31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 1 | Research priorities in communicable diseases Jai P Narain Director, Deptt of Communicable Diseases narainj@searo.who.int 31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 2 | Burden of Communicable Diseases z 40% of deaths in SEA due to communicable diseases z High risk of emerging and re-emerging diseases z Hotspot for – many zoonoses, – drug-resistant pathogen – vector-borne diseases z The Region is epicentre for – avian influenza, – ACT resistant malaria, – dengue, – chikungunya etc. 31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 3 | Risk factors z Interaction between agent, host and environment exacerbated by: – Globalization – Environmental degradation – Population movement – Unplanned/unregulated developmental activities – Climate change Poverty, poor sanitation and tropical climate enhance vulnerability, risk of infection and access to services (health, education etc.) 31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 4 | Why focus on research? z Scientific knowledge base – for health policy and practice z Filling gaps in understanding and identifying – causes of major health problems – effective interventions – implementation and evaluation of interventions z Developing a robust health delivery mechanism and addressing equity and focus on “reaching the unreached” An overarching research agenda, relevant to health policy formulation and implementation in the Region is needed 31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 5 | Criteria/rationale for research z Urgency – needs to be done as soon as possible because of immediate public health need z Relevance – specifically relevant to needs of targeted populations z Feasibility – infrastructure and expertise already exist (or requires minimal strengthening) or – opportunity exists for multidisciplinary and integrated approaches z Impact - orientation – extent of significance to population on decreasing the burden of diseases z Knowledge Translation – degree of potential for rapid uptake of results 31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 6 | WHO and Research context z World Health Assembly Resolutions – WHA 62.16 • Prioritizing research and development needs • Promoting research – WHA 60.15 • Management and organization of research within WHO • Support to countries in organizing research 31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 7 | SEARO meeting on research priorities in communicable diseases, 4-6 March, 2009communicable diseases, 4-6 March, 2009 z Application of existing knowledge and technology – increasing efficacy and effectiveness of programme implementation z Developing new tools z Need for an interface between policy makers/programmes and research institutions z Research advocacy 31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 8 | SEARO meeting on research priorities: key recommendations for Member States z Integrate research agenda in national health policies and programme z Allocate 5% budget for communicable disease programmes on research z Establish an updated research database z Find a suitable and country-specific mechanism for interface between researchers and policy makers z Networking and research capacity building z Build individual and institutional research capacity z Consider organizing similar workshops at country level 31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 9 | SEARO meeting on research priorities: key recommendations for WHO z Discuss research as an agenda of the Regional Committee z Collaborate with Member States in building research capacity z Collaborate with partners in mobilizing support for research in emerging issues z Assist preparing operational research protocols and coordinate multi-country studies z Establish a regional mechanism to set research agenda and networking z Facilitate sharing/dissemination of research information including through a Public Health Journal of SEA Region z Review progress in 2 years 31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 10 | Each programme has developed research priorities in each communicable disease area z Avian Influenza z HIV z TB z Malaria z Dengue z Chikungunya z Leprosy z Visceral leishmaniasis z Lymphatic filariasis z Laboratory support * accepted by Indian Journal of Medical Research to bring it out as a special issue 31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 11 | TDR small grants as a research model z Since 2004, providing modest amount for carrying out operational research in TDR diseases or neglected diseases of poverty z Linked with capacity building z So far, 158 proposals received and 47 (30%) funded since 2004 z National level training conducted in Bhutan and Maldives z Resources are limited; need for mainstreaming of small grants programme 31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 12 | Climate change and communicable disease research: another model? z Generic research protocols developed on – Retrospective study on vector-borne and diarrhoeal diseases – Prospective study ( over 3-5 year period) – Assessing preparedness and capacity to adapt/respond z Sharing of the protocols for review by experts and national institutions, Calcutta, August 2009 z Piloting in 1-2 countries during 2009, followed by national adaptation/application in selected countries during 2010 z In collaboration with WHO Kobe Centre, Japan 31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 13 | Research initiatives in SEARO z Regional Technical Advisory Group (RTAG) for each