Reform of research funding processes could pave the way for progress in global health

Abstract

There is a lot wrong with global health, and the COVID-19 pandemic is highlighting many of these wrongs.1Büyüm AM Kenney C Koris A Mkumba L Raveendran Y Decolonising global health: if not now, when?.BMJ Glob Health. 2020; 5e003394Crossref PubMed Scopus (61) Google Scholar The growing calls to decolonise global health point to imbalances that contribute to the status quo in global health knowledge production: insufficient funding for research capacity building in the Global South,2Maher D Aseffa A Kay S Tufet Bayona M External funding to strengthen capacity for research in low-income and middle-income countries: exigence, excellence and equity.BMJ Glob Health. 2020; 5e002212Crossref PubMed Scopus (4) Google Scholar domination of research activities by institutions and researchers from the Global North,3The Lancet Global HealthGlobal health 2021: who tells the story?.Lancet Glob Health. 2021; 9: e99Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar lack of fair credit to and representation of local authors in research publications,4Abimbola S The foreign gaze: authorship in academic global health.BMJ Glob Health. 2019; 4e002068Crossref PubMed Scopus (98) Google Scholar prohibitive publication costs and little interest in local issues from global health journals,5Nabyonga-Orem J Asamani JA Nyirenda T Abimbola S Article processing charges are stalling the progress of African researchers: a call for urgent reforms.BMJ Glob Health. 2020; 5e003650Crossref PubMed Scopus (7) Google Scholar and barriers faced by researchers from the Global South to participation in international conferences.6Velin L Lartigue JW Johnson SA et al.Conference equity in global health: a systematic review of factors impacting LMIC representation at global health conferences.BMJ Glob Health. 2021; 6e003455Crossref PubMed Scopus (11) Google Scholar But more pernicious than all of these imbalances is the underlying and pervasive dehumanisation of Black and Brown (and other) people,7Affun-Adegbulu C Adegbulu O Decolonising global (public) health: from western universalism to global pluriversalities.BMJ Glob Health. 2020; 5e002947Crossref PubMed Google Scholar and the persistent white saviour mentality and related white or northern supremacy.1Büyüm AM Kenney C Koris A Mkumba L Raveendran Y Decolonising global health: if not now, when?.BMJ Glob Health. 2020; 5e003394Crossref PubMed Scopus (61) Google Scholar Although somewhat under the radar, the instrumental role of research funders in the perpetuation of the status quo in global health research must be addressed. From our perspectives as external reviewers of numerous funding applications submitted to major global health funding organisations, we know that these organisations are drawn to applications promising to improve global health. Applications mostly come from prominent research institutions and enterprises in the Global North, usually led by well-established researchers. Such applications tend to tick the boxes now required in global health research applications such as capacity building and stakeholder engagement, but provide little explanation of how this will be achieved. Much of the funds are directed towards salaries of the researchers from the Global North, despite the applications themselves pointing to excellent talented local researchers who will lead the studies on the ground. These excellent local researchers are often not proportionately compensated monetarily or academically for their efforts. Research ethics committees in the Global North rarely question these fundamental imbalances. The focus is on the research, subject, and patient, and not enough on the ethics of researchers in relation to other researchers involved or real-world impact. Also, many grant reviewers from the Global North laud research efforts in the Global South, presuming many such efforts are worthy, while knowing little of the context and potential harms. Furthermore, funders wish to support innovative research, but are often unaware of similar projects supported by others, at times in the same communities. COVID-19 has highlighted the unhealthy scramble to publish. From the deluge of submissions and pre-print archives, it appears that being first is more important than scientific rigour or even truth. The scientific community must confront the reality that research ethics approval and scientific review processes require much reform. In global health research, the stakes are especially high as there is a promise of saving millions of lives, and careers and fortunes are being made through research. But who really benefits most from this behemoth of global health research and practice? Considering the mass of COVID-19 research that is of poor quality and largely disappears on publication, the beneficiaries are clearly not the people affected by or susceptible to COVID-19. This raises ethical problems if the research is being done in and on the people of the Global South with very little impact. Someone or something is literally benefiting from the suffering of others, some of the worst-off people in the world. Of course, this problem is not restricted to COVID-19 research. Oversight is urgently required to determine what the true impact is of much of the health research done in the Global South. What proportion of the many billions of research dollars have been translated into meaningful effects? That is, aside from benefiting the researchers, their institutions, and to some extent funders, how much of global health research improves health? Many of these dollars come from taxpayers and donors; they deserve this information. The primary beneficiaries of research about suffering should be those who are suffering. This should not be a controversial statement. Guidelines for clinical research ethics in lower income settings are clear about protection of vulnerable research participants and communities.8CIOMS2016 International ethical guidelines for health-related research involving humans.https://cioms.ch/publications/product/international-ethical-guidelines-for-health-related-research-involving-humans/Date: 2016Date accessed: April 28, 2021Google Scholar Ethics guidance for implementation of research extends this to ensure that research is locally relevant and leads to sustainable and scalable interventions.9WHOEthics in implementation research. Facilitator's guide.https://apps.who.int/iris/bitstream/handle/10665/325608/9789241515375-eng.pdf?ua=1Date: 2019Date accessed: April 28, 2021Google Scholar If we are to truly progress in decolonising global health research, we suggest there is an urgent need for an overarching ethics framework to guide research funding allocation, to ensure the following: (i) true participant collaboration and ownership by local experts and researchers; (ii) conduct of situation analyses to identify similar projects and funding activities, such that funding contributes to synergies rather than competition; (iii) capacity building is tangibly prioritised; and (iv) oversight of impact must include more than academic publications. Although funders might have the problem of figuring out how to push money out the door, and academics have the problem of relentlessly publishing, neither of these groups should be doing so on the backs of people in the Global South while flying the flag of benevolent global health. Cultivation of a new culture of humble and constructive collaboration rather than individualistic success in global health research could be one way to reduce the northern supremacy and privilege that currently rule global health.10Abimbola S Pai M Will global health survive its decolonisation?.Lancet. 2020; 396: 1627-1628Summary Full Text Full Text PDF PubMed Scopus (53) Google Scholar VL declares research support from the Swiss Kidney Foundation and the Brocher Foundation, unrelated to the areas of work discussed in this Comment. SN declares research support jointly from the Medical Research Council (UK and South Africa), Newton Fund, and GlaxoSmithKline, as a Principal Investigator. SV reports research support from Wellcome Trust and UK Economic and Social Research Council. GA declares no competing interests.

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