International Engagement Strategy 2023–2026 – strategic opportunities

Priority 1: Collaboration in the Indo-Pacific region

Goal: NHMRC fosters health research collaboration in the Indo-Pacific region and contributes to regional research capacity building

Focus: Health concerns in the Indo-Pacific region

The Indo-Pacific region, home to more than half of the world's population, bears much of the global infectious disease burden.^[1] The region continues to be threatened by the prevalence of infectious diseases including HIV, tuberculosis (TB) and malaria as well as hepatitis and diarrhoeal diseases. South-East Asia, for example, has the third largest HIV epidemic globally, the highest burden of TB and the second highest incidence of malaria, amongst all World Health Organization (WHO) regions.^[2] Further, a number of infectious diseases, such as dengue, malaria and diarrhoeal diseases, are climate sensitive, meaning they may increase in incidence, or spread to new areas, as a result of climate change.^[3] Due to the regional differences in the extent of warming, climate change is also likely to have varying impacts on infectious disease patterns in different parts of the Indo-Pacific region. The region remains at risk of resurgence of malaria and other vector-borne diseases in an increasingly warmer world.^[3]

While increased availability of treatment has reduced the burden of infectious disease globally, according to research by the Global Research on Antimicrobial Resistance (GRAM) Project, Papua New Guinea, the Pacific and South-East Asia face high to moderate prevalence of drug resistant bacteria, contributing to a higher burden of disease in these regions.^[4] Antimicrobial resistance (AMR) continues to be a challenge in the Indo-Pacific region due to increasing antibiotic consumption, a lack of stewardship programs and poor infrastructural capacity.^[3] WHO's Strategic Priorities on Antimicrobial Resistance includes 'research and development for better access to quality AMR prevention and care', which aims to promote scientific interest, research and investment in new tools and policy guidance relevant to the AMR response.^[5] Collaborating with partners in the region to foster researcher collaborations to design and implement AMR interventions is critical.

Non-communicable diseases (NCDs), such as cardiovascular disease, cancer, chronic respiratory disease and diabetes mellitus, are responsible for an increasing proportion of morbidity in countries in the Indo-Pacific region.^[6] In Indonesia, for example, stroke, heart disease, diabetes and cirrhosis make up the top four causes of death nationally.^[7] In Singapore, heart disease, stroke, lung cancer and Alzheimer's disease make up the first, third, fourth and fifth largest causes of death nationally.^[8] In Japan, Alzheimer's disease is the largest cause of death nationally, and this has increased by about 50% over 30 years (1990–2019).^[9] Australia shares many of these major causes of death: in 2020, the leading cause of death for men was coronary heart disease (12%) followed by dementia, including Alzheimer's disease, and for women the leading cause of death was dementia including Alzheimer's disease (12%) followed by coronary heart disease.^[10] The COVID-19 pandemic has brought the risks associated with multimorbidity into the spotlight as many of those who have experienced severe illness and death as a result of COVID-19 have had one or more underlying chronic conditions.

NHMRC is considering how it could play a stronger role in initiating international research collaboration in the Indo-Pacific region and contributing to regional research capacity building.

What we have done so far

Only two of the top 10 international collaborating countries are from the Indo-Pacific^[11] region. However, some Australian medical research institutes have long-standing collaborative relationships in the region, some of which are supported by NHMRC funding. Between 2012 and 2021, 254 NHMRC grants have been funded with collaborators from Indo-Pacific countries. The majority of these grants have been in clinical medicine and science (38%) followed by basic science (29%), public health (26%) and health services research (18%).

e-ASIA Joint Research Program

NHMRC has participated in the e-ASIA Joint Research Program since 2016. E-Asia formulates and supports international joint research projects in the East Asia region on a multilateral basis. Research topics for the program are often related to infectious diseases. Other participating countries are Cambodia, Indonesia, Japan, Lao PDR, Malaysia, Myanmar, New Zealand, Philippines, Russian Federation, Singapore, Thailand, the United States of America (USA) and Vietnam.

Through e-ASIA, NHMRC has funded collaborative projects with Thailand, Cambodia, Lao PDR, Indonesia and Japan.

Japan

NHMRC and the Japan Agency for Medical Research and Development (AMED) signed a Memorandum of Cooperation in October 2018. NHMRC is working with AMED to advance the development of research cooperation in health and medical research between scientists in Japan and Australia by means of cooperative research projects.

The NHMRC–AMED 2022 Dementia Collaborative Research Scheme invites applications for research on the many potential causes of dementia and modifiable lifestyle risk and protective factors that may prevent or delay the onset of dementia.