programme area z Mapping of research institutions z Inter-country workshop on scientific writing, 2008 z WHO Bulletin: special issue focussing on communicable diseases in the SEA Region, due March 2010 z Preparing a vision paper and regional research agenda on communicable diseases 31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 14 | Research initiatives in SEARO…contdResearch initiatives in SEARO…contd z Raising funds internally: -- mobilised $500 000 from within the deptt during 2008 -- Most of technical units have accepted a proposal for 5% allocation of their budget for research z Good scope for utilizing funds available in WHO country offices for research in the countries z Dialogue with international developmental partners 31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 15 | Opportunities already available for research z Outbreak investigations i.e., dengue, SARS, avian and pandemic influenza z WHO Collaborating Centres z Forging partnerships z Even existing resources can be used for building research capacity as a part of health system strengthening – GAVI – Global Fund 31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 16 | GF approved grants to SEAR countries (Rd 1- 8)GF approved grants to SEAR countries (Rd 1- Total (US$)MalariaTBHIVCountry 138,064,629185871798576757733709873Bangladesh 7,022,508378417617359871502445Bhutan 35,163,64212147150230164920DPR Korea 560,476,44963544954141856816355074676India 374,574,944124841851146748338102984755Indonesia 2,655,685002655685Maldives 53,723,312165510591448474622687407Nepal 45,652,3833499149496512291009760Sri Lanka 280,134,6201722134632205930230707344Thailand 17,308,320976350838630993681713Timor Leste 1,514,776,589 301432717 459330214 754013658 TOTAL 31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 17 | WHO Collaborating CentresWHO Collaborating Centres z 30 WHO CCs active in SEA Region in communicable diseases – 19 focused on research, as mentioned in the title z Virtually all CCs have mandate for research or/and training z However, all but 3 are in Thailand or India z National Centres of Excellence and other resources Establishment of WHO CC in more countries can help promote research! 31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 18 | Need for partnerships z With academic institutions: schools of public health, & medical schools z With research organizations z Scientists – Social scientists, economists and demographers – Behavioural scientists – Climatologists etc etc z Private sector: medical and business z NGOs 31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 19 | 19 From research to policy: lost in translation? e.g. Loose networks Lobbying NGO or civil society groups Media Professional associations Community organizations Researchers Technocrats and civil Servants Evidence makers Need for Knowledge brokers Policy makers 31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 20 | Role of WHO z Coordinate the development of a regional research agenda for communicable diseases – Create a forum for discussion between public heath professionals and researchers • To identify priority topics in research according to current public health needs in different settings • To identify gaps and monitor progress in knowledge – Ensure multidisciplinary and comprehensive approach in resolving public health issues (basic, action/operational, translational research) z Facilitate the implementation and regular update of the agenda – Provide updates to Member States and donors on key research topics for support, according to public health needs 31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 21 | Regional research agenda: Prioritization z Regional public health relevance – Urgency of need – Applicability across the region – Feasibility of implementing findings in an environment of resource constraints z Broad applicability of research efforts and findings – Integration of e.g seasonal and pandemic research activities – Promotion of interdisciplinary activities – Likelihood of applicability to other fields z Capacity-building in member countries 31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 22 | Conclusions z Solutions to health problems in SEA Region need to be developed and tested within the Region z Health research should have health system perspective and based on ethics and equity z An enabling environment for research requires vision, institutional support, adequate funds, appropriate training, and attractive career pathways z Collaboration across the region and internationally needs to be strengthened to address common problems z Health research be used to inform health policy, professional practices, and public behaviour 31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 23 | Research – a continuumResearch – a continuum Research dissemination & Programme application Research – policy interface International & Intranational collaboration Partnerships Research Support Capacity Building Research Promotion Research 31 st Meeting of ACHR, Kathmandu, Nepal, 21-23 July 2009 24 | THANK YOU
Thirty-first session of WHO South-East Asia Advisory Committee on Health Research Kathmandu, Nepal, 21-23 July 2009 SEA/ACHR/31/13 18 July 2009 Agenda Item 3.4 RESEARCH PRIORITIES IN COMMUNICABLE DISEASES
