The National Academies

10/01/2024 | Press release | Distributed by Public on 10/01/2024 09:20

Strengthening the U.S. Biomedical Research Enterprise Entails National Strategic Coordination, Focus on Health Equity, Says NAM Special Publication

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Strengthening the U.S. Biomedical Research Enterprise Entails National Strategic Coordination, Focus on Health Equity, Says NAM Special Publication

News Release| October 1, 2024
WASHINGTON - Although the U.S. is the global leader in biomedical and health research, the research enterprise is currently not achieving all it could be, due to a lack of high-level national coordination and structural issues including a lagging workforce and fragmented funding, says a new special publication from the National Academy of Medicine. These issues, compounded by existing health inequities and rising complex health concerns, threaten the nation's global leadership and the health of the U.S. population.
The publication provides a road map with priorities in five areas to ensure successful longevity of the country's biomedical research and development enterprise:
  • creating a strategic national vision
  • streamlining and coordinating funding across sectors
  • prioritizing health equity
  • improving federal coordination and the application of convergence science
  • developing a future-ready workforce
Contributing significantly to the nation's health and economy, the U.S. biomedical research enterprise includes discovery and translational research conducted by the federal government, pharmaceutical industry, academic institutions, and public health entities. It supports scientific progress nationally and globally, as demonstrated by the large number of U.S.-trained scientists who have received the Nobel Prize and have made breakthrough achievements.
"The U.S. biomedical research enterprise is a national treasure and thus far has greatly improved human health overall. The authors feel that it has even greater potential and must be fine-tuned to achieve optimal outcomes that further support the economy and improve health for all," said E. Albert Reece, former executive vice president for medical affairs, University of Maryland, Baltimore; Distinguished University Professor and former dean, University of Maryland School of Medicine; and chair of the author group. "We hope the actions we've identified will provide a road map for optimizing the country's research enterprise of the future. We owe it to ourselves - and our children and grandchildren - to ensure that we are using our resources most effectively and strategically to benefit everyone in the nation."

Developing a National Strategic Vision

The biomedical research enterprise involves many actors with varying agendas that often result in a fragmented approach to prioritization and funding. The publication suggests that there is a need for a long-lasting advisory body to be created by the president and Congress that could have representation from all sectors to galvanize national leadership, develop a national strategic vision, and coordinate efforts and resources. The advisory body could include scientists from across all disciplines, representatives from relevant federal agencies, and patients, and it could leverage existing global best practices to minimize barriers and maximize outcomes. The advisory body also could identify biomedical research and development areas of greatest need, and map out the workforce, funding, technological, and scientific resources that meet those needs.
For effective accountability, this advisory body could ensure transparency and integrate regular public engagement to help set priorities, establish measurable goals and timelines, and report progress to the president, Congress, and the public annually. A national strategic vision could ensure that the outputs and outcomes of biomedical research continue to improve population health and reach all population groups.

Streamlining and Coordinating Funding

While the U.S. currently spends more than any other country on research and development, peer nations are increasingly dedicating a higher percentage of their GDPs to growing their own biomedical research efforts. To ensure that funding focuses on issues that are most directly impacting people living in the U.S., the publication's authors proposed a federally established national biomedical research funding collaborative and federal determinations of how best to organize and allocate shared investments from the government, private sector, and philanthropy. The collaborative could be guided by best practices from existing international models. Initiatives and funding strategies could specifically entail bridging what the authors termed the "funding valley of death" now blocking the translation of promising discoveries into breakthrough therapeutics, drugs, and diagnostics.

Prioritizing Health Equity

Racial and ethnic minority groups in the U.S. experience worse outcomes in almost every measure of health and wellness compared to their white counterparts, and women or individuals who identify as women also experience disproportionate health disparities compared with men or individuals who identify as men. The publication proposes federal prioritization of research that informs solutions for achieving health equity in the U.S., particularly focused on the social determinants of health, diversifying the workforce, and the research enterprise itself. Funding organizations and agencies could also prioritize research to understand and eliminate barriers that are preventing the most vulnerable populations from receiving and accessing comprehensive, high-quality, and culturally appropriate care. Specific areas could include the digital divide, barriers to transportation access, geographic shortfalls in health care providers, and trust in science and medicine.

