ICRH Strategic Plan 2013-2016

April 11, 2013

Draft Version

Table of Contents

• 1. Executive Summary
• 2. Mission, Mandate, and Values
  • 2.1 The mission of CIHR
  • 2.2 The mandate of CIHR’s Institutes
  • 2.3 The mission of ICRH
  • 2.4 The mandate of ICRH
  • 2.5 Values that guide ICRH
• 3. The Present Context
  • 3.1 Global Perspective
  • 3.2 Canadian/CIHR Perspective
  • 3.3 ICRH Perspective
    • 3.3.1 Burden of Disease
    • 3.3.2 Recommendations from 2011 International External Review Panel (ERP)
    • 3.3.3 ICRH-additional challenges and opportunities
• 4. ICRH Goals and Strategic Direction for 2013–2016
  • 4.1 ICRH Goals
  • 4.2. Strategic Direction for 2013–2016
    • 4.2.1 Priority 1: Enhance Capacity, Competitiveness, and Impact through Networking
    • 4.2.2 Priority 2: Promote Capacity Building and Early Career Development
    • 4.2.3 Priority 3: Enhance clinical, population health, and health systems/services research through Cohort harmonization and enhancement
    • 4.2.4 Priority 4: Contribute to relevant CIHR Signature initiatives
• 5. Conclusions
• References
• List of Figures
  • Figure 1: CIHR Strategic Priorities and Roadmap Signature Initiatives
  • Figure 2: Cost/Burden of disease
  • Figure 3: Total funds awarded through OOGP grants per ICRH mandated field
  • Figure 4: Evolution in number of funded trainees, by ICRH mandated field
  • Figure 5: Proportion of funding according to four CIHR themes
  • Figure 6: Relative change in number of cardiovascular clinical trials publication Since 1997 on an annual basis, comparing top 10 countries

1. Executive Summary

The Institute of Circulatory and Respiratory Health (ICRH) - one of the 13 Institutes of the Canadian Institutes of Health Research (CIHR) – supports research that focuses not only on the health of major organ systems and related diseases but also on a variety of chronic diseases with the largest burden on society and economy. This reality and the extraordinary diversity of these medical conditions present a major operational challenge for ICRH. Despite these difficulties and limited resources, the Institute in its 2013–2016 Strategic Plan, has committed to ensuring that research excellence, capacity, competitiveness, innovation, and impact are enhanced across all research fields affiliated with the Institute, including: cardiovascular health, respiratory health, blood, stroke, critical/intensive care, and sleep. Moreover, building on previous successes, the ICRH will continue nurturing past collaborations as well as establish new meaningful alliances with the research community, partners, and stakeholders to develop interdisciplinary, integrative health research that reflects Canada’s emerging health needs, gaps and opportunities. Importantly, ICRH will strongly support partnerships with relevant stakeholders to accelerate the transfer of new knowledge into benefits for Canadians.

Based on identified gaps, opportunities, and feedback received from the International External Review Panel (CIHR’s 10-year International Review) as well as from the ICRH research communities and partners, and in alignment with CIHR’s Strategic Plan (Roadmap), ICRH identified four research priorities for the upcoming years. The first priority will focus on enhancing capacity, competitiveness, and impact of our communities through networking. This objective is consistent with the importance of aligning with CIHR’s largest comprehensive Signature Initiative - the Strategy for Patient Oriented Research (SPOR). ICRH Emerging Networks will be developed in four pre-identified gap areas: respiratory health, vascular health, stroke clinical trials, and imaging. In addition, ICRH will target two specific areas for the establishment of Focused Community Development Programs in the areas of critical care and sleep. Finally, ICRH will continue its collaboration with the National Heart, Lung, and Blood Institute (NHLBI) of the NIH in the ongoing support of two large Canada-US networks – the Resuscitation Outcomes Consortium (ROC) and the Cardiothoracic Surgical Network (CTSN), and will explore other opportunities for networking at the international level.

ICRH’s second priority will target capacity building and early career development – two areas of need which CIHR has also recognized as requiring specific attention. For ICRH, recent data has demonstrated that the growth of funding within the Institute’s mandated research areas has been slower than in all other areas at CIHR, in particular for the cardiovascular and respiratory communities. This was understood as being primarily due to a loss in capacity, including young investigators and post-doctoral fellows. More specifically, development of capacity related to health systems/services and population/public health has been identified as requiring priority attention. In the upcoming years, ICRH will work closely with relevant CIHR institutes and working groups to address this important and persistent capacity problem, focusing both on training/mentoring issues, as well as issues impacting on success in early career stages of young investigators’ career. ICRH will also continue working with partners and various stakeholders to develop a joint, comprehensive strategy which will directly align with at least some elements of partner-led programs.

