely public domain databases to obtain quantitative data bearing on III's operating environment and outcomes of CIHR and III funding⁶.

Throughout this report we reference as endnotes the sources of information and search strategies described briefly in the text. We have also included the additional results of a number of data analyses in a separate data appendix (A), referenced in the text of the report. The text boxes and quotes included in the Report are verbatim comments (lightly edited for clarity) from key informants that seemed to exemplify the input we received on that issue.

1. Changes to the I&I research agenda

Building foresight capacity and responsiveness to emerging issues

“III is nimble, can respond quickly, and address areas rapidly. It’s quite a different environment than, say, cancer, where the problems stay the same – you don’t have cancer outbreaks! III has to respond to a very-rapidly changing world.”

III is seen as very responsive to emerging issues, proactive and nimble, and open to ideas that are "out of the box". One respondent said; "As opportunities have come along, III has galvanized the community to be able to respond to them". The standard was set with SARS, when III demonstrated an unprecedented response to an urgent health issue, "getting an RFA out the door and reviewed in 19 days. Contrast this to the original HIV, which took 2 years!" III demonstrated that it "could do really rapid turn-around and yet not compromise peer review". Respondents felt that MRC could never have formed the coalition or funded urgently-needed research as quickly as III was able to do. CIHR's rapid response to SARS, led by III, received national and international attention⁷ and was cited by the federal government as an example of excellence in Canadian innovation⁸.

III has also shown good foresight, often anticipating upcoming issues before they are generally recognized as areas needing action. Respondents identified, for example, the Safe Food & Water Initiative (SFWI), whose first meeting, scheduled months earlier, occurred just days after Walkerton became a household name. Similarly, by the time the US National Institutes of Health (NIH) suggested a meeting to discuss Canada's potential role in an international microbiome collaboration, III had already brought together key leaders in this area to discuss Canada's strengths and potential contributions to such an effort.

As part of Pandemic Preparedness, III funded CIHR's Ethics Office to develop an ethics process which could be used in future public health emergencies, and together with Health Canada and the Public Health Agency of Canada (PHAC), held a series of workshops and meetings to define what public health activities during an epidemic will need research ethics board review or other, more rapid, types of oversight. Although we might not have expected such a biomedically-oriented Institute to be a leader in ethics, III is considered to be one of the three most active Institutes in this regard, and to have uniquely integrated ethical issues into all aspects of its research agenda in a way that "none of the others comes close to achieving".

At the same time, the further III ventures into new areas, the further some would still like to see it go. One respondent noted that III could benefit from significantly more foresight, to recognize and plan for issues like Avian Flu so that funding comes before an outbreak, not after. Another noted that some RFAs were useful but a little too late, and that a better process and relations with partners would allow these to be more timely.

Creating strategic initiatives – but is there a need?

Overall, most respondents believe that "The strategic initiatives complement the open operating grants quite well". Request for Application competitions (RFAs) address a variety of needs, bringing new approaches to program structures and peer review which may be more appropriate when addressing new areas and capacity building. RFAs also "help communicate to people like me what is actually needed – for me to find out where there is a perceived need is very hard." In addition, RFAs encourage research in "non-sexy issues", such as how to deal with specific risk materials, produce a SARS vaccine as fast as possible, or evaluate universal influenza vaccination. These "highly practical and focused issues really provide benefit to Canadians, but are not very exciting to an academic researcher".

"III has a culture of creating initiatives with input from the community – this is a huge departure in Canada."

Universally, III is lauded for its extremely effective role as convener: when an issue has been identified, the Institute brings together a wide range of key players from academia, government, the health system, and industry towards solving common problems, such as a SARS vaccine or C. difficile infections. "The reward is a well-focused initiative that identifies where the problem areas lie, with respect to the current state of research". MRC lacked the capacity to undertake such collective agenda building. Respondents who had experienced an III workshop thought these events provided excellent value to the community, building relationships, spurring new ideas and creative approaches, identifying national opportunities, and connecting disciplines.

Respondents with experience in initiative design or review saw distinct review criteria and international committees for RFAs as necessary "in areas we are just starting to come into, like probiotics, which our existing peer review committees couldn't have addressed". One respondent noted traditional peer review committees "are nervous about sticking their necks out…this is no good if the Institute is trying to get people out of their comfort zones".

Creating strategic initiatives – and do they work?

The subject of targeted funding can generate significant debate; many are still convinced that strategic initiatives support poor-quality research which "couldn't make it in a real competition". This misperception should be partially dispelled by our investigation into who participates: higher-performing researchers are over-represented in strategic initiatives (Appendix A/A).

In addition to quality of research, a second oft-repeated criticism of RFAs is that researchers will be quite "creative" in matching their projects to the RFA criteria – and then go ahead with their original plans anyway. However, those who have been involved in designing or reviewing strategic initiatives feel that III processes successfully distinguish the truly interested from the merely opportunistic, and we found publications emanating from the SFWI that were clearly relevant to the original grant application and to the aims of the initiative.

A third but relatively minor criticism, directed at CIHR generally, is that the merit review of multiple small RFA competitions, coupled with the unpredictable timing of such reviews, distracts the scientific community from doing its research.

“While many researchers decry the existence of strategic initiatives, don’t listen to what they say…watch what they do, i.e. they apply for this funding if they think it relevant to their interests.”

It thus seems that III's strategic initiatives are generally supporting high-quality research, and hitting their target. Furthermore, evidence suggests that researchers do "follow the money": RFAs definitely stimulate activity in the area targeted, and do build evidence and capacity in critical areas, for example in auto-immunity and pandemic influenza. If anything, a few worried that strategic initiatives could do this job a little too well, concerned that major AIDS funding was drawing researchers away from other, equally important areas of research. Because of the large scale of the AIDS initiative and higher success rates in its competitions⁹, we suggest it is particularly important to demonstrate that research funded through this program is of high quality and produces important outcomes.

Taking a look at two priority areas for III funding, Food Safety is a rapidly growing research topic in Canada, and even more so globally. Canadian publications first jumped from insignificant numbers in 2003, likely spurred by the Walkerton incident (Summer 2000), and grew further between 2005 and 2007, probably reflecting III's SFWI investment.

There has been a huge increase in Canadian publications in pandemic influenza, though with a starting point of 1, rapid growth to 31 publications per year suggests less the attainment of international leadership than an almost complete neglect of this research area prior to 2000. The SARS outbreak and III strategic initiative in 2003 triggered interest (for example, 9 of the 2005-06 publications were directed primarily to "lessons learned" from the SARS outbreak), while we expect the III funding for pandemic influenza, begun in early 2007, will sustain work in this area.

Fig 1-1 Relative growth in Canadian and World publications in Food Safety (left) and Pandemic Influenza (right) since 1996 (=1). (Source: Pub Med.)¹⁰

III has carried out its own, or has contracted out, assessments of several of its strategic initiatives¹¹, and while most are provisional, in that insufficient time has elapsed to judge the full outcomes, they are generally positive about the collaborations and research partnerships that have developed, and the potential for significant impacts on knowledge, practice and policy.

III's impact on the Infection & Immunity (I&I) agenda

“Don’t overplay that we’ve had big changes on the research agenda.”

Given broad agreement that RFAs do, in fact, increase research activity and capacity in the areas they target, it seems odd that many respondents also saw III's impact on the I&I agenda as minimal. This apparent contradiction likely reflects the contrast between the small scale of Institute-funded research, (3.7% of CIHR's investment in I&I) vs. the full scope of research, mostly investigated-initiated, which may be affiliated with the Institute but is not directly influenced by it (the remaining 96.3%). While the evidence available suggests that strategic initiatives are achieving their goals, they are a drop in the bucket of CIHR-funded I&I research, and thus have limited impact on the performance of the overall research field.

It is therefore not surprising that while a small number of researchers felt CIHR would be better off with no strategic initiatives, many more suggested the Institute needed a larger budget to address the full scope of its mandate and emerging challenges. One final point was that since Institute priorities are transient, there must be appropriate funding capacity in the open competitions of CIHR so that excellent research in evolving or underdeveloped areas that is fostered by the Institute can be sustained once the period of Institute support has ended.

III agenda: where next?

“I would love CIHR/III to get a bit more daring on the research agenda front…. It would be great if we could draw on CIHR’s networks and expertise to develop a better understanding of more upstream determinants of infectious disease spread and prevention.”

III's research agenda is determined by its strategic plan. The 2002-2007 plan included ten priority research topics, and while all of them received some attention, the second plan (2007-2012) regrouped the priorities into five more focussed and feasible areas: Emerging Infections and Microbial Resistance; HIV/AIDS; Immunotherapy; Pandemic Influenza Preparedness; Vaccines of the 21st Century. All CIHR Institutes have to find the right balance between: (a) focusing on a few strategic initiatives, with the potential for significant impact in the selected areas, but at the risk of alienating large segments of the research community and other stakeholders; and (b) fractionating the research agenda by trying to do a little bit of everything, which may reassure all stakeholders that their interests are being addressed, but risks dissipation of effort and impact. Most Institutes, III included, began by erring on the side of inclusiveness; however, according to respondents, III learned its lesson faster than most, and has now achieved a good balance. III has also been able to create room within its overall vision and strategy to be ready for unpredictable challenges such as SARS, and opportunities such as the transfer from Health Canada to CIHR of the HIV/AIDS Community-Based Research Program¹².

