Funding cardiovascular research in Europe

The second of a two-part article1 examining funding for cardiovascular research on both sides of the Atlantic Ocean, Mark Nicholls speaks to Professor Axel Pries about the current position within Europe Advances in cardiovascular research are being made at a steadily increasing rate across Europe, but this critical work is underpinned with consistent, reliable, and regular funding to ensure that studies, research and clinical trials can continue to be conducted at a high level. There is an array of sources for funding, and while that can vary from one country to another and there are differences in the way it is distributed, it is all directed towards a common goal: of improving and extending knowledge of cardiovascular disease (CVD) and facilitate world-class research to reduce and treat CVD to deliver better outcomes for patients and reduce mortality. Cardiovascular disease remains a prime source of death, killing over four million people a year in the WHO European Region and 1.9 million in the European Union (EU). It is also estimated to cost the EU economy €196 billion every year. Professor Axel Pries, who is President of the Alliance for Biomedical Research in Europe (BioMed Alliance)—which represents the main European societies in the biomedical field and was co-founded by the ESC—explained that most of the funding for cardiovascular research in the EU comes from government and public organizations and private and charitable bodies, such as the British Heart Foundation in the UK, which is a significant provider in terms of funding. Of the €876 million awarded for CVD research project grants under competitive open funding schemes in the EU over a 3-year period (2010–12), governments and other bodies delivered two-thirds of surveyed CVD research, amounting to €618 m, while the remaining third—€258 m—came from the EU. ‘National funding sources appear as key for research performed within national borders and find an important complement in EU funding that focuses on transnational cardiovascular research’, explained Prof. Pries, who is Dean and board member of the Charité in Berlin and CEO of the Berlin Institute of Health. A landmark body of work in assessing funding for cardiovascular research has been CardioScape.2 A 23-month project funded by the European Union FP7 research programme aiming to outline the current CVD research and innovation landscape across Europe, it has delivered a blueprint for recommendations for future research strategy. The ESC was partnered with PNO, Europe’s leading independent innovation grants consultancy, for the project in which 157 organizations from all 28 European Union Member States were invited to report information on the funding provided for cardiovascular research. There are some 130 organizations which fund CVD research across the EU nations. Latest figures show that government/public funding in cardiovascular research in Europe accounts for 53% of total grants awarded while charities and private agencies provide the other 47%. Prof. Pries notes that one funding agency alone, the British Heart Foundation, accounts for 14% of total funding in CVD research, while three funding agencies account for over 50% of nationally provided competitive grant funding dedicated to CVD research. It remains less easy to define the split between industry funding, academic funding, and government funding. Based on data submitted for CardioScape, the UK appears to be the top runner in the European CVD research funding landscape, followed by Germany while in Romania and Malta, no funding organizations according to the set criteria were identified. The CardioScape analysis shows that there is no or little relationship between the total national funding and a country’s population size. Countries with powerful charity/private organizations and/or fund-raising cultures and activities (UK, Ireland, Netherlands, Sweden) appear to have a far greater ratio of CVD research spending per capita. Additionally, the level of CVD research funding is not proportional to the CVD mortality rates and the ‘distribution of funding sources within European countries is rather heterogeneous among countries’. By far the largest single funding organization with more than €257 m spent is the EU, and national governmental funding dominates in many countries such as Ireland, Belgium, Finland, Poland, or Portugal. In some countries such as Italy, Spain, and Germany, EU funds provided 50% or more of total funding, though in some countries there is a high proportion of funding by non-governmental organizations (NGO). The NGO funding share is greatest in Greece, followed by the UK, the Netherlands, and Austria. The two largest NGOs are in the UK—(British Heart Foundation €120 m and the Wellcome Trust €104 m) and each of these provided more funding than the largest governmental organization in Europe. CardioScape shows that total funding awarded is highest for human and clinical research with the distribution of CVD research projects by research area in each EU country varying widely and is highly dependent on the number of projects collected for each country. However, Prof. Pries stressed that the European Research Council (ERC) scheme is an absolute European success story. The ERC aims to encourage the highest quality research in Europe and complements other funding activities in Europe such as those of the national research funding agencies, and is a flagship component of Horizon 2020, the European Union’s Research Framework Programme for 2014 to 2020. In the long term, it looks to substantially strengthen and shape the European research system. ‘In about 10 years the ERC has established itself as a gold-standard in identifying and funding excellence’, he said. ‘Now an ERC grant is taken as an undisputable mark of excellence for the awardees which is recognized by universities but also on the political level’. While data have not been closely analysed with respect to where most of the funding goes, he suggested that institutions funded will mostly be universities. When