ICRH’s third priority will focus on the expansion of opportunities for clinical research, health systems/services research, and population health through cohort harmonization and enhancement. This initiative will provide Canadian scientists with a unique opportunity that could boost knowledge development and translation at a fraction of the cost of developing new cohorts. Moreover, this coordination among cohorts will accelerate the capture of the benefits of health research and, thus, place Canada at the forefront internationally. The process will enable Canada to better develop population-based research and design individually tailored and community-based prevention and/or intervention programs. In addition, this initiative will contribute to enhancing the potential for health and health system research by creating a formidable pool of population-based data linked to Canada’s uniquely powerful administrative databases. Data harmonization and coordination will also directly assist in gathering and analyzing important and sparse data related to Canada’s Aboriginal Peoples and other vulnerable populations. Finally, by addressing issues such as data storage and access policy, this initiative will also support research on ethics. Along with CIHR and its other Institutes, ICRH will help coordinate disparate and multidisciplinary communities to collaborate towards building a cohort registry, bridging gaps and identifying ways for enriching, sharing and coordinating patient-relevant data sets and their efficient utilization. In the context of increased prevalence of many cardiovascular and respiratory risk factors, as well as the commonalities with risk factors for serious and chronic diseases in other fields, this initiative provides a unique opportunity for the ICRH community to link with several other CIHR communities in building tools to fuel clinical research, population health and health services & policy research.

The Institute identified "contribution to the advancement of relevant CIHR’s Roadmap Signature initiatives (RSI)" as its fourth priority; it is anticipated that these large-scale, multi-Institute programs will bring the Canadian scientific community together and will transform research in selected areas on a national and international scale. Importantly, the majority of these comprehensive programs, such as the SPOR RSI, directly align with ICRH priorities; thus, ICRH will work closely with CIHR and its Institutes to advance these major initiatives. For example, to support the Inflammation in Chronic Disease RSI, ICRH will fund research on inflammation and respiratory diseases through the Health Challenges in Chronic Disease program. Moreover, ICRH will support the development of the Canadian transplantation consortium in partnership with the CIHR-Institute of Infection and Immunity. In support of the Personalized Medicine RSI, ICRH will contribute to specific projects, i.e., those aligned with any of the ICRH Emerging Networks – that are funded through the Genomics and Personalize Health program. In relation to the International Collaborative Research Strategy for Alzheimer’s Disease RSI, ICRH will contribute funding towards the development of an integrated consortium-based research program which will incorporate the appropriate vascular elements and their role in the development of cognitive impairment. To support the Community Based Primary Health Care (CBPHC) RSI, ICRH will forge a unique collaboration with Pfizer and the Heart and Stroke Foundation; this program will provide funds to teams who are successful in the CBPHC competition and whose research focuses on cardiovascular health. Finally, ICRH through the cohort harmonization and enhancement priority will support the Pathways to Health Equity for Aboriginal Peoples RSI. In close collaboration with CIHR’s Institute of Aboriginal People’s Health and Heart and Stroke Foundation, ICRH will contribute to the development of a sub-cohort that will aim at thoroughly phenotyping a sample of First Nations individuals living on reserves. This undertaking will create an important resource for researchers and will be useful for developing and assessing programs designed to improve the health and health care of these communities.

Looking forward to the next four years, ICRH is in a strong position to guide the shaping of the Canadian research landscape. By working closely with its research communities and partners on common pressing issues such as networking, research training and capacity building, and cohort harmonization/enhancement, ICRH will continue demonstrating its leadership and commitment to reducing the burden of heart and lung diseases in Canada.

2. Mission, Mandate, and Values

The Institute of Circulatory and Respiratory Health (ICRH) is one of the 13 Institutes of the Canadian Institutes of Health Research (CIHR) and as such must support CIHR’s mission, mandate and strategic plan when establishing its future plans and programs.

2.1 The mission of CIHR

The mission of CIHR as expressed in the CIHR Act that created it, is to “excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened Canadian health care system¹.”

2.2 The mandate of CIHR’s Institutes

The mandate of CIHR’s Institutes as outlined in the CIHR Act is “together pertain to all aspects of health, include biomedical research, clinical research, research respecting health systems, health services, and the health of populations, societal and cultural dimensions of health and environmental influences on health and other research as required, work in collaboration with the provinces to advance health research and to promote the dissemination and application of new research knowledge to improve health and health services, and, engage voluntary organizations, the private sector and others, in or outside Canada, with complementary research interests;”

2.3 The mission of ICRH

The mission of ICRH is to support CIHR’s mission by “supporting research into the causes, mechanisms, prevention, screening, diagnosis, treatment, support systems and palliation for a wide range of conditions associated with the heart, lung, brain (stroke), blood vessels, blood, critical and intensive care, and sleep²”.

2.4 The mandate of ICRH

The mandate of ICRH is to ensure that research excellence, capacity, competitiveness, innovation, and impact are maintained across all research fields affiliated with the Institute, including: cardiovascular health, respiratory health, blood, stroke, critical/intensive care, and sleep. To successfully achieve the above goals, the Institute encourages meaningful collaborations with and engagement of the research community, partners, and stakeholders to develop interdisciplinary, integrative health research that reflects Canada’s emerging health needs, gaps and opportunities. Importantly, ICRH strongly supports partnerships with relevant stakeholders to accelerate the transfer of new knowledge into benefits for Canadians.

