Universities are pivotal players in the field of global health, not only in terms of research and medical innovation, but also in educating the next generation of global health professionals. The University Global Health Impact Report Card is a research initiative published this past April by Universities Allied for Essential Medicines (UAEM). This report studies the role of the top 54 research institutions in Canada and the U. S., and their contribution to global health initiatives. The first of a series of reports in this longitudinal study, the publication quantified universities based on three aspects: innovation, which quantifies the amount of research and funding dedicated to overlooked aspects of medical innovations, such as neglected disease research; access, which evaluates the existence of legal policies present within universities, especially in terms of technology transfer policies and ‘humanitarian’ licenses; and education, which looks at access to education resources regarding global health, such as courses, conferences, et cetera.
According to the report, McGill ranked 30th overall of the 54 universities surveyed – far below other Canadian universities such as McMaster University, the University of Alberta, and the University of British Columbia. Specifically, McGill received an overall grade of C-, with a grade of D+, B-, and D on innovation, access, and empowerment, respectively.
As largely publicly-funded research institutes, accessibility to these medical innovations depends on how universities manage their intellectual property, and ensuring equitable and socially responsible dissemination of biomedical discoveries. What’s taught in classrooms and what university researchers choose to study affects the search for new and affordable treatments – especially for neglected tropical diseases, which affect more than one billion of the world’s poorest populations.
Key research findings showed that, on average, less than 3 per cent of the 2010 research funding at the top Canadian and American universities was devoted to research projects focused on neglected diseases, such as Chagas disease, sleeping sickness, unaddressed aspects of HIV/AIDS, tuberculosis, and malaria. Substantial variations exist among these universities, [with research and capacity-building grants coming up to 24 per cent making up these universities’ research funding.] As a result of these findings, UAEM advocates, “Universities [can look to outside sources] to increase their research funding, despite potentially limited funding sources or external resources.”
“Canada as a whole, [and] McGill in general, is leading in injury intervention, research and education,” said Dr. Dan Deckelbaum.
Criticisms by the Lancet, a weekly peer-reviewed medical journal, characterizes the report as “misleading” due to its relatively narrow focus on research innovation for neglected diseases, and adoption of socially-responsible licensing strategies. However, Bryan Collinsworth, the current Executive Director of UAEM, states that the report card’s focus was specifically on aspects of global health that had received the least attention, yet had clear and practical areas for improvement. The G-Finder database, which was used for the Global Health Impact Report Card, is a comprehensive survey of worldwide funding for research and development. It not only focuses on neglected diseases, but also on the most neglected aspects of the “Big Three” diseases – HIV/AIDS, malaria, and tuberculosis.
Education and student empowerment: A shift toward multidisciplinary approaches?
McGill received a grade of D on the education section, partially due to unavailable information, or unanswered questionnaires. Surveys were sent to various department directors and deans during the data collection process, often multiple times before the release of the report card, and where surveys went unanswered, public available data was used to verify a university’s contribution.
Dr. Dan Deckelbaum, the current Interim Director of McGill’s Global Health Programs, feels that the results of the Global Health Impact Report Card are not indicative of McGill’s contribution to global health education, and the results are partially dependent on who was asked. “Canada as a whole, [and] McGill in general, is leading in injury intervention, research and education,” he said. “The work we do here isn’t as well-recognized as it should be.”
Deckelbaum emphasized the need for multidisciplinary approaches in global health. “Right now our mandate is to expand global health opportunities not just to those within the Faculty of Medicine […]. Global health is not just an intervention – it’s a multidisciplinary approach that involves health, law, policy, economics, environment – all these things are incorporated within the definition of global health.”
McGill University and “Humanitarian” licensing for drugs: Light on the horizon?
The access portion looks at how well universities are ensuring their biomedical discoveries are disseminated in an equitable and socially responsible manner, and whether a university has made a commitment by signing onto global access licensing, or “humanitarian” licensing frameworks.
McGill scored the highest onaccess, with a score of B- relative to its two D range scores on the other two sectors (education and innovation). An interview with Dr. Rose Goldstein, McGill’s Vice-Principal (Research and International Relations), reaffirmed McGill’s commitment to equity and accessibility regarding its medical innovations. Goldstein’s office is looking into endorsing such a provision within the coming year. Although McGill has not signed onto any global access licensing framework, Goldstein stressed that it is not indicative of McGill’s commitment to ensuring the accessibility of medical innovations.
“Despite being one of the foremost research institutes in Canada and North America, McGill still lacks strong access/humanitarian policies that greatly hampers [its] commitment to equity and accessibility […],” said Shreen Malaviya.
According to the Global Health Impact Report Card, between 41 to 50 per cent of McGill’s health technology licenses were non-exclusive, with zero patents sought in low and lower-middle income countries, and 1 to 10 per cent of patents sought in upper-middle income countries where they may restrict access. However, none of the university’s exclusive licenses on health technologies included provisions to promote access in developing countries over the past year. Goldstein stated that very few of McGill’s innovations actually undergo the patenting process, and many are not pursued due to the lack of a partner or resources to continue the project. However, the lack of written policies on access for exclusive licenses of medical innovations with potential impacts on the developing world does raise some concerns. This is problematic especially given the recent exclusive licensing of Cysteamine, a chemical compound sometimes used in the treatment of radiation sickness, and its related compounds to Raptor Pharmaceutical Corporation in May 2012. This was done for the compound’s treatment potential for parasitic diseases such as malaria.
The McGill Chapter of Universities Allied for Essential Medicines has been advocating for McGill to adopt a global access licensing framework since at least 2009. In an email response, Shreena Malaviya, the current Chapter Leader for UAEM McGill, stated, “Despite being one of the foremost research institutes in Canada and North America, McGill still lacks strong access/humanitarian policies that greatly hampers [its] commitment to equity and accessibility. We still have a long way to go to ensure that research at McGill is socially responsible and the research meets the needs of the people worldwide.” Malaviya went on to assert that “the [academics], students, and administration have an equally responsible role in ensuring equitable and accessible research here at McGill. We are encouraged by where McGill’s research policies are heading, and we’d be able to collaborate in the future.”
Research and innovation: What is the role of universities?
The innovation part looks at how well universities are filling the research gap that exists for neglected global diseases that receive comparatively little private investment. McGill received a score of D+ on this section. Based on 2010 publicly available data collected through the Canadian Institutes of Health Research (CIHR) databases, a total of 0.66 per cent of McGill’s research funding was devoted to projects solely focused on neglected tropical diseases. Goldstein believes that while the Global Health Impact Report Card is useful in detecting trends within universities, it’s difficult to give a strong opinion, as it is the first of a series of research reports, and hence a “snapshot in time.” The report’s emphasis on CIHR data has also raised concerns as it may provide an incomplete picture, since McGill receives funding from various other organizations, partnerships, philanthropies, and small private foundations, especially for rare and neglected diseases.
McGill’s new Strategic Research Plan for 2013-17, with plans to launch a Business Engagement Center for increased collaborations with the private industry, has raised concerns about the effect such partnerships may have on the direction of future research and potential conflicts of interest. Goldstein, however, does not believe this will be a prominent issue. “We have policies and provisions in place to ensure researchers have academic freedom […] When we do partner or receive donations from the business world or from industry, it’s always such that researchers would be able to publish, students would be able to work on projects, [and we can guarantee the] academic freedom of researchers. […] It really follows the interests and the abilities of the researchers themselves.”