QM Staff Respond to the Global Health Research League Table 2015

UAEM Barts and Medsin Barts


 

barts

University websites were awash with news of their position on the 2015 Global Health Research League Table this January. Those who had done well publicised their good standing; those who had not, made calls for action.

The Global Health Research League Table (GHRLT) ranked the top 25 research universities according to their commitment to global health research and access to medicines. It was designed with the goal of fostering student-staff collaboration to improve relevant university policies. At Barts and The London, a group of students set out to open this dialogue with a panel discussion. They were met with unexpected criticism, and this serves as an example of how raising questions about university policies can sometimes meet unpredictable roadblocks.

Universities Allied for Essential Medicines (UAEM) and Medsin UK, the two student organisations who collaborated on the league table, ranked QMUL 19th out of 25. Not only did QMUL receive low scoring on the metrics used for global health research funding and output, but its licensing frameworks are on occasion out of line with universal access to medicines. Typically, universities research and partially develop health technologies (medicines, vaccines and diagnostics) and other innovations, which they then license to biotech and pharmaceutical companies. These companies complete the development of the health technology and patent it, choosing which countries the patent applies to. Patents allow companies to set monopoly prices on the innovation. Seven universities in the UK have Socially Responsible Licensing policies (SRL), which commit them, and the licensees, to ethical patent-seeking behaviour. With SRL, patents are not sought in low- and middle-income countries, allowing them to manufacture these health technologies. The resulting competition between generic pharmaceutical companies lowers the costs of medicines for citizens. QMUL has not yet taken up SRL.

In an effort to help drive change at QMUL, Medsin Barts and the UAEM Barts organised a panel debate, inviting a representative from the Technology Transfer Office, the Dean for Research, the Director of Global Public Health Unit and Professor of Public Health Research and Policy, and the co-author of the GHRLT.

After initial encouraging signs, there were last minute withdrawals, which meant that ultimately, only Jonathan Meldrum (the co-author of the league table) and Professor Allyson Pollock (Director of Global Public Health Unit and Professor of Public Health Research and Policy) spoke. Some of the other invited speakers gave no reason for unwillingness to talk other than an understandable apprehension of saying something publicly on behalf of the university. The debate that resulted illuminated some causes behind the problems experienced.

Professor Allyson Pollock conveyed serious concern about the league table, both the concept of a league table itself and the metrics used to construct it. She pointed out that ‘global health research’ was a very broad term, and the way the GHRLT team measured it, omitted a vast majority of QMUL’s global health research contribution, including engineering, law, and arts and humanities. She stated that QMUL’s ‘global health research’ would be found mostly in academic fields that wouldn’t publish their work in journals indexed in PubMed (the database used in the league table). She also highlighted that the biggest health gains in history have not come from biomedical research, but from addressing the social determinants of health, including sanitation, clean water, and nutrition. She believed that these have been neglected due to the sole use of PubMed as the database for the league table. It was argued that the main problems with access to medicines were not the patents sought by universities, but social determinants such as a lack of healthcare infrastructure and high user charges. Given the difficulties in ranking universities’ global health research, it could be argued that league tables may have unintentional harmful consequences, such as being used as a tool for allocating governmental funding away from low-scoring universities. Instead, she argued, we should simply publicise that certain universities have Socially Responsible Licensing policies and certain ones do not, and use that distinction to drive change.

In defense of the league table, Meldrum pointed out that using PubMed was not meant to capture all available research, but was used to take a snapshot of the output of the universities. He questioned Professor Pollock’s estimate that the vast majority of QMUL’s global health research had been omitted by only using PubMed-available data. It was pointed out that other universities probably have a comparable proportion of research in non-PubMed fields. He also argued that the methodology of the league table did include many studies that looked at social determinants and didn’t just focus on drugs and innovation. And while access to medicines may be influenced more by other factors than by universities’ patent-seeking behaviours, it is still a significant problem, and one that universities are in a place to change easily. In response to the suggestion made that Barts Medsin and UAEM should publicise universities with or without SRL, Meldrum pointed out that UAEM have been campaigning in the UK for ten years, and has seen minimal change. The league table is therefore a high profile tool to catalyse change at a faster pace.

Intended to be an event of staff-student collaboration, there was only one staff member in the audience, a researcher in Global Health. He said that instead of encouraging staff-student collaboration, the league table could sometimes give the wrong impression and alienate global health researchers and relevant staff. They feared that the league table could encourage ‘teaching for the test’, where universities would focus more on the metrics that would benefit their league table position, rather than giving them the freedom to work in areas that may have the most benefit in global health.

Overall, the attitude from university staff welcomed socially responsible licensing policies, but suggested that the current metrics used are in their view, flawed if it is to be labeled as a league table for ‘global health research’. The difficulties faced by Barts students trying to change QM policy calls attention to problems that students in other universities might face in the future in their own efforts.

To date, the Technology Transfer Office has expressed willingness to adopt a Socially Responsible Licensing policy, co-developed by students and staff. Perhaps the global health research league table’s controversy is actually its strength; after all, we are talking about it.

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