2.5 Values that guide ICRH

• Excellence
• Rigor
• Respect
• Responsibility (including social responsibility)
• Innovation

3. The Present Context

3.1 Global Perspective

Investment in health research in most western countries has generally been maintained, and in some cases increased despite the economic downturn of the last few years. Nevertheless, because of continued economic uncertainty and the need for countries to reduce their deficits and debt despite a stagnant economy, it is unlikely that significant increases in funding are forthcoming, and there is a real risk of reduced funding in the near future³. This situation exerts added pressure on research funding organizations that are tasked not only with supporting research that addresses key knowledge gaps but also with more carefully assessing the impact of funded research on the health of populations, and evaluating return on investment in creating wealth and reducing costs of health care in the country they serve. Indeed, the persistently greater rise in health costs than would be expected with inflation and change in GDP has progressed to a level that is unsustainable which puts the fragile economy of many countries at further risk³.

International collaboration:

As with other sectors, health related research has become progressively more global, involving a growing number of collaborative efforts among scientists from different regions and countries. This is true in Canada as well⁴. Such partnerships, whether international or more national in scope, encourage collective identification of the most pressing knowledge gaps in a given field; integration of multi-disciplinary expertise; optimization of use of essential, sophisticated, and costly equipment; and increased impact of health research by partnering with national organizations that can facilitate knowledge translation and technology transfer and increase value for money in health research. Despite much progress in the development of international research, achieving research excellence is impeded by the complexity of structuring and co-funding large complex national and international studies⁵.

Innovation and Knowledge Transfer:

At the present, there is widespread realization that a growing gap exists between discovery and our ability to bring these discoveries to the service of populations, patients and the health care system^6–7. Despite the dramatic increase in scientific publications in health research, there is a dearth of new therapeutic agents and targets - a situation threatening the ability of the biopharma industry to develop and market new therapies that offer significant improvement over existing ones. This situation leads to questions about the effectiveness of present innovation processes and the necessary links between (academic) research and industry.

Patient Oriented Research:

Over the past several years, a growing concern has been expressed regarding the responsibility to bring evidence-based best practices to the right patient at the right time, and the need to optimally organize health care to better meet the needs of patients and of society. This realization has led many countries to develop strategies to reinforce knowledge translation and better support patient-oriented research targeting these problems. The funding of patient oriented research in the UK, exceeded $1.6 billion per year in 2011⁸ and continues to grow.

3.2 Canadian/CIHR Perspective

The global research environment has invariably influenced the Canadian research environment. Despite substantial increase in health research funding in Canada since 2000 (CIHR’s total budget has progressed from $280 million in 1999 to almost $860 million in 2006), it has levelled off in the past 6 years to an annual rate of increase of about 5% (thus a mere 3% increase after inflation adjustment), and that rate of increase has diminished in recent years. As the Canadian and Provincial governments struggle to balance their budgets in the face of stagnant economies and existing deficits, funding for health-related research is unlikely to grow rapidly over the next few years, and may even decrease further in some jurisdictions. Understandably, greater accountability and a more strategic use of existing funds are expected, as well as better leveraging of existing funds through partnerships. This having been said, CIHR has wisely committed to protecting and even, if possible, increasing the funding for the Open Operating Grants Program (OOGP) - the cornerstone of research at CIHR.

Consistent with the need to strategically focus its resources, CIHR has chosen to focus on 4 Strategic Directions, as outlined in the CIHR’s Strategic Plan or Roadmap:

Strategy 1: Invest in World-Class Research

• Goal 1: Train, retain and sustain outstanding health researchers
• Goal 2: Select and sustain research excellence
• Goal 3: Promote interdisciplinary and international innovation

Strategy 2: Address Health and Health System Research Priorities

• Goal 1: Improve focus, coherence and impact from CIHR's strategic investments
• Goal 2: Build strategies and initiatives that address health and health system priorities

Strategy 3: Accelerate the Capture of Health and Economic Benefits of Health Research

• Goal 1: Reap the socioeconomic benefits from research through KT and partnerships
• Goal 2: Enhance the application of research and its evaluation

Strategy 4: Achieve Organizational Excellence, Foster Ethics and Demonstrate Impact

• Goal 1: Advance organizational excellence and ensure transparency and accountability
• Goal 2: Evaluate the overall success of CIHR
• Goal 3: Foster a culture of ethical research by promoting and assisting in ethical analysis and the application of ethical principles to health research
• Goal 4: Assess progress and impact by demonstrating the impacts of CIHR investments

* These CIHR Strategic Directions will be referred to throughout the document as *CIHR Strategic Direction 1, 2, 3 and 4

To achieve international excellence, and consistent with the need to network and focus resources, CIHR’s Roadmap identified five major research priority areas which will:

1. Enhance patient-oriented care and improve clinical results through scientific and technological innovations;
2. Support a high-quality, accessible and sustainable health-care system;
3. Reduce health inequities of Aboriginal peoples and other vulnerable populations;
4. Prepare for and respond to existing and emerging threats to health; and
5. Promote health and reduce the burden of chronic disease and mental illness.

To address these research priorities and achieve greatest impact while maximizing its strategic investment, CIHR launched a process to identify and develop large scale, multi-Institute programs or Roadmap Signature Initiatives (Figure 1). Following environmental scans and extensive consultations, eight Signature Initiatives were approved and are now in the process of being developed and rolled out. It is expected that these slate of programs – which will be funded by the 13 Institutes - will bring the Canadian scientific community together and transform research in these areas on a national and international scale.