Some partners see the role of CIHR, like MRC, to provide a base of fundamental research support upon which they can build more applied science. Most, however, feel that III needs to focus more strongly on translational research, and noted that the Institute, like CIHR, invests the majority of its resources on basic biomedical research. While in III interactions between the four CIHR themes have improved, they still have a long way to go to achieve effective translational research.

III has moved CIHR into some notable new areas, such as probiotics and phage therapy, through the Novel Alternatives to Antibiotics Initiative. This innovation has made some of MRC's traditional community uncomfortable. At the same time, new partners are eager to work with III on issues that go beyond typical public health concerns, such as infectious disease risks resulting from climate change, factors that allow cross-species transmission of pathogens, and environment- and food-borne zoonoses.

Summary

We conclude that III has had valuable impacts on the I&I research agenda in ways that would not have been possible for MRC. III has been nimble and responsive, enhancing CIHR's reputation as an agency that helps solve real health problems. Through efforts to convene researchers and research users across disciplines, III has galvanized the research community to respond to challenges and opportunities in under-researched and emerging areas, by carefully and selectively investing its strategic research budget. Evidence available so far suggests that III's strategic initiatives address clear needs which are not responsive to traditional funding modes, attract quality researchers, and achieve their goals of building capacity and activity in the targeted areas. III has also helped researchers identify and resolve real-world problems of importance to Canadians and the users of I&I research. It will be difficult for III to have major impact on the overall I&I agenda, however, as long as its funding and direct influence extends to only 3.7% of CIHR's total investment in I&I research.

2. Changes in how research is done

Without question, the largest and most fundamental change respondents associate with III is the dramatic growth of research teams, which have become more usual, larger, and multi-disciplinary. III has required such teams in many of its RFAs, but it has also provided substantive support and encouragement for collaboration within and across research teams. While a few respondents felt that the verdict is not yet in on the effect of this shift towards team-based research, most respondents identified a range of significant benefits associated with it.

How to encourage collaboration

“RFAs give you brownie points for involving new collaborators. In a standard grant, proposing a collaborator you never worked with before is the kiss of death.”

From its inception, CIHR has encouraged team grants, and III has been a major proponent of this approach. III has helped build teams across disciplines and sectors, teams with research users, and with previously unknown collaborators. Participants are enthusiastic about these grants¹³, and they work: overall, the number of investigators per I&I grant has been steadily increasing, and this change is even more pronounced in III's strategic grants (Appendix A/B). International collaboration is also increasing, as measured by the percentage of Canadian publications with international co-authors in the I&I field. Collaboration is overwhelmingly with the USA, followed by the UK, France and Germany, but increased dramatically between 2000 and 2007 with China (Appendix A/B).

In addition, the Institute has supported team building through Application Development Workshops, such as the Influenza Research Network Application Development Workshop held in February 2008, and its infamous SFWI 'proposal writing exercise', in which a table full of unacquainted researchers from all sectors was given a limited time to produce a proposal that incorporated the skills and interests of every player at the table. Respondents report that this eye-opening exercise has not merely opened minds to new possibilities, but actually provided the starting point for new collaborations – some eventually funded through the initiative, some funded by other organizations.

“I wouldn’t normally write grants with 4 or 5 investigators, but with III, I do.”

III has also successfully encouraged collaboration across teams, for example by bringing all the teams funded through an RFA together to share progress and ideas. Informants noted that such meetings can help propel a whole area of research forward, instead of just one group. The New Investigator Forums have similarly spurred new research approaches and collaborations.

“I’ve been doing medicine since I was 17 – and the only other people I’ve interacted with since were other doctors. Now I read different literature, interpret data differently, ask different questions. Now I can interact better with the scientists around me. I’m a co-PI on a grant on gene expression, and I’m collaborating with two basic scientists I met through the STIHR.”

Serendipity may be viewed as the keystone of science, and sometimes also, it seems, of science funding. One frequently mentioned lever of change is CIHR's Strategic Training Initiative in Health Research (STIHR) Program, designed to create a new kind of learning environment, but not just for trainees. "Once people start talking, they find things to collaborate about. Some collaborators are now writing manuscripts together because a student was the glue."

Despite the enthusiasm of many for collaborative and interdisciplinary research, others wondered if this approach was beneficial to the progress and achievements of I&I research. This debate probably boils down to definitions: if "achievement" is measured only in bibliometric terms, then given the inherent difficulties of multidisciplinary work, there may well be little improvement in the short-term. If "achievement" means actually having an impact on the health of Canadians, then it is difficult to see how there can be any achievements for III without requiring the participation of multiple disciplines as biomedical discoveries are converted into new technologies, products, or clinical practices, and implemented within the health care or public health systems. III researchers who have shifted to multidisciplinary teams expressed much amazement at how much more effective and innovative team research was in addressing complex health questions and producing breakthrough, rather than incremental, results. However, they also recognized the additional time and effort required to make a team work well. It may be that a longer-term evaluation of team research finds that publication quantity is sacrificed for quality.

In addition, a couple of respondents noted that while funders like III have increasingly prioritized team research, academic review structures do not: "the major criteria by which I am judged is how well am I establishing myself as an independent investigator". Not surprisingly, then, the average age of receipt of first strategic grant is about five years older than the average age of receipt of an open competition grant¹⁴, suggesting that young investigators are indeed establishing their "independent" credentials before diversifying into strategic research. Until efforts and achievements in a team and multidisciplinary environment are properly valued by academic and peer reviewers, III's attempts to encourage collaboration will be compromised.

Forced marriage, fast divorce?

Most respondents were grateful for the new relationships they've developed with people they would never have otherwise met. However, there were some warnings that teams are not a universal panacea: III staff echoed the importance of evaluating the research needs of each challenge on a case-by-case basis.

“I’m not a believer in forced marriages, but we should make it possible where the science demands – and even push a little. Team grants encourage researchers to think big, not be so risk averse.”

In contrast to mostly positive views, one respondent believed that the Safe Food and Water Initiative (SFWI), for example, failed to be effective because it targeted people who had never worked together before, noting that "With one exception, those teams have not been sustained. It's better to target people with prior working relationships." The evidence, however, suggests that SFWI's novel teams are quite effective: each line in Fig. 2-1 shows a co-authored publication among team members, before and after SFWI funding¹⁵.

Clearly the award of SFWI funding overall increased co-publication between team members, both in areas directly relevant to the topic of the SFWI grant, as well as in other areas. Furthermore, the funded teams report additional publications under development, so the number of co-authorship linkages will continue to increase beyond those shown here. For comparison, we also examined other team-based III-funded initiatives (see Appendix A/C).

Fig 2-1 Co-publication among members of funded SFWI teams. Each line represents a co-publication; each colour a different team¹⁶.

"A major advantage of SFWI grants is community building with people you wouldn’t otherwise know or work with. We brought together 6 arms of government, provinces, academics, and industry together to discuss the problems and come up with a strategy. It was similar in the Novel Alternatives to Antibiotics Initiative."

Teams – what's in it for science?

"The Institute has really encouraged transnational and national partnerships; this is really encouraging: researchers have discovered they can accelerate the pace of discovery and development."

For most respondents, teams find bigger answers to bigger questions: "paradigm-shifting science" instead of the simple incremental additions to the knowledge base achieved by the same experts working in individual labs. "I&I issues are too big for one researcher to address by themselves. To answer them, these questions need to be addressed from many disciplines." III is also doing much to encourage international collaborations, where "the big things happen". Furthermore, "more focused questions lead to more translatable results", especially when teams incorporate both knowledge users and creators.

Encouraging risk and innovation

"Risk, which involves a certain amount of failure, will put you out of the game."

A significant trend of concern to all respondents who addressed it is the increasing risk-aversion of the peer review committees that are the gatekeepers to open grant competition funding. CIHR staff agreed: "Absolutely, researchers would not present risk on an application. They must show proof-of-concept, and that means the project needs to be 40-60% done when they apply." However, III staff believes that "while researchers in general are shying away from high-risk proposals, strategic initiatives create an avenue for these." Researchers agree: they "allowed me to pursue questions that I had no way of getting funded. Reviewers must be receptive to ideas that haven't been researched for 20 years".

The other aspect of innovation is technical. Respondents noted a range of changes in research approaches, including the wide spread adoption of "omics" over the past eight years. However, few saw III as involved in these changes, though some felt it could more actively manage the community's uptake of key new approaches.