Global Alliance for Chronic Diseases

NHMRC is a founding member of the Global Alliance for Chronic Diseases (GACD) and regularly participates in GACD funding calls. The GACD brings together national and international funding agencies to support implementation research to address chronic NCDs in low and middle-income countries and disadvantaged populations in high-income countries. GACD members include the Indo-Pacific countries, India, Japan, New Zealand and Thailand, as well as Brazil, Canada, South Africa, United Kingdom, the USA and the European Union. GACD projects can also be carried out in non-GACD member countries.

Through the GACD, NHMRC has funded collaborative projects involving India, Sri Lanka, Bangladesh, Vietnam, Fiji, Samoa, Indonesia, Singapore and Papua New Guinea.

India

NHMRC signed an MoU with the Indian Council of Medical Research (ICMR) in February 2016 until 2026. The MoU covers implementation and execution of joint collaborative research projects, joint scientific workshops, symposia and conferences and researcher exchanges. No activities have yet been carried out under the MoU but NHMRC has been collaborating with ICMR through the GACD.

Previous bilateral agreements

NHMRC has previously had MoUs with Vietnam and Singapore that have facilitated joint funding calls with both countries.

What other Australian Government agencies are doing

The Department of Foreign Affairs and Trade's Health Security Initiative (HSI), implemented by the Indo-Pacific Centre for Health Security, was launched in 2017 with an allocation of $300 million over five years, funded from Australia's aid program. The objective of the HSI is to contribute to the avoidance and containment of infectious disease threats in the Indo-Pacific region with the potential to cause social and economic harms on a national, regional or global scale.

The HSI was designed to support and generate evidence-based health security interventions. It does this by accelerating research on new drugs and diagnostics, expanding partnerships at the national, regional and global level to strengthen human and animal health systems, and deepening people-to-people linkages that build national and regional health security capacity.

The Department of Industry, Science and Resources supports international collaboration on science and research through the Global Science and Technology Diplomacy Fund (GSTDF)^[12]. The GSTDF's Strategic Element is designed to support collaborative projects with identified research partners in four priority areas:

• advanced manufacturing: USA, Italy, UK, France, Switzerland
• artificial intelligence and quantum computing: Japan, UK, France, Spain, USA
• hydrogen production: Germany, Canada, Malaysia, South Korea, Thailand
• RNA (including mRNA) vaccines and therapies: USA, Spain, Japan, Brazil, Singapore.

The GSTDF also has two components under the Bilateral Element: the Australia-India Strategic Research Fund (AISRF) and the Australia-China Science and Research Fund (ACSRF). For example, the AISRF has previously supported research collaboration across a number of mutual health research priority areas, including stem cell research, biomedical devices and implants, and vaccine.

Strategic opportunities

• Participate in targeted multilateral/ bilateral funding calls and global organisations/ alliances in the region focused on:
  • infectious diseases, including the emergence and spread of infectious disease as a result of climate change
  • AMR, including implementation science projects
  • prevention and management of non-communicable diseases.
• Partner with Australian Government agencies that prioritise and fund the issues above.

Priority 2: Shared global health priorities

Goal: NHMRC grants support research on shared global health priorities to build a healthy Australia and world

Focus: Addressing climate change and environmental health

The WHO considers climate change to be the single biggest health threat facing humanity.^[13] Climate change affects physical and mental health in many ways, including through frequent extreme weather events, such as heatwaves and floods; disruptions to food systems; and increasing vector-borne diseases. Climate change also undermines many social determinants of health, such as access to health care and social support structures, and disproportionately affects vulnerable populations. The Pacific Islands, for example, are highly vulnerable to the adverse consequences of climate change and face particular health challenges as a result.

Research on the extreme and long-term impacts of environmental change on human health, and the performance of the health system, is critical to assisting policy makers to develop robust evidence-based policies and plans.

What we have done so far

Strengthening resilience to emerging health threats and emergencies, including environmental change, pandemics and antimicrobial resistance is an NHMRC health priority for 2021-2024. NHMRC hosted a workshop in 2019 to determine how we can stimulate capacity and support research to address the impacts of environmental change on individual and population health and the health system. Through the workshop it was identified that building a multidisciplinary, collaborative research network is needed to understand the complex interaction between primary, secondary and tertiary health effects of environmental and climate change. NHMRC has since committed $10 million to establish the Healthy Environments And Lives (HEAL) National Research Network through the NHMRC Special Initiative in Human Health and Environmental Change.^[14]

From 2012 to 2021, there have been 15 grants awarded to projects with at least one international collaborator that have had a focus on climate change/environmental health. Approximately half of these grants (7) have been funded through NHMRC's International Collaborative Schemes:^[15]

• 2013 NHMRC-European Union Collaborative Research Grant (1 grant)
• 2019 UK Research and Innovation-NHMRC Built Environment Prevention Research (5 grants)
• 2020 e-Asia Joint Research Program (1 grant).