Figure 1: CIHR Strategic Priorities and Roadmap Signature Initiatives

CIHR Priorities	Roadmap Signature Initiatives
Enhance Patient-Oriented Care and Improve Clinical Results through Scientific and Technological Innovations	Strategy For Patient-Oriented Research Personalized Medicine
Support a High-Quality, Accessible and Sustainable Health-Care System	Community-Based Primary Health Care Evidence-Informed Health Care Renewal
Reduce Health Inequities of Aboriginal Peoples and other Vulnerable Populations	Pathways to Health Equity for Aboriginal Peoples
Prepare For and Respond to Existing and Emerging Threats to Health
Promote Health and Reduce the Burden of Chronic Disease and Mental Illness	Int’l Collaborative Research Strategy for Alzheimer’s Disease Canadian Epigenetics, Environment and Health Research Consortium Inflammation in Chronic Disease

3.3 ICRH Perspective

3.3.1 Burden of Disease

ICRH, as compared to the other 13 Institutes at CIHR, has within its mandate the largest burden of chronic diseases (Figure 2). In addition, the Institute supports research that focuses on the health of major organ systems and related diseases, including: atherosclerosis, heart failure, stroke, asthma, sleep apnea and chronic obstructive lung diseases. This epidemiological reality and the extraordinary diversity of these medical conditions present a daunting organizational and strategic research challenge for ICRH.

Figure 2: Costs due to disease⁹ for the leading 20 diagnostic categories, by direct¹⁰, and indirect costs¹¹, Canada, 2000¹²

Figure 2 long description

Although advances in the therapy of cardiovascular diseases have accounted for an overwhelming majority of the increased longevity of people in Canada and the US over the last 30 years¹³, it is anticipated that cardiac ischemic disease will become the leading cause of death and disability world-wide by 2020 because of the rapidly increasing prevalence of risk factors for cardiovascular diseases globally. Other diseases included under ICRH’s mandate are also major sources of morbidity and mortality, with cerebrovascular disease being the fourth most common cause of death and disability (and a known factor in the development of cognitive impairment), chronic obstructive pulmonary disease as the fifth, and lower respiratory tract infection as the sixth most common cause of death and disability. Importantly, the disease processes of most chronic respiratory diseases are still not well understood, posing a real challenge to our ability to impact health outcomes. In fact, it is anticipated that 5 out of the 7 most important causes of death and disability world-wide by 2020 will fall within the ICRH’s mandate¹⁴.

3.3.2 Recommendations from the 2011 International External Review Panel (ERP)

As with the other CIHR Institutes, ICRH’s progress from 2005–2010 was assessed by an External Review Panel (ERP) as part of CIHR’s International Review. The ERP provided an assessment of the progress of ICRH, and recommendations to guide its future development¹⁵. Overall, the ERP was favorably impressed by the influence that ICRH has had on both the quantity and quality of health related research within its mandate. On the basis of available data, they concluded that, since ICRH’s inception 10 years ago, and especially over the last 5 years, research activity had adopted a greater translational direction towards public and patient benefit. This was achieved by the catalytic influence of the Institute in encouraging multidisciplinary, multi-institutional and multi-partner funded research that was especially effective in circulatory diseases, but less so in lung diseases, blood and sleep. However, in each of these latter fields the ERP perceived new activity in the right direction. It was the panel’s view that establishing a firm productive translational agenda with support for clinical and health scientists had provided the substrate for increasing Canada’s international competitiveness in health research and its beneficial impact on patients. These successes notwithstanding, the ERP had several important recommendations:

Networks:

The ERP remarked that the development of Networks in areas under the ICRH mandate catalyze the development of the ICRH community and would be an excellent tool to impact the greatest number of researchers who are part of ICRH’s broad mandate. They added “we wish to strongly encourage further activities of this type not only in cardiovascular disease but in lung, blood and sleep”.

Capacity Building:

The ERP expressed concerns regarding the training and career development of young researchers. They understood that this was a challenge that required the collaboration of many stakeholders, of which ICRH was a reasonably small but important player. The ERP went on to stress that “the right balance of research expertise to populate and drive forward these large initiatives is essential as is ensuring a strong pipeline of young, diverse and skilled researchers”.

Clinical Trials:

The ERP commended the great productivity of cardiovascular researchers in performing meaningful clinical trials. However, they commented: “we would encourage a wider spread of trials across the Institute’s disease areas and greater international engagement with countries beyond the US.”

Governance:

The ERP alluded that there is a need for greater transparency and inclusiveness in setting the research priorities of the institute, stating: “greater openness and inclusiveness in research priority setting should also help deliver high quality outcomes in these disease areas where there remains considerable unmet clinical needs set against an aging population, changing lifestyles and living with environmental change.”

3.3.3 ICRH-additional challenges and opportunities

(i) Comparatively slow growth in grants and awards competitions

Figure 3 based on data extracted from the CIHR database clearly indicates that during the 2000–2010 period, the relative growth in total grants and awards (CIHR Open Competitions) for scientists whose primary institute was identified as ICRH, was the smallest among all CIHR institutes. In fact, while the 2010 to 2000 ratio for ICRH was 1.77, that of other institutes varied from 1.89 to 9.13. Even the more traditional domains of research (i.e. cancer, infection-immunity, and neurosciences/mental health/addiction) had more than doubled. This is particularly alarming, given the heavy and increasing burden of disease that is covered under the ICRH mandate.