Summary

The comments of the key respondents in our survey stand in stark contrast to the long-held and supposedly widespread concern among health researchers about the quality of research being undertaken within RFAs. Projects funded by III strategic research initiatives are perceived, by those involved at any stage of the process, as: (i) mobilizing novel multi-disciplinary teams; (ii) pursuing multi-dimensional questions at national and international levels; (iii) increasing appetite for risk-taking and consequent potential for innovation and breakthroughs; and (iv) providing greater impetus for translation of results. The question raised by respondents is thus not whether strategic initiatives have any value, but rather whether they will prove to be the major source of innovative research in the future. This assessment implies a remarkable impact of III on the culture of I&I research.

III's major impact on 'how research is done' has thus been to support and increase multidisciplinary collaborative research in the I&I research community. While it is still early days, these collaborations are generally real and sustained, and yield results. By attracting leading researchers, a broad swathe of the research community, and diverse and appropriate stakeholders and partners to participate in agenda-setting and initiative development, III has made strategic team research not just respectable, but truly innovative.

3. Changes in who is doing I&I research

Expanding the scope of the I&I portfolio

Despite dramatic budget increases, success rates in the CIHR open operating grants competitions have fallen to historically-low levels, causing even III's strongest biomedical supporters to fear that funding is being severely diluted by expansion into new areas. However, with almost 90% of the funds flowing through III going to basic biomedical research, and more than 95% of funding for I&I research coming from open competition grants, the evidence fails to support this view of a fundamental shift in funding that disadvantages biomedical research.

While there has been a quadrupling since 2000-01 in the number of investigators affiliating with III at the time of application (Appendix A/D), (compared to a ~2.6-times increase for CIHR overall), almost 90% classify their work as biomedical (Fig 3-1). Both the number and proportion of health services projects, and projects dealing with the social, cultural and environmental determinants of health have grown (Appendix A-E), but these still remain a tiny portion of III activity.

In clinical research, the number of projects has grown, but the proportion of these projects has stayed about the same. A recent study using the CIHR public database¹⁷ concluded that the "number of clinical researchers funded by CIHR is alarmingly small", and noted that, when similar definitions are used, CIHR funds a lower proportion of clinical research than does NIH. In particular, this study identified only 62 principal investigators (PIs) affiliated with III who were working in clinical research between 1999-00 and 2006-07.

In contrast, within the grants supported from III's strategic initiatives, the Institute has achieved a portfolio that contains a higher proportion (about 35%) of projects classified in the three non-biomedical themes (Fig 3-1, far right). This difference likely reflects the many real-time health threats III has addressed through strategic initiatives, and clearly demonstrates that III is broadening its scope where it has the influence to do so. Ironically, the visibility of these small but high-profile initiatives may fuel the myth of dramatic funding shifts in I&I research.

Fig 3-1 III-affiliated and III-strategic projects classified by theme

(Source: CIHR web database)

Opportunities for new researchers

A major target of the negative perception of the value of strategic research is in the area of capacity building. Some respondents blamed low success rates in CIHR's open grants and awards competitions on the diversion of funds to strategic research, and the majority equated the low success rates with lack of opportunity for new researchers to establish their research reputations. However, capacity development is a major priority for CIHR and III, and both have invested heavily in I&I capacity. Fig 3-2 shows the growth in investment in awards for studentships, fellowships and new investigators, plus grants specifically intended to benefit young investigators. Overall, III has invested 29% of its strategic budget in these capacity-building programs, with the proportion as high as 47% in 2003-04.

Since 2000, including Tier 2 Canada Research Chairs, 208 individuals have received CIHR salary support at the start of their independent research careers (Appendix A/F) . CIHR's support through New Investigator Awards has been primarily through an expansion of the open competition, as well as through various III and other Institutes' initiatives. Both III's and CIHR's awards show more balance between the themes, with 22% going to themes 2, 3 and 4 (Appendix A/G). This thematic distribution for New Investigator Awards is less heavily oriented towards biomedical research than the distribution of I&I grants (Fig 3-2), suggesting that over time the distribution of grants will become more balanced between the four themes.

Fig 3-2 Investment in research capacity

(Source: Funding data provided by III staff, May 2008)

III held several Forums for new investigators: three quarters of the 2007 participants "are more likely to explore or engage in interdisciplinary research, while just over half are planning new research collaborations as a result of attending this Forum" ¹⁸. Respondents confirm this positive view.

"Sustained relationships have developed out of the Forum: I am co-investigator on two grants with people I met there. I’ve been invited by them to give talks and vice-versa – and at our career level, this is very important to our CVs."

It's interesting to note that those with a basis for comparison, namely younger researchers with US experience, found the barriers to funding in Canada much lower than in the US: "CIHR is the most equitable funder in Western countries, it really gives new investigators a fair stab"; "CIHR is very supportive of a new investigator – friends in the US have a very hard time getting started."

Concerns for young investigators are reinforced by a recent report prepared for III: "the average age of those receiving a New Investigator Salary Award, presumably a group that amply defines highly qualified entry-level researchers, is 36 years…Yet the average age to receive a first CIHR grant is 41 years, suggesting that for some entry-level researchers, obtaining a first grant is difficult."¹⁴ This report also pointed out that "Entry-level researchers also have lower rates of success in the Open Grants Competition when compared to other career levels".

Other than through the HIV/AIDS and hepatitis C funding streams, III has not used its strategic budget extensively to support personnel awards for new investigators, but it has played an important role in assisting them to obtain operating funds at the beginning of their careers, through the Pilot Project Grants for new investigators in III priority areas¹⁹. These grants were identified by respondents as a valuable career instigation support, and this opinion was borne out by our analysis of the subsequent success of those who received them (see Appendix A/H).

The good news is that almost all the I&I New Investigator Awardees are receiving some form of grant funding; the bad news is that female New Investigators are much more likely to secure funding sources other than CIHR. Those who received III Pilot Project Grants are also more likely to have other CIHR funding. Those New Investigators who do have CIHR funding actually have larger than average total CIHR grant funding, with a handful even in the <$1M range (Appendix A/H).

In addition, respondents applauded III's decision to provide $1.6M in one-year bridge funding to projects that were highly rated but narrowly missed the funding cutoff for CIHR open grants competitions. Almost half of the "bridge grants" went to young investigators, and almost all recipients went on to receive multi-year operating grant funding, totaling $9.3M, in subsequent CIHR competitions, a notable leveraging effect of III funds.

Forming a new kind of trainee

"The impact is hard to quantify, but it is there in spades. The people the trainees know now will be leaders in 10-15 years, and they’ll know each other and still be working together. They’ll think much more broadly and inter-disciplinarily than their predecessors. They’ll be not just a finely-honed research machine that can do one thing really well."

Respondents believe CIHR's STIHR program is making significant changes in the training environments they experience, both as mentors and trainees. A key component is that "students are going to other collaborators' labs to spend time, instead of just being in yours – this is a phenomenal experience". From the student's perspective: "Before, I only knew the types of research we do here. But now I'm trying to look at how our research affects the others we know, what relates ours to theirs." With the STIHRs, "We are producing very different scientists", such as social scientists who study gene expression. A bio-statistician trainee reported having "a life-changing experience" in the clinic: "now I know what this means. I know what these genes are. They have a face and a name and a story". One of the leaders of a STIHR commented on the limitations of conventional graduate training "30-80% of trainees go somewhere else than academia– so why are we training them to be mirror images of ourselves?" The broader range of experiences and influences that trainees receive in a well-run STIHR may better prepare the majority for careers outside academia.

Building capacity in emerging areas

“Before CIHR, HIV research was in trouble; we were a decade behind most countries. We now have multiple world-class leaders, both in fundamental research and in health care delivery.”

One respondent noted, "operating grants work only on established areas". III has thus used a range of strategies to build capacity in emerging areas, and to attract established researchers to new topics. As mentioned Chapter 1, money orients curiosity. Large investments in HIV/AIDS and pandemic influenza have attracted people to these areas: "There were three researchers, now everybody's an influenza researcher!" (several respondents added: "…at least until the funding runs out").

We found that the number of researchers funded by CIHR in the HIV/AIDS area has grown more than three-fold over the last 7 years (Appendix A/I). Although the HIV community was not formerly large enough to build a STIHR, there are three such applications in the current STIHR competition. Consistent with the growth in grants and PIs, publications have also increased.²⁰

A striking departure from the traditional academic mode of capacity building has been the Community–based HIV/AIDS Program, which is advised by a steering committee with strong representation from community organizations. This program has emphasized capacity-building for research within community service organizations, funding workshops for such organizations, and Community-based Research Facilitators, who work with organizations in their region to develop research capacity through training and establishing contact with research collaborators in academia and government. This program is currently being evaluated elsewhere.

The number of PIs with grants dealing with influenza has grown from 15 to 105 during the same period, and similarly, "PrioNet Canada has really grown with support from CIHR and III. We have gone from 3 bone-fide prion researchers to 63 researchers working in various aspects of prion science, not only biomedical, but multi-disciplinary, including social scientists and economists."

