Global Funding for Local Health Issues Jeremy Farrar Tells Fiona Fleck Why Global Health Research Must Go Local to Respond to Social Needs

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Global funding for local health issues Jeremy Farrar tells Fiona Fleck why global health research must go local to respond to social needs.

Q: The Wellcome Trust was set up in 1936 and has been a major player in many Jeremy Farrar is one of the world’s leading scientists in scientific advances, including sequenc- the field of infectious tropical diseases and since 2013 ing the human genome. It’s the world’s has been funding research globally as director of the second largest health research funder Wellcome Trust. From 1996 to 2013 he was the director after the Bill & Melinda Gates Founda- of the Oxford University research unit at the Hospital tion with an endowment of £19 billion for Tropical Diseases in Ho Chi Minh City, Viet Nam (US$ 29.5 billion). How did it feel to take that focuses on a wide range of infectious diseases over the reins as director of the Wellcome and became a leading centre for clinical research

Trust in October 2013? Trust Wellcome Courtesy of the on emerging infections. He became a professor of A: Tremendous excitement but of Jeremy Farrar course also daunted by the responsibil- medicine at Oxford University in 2000. He is a member ity. The first outweighs the second, and of several World Health Organization (WHO) expert panels, including the you grasp the amazing opportunity and scientific and technical advisory committee on Ebola experimental interventions seek to contribute what you can. It is an and the emerging viral threats disease reference group. He is chairman of the enormous privilege and honour to be the WHO technical advisory group on dengue vaccines. Farrar trained in neurology director of such an organization. Hav- and infectious diseases in London, Edinburgh, San Francisco, Melbourne and ing been funded by the Wellcome Trust Oxford and has a PhD in immunology from Oxford University. as a researcher for almost two decades, I knew it very well from the outside. I knew its approach to research, its history and ethos and its values and many of the encourage teams of researchers to work initial data and apply for larger funds to people working there. This was incred- together within or between disciplines. further develop their projects. ibly helpful when I took over as director. Q: What other new initiatives have you Q: The Trust has been criticized in the Q: To what extent are you funding brought in? past for a lack of transparency over the individual researchers as opposed to A: Major scientific breakthroughs reasons for specific grant awards. How collaborations? are often made by relatively young peo- are you making the decision-making A: Globally there has been a trend ple in their 20s or 30s. I felt we need to process more transparent? over the past 20 years – and this has back young people taking on what might A: It is fair to say that we have not al- been true of almost every major funder seem improbable ideas and encour- ways provided as detailed and construc- – to increasingly focus both on indi- age them. There has been a tendency, tive feedback as we might have done. We viduals and very large consortiums of and not just at the Wellcome Trust, to get a huge number of applications and researchers. There are stellar individual move away from funding young people we cannot fund everyone. We are aware researchers out there and I strongly and award very large grants to people of the importance of feedback and aim to believe in funding the best people, but with long established track records. make more effort to provide feedback to I also believe in funding the best people We should support well-established unsuccessful applicants on the reasons working in great teams in great environ- scientists, but we risk disenfranchising why their applications were not funded ments. I also believe in funding young young people. We need to support the and how applications can be improved. people. Writing a book is an individual development of the next generation of This feedback is particularly important pursuit and there are areas of science research leaders. for young researchers. where a brilliant individual working alone makes a breakthrough. But the Q: What research funding model would Q: How do you decide who to fund? world of research is increasingly about you like to see and what are you doing A: In the Wellcome Trust we stimu- people working in multidisciplinary to support this? late ideas, advise and encourage research teams that consider the social context A: We need a mixed model which grant applicants. But most of the deci- of their work and are not working in a supports individuals throughout their sions on which grants receive funding scientific vacuum. While I believe we careers, encourages people to take risks are made by the committees of external must continue to support individual re- and, when driven by the research, allows experts that peer-review applications searchers to explore their dreams, there people to work in teams which take a and interview candidates. We are pres- is also a need to put back into the heart broad view of the question, including the ent at the committee meetings to ensure of research funding the opportunity for social context of the issues. Recently we that the process is fair and that the com- groups of researchers to work together took steps to increase the opportunities mittees’ work is aligned with the Trust’s and integrate the broader social conse- for early and mid-career researchers. strategic areas. The Trust decides the quences of their work. That is why we re- We also introduced seed grants to allow level of funding for each of our five stra- cently introduced collaborative grants to people who take on risky projects to gain tegic directions and each grant’s funding