This relative lack of growth varies markedly according to the community served within ICRH, with total funds awarded through OOGP grants remaining stable or decreasing since 2004–2005 in cardiovascular, remaining stable or decreasing since 2007–2008 in respiratory diseases, but increasing in the smaller communities of blood and sleep (Figure 3).

Figure 3: Total funds awarded through OOGP grants per ICRH mandated field

Figure 3 long description

As described below in more details, this situation seems to be related to a relative lack of growth in capacity and to a lesser extent, to issues of balance across pillars and competitiveness in certain strategic research competitions.

(ii) Shortage of trainees and young investigators

According to CIHR data compiled for the period 2000 to 2010, the number of training award applications from the ICRH community has increased by only 30% while the number of applications to CIHR overall increased by 75% during the same period. Notably, the success rates for candidates from the ICRH community and other CIHR communities were generally comparable. Thus, the problem appears to relate to the relatively low number of applicants, with ICRH-related training award applications remaining stable over the last 5 years, while increasing significantly in almost all other communities. Interestingly, within ICRH, some differences were noted within its various research communities (Figure 4), with an increase in the areas of blood and sleep, and a decrease in the areas of cardiovascular and respiratory health. Of greatest concern was the almost constant decrease in the number of post-doctoral fellows (the ones closest to the start of their scientific career) over the last seven years in these two areas of great disease burden. Collectively, these data would suggest difficulties in attracting, mentoring and/or retaining young researchers - a problem that appears to be particularly important for the two largest communities of ICRH.

Figure 4: Evolution in number of funded trainees, by ICRH mandated field

Figure 4 long description

(iii) Lack of applicants, lower success rates in Strategic Competitions, and inadequate balance across CIHR Themes?

Although the relatively slower growth in total research funding in the ICRH community is largely due to a relative decrease in the number of trainees and researchers, data extracted from the CIHR database, suggests that ICRH investigators may have lower success rates at certain research competitions where the focus is, for example, on health systems/services and/or population/public health. For example, although ICRH investigators have had excellent success in large clinical research competitions there is evidence that ICRH investigators have had lower success rates and have applied significantly less (than other communities) to other grant competitions, particularly those involving multi-pillar, multi-disciplinary team research with KT and partnership features. Indeed, from 2000 to 2010, the annual number of non-OOGP grant applications submitted by ICRH scientists decreased by 25%, while it increased 160% for CIHR as a whole. Furthermore, success rates at these competitions were consistently and significantly lower for ICRH applicants than the CIHR average (a difference that since 2006 has put ICRH scientists’ success rates for these grants at 6 to 12% below that of CIHR overall).

Importantly, this would suggest that ICRH researchers are missing out on a number of funding opportunities. In addition, this data may indicate a need for more networking within and beyond the ICRH community, including scientists from across the four CIHR themes, decision-makers and other stakeholders including charities, provincial research funding agencies and industry, as well as a need to develop capacity in areas related to health systems/services as well as population/public health.

Analyses of CIHR data regarding the balance of funding according to the four CIHR themes (i.e., biomedical, clinical, health systems and services, and population and public health) in various ICRH communities, i.e., blood, sleep, cardiovascular and respiratory seems to indicate relative weaknesses and lack of growth in health systems/services and population/public health research (CIHR themes 3 and 4, respectively; Figure 5). The proportion of funding going to theme 3 in 2010–2011 among ICRH mandated fields represents slightly more than half compared to that observed for CIHR overall; the proportion of this funding has been decreasing since 2003 (from 5.0% to 3.6%) while that for theme 4 remains less than the proportion of funding observed for CIHR overall (7.0% vs. 9.45%), despite significant progress since 2003. Weaknesses across CIHR themes 3 and 4 could help explain the relative lack of funding of ICRH investigators in some strategic programs, particularly those with a focus on knowledge transfer.

Figure 5: Proportion of funding according to four CIHR themes
ICRH vs CIHR – Balance Among Pillars

Figure 5 long description

Paradoxically, despite relatively poor funding of clinical research within ICRH and CIHR as compared to other countries, investigators from the ICRH community are world leaders in clinical trials research. This is particularly true for investigators in the cardiovascular (Figure 6) and critical care fields. However, such successes remain fragile and require more adequate funding if they are to remain competitive.

Figure 6: Relative change in number of cardiovascular clinical trials publications since 1997 on an annual basis, comparing top 10 countries¹⁶

Figure 6 long description

Data extracted by Observatoire des Sciences et Technologies from US National Library of Medicine Medical Subject Headings for 2000 to 2008, at request of CIHR.