Making research funds available will certainly attract people, but ultimately, in truly new areas, a major investment in supportive interventions by CIHR staff may be what's required: "In SFWI, the best proposals we could shepherd through right to the end. But this is too resource-intensive to sustain". We asked if this hands-on support, so different from the MRC approach, worked. "Absolutely! It was a very effective way to build capacity. If you are really committed to a strategic initiative, you have to bring people together and make this kind of effort."

The rich get richer?

"It seems like a few superstars have consolidated as team leaders, and young people now face tough slogging. People who were already at the top when CIHR was created have consolidated – they’re like the big-box stores of researchers, and they’ve taken over, leaving very little room for new people. We have many bright shining stars, but I don’t see how new ones are going to be able to step in."

There was strong agreement among respondents that "III has not necessarily attracted more researchers – it's still all the same ones." Some saw strategic initiatives as the solution, though staff noted they can be part of the problem, too: "The disadvantage of strategic initiatives is that researchers have to show they can achieve the goals they've laid out, and therefore already-successful researchers are more successful." An increasing focus on new collaborators and new investigators within teams is needed, "Otherwise, the consolidation around successful teams will increase, rather than building new capacity."

These frequently stated concerns prompted us to investigate the issue of the "rich getting richer" as a result of CIHR and III budget growth. We have already shown the growth in PIs affiliating with III, and in HIV/AIDS research in particular, which indicates that many newcomers to I&I or HIV research have been able to access CIHR funding. At the institutional level there are now 85 institutions receiving CIHR funds in the area of I&I research, compared to 54 in 2000-2001; we found no evidence that the larger institutions have increased their funding at a greater rate than the smaller ones (Appendix A/J). Finally, with respect to individuals, we compared "rich" PIs to a random sample, and found no evidence, from this admittedly limited sample (Appendix A/K), that the rich do get relatively richer.

Summary

The big change since 2000 in who is doing research has been the attraction and support of new investigators in this field. This is an outcome of overall CIHR funding increases and partnerships, and a deliberate strategy of III in the HIV/AIDS field.

The major impact of III has been to assist these new investigators to become established through: (a) grant funding that is targeted to them, the Pilot Project grants and to a lesser extent bridge funding; and (b) the New Investigator Forums. It's unlikely that either of these amenities would have been available through MRC.

Many respondents thought that the STIHRs funded by III were already having an important impact on the interdisciplinarity of both PIs and trainees associated with them, and expected greater impacts as the graduates of these training programs entered the research workforce.

Significant staff support can really help new teams come together and develop research programs in novel areas, but III's capacity to provide this level of support is limited.

Finally, we were struck by the number of discrepancies between perception and reality, driven by low success rates in the open grants and awards competitions. Young investigators in I&I research who receive CIHR New Investigator Awards are doing well in securing operating funds. While established researchers have quite reasonably increased their funding as a result of CIHR's budget increases, they have not done so by squeezing out the many new recruits to the field of I&I research.

4. Changes in how I&I research is funded in Canada

Canadians are now aware that highly infectious diseases sweep rapidly around the world. With climate change, diseases once thought to be all but eliminated in the developed world are re-emerging. Antimicrobial resistance is increasing, and not only in health care facilities. Government interest, and possibly funding, is thus shifting somewhat from chronic to infectious diseases and human defence against them, focusing on previously unglamorous areas such as food safety, clean water, avian flu, and vaccine, antibiotic, antiviral and immunotherapeutic development. Particularly in the USA, this shift has been accelerated by concerns about bioterrorism.

"It’s sad to say, but infectious disease is the future – as part of the trend in globalization, it’s just going to get worse. We need to strengthen III, and III’s research funding if the government is really interested in keeping Canadians healthy."

Canada is becoming increasingly aware of the costs of these risks to public health: for example, the limited SARS outbreak in 2003 was forecast to reduce GDP by $1.5B²¹. Although CIHR investment in I&I is fairly proportional to the economic burden of past infectious disease (Appendix A/L), it is inadequate to address likely future burdens. Extrapolating from a BC report²², the national cost of an avian flu pandemic could exceed $50B.

The CIHR and III budgets

At its most broadly defined, I&I research has grown from 25% to 34% of the CIHR "core" budget over the period 2000-2008²³ (Fig. 4-1,compare diamond and square symbols). However, the funding under discretionary control of the Institute is a small percentage (3.7%) of this amount, raising questions about how much impact one might expect III to have overall on I&I research and its outcomes.

To date, all 13 Institutes have been allocated the same annual budget, currently $8.5M, in order to promote collaboration and cooperation, rather than competition, between them. Many respondents felt that the Institute's influence and impact is limited by its budget, and the sustainability of its initiatives is also hampered: "Institute budgets should be commensurate with the size of their community, not all equal as is the Canadian way."

Despite the major increases in CIHR's budget shown in Fig 4-1, the success rates in CIHR's open grants competition have fallen steadily during CIHR's existence (Table 4-1), because there has been a compensatory increase in the number of applications, and also because individual grants have increased in value. Not surprisingly, then, many researchers expressed particular appreciation for III's "bridge" funding for "just-missed" grants. There were also many positive comments about III's efforts to facilitate access to international opportunities, such as the Gates Foundation Global Challenges, and the Canada-Germany and Canada-UK partnerships. These initiatives involve small numbers of researchers, but have a big impact in helping Canada become a major player internationally.

"The most notable impact of CIHR was the tripling of the budget. You can’t separate any change in its reputation from the sheer size of the increase."

Some noted that a perhaps inevitable side-effect of increased budgets, public awareness and consultation is the increased politicization of science, particularly as it affects the allocation of research funding. While all agreed that HIV/AIDS is an important research area deserving of major funding, other programs also focused on highly devastating but not politically "hot" diseases may not fare so well. For example, the final settlement with those who contracted hepatitis C through the blood supply was completed in July 2006²⁴, after which the PHAC/CIHR Research Initiative on Hepatitis C was not renewed despite a subsequent positive evaluation of its effectiveness²⁵. In general however, there was praise for the way the Scientific Director had been able to manage the political pressures on the Institute.

Fig 4-1 CIHR and III spending on I&I research, $000s (Source: CIHR database and III data)

Table 4-1 CIHR Open Operating Grants Competition	FY 2000-01	FY 2006-7
# of applications	2379	3894
# funded	800	846
Average value of grant	$80k	$130 K*
Success rate, applications affiliated with III†	45%	22%
Success rate, first-time applicants affiliated with III†	30%	18%

Allocating the research investment

The biggest change in I&I research funding is how III involves its partners and stakeholders in all stages of research planning, from setting global priorities to evaluating specific programs (Fig. 4-2). What was a rare practice in MRC is now standard at III. In engaging with partners at multiple points in the life-cycle, III is adopting one of the key trends predicted for 21st-Century science, the development of reliable and "socially-robust" research.²⁶

Figure 4-2 Points during the life cycle of a strategic initiative where partners and stakeholders may be involved in III decisions

Impact on other funding sources

Partners are increasingly attracted to CIHR. Their contributions to joint research initiatives with CIHR have doubled from $52M in 1999-00 to at least $107M in 2005-06 (Appendix A/M), while the number of partners involved has increased five-fold from 48 in 2000-01 to 256 in 2005-06²⁷. Other funders generally value the new CIHR and appreciate its increased budget. While research funders have always sought to maximize the value of their investments in the context of MRC's funding, they are now increasingly rethinking more fundamental priorities and values in response to CIHR's more proactive management of Canadian health research.

"CIHR’s voice is respected: when the Institutes say ’this is important/ worth funding/ we need to do more’, they are listened to."

Many funders see CIHR as a model, and as a leader within government. Some have adopted CIHR terminology, others have expanded their own mandates commensurately with CIHR's, because "there have been changes in the kinds of questions asked, and the level of interest, in population health and health services research", or because "having seen the success of CIHR, researchers in Canada would now be more open to the multidisciplinary approach." Some have used III's own partnership models or consultation approaches in their own activities. For some funders, "CIHR provides a pool of expertise and knowledge that we tap into" when planning new strategies or initiatives, and many would like to find more effective ways of involving CIHR and III in their own agendas – and not just contribute to III's agenda.

A number of funders now more explicitly focus on "bringing people up to the level where they are competitive for CIHR funding", or see that "with our limited funding, we could help people with start-up grants, be a catalyst to build their applications to CIHR or NIH". Other "non-traditional" funders have met researchers through III-sponsored activities, and developed strong relationships: "I know at least two cases where proposals to III were not funded, but got funding from a partner who was previously unknown to the researcher."

“I think the SFWI grant was practice for the (PrioNet) NCE. There wouldn’t have been one – or at least it would have been an infinitely more difficult and divided NCE - without this practice run through the SFWI.”