Improving Federal Coordination and Convergence Science

The authors proposed federal requirement and facilitation of necessary coordination across government agencies, as well as with external parties, to enable the use of convergence science, coordinate funding and strategy, and promote information sharing. Better federal coordination could enable the deployment of convergence science - an approach that draws on large teams of collaborators from multiple scientific disciplines - to solve increasingly complex and interconnected health challenges in the U.S. Federal coordination and advancement of convergence science could also facilitate the use of public-private partnerships, which were implemented during the COVID-19 pandemic often to great success, but should not be relegated to times of crisis, the publication says.

Supporting a 21st Century Workforce

International students, scientists, and scholars have contributed significantly to the U.S. biomedical research enterprise. In 2019, more than 4,000 individuals holding temporary visas in the U.S. were awarded bachelor's degrees in biological sciences, more than 2,500 were awarded master's degrees, and almost 2,000 were awarded doctoral degrees. The biomedical research enterprise must ensure that the U.S. remains a welcoming and accessible country for scholars to live, learn, and work, the publication says.
In addition, the publication proposes steps that the federal government and Congress could take to ensure the country has a competitive, committed, and well-compensated biomedical research workforce. Examples include:
  • incentivizing and implementing specialized and necessary education and training for all levels of the workforce - including a reinvigorated focus on K-12 STEM education to reinforce the pipeline at its earliest stages;
  • removing barriers that may prevent full accommodation and integration of international scientists into the workforce, including expanding eligibility for federal research funding to temporary visa holders; and
  • implementing innovative approaches to recruiting and retaining the specialized workforce, including by expanding student loan forgiveness, providing new funding modalities for postdoctoral trainees, and creating early career development awards for new investigators seeking to pursue research fields prioritized by the national strategic vision.
"Until the enterprise can address all unique needs of the American people and ensure that the research and products it advances are accessible, it will not have achieved its goal of improving health for all," said Victor J. Dzau, president of the National Academy of Medicine. "Now is the time to take bold steps to structurally improve the U.S. biomedical research enterprise, implement efficiencies, increase the use of convergence science, break down silos, and close the gap of health inequity."
The special publication was authored by experts who were assembled under the charge of the National Academy of Medicine. The views presented in the publication are those of individual contributors and do not represent formal consensus positions of the authors' organizations, the National Academy of Medicine, or the National Academies of Sciences, Engineering, and Medicine.
The National Academy of Medicine, established in 1970 as the Institute of Medicine, is an independent organization of eminent professionals from diverse fields including health and medicine; the natural, social, and behavioral sciences; and beyond. It serves alongside the National Academy of Sciences and the National Academy of Engineering as an adviser to the nation and the international community. Through its domestic and global initiatives, the NAM works to address critical issues in health, medicine, and related policy and inspire positive action across sectors. The NAM collaborates closely with its peer academies and other divisions within the National Academies of Sciences, Engineering, and Medicine.

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Featured Publication

2024

The State of the U.S. Biomedical and Health Research Enterprise: Strategies for Achieving a Healthier America

The U.S. biomedical research enterprise has played a vital role in advancing science, human health, and the economy. It has contributed significantly to fields such as agriculture, environmental remediation, job creation, and technological innovation. Over the past 80 years, landmark achievements include reducing cancer mortality, developing HIV/AIDS treatments, sequencing the human genome, and creating vaccines that mitigated the impact of the COVID-19 pandemic. The enterprise has grown remarkably in less than a century and holds even greater potential for future success. However, its progress is hindered by a lack of high-level national coordination, a fragmented funding system, and a declining workforce.

The State of the U.S. Biomedical and Health Research Enterprise: Strategies for Achieving a Healthier America addresses these challenges in five key areas-strategic vision, funding, health equity, coordination and convergence science, and workforce development-offering a roadmap that could be used to sustain U.S. leadership in global health.

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