4. ICRH Goals and Strategic Direction 2013–2016

4.1. ICRH Goals

In response to both CIHR’s 10-year International Review panel, the latest ICRH External Review Panel, as well as the data mining and environmental scan presented above, ICRH identified the following 4 goals, which are in line with CIHR’s strategic directions*:

ICRH Goal 1:

Increase the number and competitiveness of ICRH researchers in national and international grant competitions
(*CIHR Strategic Directions 1 and 3)

ICRH Goal 2:

Achieve better balance across the four CIHR research themes in ICRH-relevant fields
(*CIHR Strategic Directions 1 and 2)

ICRH Goal 3:

Enlarge the clinical trials activity in ICRH fields, particularly in respiratory health and stroke, and increase international collaborations in clinical trials
(*CIHR Strategic Directions 1, 2 and 3)

ICRH Goal 4:

Enhance transparency in priority-setting, planning, and decision-making
(*CIHR Strategic Direction 4)

4.2. Strategic Directions 2013–2016

To advance the above goals, ICRH will focus on the following four major priorities which will guide its programs and activities in the upcoming years: (1) Enhance capacity, competitiveness, and impact through networking; (2) Promote capacity building and early career development; (3) Enhance opportunities for clinical, population health and health services research through cohort harmonization and enhancement; and (4) Contribute to the advancement of relevant CIHR Signature initiatives.

4.2.1 Priority 1: Enhance Capacity, Competitiveness, and Impact through Networking
(*CIHR Strategic Directions 1, 2 and 3)

A) Development of Complex Thematic and Cross-Cutting National Networks in Areas of Need and of Opportunity

In alignment with three recommendations from the ERP concerning capacity building, networking and the development of clinical trials, and consistent with the importance of aligning with CIHR’s largest comprehensive Signature Initiative - the Strategy for Patient Oriented Research (SPOR) - ICRH will focus one of its main strategic developments around the development and support of national networks.

SPOR builds on Canada’s excellent profile in clinical research and will focus on improving health systems research in order to improve the efficacy of the health care system and the quality of health for Canadians. In order to achieve its objectives, SPOR is developing four major programs: 1) Building the infrastructure for performing clinical research by: (a) developing SUPPORT Units, a program developed in partnership with the Canadian provinces, but with national implications and (b) developing SPOR comprehensive research Networks, developed in partnership with charities and other funding partners, in order to fill important gaps in clinical research; 2) Training and career development programs focused on the expansion of the research community conducting patient-oriented research; 3) Improving the clinical research environment as well as removing various impediments that obstruct valuable and productive clinical research in Canada; and 4) Supporting best practices in health care.

ICRH’s strategic initiative that focuses on the development of national networks differs somewhat from that of the SPOR program as ICRH networks can focus on any aspect of clinical translational research, from bringing discovery to the bedside and back, as well as integration of population and/or health systems research. ICRH-supported networks will bring together unified groups of researchers in ICRH mandated fields to build a critical mass of outstanding technical and scientific expertise on a national scale, and provide research leadership in an effort to identify key knowledge gaps. These gaps will be addressed in a coherent fashion so as to maximize the potential impact of research on our understanding of disease and disease processes, on improved clinical practice, on the health of individuals and populations, and on the delivery of care. ICRH-supported networks will focus on central questions to direct pan-Canadian studies that are most relevant to Canadians; in addition, the networks will generate evidence and transfer it to the patient-care community.

Led by the best brains in Canada in a given domain, ICRH-supported networks are expected to contribute significantly to reversing the decline in trainees and young scientists; these networks will serve as hubs for attracting, mentoring, and training of emerging talent as well as support early career development of young scientists, particularly in population health, health services, and policy research. Linking together many of the best centers and teams in a given field, they will offer possibilities for tailored multidisciplinary, multi-site mentoring and training and will serve as a magnet for attracting future trainees and young investigators eager to engage in networking as a means to develop their skills and enhance their knowledge-base. Importantly, these networks will enhance competitiveness by engaging the scientific community and partners (non-profit organizations - with expertise in patient-oriented knowledge transfer, provincial research funding agencies and other government agencies, as well as industry) in large-scale national and international research programs. Networks will also offer opportunities for developing clinical trials, particularly in areas of need identified by the ERP, namely in stroke and respiratory health. The ICRH Emerging Networks RFA was launched in the summer of 2012 with funding to start in October 2013.

Although ICRH networks can cover a broader range of patient oriented research as compared to the SPOR Networks (i.e., going from bench to bedside research and all the way to health systems and population health), ICRH and SPOR networks are expected to share many common characteristics. Thus, in addition to complementing the SPOR program, it is anticipated that, in the future, some of ICRH-supported networks will compete to become full-fledged SPOR Networks. If successful, ICRH’s funding for these networks would be applied to support these new SPOR networks.

Based on feedback from the External Review Panel (International Review) and identified gaps and opportunities, the four major areas targeted by ICRH for Network development are:

(i) A National Respiratory Network

According to the 2012 report produced by The Council of Canadian Academies¹⁷, Canada is well regarded internationally for its research in the respiratory system sub-field, being placed fourth in the world in terms of productivity and impact in this research area. The development of a Canadian respiratory network, through the ICRH Emerging Networks RFA, will build on this Canadian strength. In addition, the new program will answer a long term wish of the respiratory community and its partners to develop a formal national network in a field with an important and growing disease burden and equally important knowledge gaps. Considering the global trend towards networking, without this development, it is unlikely that the Canadian community will be able to maintain its enviable position. It should also address two of the specific recommendations of the ERP, concerning the development of networks and the development of a clinical trials capacity in this field.