In 2022, NHMRC participated in the Canadian Institutes of Health Research (CIHR) Healthy Cities Implementation Science Team Grants Scheme and is participating in the 8th GACD funding call. Both calls are focused on chronic disease prevention in urban environments/ cities (see further details below).

What others are doing

National

The Australian Government established the Department of Climate Change, Energy, the Environment and Water in July 2022 to deliver on the Government's climate change and energy agenda and protect Australia's environment and water resources. A number of other government and non-government organisations also have a lead role in addressing climate change, such as:

• CSIRO's Climate Science Centre
• UNSW's Climate Change Research Centre
• Australian National University's Institute for Climate, Energy and Disaster Solutions.

In April 2022, the Australian Academy of Health and Medical Sciences released a statement, 'Climate change: an urgent health priority' which outlined key steps that the health and medical research sector can take:

1. Promote among decision makers that climate change is an urgent health issue
2. Deliver research that further advances knowledge of the direct and indirect health impacts of climate change
3. Support investigations to prevent diseases from the causes of climate change
4. Collaborate with First Nations communities to learn from Indigenous Knowledge practices.^[16]

International

International funding agencies and organisations that NHMRC engages with have undertaken several initiatives to address the health impact of climate change:

• The GACD's 8th funding call focuses on NCD prevention in cities. Applicants are invited to conduct implementation research that leads to improved understanding of how specific interventions that reduce the risk of NCD onset or progression can be better adapted to different city environments and/or scaled within and across cities. Applications investigating strategies that can positively impact planetary health and/or climate change resilience and prevention will be encouraged.
• In 2020, the e-Asia Joint Research Program called for applications focusing on the 'Human Health impact of Climate Change' in the Southeast Asian region. NHMRC participated in this call. E-Asia also hosted a workshop on Climate Change and Human Health in August 2022.
• CIHR, in partnership with the Public Health Agency of Canada, launched the Healthy Cities Implementation Science Team Grants Scheme in February 2022. The funding call supports research proposals to improve the understanding of how to design, implement and promote systematic and equitable uptake of evidence-based interventions, to improve population health and well-being in multiple urban environments in Canada and Australia. One of the research areas was Environment and Climate Change.
• The UK's National Institute for Health and Care Research (NIHR) launched a new sustainability-themed package of funding for domestic and global health research on climate and health to investigate how health services in low- and middle-income countries can adapt to disruption caused by extreme weather events due to the changing climate. NHMRC is not involved in this program of funding.

Strategic opportunities

• Participate in bilateral/ multilateral schemes and global organisations/alliances that address climate change/ planetary health.
• Develop guidance for NHMRC applicants on how to consider the impact of their research on the environment. Guidance could include how applicants consider environmental impact:
  • In the performance of their research (researcher footprint)
  • In the design of the intervention (implementation strategies)
  • In the outcomes of the intervention.

Priority 3: Researcher capability and research impact

Goal: NHMRC facilitates international collaboration and researcher exchange to build Australian research capability and impact

Focus: Support early to mid-career researchers to develop international networks and undertake research overseas

NHMRC aims to support Australian researchers to develop international networks and undertake research overseas. NHMRC recognises the importance of enabling early to mid-career researchers (EMCRs), as the future leaders in the research community, to connect with international partners. EMCRs can also be catalysts for expanding international networks and collaboration.

What we have done so far

Early Career Fellowships and Investigator Grants

From 2012 to 2021, almost 16% of grants with at least one international collaborator were funded through the Early Career Fellowships scheme (ECF). The ECF scheme, which ended in 2019, provided 4-year fellowships to early career researchers to assist them in their health and medical research training within Australia or overseas. Schemes allowed successful applicants to spend a portion of their grant period overseas.

From 2019, EMCRs could apply through the Investigator Grant scheme by self-selecting Emerging Leadership 1 (EL1) or Emerging Leadership 2 (EL2) (collectively known as Emerging Leadership Fellows). Seventy% of grants with at least one international collaborator have been at the EL1 level with the remaining 30% in the Leadership category. This may be because Chief Investigator As (CIAs) with Emerging Leadership Fellowships can spend 50% of their grant duration overseas (compared with 20% for CIAs for non-EL categories).

