How to pick Australia's health and medical research priorities

Earlier this month, Health Minister Sussan Ley announced the board of the Australian Medical Research Future Fund (MRFF). It is led by Professor Ian Frazer, one of Australia’s most innovative and successful researchers who developed the highly successful human papillomavirus (HPV) vaccine that protects against cervical cancer.

The MRFF was originally announced in the Abbott government’s 2014 budget and aimed to have around A$1 billion to spend each year.

The board will establish the fund’s research priorities. But how should they choose? Two main approaches are possible: prioritising a health problem and prioritising quality and impact.

Prioritising a health condition is tempting for governments. No-one would argue against the strongest possible worldwide research effort on any area of ill health, whether it’s to defeat, say, dementia, breast cancer or diabetes.

But it is a poor way to get the most benefit for Australia. Even devoting all of the Australian MRFF to a single disease would represent only a tiny increase in the worldwide research effort (perhaps by 1-2%). This is unlikely to make much difference, no matter how large the burden of the disease on individuals and societies.

There are exceptions. These include uniquely or predominantly Australian issues such as the health of our First Peoples, or research to make our unique health system work better for the patient and the taxpayer.

So it’s much wiser to prioritise quality and impact. The highest-quality research is much more likely to be impactful research. Poor-quality research, no matter how important the problem being investigated is, is a waste of money.

We should expect the MRFF to make two broad impacts – better health and health care, and improved national prosperity.

First, then, the MRFF should support research that is needed to more rapidly improve health care (which, incidentally, is one of our largest industries). Australian universities have some high-quality research centres that could, with increased funds, contribute quickly to this.

Second, lots of great discoveries are made by Australians. To have an impact on national prosperity, including high-quality manufacturing and jobs, the MRFF should strengthen, stimulate and accelerate the pathways from discovery to a robust Australian innovative industry sector in biotech, IT, financing, devices, consulting and more.

However, some things need to change.

Australian medical research is too fragmented. We have more than three dozen universities and their associated hospitals and more than five dozen separate medical research institutes, some of which are very small. Some hospital campuses contain several separate independent institutes as well as university clinical departments and research centres.

There is much duplication of research resources and services, and little co-ordination.

In the second decade of the 21st century, visionary, breakthrough research is characterised by collaboration of biomedical research and the life sciences with physics, engineering, chemistry, IT and mathematics.

To tackle the really difficult issues, such as reducing the individual and financial costs of chronic diseases, we also need high-quality social sciences, economics, policy research and entrepreneurship.

These international trends will require a much more open and collaborative Australian research effort, internationally focused.

Gaining national wealth through innovation will likewise require a major leap in collaboration with researchers in other disciplines, drawing on their skills and experience, and especially with industry big and small, here and overseas. After decades of talking about innovation being essential to our futures, there is still little interaction between universities and industry.

Small institutions with few resources and a narrow research focus are likely to struggle to contribute. It should not be a MRFF priority to prop them up.

The MRFF will need to fix its eyes firmly on what is best for Australia’s health and prosperity. This involves maximising ambitious, collaborative, frontier research at top international levels and accelerating the research findings into increased wealth and health for Australia.

But we need to keep in mind that innovative ideas and the greatest successes come from talented driven individuals, not the priorities of committees and boards.