(ii) National Vascular Network

This large and disparate community has already started to come together with the expressed goal of developing a National Vascular Network. Taking advantage of the ground work initiated by this community and the considerable potential of their collaborations, ICRH chose to support the development of a Network in this area as one of its priorities. Funding of this group will provide an opportunity to support this community in their pursuit towards working closely together to address key issues that have immense impact on several organ end-points including heart, brain, kidney, eyes, etc.

(iii) A National Stroke Clinical Trials Network

Canada has a stroke NCE (Networks of Centres of Excellence) that has successfully changed the way strokes are being considered by the public and treated by the health care system. The proposed ICRH network will not be an extension of this NCE, but will focus on performing clinical trials in the therapy of strokes, an area not targeted as a priority by the stroke NCE. In this way, ICRH will leverage the expertise of the strong but financially fragile stroke clinical trials community, and be complementary (different and additive) to what has been accomplished by the stroke NCE, scheduled to phase out in 2013.

(iv) A National Imaging Network or Consortium (network of networks)

Two successful imaging networks associated with the mandate of ICRH have been supported by CIHR in the past few years (the Canadian Atherosclerosis Imaging Network (CAIN) and the Medical Imaging Trials Network of Canada (MITNEC). In addition, in 2009, ICRH and partners funded four clinical imaging teams through the ICRH-led Clinical Imaging RFA, addressing one of the previously identified ICRH research priorities (2006–2010). Together, the above groups make up a critical mass of expertise that is world class. The ICRH Emerging Networks Initiative will allow these groups to fill gaps that prevent them from federating among themselves, and optimally networking with other important CIHR signature initiatives (e.g., personalized medicine). The new imaging network will focus on strengthening the innovative technical aspects of this large and successful cross-cutting sector of the ICRH community and of its partners. Interestingly, the area of improved diagnostics was identified by Canadian science and technology experts as one where Canada is positioned to be a global leader¹⁷.

B) Establishment of Focused Community Development Programs

The ICRH research community has a number of very strong, focused, and successful research communities in other research fields not mentioned above, including critical care and sleep. To date, these groups have succeeded in performing major practice altering research without significant outside funding due to the exceptional circumstances under which they were developed and due to the culture that drives their success. However, at present, these groups are at a crossroads; they can either continue, with difficulty, as they are today, or optimize and expand their programs to include more training and knowledge transfer. Building on strengths in the ICRH community and based on ERP feedback (International Review) as well as earlier identified gaps, ICRH will target two focused areas for the establishment of focused community development programs: critical care and sleep research. The launch for the funding of these programs is planned for 2014.

(i) National Critical Care Program

The Canadian Critical Care Trials Research Group (CCCTG) is composed of clinician-researchers that have been working together for a number of years to design and perform randomized controlled clinical trials, the results of which have shaped the way patients are treated in the intensive care setting over the world. Due to the success of this group, their model has expanded to form a global critical care group, the chair of which is the chair of the CCCGT. Currently, this group does not benefit from CIHR or ICRH funding. The funding of a program in this field would allow much faster implementation of pilot studies thus permitting greater development of evidence to guide the therapy of patients in the critical care setting. It would also facilitate the enhancement of the training and of knowledge transfer aspects of the group, a milieu where best practices are the norm.

(ii) National Sleep Program

In June 2009, ICRH and partners launched two Sleep and Circadian Rhythms programs - Operating and Teams Grants - which addressed one of ICRH’s research priorities (ICRH Strategic Plan 2006–2010). Notably, during the Institute’s review, the ERP commented that sleep research is an area of strength in Canada which could benefit from the development of a national consortium. Based on this feedback and building on our past initiatives, ICRH chose to focus on supporting a large scale national program in this area; networking through this association will enable the sleep community in Canada to take into consideration more multi-disciplinary and multi-thematic approaches, collaborate more effectively, and compete successfully for additional national and international funding. It is expected that this Network will be formed by coalescing the four presently funded teams into a network, and the enrichment of this network by the addition of other strong sleep research groups in Canada.

C) Support of Ongoing International Clinical Trials Networks

According to the 2012 report produced by the Council of Canadian Academies¹⁷, Canada’s level of international collaboration is particularly high in areas related to clinical medicine. Building on this strength, ICRH, since 2003, has worked closely with the National Heart, Lung and Blood Institute (NHLBI) of the NIH to support two large Canada-US networks. The Resuscitation Outcomes Consortium (ROC) is a network which has conducted clinical research that has improved the way resuscitation is performed over the world. The second network - the Cardiothoracic Surgical Network (CTSN) – is the leading cardiothoracic research network in the world. Both the ROC and the CTSN have been conducting unique research in extremely challenging fields and, thus, act as global resources. In support of CIHR’s vision – enhance patient-oriented care and improve health outcomes - and the great contributions of Canadian researchers to the success of these two networks, ICRH intends to continue funding these programs in the upcoming years.

