Canada needs to take a clinical look at how it supports biomedical discoveries
This editorial originally appeared in The Globe and Mail.
Canada is known internationally for the excellence of its medical research, particularly in the field of infectious disease. When the first SARS outbreak struck in 2003, the viral sequence was determined quickly and efficiently in Vancouver. The Ebola vaccine, currently used to limit the spread of this deadly virus, was developed in Winnipeg.
Across Canada, many scientists and researchers are doing groundbreaking work researching the causes of infectious diseases and the immune responses that help us to clear them. Despite the work of high-calibre Canadian scientists who are developing new delivery systems and therapies for COVID-19, the pandemic has exposed significant flaws in Canada’s ability to respond effectively to health care priorities on a large scale.
More importantly, the pandemic has exposed the inability of Canada’s science infrastructure to move discoveries of new drugs and diagnostics from the laboratory through to clinical trials and into clinical practice. These limitations impact our ability to respond to health challenges and to leverage a healthy bioscience industry to grow the economy.
Sadly, the discoveries of Canadian biomedical science too often end up benefitting the economies of other countries that are eager to take advantage of the excellence of our science.
The Association of Faculties of Medicine of Canada (AFMC) represents the leaders of Canadian medical schools and academic medicine. Faculties of medicine are responsible for the education of medical and health professionals. They are also responsible, in partnership with our health partners, for the creation of new knowledge through research, and its translation and dissemination into clinical use.
Countries such as Britain and the U.S. have long recognized the importance of solidifying the relationships between universities, health authorities and industry. This leads to the ability to ask important research questions – and to answer them – within the health system.
They have also created structures such as the National Institute for Health Research (U.K.) to help specifically allocate support for these relationships and ensure research is translated rapidly for the benefit of the population.
This type of funding in the U.K. provided the infrastructure for the very rapid execution of clinical trials that demonstrated that drugs such as dexamethasone and tocilizumab were effective in the treatment of COVID-19. In addition, the system provided outstanding real-time data about the immune response to COVID-19 that continues to inform our understanding of disease.
The partnership between academia and health care, and the consequent relationships with industry, also lead to the very rapid development and manufacturing of COVID-19 vaccines in the U.K.
What does this mean in practice? These days, many new drugs, therapeutics or devices originate in academic laboratories but the process of generating real value involves creating clinical-grade product, testing in animals and then moving into testing in first-in-human trials before entering later-stage trials designed to prove efficacy.
This process of moving up the value chain typically results in creating a new biotechnology company or licensing the product to a pharmaceutical manufacturer. A new product acquires additional value as it successfully completes each phase of the process and, most importantly, it typically attracts investment and creates new jobs.
Unfortunately, the processes for moving up the value chain are lacking in Canada, as are research and development investments. Discoveries made in Canada typically see their movement up the value chain take place in the U.S. or elsewhere.
For example, the commercial value associated with the discovery of insulin in Canada ended up in Denmark. Vyxeos, a product for acute myeloid leukemia, was discovered in B.C., but manufactured in the U.S. and acquired by a Dublin-based company.
These are just a few examples that illustrate Canada’s lack of support for translating basic research into business growth and job creation.
Biotechnology is undoubtedly an international business, but other systems show that a country such as Canada needs effective government support to retain value from its research. Here, that retention currently depends on the tenacity of inventors and entrepreneurs who are determined to ensure the economic value – in revenue and jobs – sticks.
How do we address these flaws in our system? Around the world, health systems are configured to enable early-stage clinical trial research. This structure is lacking in Canada. We need to formalize and fund academic health systems in which faculties of medicine are aligned on the need for embedded research capacity in a learning health system.
Canada needs the physical and human capital to perform clinical research and first-in-human clinical trials within our health systems. Further, we need to build a truly national learning health system. This involves breaking down inter-jurisdictional boundaries – between provinces and at other levels – that impede the sharing of health data, and developing the capability to ethically ask and answer questions on a truly national level.
We also need to develop fresh approaches to implementing new discoveries, both by encouraging innovation within our system and engaging effectively with industry in pursuing goals.
Industry engagement is not currently a formal criterion for evaluating the strength of the academic health system in Canada, as it is in other countries such as the U.K. Collaboration with industry needs to be actively encouraged in Canada.
Finally, we in the academic sector must develop imaginative new programs to educate and train the next generation of scientists, clinicians and innovators in business. We must ensure this next generation has the tools to truly translate new knowledge for the benefit of patients and the economy in the minimum of time.
Given the recent commitment from the federal government to invest $2.2-billion over seven years toward growing a vibrant domestic life sciences sector, the time to act is now. We know this is not the last pandemic we will face, and there are other health problems in society that warrant such initiatives.
There has never been a time when the objectives of the academic world and its health care and industry partners have been better aligned in Canada. Let’s seize this opportunity to make a transformational change for the benefit of the people of Canada.
Dermot Kelleher, MD, FRCP, FRCPI, FMedSci, FCAHS, FRCPC is Dean, Faculty of Medicine, University of British Columbia and Chair, AFMC Committee on Research and Innovation
David Anderson, MD, FRCPC, FACP is Dean, Faculty of Medicine, Dalhousie University and Chair, AFMC Board of Directors