III's "catalytic" role in providing assistance to nascent collaborations to enable them to compete effectively for major funding is well exemplified in the case of the Networks of Centres of Excellence (NCE) Program. While it is an overstatement to claim III actions led directly to the creation of new NCEs, those involved with PrioNet Canada and AllerGen give generous credit to III for facilitating their formation and helping with the development of coherent research agendas that were able to secure over $60M in new funding. The relationship between III and the NCE program has also operated in a reverse fashion: following the June 2005 decision to not renew funding for CANVAC (The Canadian Network for Vaccines and Immunotherapeutics), responsibility for further development of a Canadian capacity for vaccine research fell to III.

Summary

CIHR's investment in I&I has increased faster than its overall budget, appropriately, given the growing awareness since 2000 of Canada's vulnerability to infectious diseases and the need to boost Canadians' personal and public health defences against them. However, III's strategic investments are so overshadowed by the 96% of funding that flows to I&I research through the open competition that it is difficult to disentangle the impacts of III from those of CIHR.

Owing to the Institute's limited budget, which many thought should be increased, the primary impact of III has been catalytic, for example, by seeding neglected areas, developing international opportunities, and providing limited funding to allow high-quality research projects to proceed while re-applying for long-term CIHR funding.

A second important impact has been the involvement of funding partners and stakeholders in setting the Institute's research priorities. This had several mutual advantages: partnered research programs became increasingly relevant to actual needs, and uptake of results was more assured.

For their own part, funders are rising to the challenge of the new CIHR funding environment, and adapting their own priorities in a variety of ways, including increasing the interdisciplinarity of their own funding programs. III has been able to link researchers with suitable funding partners, and other funders helped to prepare I&I researchers to be more competitive for large-scale CIHR and other funding. The broader impacts of III on partnerships are explored in the next chapter.

5. Changes in partnering

In health research, partnerships serve many functions: they make the research agenda more relevant to those affected by, or requiring answers to, the problem at hand; partners help design programs and select projects more likely to produce the desired outcomes; they provide built-in receptor capacity for the results of the research; they can pool resources to support novel large-scale research; and support mutual advocacy.

“Public and lawmakers in the US will start looking at NIH and saying “what are you doing for us?” NIH got four years of small budget increases, while the National Science Foundation got big ones: it said ‘we can help you with your security issues’, while NIH said ‘we need to keep our success rates high.’”

For these reasons, partnerships are the cornerstone of CIHR. III is particularly widely praised for the extent to which it involves a wide range of stakeholders in all its activities; partnering is fundamental to the Institute's functioning. As one CIHR staff member noted: "Our programs are always partnered. A lot of negotiation is required to have a peer review process that suits all parties. I don't see this as a disadvantage, but it is certainly a challenge!" One of III's earliest initiatives was to hold a Partnership Forum with over 30 potential partnering organizations, to discuss the principles of good partnerships.²⁸ The lessons learned at this Forum have served the Institute so well that recently an III staff person was invited to talk at a national forum on partnership²⁹.

A leader in partnerships

"MRC had no way to listen."

What impressed our informants, first and foremost, is the "widely acknowledged ability of III to convene partners in a way that MRC couldn't." III regularly brings together researchers, decision-makers, governments, foundations, industry, practitioners – groups who "never used to have a role with MRC" – to work collectively to address a shared health issue. Respondents saw III as a leader in engaging partners, and some believe this reputation has given other federal agencies the confidence to invest significant federal research funds in III. The Institute capitalizes on the specialized knowledge brought by an expert Scientific Director, and a focused and dedicated staff, to develop knowledge of the priorities and needs of stakeholders in the I&I community, continually impressing potential partners with its scope and depth.

Partners and researchers both consider III an excellent listener. Partners are thus encouraged to provide advice to the Institute about its funding priorities, and consider III as a potential funding source to help them realize their objectives³⁰.

What attracts partners to III?

Respondents agree unequivocally that III has excelled in reaching out to and involving partners in all its activities, giving credit to the approachability, flexibility, and responsiveness of III staff.

• III has a "what can we do to help?" attitude, and follows through, helping government agencies and other partners meet their own goals: "Now, when a public health issue arises, there is an expectation that CIHR-funded research will do something to protect Canadians from this threat. This was not necessarily the case with MRC".
• III has proven ability to build consensus-based research agendas, even in extremely disparate or even divisive areas: for example, in HIV/AIDS, III has "been pretty successful at keeping the peace in this highly politically-charged area". Partners both contribute to and benefit from timely and relevant agendas and their involvement creates a built-in interface between researchers and users to assist KT.
• III staff are recognized for working hard on partnerships, for having "done their homework before approaching us" and understanding how to develop mutual benefit from a partnership. They then commit the time to make it work.
• Partners have found III both willing and effective in helping them connect to the I&I community: "They know the community much more than we do; we do fund some projects in this area, but we are not as tapped into the people, don't have the contacts." In addition, "III has been quite proactive in making their community aware and getting them involved".
• III is lauded for its flexibility, openness, willingness to try to meet a partner's needs, and its rapid responsiveness. Beyond the remarkable response to the threat of SARS, another good example is the participation of III in the Quebec consortium for research on C. difficile: "the sense in the provinces is that too many approvals would be required by CIHR to get something going, but not at III – they got something local going very quickly". Another partner said: "We don't normally deal with the federal government: it takes months of calls to even identify the right person to talk to. But at the CIHR it's very clear: I went straight to Bhagi." Another agrees: "In MRC there wouldn't even have been a staff member to point to, let alone a mechanism".
• III's mandate includes major public health priorities and it has proven the value of incorporating a research component into public health activities; other agencies, such as regulatory ones, now seek to increase research which supports decision-making.
• International-level science increasingly requires international-level teams and funding, which can only be achieved by pooling resources within and beyond Canada. III has played important roles bringing Canadians together to identify niche areas and develop a strong Canadian presence, with the International Human Microbiome Consortium, Canadian-German Collaboration on Infectious Disease Research, and the Canada-UK Workshop of February 2008 on "Beating the Bugs" as examples. Partners also cite the need to combine forces, pool resources, and seek synergies.

In addition to III's own strengths, CIHR as a whole contributes attractive advantages for partners. For example, it can work with the provinces without bringing along the baggage of federal/ provincial/ territorial disputes in healthcare. CIHR also provides a ready-made, well-respected and substantive peer-review capacity, reducing duplication and providing a quality-control mechanism many partners appreciate as legitimizing the funded research.

Key lessons learned from partnerships

Involving partners as early as possible is critical to a successful and mutually beneficial relationship: "Involving those most interested at an earlier stage would be helpful, to be part of the design, not asking 'Are you in or are you out?'". The more III matured, the more able it was to build time for these discussions into priority-setting and initiative-planning timelines, and partners responded enthusiastically to early involvement. It is worth noting, though, that such consultations may slow the timely launch of new initiatives, an opportunity-cost which could be significant when confronted with urgent threats to health.

"Keep communicating. I know it’s hard to deal with us small charities – we’re understaffed and don’t always respond in a timely way. But don’t slow down your efforts at outreach, they are very important to us."

Sustaining partnerships beyond the duration of dedicated funding is also an issue. For example, with the end of funding for the SFW initiative, the sponsoring partnership of funders and stakeholders (Canadian Research Coalition for Safe Food and Water) effectively ceased. It would be desirable to maintain the Coalition in order to provide a rapid research response to other food safety incidents (e.g. Listeria in cold meats, 2008; Salmonella in peanut butter, 2009) that reveal flaws in food and water safety, and to develop a proactive research agenda that could be supported through application to routine funding opportunities. Maintaining ongoing partnerships while also building new ones would require additional staff capacity in III. Another challenge for the Institute is to make efforts to identify and build on partners' capacities and competencies, rather than developing, within CIHR or academia, expertise which is readily available elsewhere, especially during an emergency like SARS.

Bureaucracy and coordination

“We developed a draft document, agreed to a whole bunch of changes, but all the time invested in finding mutually agreeable language was ignored. In the end, we never did sign the MOU – the call for applications was over and it wasn’t done yet.”

A number of partners expressed concern that partnership discussions, entirely agreeable with III, fell apart when drafts moved on to CIHR-Central, described as "excessively bureaucratic". Others found CIHR excessively rigid in insisting on 100% adherence to CIHR processes; "they use a cookie-cutter mould at CIHR-Central", with no compromise with the partner, who as a result, did not feel like a partner at all; "CIHR comes up with all sorts of rules that we don't have, that we were not part of creating. How can we benefit from a partnership, rather than just putting our money into a CIHR activity?" Clearly, CIHR must respect its mandate and the federal laws and regulations under which it operates, and these will limit some of the approaches partners wish to take. It also needs to maintain some level of consistency among its many programs, in part to deal with an excessive workload. However, two concerned partners noted that mutually agreeable deals had been negotiated with NSERC, suggesting that flexible solutions should be achievable within the limits of Treasury Board regulations.

"Collaboration between institutes should be the default setting, but instead it’s the exception rather than the rule."

