CIHR's first five years deemed a major success despite growing pains

International Review Panel report released

The governing council of the Canadian Institutes of Health Research (CIHR) will meet late next month to consider the ramifications of a major review of its first five years and its implications for the future direction of health research in Canada. The Report of the International Review Panel (IRP) lauded CIHR for the advances and diversification of Canadian health research since its founding in 2001, noting that its structure of 13 virtual institutes was unique, has positioned Canada to benefit from advances in health research over the next 20 years and serves as a potential model for other nations.

But the prestigious 27-member IRP - headed by Dr John Bell, a professor of medicine at Oxford Univ - warned that CIHR's rapid growth had created "excessive complexity" and over burdened the peer review system. It suggested devolution of the certain aspects of governing authority to the institutes and their scientific directors, striking a better balance between strategic and investigator-led research and a greater emphasis on knowledge translation, ethics and commercialization.

"As the CIHR begins the next phase of its development, it will likely need to consolidate some of its activities, embedding new ones in an organization that can ensure that the vision behind CIHR is sustained," states the report. "Substantial activity in areas that have previously received little or no research support in Canada provides clear evidence that that CIHR has been delivering on its mandate across all four pillars of activity (biomedical, clinical, health services, population health)."

The panel avoided commenting on the appropriateness of the budget allocated to CIHR, although it described the institutes as modestly funded and deemed the lack of stable, long-term funding unacceptable. It found the funding of Canadian health research fragmented among too many bodies and stated that "rationalization of federal sources of support for health research is essential".

CIHR president Dr Alan Bernstein says he's happy and gratified by the work of the IRP, adding that CIHR will take time to examine the implications of its observations with his governing council, as well as with members of the research community, other partners and stakeholders.

"There's a lot of wisdom in the report. It's very high level," says Bernstein. "On the biggest issues it provides observations, not recommendations and they're extremely astute. For instance, it comments that CIHR should bring the institutes closer to peer review in the open grants competitions. But the devil is in the details. Our task is to see if we all agree on the observation. In this case we are already moving in that direction."

CIHR HAS EXPANDED SCOPE OF HEALTH RESEARCH

The IRP notes that CIHR has had remarkable success in broadening the nature of health research in Canada beyond the traditional areas of biomedical and clinical research to health systems, health services, population health, environmental influences on health, and its social and cultural dimensions. It judges the successful launch of 13 distinct institutes as a major accomplishment of the first five years and positions its comments as suggestions for how to build upon the initial successes.

The IRP expressed surprise at the diversity of funding sources for health research in Canada, ranging from charities and provincial foundations to other federal bodies such as Genome Canada, the Canada Foundation for Innovation and the Networks of Centres of Excellence. These other funding bodies , it says, have placed considerable strain on CIHR as the primary source of operating grants --a challenging situation made more difficult by lack of coordination.

"If all such streams of funding were coordinated this would provide a powerful expansion in capacity across the research sector in Canada," it notes. "Failure to align these funding streams at the federal level creates a serious risk that supply and demand in health research becomes dangerously unbalanced."

While the IRP acknowledges that alignment between federal and provincial funders may be difficult to achieve, it asserts that a new mechanism to "better orchestrate and coordinate the various sources of Federal research funding" is crucial.

The IRP also delved into the areas of knowledge translation (KT), commercialization and ethics. It found that, while these are extremely important components of the CIHR mandate with notable initial successes, they are not being uniformly pursued across all institutes. Bernstein agrees that much more can be done to strengthen these aspects of the CIHR mandate, and cites a number of initiatives that currently exist and could be expanded if additional resources were secured.

"Knowledge translation is moving research into clinical practice, health policy and commercialization. We're working in all of these areas but we need to do more," he says. "If government really wants to have more commercialization, it needs to continue to invest in university research and look at the demand side - tax regimes, knowledgeable investors, incubator space and the like. We need to look at the whole ecosystem and ensure it works as a viable system."

As for the devolution of management and governing authority, the issue will be front and centre at the governing council retreat scheduled for August 23-25. Bernstein says the suggestion of a review of CIHR's executive team and the formation of a research committee that includes a number of scientists external to the organization complements the direction that the governing council is already moving in. But he makes no apologies for the way the organization has been run so far.

"We started out very hands-on and appropriately so. But the governing council is already letting go and devolving to management and the institutes," he says. "The research community also needed time to get used to the new structure. Perhaps we made things more complicated than they needed to be in our enthusiasm to get things done."

The release of the IRP report comes as the new Conservative government is developing an S&T framework for the fall. Bernstein says the collective perspective of 27 distinguished foreign scientists on Canadian health research sends a powerful message that CIHR's early successes need to be built upon.

"I can't imagine a better statement for the S&T framework for health research. The timing could not be better," he says.

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