International Collaborative Schemes

In several funding calls for NHMRC's International Collaborative Schemes, consideration is given to EMCRs. For example:

• The GACD requires applicants to include early career investigators in their research teams as well as a detailed capacity building plan for professional development.
• For the NHMRC-AMED 2022 Collaborative Dementia Research Scheme, the lead Chief Investigator/Principal Investigator has to be an early career researcher.
• One of the assessment criteria for the e-Asia Joint Research Program is: “Early career researchers who are exceptionally strong contributors to the overall team quality and capability”.
• The NHMRC-CIHR Healthy Cities Implementation Science Team Grant Scheme also includes assessment criteria on building capacity among early career researchers.

NHMRC is also a member of the Human Frontier Science Program (HFSP) which supports international and interdisciplinary collaborations in high-risk/high-reward basic research, focusing on complex mechanisms of living organisms. The HFSP allows Australian EMCRs to apply to participate in international research teams and undertake training overseas.

What others are doing

National

As part of the Department of Industry, Science and Resources' (DISR) Australia-India Strategic Research Fund, EMCRs can access funding to travel to India and work with researchers at major Indian science and technology organisations. The Indian Government also supports Indian researchers to spend time at Australian institutions. Under the Australia-China Science and Research Fund, the Australian and Chinese Governments jointly fund the Young Scientists Exchange Programme (YSEP) for EMCRs. YSEP provides an opportunity for researchers from Australia and China to undertake a two-week exchange. Successful applicants establish linkages with a range of research organisations and learn about the science and research environments of each country.

The Australian Research Council signed an Implementing Arrangement with the European Research Council (ERC) in late 2019, which is designed to provide opportunities for ARC-funded early career researchers from Australia to pursue research collaborations with European researchers supported through a relevant ERC grant.

International

A number of international funding agencies have initiatives dedicated to providing opportunities for EMCRs overseas.

The CIHR supports EMCRs through the Health System Impact (HCI) Fellowship. The HSI Fellowship provides doctoral and post-doctoral fellows with an embedded research opportunity within the health system where they dedicate most of their time to a co-developed program of work that advances the organisation's impact goals and contributes to improved health system performance. This year, under the HIS Fellowship, CIHR introduced a pilot international funding stream whereby CA$434,000 (approx. AU$466,445) is available from CIHR to fund four awards deemed relevant to CIHR's mandate and at pre-approved international host organisations.

The US' National Institutes of Health's (NIH) International Research Scientist Development award supports advanced postdoctoral US research scientists and recently appointed junior faculty for a mentored research career development experience in a low- or middle-income country.

The UK's NIHR Global Health Research Training Programme offers several schemes to support training and academic career development of researchers in NIHR's Global Health Research programs. For example, the NIHR-Wellcome Global Health Research Partnership funds global health researchers with a focus on health priorities in low- and middle-income countries.

Strategic opportunities

• Promote overseas opportunities on offer through NHMRC schemes, especially for early to mid-career researchers
• Promote the opportunity for overseas-based researchers to be co-investigators on NHMRC research grants
• Introduce requirements in NHMRC International Collaborative Schemes for early to mid-career researchers to be included in the project team, with capability building also reflected in the assessment criteria
• Participate in existing international fellowship programs.

Priority 4: International networks and resources

Goal: Australian researchers have access to and benefit from international expertise, resources and best practice in the conduct of research

Focus: Facilitating access to international data repositories for research, engaging with the Australian and international research community about open science and supporting Australian researchers to lead and participate in international biomedical research and clinical trials.

The COVID-19 pandemic has demonstrated the importance of global research networks, open access to publications and preprints and open, safe and interoperable data sharing practices to optimise research efforts and innovations (for example, for the development of vaccines). Through global networks, Australian researchers can leverage their expertise and capabilities, have access to large data repositories, share knowledge and build capacity, ultimately strengthening the breadth and depth of Australian health research. As seen in the pandemic, this is particularly important in clinical trials, where involvement in REMAP-CAP, an adaptive multi-country trial of pneumonia treatments, helped save the lives of critically ill COVID-19 patients.^[17] Involvement in international clinical trials and other large studies gives Australian researchers access to international data resources and allows rapid upscaling and translation.