Partners are impressed with III's efforts to collaborate with its sister Institutes, and see its Scientific Director as a leader in this regard. Nonetheless, they are concerned about fragmentation among the Institutes. The risk is that broad issues may be dealt with narrowly, and cross-cutting issues find no home. Worse, partners see some Institutes fighting for ownership of issues rather than pooling competencies to deal with them effectively. CIHR's structure creates inherent challenges in this regard: Institutes may address health problems, body parts, populations or research themes. It is inevitable that some research has no home, and other research too many homes. One respondent warned: "You don't want to have 13 institutes totally independent, that don't have a corporate identity, and don't support the corporate mission, values, strategies or policies. Some Institutes have gone too close to the edge..."

These are issues to be fixed, however, and are not a blanket condemnation of the CIHR model, which partners strongly support. Respondents see the specialist Scientific Director and staff as responsible for III's achievements in partnering: "they're the experts, on the ground, knowing what's important and needs to be done".

Summary

III is considered an excellent and desirable partner, thanks to the expert knowledge, early and continued engagement, patience, flexibility and due diligence it brings to its partnerships. III has significantly enhanced the positive perception of CIHR by partner organizations, in comparison to their rather jaundiced view of the former MRC, about which an executive of a health charity once noted: "Partnership with the MRC means: part with your money".

The impacts of III's partnering efforts are widespread, though impossible to quantify. They include a research agenda more relevant to the real health problems of Canadians, a growing interest in the utility of health research among important health agencies, improved representation of Canadian research in international I&I research initiatives, and an appreciation that CIHR, thanks to the Institute structure, can respond rapidly to emerging health threats by mobilizing the expert health research community.

Despite the efforts that III has made, there remain partnership issues for CIHR as a whole: the perceived bureaucracy at CIHR headquarters, and lack of coordination among the 13 Institutes.

6. Changes in how I&I research is being used

Although it is much too early in the history of III to assess health or economic impacts of Institute activities, we evaluated many precursor steps towards effective knowledge use, seeking intermediate outcomes which would signal movement towards longer-term change. So long as I&I research maintains its present high quality, its results will be increasingly used if III's strategic initiatives are relevant and timely, and their results are accessible and easily taken up by those who need to use them. We thus sought evidence of impacts in these areas.

Changes in the advancement of knowledge

We first investigated the productivity, quality, and competitiveness of research conducted in the field of I&I, and found that improvements in Canadian research funding had caused striking effects.

An increased quantity of Canadian research makes it more accessible to Canadian researchers and research users, as well as more relevant to the Canadian context. Looking first at publications (Fig 6-1), Canada's I&I productivity was shrinking as a portion of world I&I publications until 2001, when a recovery began. The publication patterns lag behind the changes in the MRC/CIHR budget: the nadir of MRC funding occurred in 1997, and the publication minimum in 2001, about the usual time interval between funding and publication. It is striking that even with all the recent federal and provincial investments in health research, Canada has merely regained its world share: it has not advanced, since competitors have also increased their funding. In fact, China's rapid advances in I&I research over the last five years recently bumped Canada from 6th to 7th place in actual numbers of publications produced (Appendix A/N).

Although world share has not grown, by 2007 number of publications had increased to record levels for all subfields. The most dramatic of these changes, the doubling of publications in virology, may reflect the higher-than-average increase in investment, including III's strategic initiatives in this field. (HIV/AIDS, hepatitis C, and influenza). However, it is difficult to credit any increase in publications to III specifically, given the large overall increase in the CIHR budget and partner contributions, as well as the impact of other new funding programs⁴.

Fig 6-1. I&I Publications
(Source: SCImago Research Group, Copyright 2007-2008. Data Source: Scopus®)

Higher quality research is more likely to be published in higher quality journals, and be read by a larger and broader audience, thus increasing the uptake of research, especially by other researchers. Citation data are widely used as a proxy indicator of research quality: they indicate the extent to which other researchers found the work important. Our analysis (Fig 6-2) confirms the high quality of research in the primary areas relevant to III: immunology+microbiology is one of the two most highly cited fields of Canadian science in 1996-97, and the most-cited in 2006-7, moving ahead of neuroscience. In terms of overall impact (H-index³¹), it has remained in 4th place. Despite the high impact of individual publications, immunology+microbiology has fewer publications overall compared to medicine, biochemistry+genetics+molecular biology, and neuroscience.

Canada is clearly producing high quality I&I research as compared to other fields of science, but how does it stack up internationally? Over the last 10 years, Canadian immunology and microbiology papers have ranked 2nd or 3rd internationally in cites/paper, attesting to the highly-competitive quality of Canadian research in this area (Appendix A/O). We found a consistent pattern in all measures of Canadian competitiveness, whether publications, citations, or international collaborations (Appendix A/B). There is a declining trend in competitiveness until 2001, with subsequent improvement following the creation of CIHR. We found similar patterns for immunology, microbiology and virology separately, and similarly high relative impacts of Canadian publications in these fields.

Fig 6-2. Citation data for the major fields of Canadian science in 1996-7 and 2006-7³¹.
(Source: SCImago Research Group, Copyright 2007-2008. Data Source: Scopus®)

Note that the tenfold difference in cites/document between 1996-7 and 2006-7 does not indicate a precipitous decline in the quality of Canadian science. It occurs simply because there has been less time for documents published in 2006-7 to be cited by other researchers in papers published subsequently.

 

A different indicator of trends in Canadian competitiveness is our ability to compete for funding from the NIH. Its investments in Canadian health research have increased 200% between 2000 and 2007 (Appendix A/P). I&I has done even better, increasing 275% over the same time period, probably due in part to NIH's increased funding for bioterrorism.

Changing roles in knowledge translation

"For the people involved in SARS, there was an urgent, immediate need from their country – this is a powerful turn on! "

We also investigated changes in the accessibility, and ease of uptake and application, of I&I research. To start with, are researchers more willing and able to participate in KT-related activities? A small number of researchers felt that they should remain firmly in fundamental discovery, and stay aloof from any application of their work: one stated "Personally, I don't get involved, I decided not to compromise, but I know colleagues who do." However, those researchers who have been involved in efforts to see their work put into practice found it a rewarding experience: "Some people are seeing that research can have a real effect, becoming more interested in KT. But CIHR will have to be much more effective in helping these people. I went from being a very conceited researcher who just didn't care to 'Wow! I can do something really useful!' I'm converted."

"I think there is more awareness about the "famous knowledge translation business". But we’re not very good, collectively, at teaching people to do that. We don’t design our grant applications to make it easier. Simply requiring it, without helping change the way research and policy are being done, isn’t helping."

Are research results being increasingly used – by other researchers, health care providers, policy makers or industry? Answers were inevitably equivocal, fundamentally coming down to "Yes, small steps have been taken, but there's a long way to go". Most respondents wanted more support from III for KT; some offered concrete suggestions. For example, one suggested: "We take for granted, wrongly, that what we learn in one province will be translated to and applied in the others. This is where a federal agency is key: dissemination". Others noted that CIHR may be able to work more constructively with the provinces than most federal agencies. Some see a role for III in identifying and disseminating the results of key projects, to get them into practice. Many partners are looking to III and CIHR to provide guidance, best practices and role models, though some note they have their own KT expertise and resources of which III could take more advantage. Overall, III's community feels more aware, more willing, but not necessarily more able, to undertake KT.

Linkage & exchange

“III (staff) are becoming knowledge brokers - but I’m not sure they’re resourced for that!”

III has provided support for dissemination of research uptake activities, through grants for meetings and for knowledge syntheses. However, the aspect of knowledge translation where III has excelled is in "linkage & exchange", connecting researchers with various sectors of research users, within and across initiatives. Good linkage and exchange will dramatically improve the availability, uptake and application of research.

III was praised for making linkage & exchange its business standard, incorporated into everything from Institute strategic planning to every aspect of initiatives, from agenda setting, program development, workshops, peer review, to advisory committees. III has encouraged, and sometimes required, the inclusion of research users on research teams. "One thing III has been able to do is strengthen connections between government departments and academia, such as with the pandemic task force, which mixes researchers and policy makers. It provides a meeting place for these groups." Respondents commend events where researchers and decision-makers meet, and suggest setting up more regular interactions at various levels within user organizations.

“Everyone wants to make a great discovery and see it applied in their lifetime, even if they don’t apply it themselves.”

Each of these types of interactions has its own challenges and rewards, as has been noted throughout this document. One area which III needs to pursue is increased involvement of end-users on research teams. Generally, both researchers and end-users were enthusiastic about these experiences. For example, when researchers are encouraged to go beyond presenting their research data to their peers, to also providing policy recommendations based on their work, a decision-maker member of the team can have the expertise or contacts to do this. However, "if this were a requirement of every operating grant, the government would soon refuse to participate: there aren't enough decision-makers to go around!" The laudable goal of involving end-users risks back-firing if researchers face refusal to participate from over-extended policy makers. As strategic initiatives are designed in the future, it will be critical to involve end-users from the earliest stage to identify appropriate levels of involvement and a wider cadre of potential user participants. In addition, early involvement could help more clearly define "what's in it for me" from the user perspective, so that the research to policy/policy to research linkage becomes clearly advantageous, rather than an onerous addition to their schedule.

