Health and medical research sector at a crossroads: a call for action

Australia has a proud history of innovation in health and medical research. As a country, we have fostered some of the greatest minds and greatest discoveries: from Prof Ian Frazer and his team’s invention of the technology behind Gardasil, to Prof Fiona Stanley’s discovery linking adequate folic acid intakes with prevention of neural tube defects, and Prof Fiona Wood’s pioneering invention of spray on skin. Australian researchers have made global impact, yet our health and medical research sector is at a crossroads. 

Limited funds mean researchers are submitting excellent and clinically important project proposals in what could be perceived as a ‘high-stakes lottery’. In the quest to secure funding, researchers contend with systems that are constantly changing and decreasing success rates that now sit at less than 10% across most Commonwealth schemes. 

Our workforce is fragile. While there are more PhD graduates than ever before (an increase from 4 000 to 10 000 per year over the last 20 years, the health and medical research workforce is generally older than the Australian workforce, implying an exodus of our budding scientists at their early- and mid-career stages. Irrespective of whether this relates to restricted opportunities for early- and mid-career scientists or the hypercompetitive nature of funding with associated lack of security, we are losing some of our best and brightest minds.

Covering the full costs of research, in both the university and medical research institute sectors, is a significant and well-known challenge. Salaries awarded in grants do not cover the full salaries of researchers, and costs associated with new technologies, data storage, analysis and protection (cybersecurity), and engagement with health services, are ever increasing. 

Under-investment in health and medical research is a critical issue in Australia. Our collective challenge is to improve and right-size our sector so that it can systematically deliver on saving money in the health system by supporting high value care, implementing evidence-based interventions and limiting ineffective or wasteful practices. Support is also needed for the evolution of health-related industries and creating high value jobs to deliver new advances. 

My personal reflection 

For over 30 years, I have been a researcher, mainly in the medical research institute sector. For the last three years I have been Executive Director of the South Australian Health and Medical Research Institute and recently joined the Board of the Association of Australian Medical Research Institutes. I started my career as a dietitian but quickly realised I would make the biggest impact by creating the new evidence base for nutritional care through research, rather than as a clinician working within a health care setting. 

Together with many colleagues, my team led the pivotal studies and trials to define the essential fatty acid requirements for preterm and term infants as well as in pregnancy and lactation. The studies have formed an important part of the evidence-base to establish specific nutrient recommendations for pregnancy, lactation and infancy worldwide: to define the minimum nutritionally safe levels of essential fatty acids for infant foods forming the basis of international food regulations for products sold in the in the European Union and 186 other counties around the world, and to launch a unique program to reduce prematurity risk by correcting omega-3 depletion in pregnant women who are identified as having low levels.

The longevity and the success of our research program have been driven by multiple factors:

Our scientific contributions have only been possible through the generosity of a complex multidisciplinary network of collaborators and end-users. Together we answered questions of significance and relevance to young families, public health authorities and industry, ensuring our research studies were large enough, long enough and executed to the highest standards, so results were conclusive and provided the go-no-go sign posts for the next phase of work.

This was only possible with a diverse funding base. While NHMRC (and more recently MRRF) support have been core and important to maintain independence in a sometimes polarised and contentious field, complementary industry funding and health service in-kind support and partnerships have been vital to consistently deliver outcomes over a period when national funding rates have varied from 5% to 25%. This has become increasingly difficult in more recent years as health services become stretched and expectations have shifted towards paying for services as transactions rather than collaborations. Furthermore, industry has become less willing to support studies as part of their corporate responsibility outside regions where they have large market share.

Leading from the medical research institute sector has afforded me the opportunity to stay 100% focussed on research and to forge the necessary partnerships with end-users for translational success, as well as to encourage and support numerous researchers from various disciplines to become leaders. 

I therefore echo the sentiment expressed in the open letter from Australia’s Medical Research and Scientific community to the Health Minister: translation, scale and sustained capability are critical for the ongoing success of our sector. 

Implications and next steps 

Australia also has a proud history of adapting to the changes in the global forces that shape our economies. We cannot rely on other countries to safeguard the health of our population nor to develop the solutions for health care in Australia. To ensure our long-term resilience, we must protect and re-shape Australia’s world-class research, build the capability and sustainability of the workforce and position the country as a world-leader in innovative research and healthcare. This can only be achieved with careful coordination of all sectors.

Recognition must be given to the workforce challenges, including a pipeline of success for our early- and mid-career researchers. 

We need a system that encourages fresh perspectives, advances drive and innovative thinking and provides real opportunity to take calculated risks. 

I, along with many of my colleagues, call on the Federal Government to focus on the long-term value of health and medical research through greater investment, achievable through:

• increasing annual disbursements from the Medical Research Future Fund, including support for the full cost of research; 
• strengthening National Health and Medical Research Council funding to better support researchers, infrastructure and workforce sustainability; and
• have clear incentives for the Medical Research Institute, University and Health sectors to enable effective, collaborative and clinically relevant health research. 

We need action now.

Professor Maria Makrides, FAA, FAHMS, is the Executive Director of the South Australian Health and Medical Research Institute and member of the Board of the Association of Australian Medical Research Institutes.