There is a growing international shift towards open science, including immediate open access publishing. Immediate open access publishing allows other researchers, industry and the wider community to use and benefit sooner from the outcomes of research, supporting rapid innovation and the sharing of knowledge, and advancing human health in Australia and globally, as witnessed throughout the COVID-19 pandemic. International funding bodies that have adopted immediate open access publishing in their policies include UK Research and Innovation, UK National Institute for Health and Care Research, the Wellcome Trust and the Gates Foundation. Most recently, the White House Office of Science and Technology Policy released new policy guidance that requires all US funding agencies to adopt open access publishing policies without embargos. UNESCO released its Recommendation on Open Science in Novembe 2021 and has convened Open Science Working Groups to advise about key impact areas for the implementation of the Recommendation.

As seen in the pandemic, global research networks in clinical trials are particularly important, where involvement in REMAP-CAP, an adaptive multi-country trial of pneumonia treatments, helped save the lives of critically ill COVID-19 patients.^[17] Involvement in international clinical trials and other large studies gives Australian researchers access to international data resources and allows rapid upscaling and translation.

What we have done so far

Data sharing

NHMRC welcomes international efforts to link existing datasets and to promote the consideration of data sharing and connectivity in the development of new public and private biodata repositories. We support national FAIR principles (Findable, Accessible, Interoperable and Reusable) aimed at opening access to publicly funded research. NHMRC supports making metadata available through repositories for both publications and data and closely monitors international developments that encourage open data. NHMRC participates in the development and implementation of internationally consistent platforms and standards to facilitate and guide research through data sharing through our membership of organisations such as the Global Biodata Coalition and GLoPID-R, including participation in their working groups.

Open Access

NHMRC released its revised Open Access Policy and the supporting document Open Access and Retention of Ownership Rights in September 2022. The revised Policy requires publications arising from NHMRC-funded research to be made available immediately upon publication, removing the 12-month embargo, and the use of open licensing (CC BY). NHMRC is the first funding agency in Australia to require immediate open access for publications arising from publicly-funded research. Unlike other open access policies internationally, NHMRC's revised Policy requires consideration of Aboriginal and Torres Strait Islander intellectual and cultural rights. A more restrictive licence is allowed as appropriate for publications about research involving Aboriginal and Torres Strait Islander people and communities. NHMRC has also become a member of cOAlition S, an international consortium of research funders that support the principles of open access, and has representatives on the cOAlition S Leaders Group and Experts Group. NHMRC is also participating in several of the UNESCO Open Science Working Groups.

Clinical trials

In the past 10 years, across all the grants with at least one international collaborator there have been 98 grants awarded specifically to undertake clinical trials ($182 million investment). From 2012 to 2019, NHMRC funding for clinical trials with at least one international partner/collaborator has mainly been through the Project Grant scheme. From 2019 onwards, since the introduction of the Clinical Trials and Cohort Studies Grant scheme, 28 clinical trials (with at least 1 international collaborator) have been funded through this scheme, with a total investment of $75 million.

Clinical trials funded through the International Collaborative Schemes have primarily been through the NHMRC–NIHR Collaborative Research Grant Scheme (9 projects). Other International Collaborative Schemes that have funded clinical trials include NHMRC-EU Collaborative Research Grant (3 projects), GACD (2 projects) and NHMRC-NAFOSTED (Vietnam) (2 projects).

What others are doing

Open Access

Australia's Chief Scientist is developing an 'Australian model' for open access that would provide national access to publishers' catalogues for Australian users, including researchers, industry and the wider community, and unlimited open access publishing of Australian-authored journal articles.

The Australian Research Council is considering reviewing its Open Access Policy. The Department of Health and Aged Care is considering adoption of relevant sections of NHMRC's Open Access Policy for research funded through the Medical Research Future Fund (MRFF).

Clinical Trials

The Department of Health and Aged Care (through the MRFF) has invested $750 million to increase clinical trial activity in Australia and bring investigator-led international clinical trials to Australia. Since 2018, there have been five funding calls for International Clinical Trial Collaborative Grant opportunities with each funding call incorporating multiple rounds of funding (11 rounds altogether).

CSIRO's Strengthening Australia's Pandemic Preparedness report recommends developing and engaging with coordinated clinical trial networks to streamline research and avoid duplication of effort during the response to a pandemic and recommends that this should be at a jurisdictional, national and global levels. CSIRO's report also recommends the development of national pandemic data standards to streamline data collection and sharing.^[18]

Strategic opportunities

• Seek to develop partnerships to build international networks and resources for Australian researchers, particularly to provide access to biodata and clinical datasets and/or to scale up Australian biomedical research and clinical trials
• Engage with the Australian and international research community about open science
• Continue to partner with international funding agencies and participate in funding calls that give Australian researchers access to resources or cohorts not readily available in Australia
• Engage regularly with the Department of Health and Aged Care/MRFF to coordinate and avoid duplication in investments in international clinical trials.