Bull World Health Organ 2015;93:367–368 | doi: http://dx.doi.org/10.2471/BLT.15.030615 367 News

comes out of the funds that are flexibly will be led by the African Academy of severe acute respiratory syndrome allocated for the relevant strategic areas. Sciences. These two major initiatives (SARS) and H5N1 [avian influenza] support the development of the next outbreaks as well as from the develop- Q: How flexible is the Trust’s funding if the generation of research leaders based in ment of artemisinin-resistant malaria, committees make the decisions? Africa and India. I hope to work towards the current epidemic of MERS-CoV A: We are not fixed in our allocation further initiatives in the future in eastern [Middle East respiratory syndrome of funding and are able to move fund- Asia and other parts of the world. coronavirus] and many other national ing between our strategic directions to and regional epidemics over the last support the most promising research Q: One of the issues you have taken up is decade. We need to be much better pre- – research that we hope will have the antimicrobial resistance, why? pared to identify and report such infec- greatest impact. A: Antimicrobial resistance is the tions when they emerge as well as other most important emerging infectious potential public health threats. We also Q: Is there a shift away from awarding disease problem of our time. Currently need to be able to respond to these grants to recipients from the United King- we are all working in siloes. We need to threats in a much more decisive and dom and Commonwealth countries? bring together people working in differ- coordinated manner. Such a response A: The Commonwealth doesn’t ent disciplines: the human and animal requires much stronger public health come into it, we are a global organiza- health sector, people working in eco- and clinical systems in all countries but tion. We fund research in some Com- nomics, social sciences, anthropology, in particular low- and middle-income monwealth countries, but also in many law and policy to respond to this mas- countries. It also requires honest, others, such as China, Indonesia, Lao sive and growing problem. The whole transparent and accountable reporting People’s Democratic Republic, Nepal, of modern medicine relies on having and sharing of data, equitable sharing Viet Nam and others. Under my pre- effective antibiotics to prevent and treat of the benefits of that data (including decessor Mark Walport, the Trust’s infections. Without antibiotics basic sur- affordable and real-time access for spending on grants outside the United gery, chemotherapy for cancer and care diagnostics, drugs, vaccines or social Kingdom increased from approximately of patients with diabetes, for example, interventions) and much greater incen- 11–12% to 23–25% and I hope we can become very difficult if not impossible. tives for countries to work together and increase this even further. This is im- Addressing antimicrobial resistance is a share information. portant to the Trust’s history and goes major priority for the Wellcome Trust. back to our founder, Henry Wellcome, Q: How? who was an internationalist. We are a Q: What is the Trust doing to address A: I hope that all of us – commu- global funder of research with a focus the problem? nities, funders, public health, clinical, on support for research that can make A: We are working closely with governments, global organizations – can a difference to people’s lives. The United WHO, governments and philanthropic work together to really learn the tough Kingdom has a very strong basic science, organizations around the world to make lessons of the Ebola epidemic and put clinical and humanities research base, sure the issue of antimicrobial resistance in place the systems and approaches but the Trust is committed to global is a priority so that collectively we act to that we increasingly need so that we can health and is a global organization. reduce the burden of resistant infections, prepare for – and respond to – epidem- prevent new resistant strains emerging ics and other public health crises. With Q: Can you give some examples of proj- and develop new drugs (and use existing changing environments, habitats, ur- ects that aim to do this? drugs better) and other interventions, banization, increased travel and changes A: We are shifting some decision- for example, vaccination and sanitation, in societies around the world we are making and other activities to where to treat resistant infections when they inevitably going to face more national, the needs are. For example, we have set arise or – even better – to prevent them. regional and global epidemics. up a research hub with the Indian gov- ernment, the Wellcome DBT India Al- Q: Where does research come in? liance, which peer-reviews applications A: To mount the required response from Indian researchers, interviews Antimicrobial to future epidemics and health threats candidates and decides which appli- resistance is the most we need a strong research component cants should receive funding. This way “ that works in the inter-epidemic times research is defined at local level and not important emerging to ensure that we have interventions from an office in London. We have also infectious disease that might be needed in times of crisis. recently created a research hub in Af- problem of our During epidemics, we need a robust and rica called the Alliance for Accelerating time. ethical research framework to ensure Excellence in Science in Africa. This is a that the information needed to guide partnership with the United Kingdom’s ” the public health and clinical response Department for International Develop- can be acquired, shared and acted upon ment, the Bill & Melinda Gates Founda- in real time. Importantly, we need to tion and we hope others in future. The Q: What have health funders learned ensure that the knowledge, interven- African programme is now transitioning from the current Ebola outbreak? tions and systems needed to prevent from London to the African Academy A: There are many lessons not just future epidemics and bring them under of Sciences in Nairobi, where the peer- for funders but for everyone. Many of control are equitably shared among all review process and interviews for grants them are the same lessons from the those who need them. ■

368 Bull World Health Organ 2015;93:367–368| doi: http://dx.doi.org/10.2471/BLT.15.030615