RESEARCH PRIORITIES IN COMMUNICABLE DISEASES The South-East Asia Region of the World Health Organisation is at high risk from new and emerging infectious diseases and has become a centre for many zoonotic diseases, drug resistant pathogens and vector borne diseases. The region bears one-third of the global burden of tuberculosis. It has the second highest HIV burden in the world. The region has been the epicentre of avian influenza. Drug-resistant malaria is emerging as a global threat. Dengue is spreading to newer geographical areas while Chikungunya has again emerged after 30 years of quiescence. All these changes were recently reviewed at a Regional meeting on Research Priorities in Communicable Diseases held at WHO Regional Office from 4-6 March 2009. The objectives of the meeting were: a) to share information on ongoing research on communicable diseases in Member countries; b) To develop consensus on research priorities for communicable diseases control, elimination and/or eradication in the Region; and c) To identify mechanisms for promoting, implementing and using research as an integral part of public health action. To ensure that resources are invested in generating relevant evidence that is critical to control of communicable diseases, it is important to analyze gaps in knowledge and accordingly provide guidance on the priorities which need to be addressed by national programmes as well as by independent researchers and the academia. The attention to research in communicable diseases may therefore be firstly focused on the application of available know-how and technology. At the same time, research for development of the tools to increase the efficiency and effectiveness of programme development and management in disease prevention and control is indeed crucially important. To reach this aim, operational research, social and economic research, as well as health systems research are needed, among others. 1 Research on priority health problems should be considered to be the primary responsibility of scientists and academicians. National health programme managers cannot afford to isolate themselves from research institutions. There is a lot of scope to integrate the research agenda of academic institutions into national health policies and programmes. These are particularly health systems research or health services research, operational research and evaluative research. Energetic advocacy at policy and decision making level is required to fulfill this need. Due to competing priorities, research has received little attention and funding. However, more recently, donors such as the Global Fund for AIDS, TB and malaria have expressed explicit interest in funding operational research projects to guide national programmes. In the face of the financial crisis facing countries, priority setting becomes important, in order to target research for health problems that target groups or populations such as the poor, vulnerable, marginalized and under privileged. Besides old challenges, research should address new challenges such as climate change and its impact on health. As a cross cutting issue, research agendas in this area would include study of host factors, environmental and socio-cultural and ensuring optimal health service delivery systems. The Regional Workshop mentioned earlier made several recommendations regarding the management of research in communicable disease. The recommendations made to Member countries are given below: • Mandate the inclusion of an appropriate research agenda into national health policies and programmes; • Allocate at least 5% of the budgets allocated to communicable disease programmes for research; • Establish a national data base of all on-going research relevant to the programme, including drug trials, development of vaccines ad diagnostic tools and share this information both within the country and with other countries of the Region; 2 • Establish a mechanism such as a National Commission on Research to Policy to interface between researchers and the policy makers/programme managers to facilitate the translation of research into policy and strategy; • Set up a network of institutes engaging in research, such as national centres of excellence, academic institutions and WHO Collaborating Centres to support research relevant to national programmes, facilitate close collaboration between researchers and programme managers and promote actionable research; • Build/enhance institutional and individual capacity building for preparing quality research proposals and conducting research that can be applied for prevention and control of communicable diseases; • Promote research that determines influence of environmental, ecological and social factors on epidemiology of communicable diseases; • Utilize available financial resources e.g., GFATM to support research in country-specific context; and • Consider organizing similar workshops in member countries bringing together policy makers, researchers, programme staff and other stakeholders to identify gaps and priority areas for research in countries. Besides old challenges, research should address new challenges such as climate change and its impact on health. As a cross cutting issue, research agendas in this area would include study of host factors, environmental and socio-cultural factors, and also health systems leading to developing policies and strategies and ensuring optimal health service delivery systems. The research agenda should include priority areas such as avian influenza, HIV, Tuberculosis, Malaria, Dengue, Chikungunya, Leprosy, visceral leishmaniasis and neglected tropical diseases such as yaws lymphatic filariasis and helminthiasis, O:\EIP\RPC\ACHR\31 ACHR\ Final documents\SEA-ACHR-31-13_research priorities in communicable diseases_18 July09 at 1410 hrs 3