Some discussions about conflict of interest may also need to be pursued with government partners. As one policy maker noted: "I'm dishing out the funds, so to be part of the research team didn't seem appropriate. I have had to turn down a lot of requests where I could have made valuable contributions, because of a sense of conflict."

Creating new products and services

Although the Institute has not undertaken extensive commercialization activities, III has excelled at creating the kinds of teams and environments in which innovation happens, including creation of new products and services. 18% of the grants awarded under CIHR's Proof of Principle Program have been affiliated with III³². The Institute has representation from the Canadian life science industry on its IAB, and its Strategic Plan 2007-12 emphasizes "the potential for significant impact that can be quantified based on assessments of potential social, economic, or commercial impact…" in the selection of strategic research investments. Therefore, it has selected research topics with a high probability of producing useful products and services as an outcome³³. III has been diligent in inviting representatives of industry to its agenda-setting workshops, including the latest Canadian Pandemic Preparedness Meeting held in November 2008.

For the past 4 years, III has invested an average of 14% of its strategic budget in grants that have generation of a useful product or service as their ultimate goal, mainly through Emerging Team Grants in the "Novel Alternative to Antibiotics" Research Initiative, which was launched in partnership with over 20 public and private sector organizations, including six industrial partners. This contrasts with CIHR as a whole, where <4% of the investment in I&I research is similarly directed.

There have been some notable "success stories" from this Institute funding, including the development of a potential new vaccine against hepatitis C³⁴, and an HIV vaccine currently undergoing phase I/II trials, an outcome from the HIV/AIDS research program.

Role and effects in the policy and practice environment

“CIHR is actually producing results that can be used! Before, agencies saw MRC as working on long-term timescales which couldn’t produce anything useable by decision-makers with current problems. But now, there’s wait times, SARS, SFWI, HIV/ AIDS, pandemic…”

CIHR has taken on a meaningful role in the federal policy environment, and its senior staff give significant credit to III for its contributions to building CIHR's reputation and credibility with major agencies, and building bridges between academia and government. III has shown that it can help governments address very specific and immediate needs, such as Oculorespiratory Syndrome and the Influenza Immunization Program Evaluation in Ontario, or evaluating and addressing the C. difficile problem in Quebec.

While it is difficult to obtain a comprehensive picture, there are examples of significant impacts from III initiatives on practice and policy, such as through the SFWI. One PI described how people with private water supplies who were involved in the research study became educated about the risks of contamination with E. coli and are now aware of the need to get their water tested regularly; this awareness spreads through their communities. Another PI prepared an assessment tool which helps farmers make decisions about changing herd management, and through their partner, the BC Cattlemen's Association, a pamphlet was distributed to all the members. As a result, individual farmers contacted the researchers, and these farmers are now full partners in the follow-on research projects.

Changes in public awareness of health research and its benefits

The impacts, actual and potential, of Institute and other CIHR funding for specific I&I research projects have been described on many occasions by the Institute and CIHR in news releases, annual reports, and newsletters³⁵. For the past five years 20% of the CIHR news releases describing new funding partnerships or the results of research deal with topics in the Institute's mandate.

The Institute, and particularly its Scientific Director, has played an important role in public communication about the risks and impacts of immune system and infectious diseases. Dr Singh has been a frequent media spokesperson, particularly during the SARS outbreak, when he gave approximately 100 interviews, 22 of them on the same day³⁶. He is often asked to comment on research breakthroughs, and some of these media articles have been disseminated worldwide through the websites of news agencies, alerting services, and patient advocacy groups³⁷.

Summary

I&I research is improving in quality, relevance, availability, and ease of uptake and application, all of which are important steps towards increased research use.

Canada has recovered from the research budget cuts of the 90's, and has improved the quantity and quality of I&I research. Given III's small budget, these overall changes are more likely attributable to the increase in CIHR's budget, not to mention a range of other major improvements to the Canadian research environment since the 90s. Nevertheless, the doubling of virology publications may be related to III's several priorities involving this field.

The Institute's community is more aware and more willing to engage in KT activities, but seeks guidance and support as to how to go about it. Researchers are becoming more interested in orienting their programs to increase timely application of results, while provincial and federal health agencies trust III, and will rely on it again to provide research results to inform policy decisions. Receptor agencies may find it difficult to meet the demand to participate on research teams, especially within more targeted strategic initiatives.

Where III has excelled is at creating opportunities for linkage and exchange between researchers and research users, including other researchers, health practitioners and policy makers, and industry. There are many examples of policies, practices, products and services which are being developed as a result of projects created within III's strategic initiatives.

Finally, III has been successful at conveying to the public both the nature of threats to public health and the importance of investing in research in order to mitigate them.

7. Where to now?

III is successfully demonstrating what can be achieved under CIHR's new mandate, and the value Canadians derive from such changes. As III transitions into its next phase, it will want to build new strategies upon the core assets and strengths which have led to its successes. In this context, we offer the following unsolicited advice to III and CIHR, informed by the data we gathered in creating this report.

• III's core asset is the partner and community respect it has earned. III has invested enormous effort in reaching out to its entire research community and stakeholders. This allows it to prioritize while seeming fair and non-partisan. Partners lauded III's responsiveness, flexibility, listening skills, and its focus on doing its homework and meeting partners' needs. It will be critical to maintain and cement these strengths to preserve the extraordinary goodwill enjoyed by III.
  
  
• III's most effective and appreciated role has been as a convener, bringing together scientists and diverse stakeholders to participate in agenda-setting, initiative development, exchange of ideas and experiences and on-going research planning. Many researchers confessed to initial scepticism, but found that participation resulted in research better tailored to address the issues, and ultimately improved their own productivity. III must keep bringing stakeholders to the table at the earliest possible stage when thinking about new research initiatives, to ensure the best use of their time, and take advantage of their ideas at a time when they know they can make a valued contribution.
  
  
• III has proven that CIHR research can respond to public health threats. III's cultivation of enduring relations with partners gives it the levers it requires when it has to respond rapidly and effectively to public health emergencies. III should maintain or enhance its resources and staff flexibility to remain as nimble. In collaboration with partners, III may need to expand its foresight capacity, to earlier identify and respond to the movements of emerging pathogens in food, animals, and the environment.
  
  
• The most innovative research and knowledge translation happens in strategic initiatives. III has made strategic research not merely respectable, but actually viewed as the more innovative component of CIHR funding for infection and immunity research. III's strategic initiatives address "practical" under-researched as well as "breakthrough" emergent topics, building capacity and new teams while attracting high quality researchers.
  
  
• III and CIHR must sustain the research capacity built by strategic initiatives. To build resilient capacity in novel research areas, staff support and funding are required beyond the 3-5 year time span of most strategic initiatives. III should therefore consider even fewer, more highly-focused priorities so that staff can consistently support applicants and grantees in novel research areas both during and beyond the initial development phase of the initiative. III should also play a greater role in sustaining effective coalitions and cultivating champions from among partners for continued networking, research funding, and KT during and after III's own funding period. With CIHR, III must ensure that teams and topics launched through time-limited initiatives have appropriate programs and peer review committees to apply to in the long-term.
  
  
• Support for trainees and young investigators is limited but effective. STIHRs are increasing the interdisciplinarity of both trainees and mentors. For young investigators, specialized forums, pilot project and bridge grants seem to be providing great value for money. Despite widespread concerns, New Investigator Awardees are winning grants. However, CIHR should further investigate whether its low success rates for open grants are leading to an unacceptable loss of well-trained new talent.
  
  
• III provides critical support for linkage and exchange between researchers and knowledge users. However, while infection and immunity researchers increasingly appreciate the importance of the timely uptake of their results, they are unsure how to disseminate their knowledge to users more effectively, and are looking to III and CIHR for more help than has been available. Partners are also looking to III to provide models and best practices for them to emulate. III should continue to monitor the KT impacts of its initiatives well beyond the end of the funding period.
  
  
• III's communications should stay focused, economical, and be better supported by CIHR:
  • Broad public communications require enormous budgets: instead, III should continue its strategy of making media-trained research spokespeople available to address "hot topics". Changes to CIHR's website have obscured the Institutes, and rendered their homepages deadly dull. III's homepage should feature the important research results flowing from III's initiatives, and their implications for the health of Canadians.
    
    
  • While III is proving the value of the CIHR model in its own area, CIHR's inability to collect systematic information about the outcomes of its funding jeopardizes attempts to demonstrate the broader value of public investment in health research.
    
    
  • CIHR must address continued and widespread misperceptions among the research community about its funding and operations, including the belief that strategic research and expansion of the four themes are the cause of low open grants success rates, when in reality, over 90% of infection and immunity funding supports basic biomedical research.

• Time for a new phase in the relationship between III and CIHR:
  • CIHR should ensure it balances the need for "global" consistency and efficiency in partnering against Institutes' "local" needs for flexibility and responsiveness to partners. Increased collaboration and coordination among Institutes would help.
    