it comes to securing funding, several factors come into play in terms of challenges, ‘strings attached’, and pressures to deliver results, and all can influence or impact on the progress of research. Prof. Pries said: ‘These questions relate to general mechanisms of scientific funding and the parameters used for peer evaluation of grant applications. Obviously, this system has some self-stabilizing aspects: good groups have cutting edge infrastructure and publish in high impact journals and they know what is needed to produce top science. It is not easy for younger scientists from emerging countries to prove their ability to compete and to secure funds. The second aspect is the use of partially self-referral criteria for scientific evaluation. The impact factor and third-party money of a group are parameters, which are often biased towards basic insight and not towards the value of the research for the society. ‘There is an increasing discussion about the apparent low effectivity of biomedical research and how its overall value can be increased. One mechanism would certainly be to modify the incentive structures for science in a value-oriented direction, and this includes funding mechanisms and agencies.’ Work is under way to update the CardioScape data to establish what is happening with funding opportunities and where more, or less, funding is becoming available and what the current trends are in funding for cardiovascular research in the EU. ‘Currently, we are starting a new phase of the CardioScape project in conjunction with the ERA-CVD network’, said Prof. Pries. ‘When we get updated information, it will be possible to analyse trends and developments—with respect to overall funding, regional distribution, and research areas funded. With respect to EU-Funding, which is the main source for transnational funding in Europe, the BioMed Alliance (https://www.biomedeurope.org/) has issued status papers which argue for an increase of the share allocated for health research since this is an area of direct benefit for the European population and will also strengthen the EU economy in a sustainable fashion’. As for the impact on development of new drugs, treatments, therapies and patient outcomes, it is widely accepted that biomedical research positively impacts European citizens’ health and wellbeing and has economic benefits too. The Biomed Alliance states: ‘Biomedical research advances diagnostics, therapeutics, and technology, and has had a major impact on life expectancy and healthy life years. It also offers a high return on investment, which according to a recent analysis, showed that medical research offers the equivalent a 25% return every year, forever’. Yet there is one aspect on the horizon that could have an impact, particularly with the UK being such a significant player in European CVD research, and that is Brexit. What the impact of Brexit will be—for the UK, Europe, and cardiovascular research in Europe—is less certain. Axel Pries said: ‘The UK is a central component of European strength in biomedical research. In the UK, research funding is higher than in other European countries, including Germany. Also, top research is predominantly collaborative and international.3 ‘Brexit threatens this type of research with a major scientific player—a development that is strongly opposed by the scientific community in Europe. And this is true—in spite of the fact that the “remaining” scientific community will get a higher share of EU funding when the UK colleagues no longer have the chance to participate’. The BHF delivers around £100 million (€120) of new research each year, making it the largest non-commercial funder of cardiovascular research in Europe apart from the EU, and one of the largest in the world. It is on track to fund half a billion pounds of research between 2015 and 2020 to improve the prevention, diagnosis and treatment of all cardiovascular diseases. With no Government funding, the BHF relies entirely on public donations across the UK, which then goes on to fund research into the prevention, diagnosis, and treatment of all cardiovascular diseases. The organization also supports people at every stage of their careers (from PhD studentships to BHF Professors); projects in discovery, translational, and clinical science; and fund research infrastructure. Across the UK, BHF has a network of 32 BHF Professors, who are world-class scientists leading the way in their respective fields, and the organization has also established six Centres of Research Excellence and three Centres of Regenerative Medicine. There is also an internationally collaborative element to the charity’s funding. For example, it recently partnered with the German Centre for Cardiovascular Research (DZHK) on CVD research projects. For more than half a century, BHF-funded researchers have pioneered world-leading efforts to understand the causes of heart and circulatory disease and develop new methods of prevention, diagnosis, and treatment. Examples include helping to identify the cause of myocardial infarction; conducting clinical trials leading to the adoption of thrombolytic drugs and statins; and discovering genetic mutations in inherited forms of heart and circulatory disease. It is currently investigating the potential for stem cells and regenerative medicine to repair broken hearts. Professor Jeremy Pearson, associate medical director at the British Heart Foundation, said: ‘Cardiovascular disease remains the world’s biggest killer, devastating families around the globe on a daily basis. As the largest independent funder of cardiovascular research in the UK, we’re dedicated to beating the heartbreak caused by conditions like heart diseases, diabetes, stroke, and vascular dementia. ‘Last year alone, we funded over £100 million in new research grants which will not only benefit the British public, but those suffering from heart and circulatory disease around the world. With support from the public, we look forward to continued investment in future medical advances’. Conflict of interest: none declared.