    
  • If CIHR intends to drive continuing change in the infection and immunity agenda in order to strengthen translational research and knowledge translation, it must invest much more than 3.7% of its total infection and immunity spend in III, which has proven its ability to deliver.
    
    
  • There is concern about losing III's SD, staff, experience, and well-nurtured relationships during the transition in leadership. CIHR should heed advice from the infection and immunity community about the qualities it values most in a new SD, and maximise operational continuity.

Endnotes

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Introduction

¹ The CIHR Act, April 2000

²CIHR International Review Panel Report, 2000-2005

³CIHR Departmental Performance Report 2005-2006, section 2.

⁴ Canada Research Chairs, continued Canada Foundation for Innovation investments, Indirect Cost Grants, Canada Graduate Scholarships, Genome Canada, increased funding for Networks of Centres of Excellence, and augmented support for health research in many provinces.

⁵ In this document "partner" refers to an organization that contributes resources, cash or in-kind, to support a request for applications competition in partnership with III and others. "Stakeholders" are those who have an interest in the outcome from an III research program or other activities of the Institute, and can include partners as well as other organizations and individuals who have not provided any resources other than advice or information.

⁶ The principal databases used were: a funding database prepared by III staff; CIHR's web database of funded grants and awards; the US National Library of Medicine's Pub Med; Google Scholar and SciImago, which is a publicly-available portal into certain content in the proprietary Scopus® database. We used the proprietary Thomson-Reuters Web of Science database to a limited extent.

Chapter 1 Changes to the I&I research agenda

⁷ "SARS Outbreak Prompts Rapid Funding Response" Lesley McKarney, "SARS and the Academic Health Sector" Jean Gray, Clin Invest Med 2005; 28 (1): 30–32.

⁸  Canadian Biotechnology Strategy (accessed October, 2008 but no longer available)

⁹ E.g. Over the last 10 operating grant competitions, the median HIV/AIDS success rate has averaged 38%compared to 26% for the open grants competition. In some smaller personnel competitions, success rates have been as high as 100%, due to greater funding than demand.

¹⁰ The red line indicates the growth of all Canadian health publications catalogued in Pub Med. The numbers at the beginning and end of the green line are the actual number of Canadian first-authored publications in those years. These data were compared with a similar analysis done using the Web of Science, with similar results (AppendixA/Q).

¹¹ Sometimes, these have been informal "snapshots" of current research activity, rather than longer-term assessments of impacts. For example, in 2002 it conducted a survey of HIV/AIDS researchers and in 2006, it reported a number of significant research findings from the HIV-AIDS program, with public health and therapeutic implications. On the other hand, a formal evaluation of the Canadian SARS Research Consortium (CSRC) was conducted by an independent contractor in 2005, and provided many valuable recommendations on preparing for rapid and effective research response to future infectious disease outbreaks. A provisional assessment of the Safe Food and Water Initiative was conducted by III staff even before the initiative was formally concluded, and noted a number of examples of important research activities and results. In December 2007, III reported on the Pandemic Preparedness Strategic Research Initiative (PPSRI), though this had to be limited to the agenda-setting, partnerships and research funding aspects only, because funding for the selected research projects had only just begun.

¹² III's Strategic Plan 2002 included both "HIV/AIDS is a global health problem with serious social and economic impacts. A new research strategy is needed to improve the quality and duration of life of HIV-infected individuals…" and "Response to Emerging Challenges:…global health problems and the threat of biological terrorism require collaborative research efforts, with the coordinated support of other CIHR institutes, governmental and non-governmental partners."

Chapter 2 Changes in how research is done

¹³ III: III New Emerging Team Tackles Asthma

¹⁴ "Success within Canadian Institutes of Health Research (CIHR) Grant Competitions for Entry-level Researchers" Stephanie Rees and Jean-Francois Roy, CIHR Evaluation and Analysis Unit, July 2008.

¹⁵ For the SFWI grants, we identified, using Google Scholar, the number of publications (including patents and reports) co-authored by each co-investigator with one or more of the other members of the team for the four-year period preceding and following the award of the SFWI grant.

¹⁶ Each circle represents one member of a funded team: some teams had 6 members (A-F), while others had 4 (A-D) or 5 (A-E). Each team is represented by a different color. A line linking team members represents a co-publication, thick lines are publications judged relevant to the aim of the SFWI grant. This lines are publications not directly relevant. Publications authored by only one of the team members (solo or in collaboration with non-team authors) were not included.

Chapter 3 Changes in who is doing I&I research

¹⁷ "The number, scope and geographic distribution of clinical researchers in Canada" Raghavan, M. and Sandham, D. Clin Invest Med 2008; 31 (5): E222-E230.

¹⁸ III New Investigator Forum 2007 Report 

¹⁹ CIHR Pilot Project Grants for New Investigators (Archived) Request for Applications

²⁰ The number of papers in PubMed retrieved using the search term "HIV OR AIDS OR SIDA" and with an investigator working at a Canadian institution as first author increased from 207 in 2000 to 405 in 2007.

Chapter 4 Changes in how I&I research is funded in Canada

²¹ "The Economic Impact of SARS" Paul M. Darby, The Conference Board of Canada (2003)

²² Potential Impact of Pandemic Influenza on the BC Economy, for the British Columbia Ministry of Economic Development, March 2006

²³ The CIHR core budget (brown line in Fig 4-1), which is under the control of its Governing Council (GC), is the total appropriation from the federal government, minus the operating cost of CIHR, minus the "flow- through funds" for e.g. NCEs, Canada Research Chairs, and other funding "earmarked in the federal budget, whose allocation is not determined by GC". As reported in the 2007-8 Annual Report, the total spend was $1,011,000,000 but the core budget was $747,000,000. The green line in Fig. 4-1 shows the investment in I&I research according to a database compiled by III staff including every funded item that could be considered relevant to the mandate area. This graph shows that funding in the mandate area has increased from 25% to 34% of the CIHR "core" budget over the period 2000-2008.

²⁴ “Prime Minister Harper announces agreement to compensate pre-1986/post-1990 hepatitis C victims” 25 July 2006

²⁵ "Turning Research into Action A Review of the Public Health Agency of Canada (PHAC) and the Canadian Institutes of Health Research (CIHR) Research Initiative on Hepatitis C" by Lynne Leonard and Emily DeRubeis, 2008

²⁶ "Science's New Social Contract with Society" M. Gibbons Nature 402, C81 (1999)

²⁷ CIHR Departmental Performance Report 2005-6

Chapter 5 Changes in partnering

²⁸ CIHR-III Partnership Forum Report

²⁹ "Inter-government Coordination and partnership for best practice grant management"
Dr. Judith Bray, Federated Press Government Grants and Funding Course, Ottawa, January, 2006.

³⁰ For example:

• The National Stakeholders Meeting on Improving Access to Care, Treatment, and Support for People Living with HIV and Hepatitis C Co-infection, January 2004 recommended that "more money to be devoted to researching various aspects of co-infection, including natural history and pathogenesis issues".
• The federal Interdepartmental Antimicrobial Resistance Science Committee has as one of its responsibilities to explore funding possibilities through III.
• III was invited to the Lupus Canada's Consensus Conference on Systemic Autoimmune Rheumatic Diseases in December 2005.
• The Canadian Medical Association, in its submission to the National Advisory Committee on SARS and Public Health in 2003 recommended increased funding for public health research, involving III and IPPH.

Chapter 6 Changes in how I&I research is being used

³¹ In Fig 6-2, the Y-axis represents the average number of citations received for documents of Canadian origin published in the two periods in each field. The X-axis represents the H-index, an indicator of total impact of any specific collection of publications, be they scientist or country or field or some combination (see Hirsch, J. E. (2005). "An index to quantify an individual's scientific research output". PNAS 102: 16569–16572), and the area of the circles is proportional to the number of publications in each field. The pre-eminence of the life sciences and medicine in all three parameters is striking. We have only labeled a few of the many fields represented.

³² Data from Michelle Peel, Deputy Director Targeted Initiatives Branch, CIHR, current as June 2008.

³³ III Strategic Plan 2007-2012

³⁴ “New Vaccine Candidate Against Hepatitis C”

³⁵ E.g The most recent newsletter, Microcosm, Winter 2008, highlights achievements in asthma and allergy research, C difficile infection control, safe water management practices, and an HPV diagnostic test.

³⁶ "News And Newsmakers" Clin Invest Med Vol 26, no 3, June 2003

³⁷ e.g. “Montreal researchers identify defects of immune cells” 2006; “Study reveals body's defense mechanism worsens asthma symptoms” 2005; “The Trials of Keeping Track”; “Key found to kill cystic fibrosis superbug”; “New alert on superbugs”; “Le Bulletin des biotechnologies, février 2002, n. 192” (French only); “Defeitos em células imunes determinam suscetibilidade à candidíase” (Spanish only)