4.2.2 Priority 2: Promote Capacity Building and Early Career Development
(*CIHR Strategic Directions 1)

Recent data indicates that the growth of funding within ICRH’s mandated research areas has been slower than in all other areas at CIHR. This is particularly problematic in the cardiovascular and respiratory areas where funding is on the decline. Analyses of the situation would suggest that it is due, at least in part, to comparatively fewer new investigators, a problem that appears to stem at least partially from a lack of senior trainees (post-doctoral fellows). A second problem identified is a severe shortage of trainees and young investigators among the ICRH mandated fields, with expertise in the areas of health systems/services and population/, and public health (CIHR themes 3 and 4).

According to the Council of Canadian Academies 2012 report¹⁷, Canada has the largest number of post-secondary graduates in the OECD (Organization for Economic Co-operation and Development) – a strong basis to build from; however, this is not translated into large number of doctoral graduates who will contribute to science and technology in the country. Moreover, the report alluded that Canada is behind some other countries in terms of number of researchers, and the training of the next generation of researchers. Importantly, CIHR has identified training and career development as an area that needs greater attention. As such, CIHR is now in the process of developing recommendations and new programs to advance these areas of need. An ICRH IAB task force, enriched by membership from ICRH’s close partners, has also studied this problem and has developed recommendations to advance this gap area. Of note is ICRH’s specific interest in building initiatives that will support training and career development for ICRH researchers, particularly those working in areas relevant to CIHR’s themes 3 and 4.

In the upcoming months, ICRH will work closely with the various CIHR working groups, particularly the SPOR task force on training and career development (chaired by Dr.N.Rosenblum), to address this chronic and important capacity problem. ICRH will also continue working with partners and various stakeholders to develop a joint, comprehensive strategy which will directly align with at least some elements of partner-led programs. Elements of this comprehensive strategy would include commitments from recruiting institutions (regarding salary support, structured mentoring, protected research time, adequate space and equipment support, start-up operating funds, and a clear academic career perspective) and will involve partnerships with ICRH networks and/or ICRH’s partners for start-up funding. As indicated above, development of capacity in themes 3 and 4 will receive high priority consideration.

It is anticipated that an effective training/mentoring and career strategy, focusing on those factors that are critical for early success in the first three years of a research career, will attract senior trainees and improve the application and success rates of new investigators.

4.2.3 Priority 3: Enhance opportunities for clinical, population health, and health services research through cohort harmonization and enhancement
(*CIHR Strategic Directions 4)

The Canadian Heart Health Strategy¹⁸ recommended that priority be given to the development of a Cardiovascular cohort to enhance Canada’s capacity to advance knowledge on the relative role of various risk factors, including those related to environment and community as well as those related to lifestyle and biological determinants of cardiovascular disease. In the context of increased prevalence of many cardiovascular risk factors, this becomes a critical issue.

A number of Canadian health-scientists, groups, teams, and networks have, over the years, developed a range of cohorts, funded at least in part with public funds, each with its own specific focus (e.g., for CVD, diabetes, respiratory diseases, cancer, children, etc.). Unfortunately, most of these cohorts were developed in abstraction of each other and are under-utilized, seldom shared with scientists in other institutions, and almost never with those in other fields/disciplines despite collecting data on several similar risk factors. Given the significant efforts and cost involved in developing a single cohort, these existing cohorts constitute a relatively untapped resource for the Canadian research enterprise as well as an opportunity to compare, coordinate and extrapolate with similar health data on an international level.

The goal of this ICRH priority is to develop a program that will help coordinate and enhance the efforts of existing cohorts through cohort enrichment and data harmonization; this undertaking will provide Canadian scientists (particularly in clinical research, health systems and population research) with a formidable and unique asset that could boost knowledge development and knowledge translation at a fraction of the cost of developing new cohorts. Moreover, this coordination among cohorts will accelerate the capture of the benefits of health research and, thus, place Canada at the forefront internationally.

Along with CIHR and its other Institutes, ICRH will work to allow disparate and multidisciplinary communities to first work together toward a common goal of building a cohort registry, then bridge gaps and identify ways for sharing and coordinating patient-relevant data sets. The harmonization and enrichment of multiple existing Canadian cohorts will enable Canada to better develop population-based research and design individually tailored and community-based prevention and intervention programs. In addition, this initiative will contribute in a major way to enhancing the potential for health and health system research by creating a formidable pool of population-based data linked to Canada’s uniquely powerful administrative databases that are available to scientists and health-care professionals to follow outcomes and use of health services. Data harmonization and coordination will also directly assist in gathering and analyzing important and sparse data related to Canada’s Aboriginal Peoples and other vulnerable populations. Finally, by addressing data harmonization issues, data storage and access policy issues, research ethics board (REB) assessment and re-consent issues, this initiative will pave the way for improved organizational excellence and create opportunity for knowledge expansion in research on ethics.

4.2.4 Priority 4: Contribute to the advancement of relevant CIHR Roadmap Signature Initiatives
(*CIHR Strategic Directions 4)

CIHR has developed eight large Roadmap Signature Initiatives to support its objectives. As explained previously, of these, the largest and the one with which ICRH is most closely aligned is the Strategy for Patient Oriented Research (SPOR). However, as outlined below, ICRH is directly or indirectly involved with and supports most of the other Roadmap Signature Initiatives.

A) Inflammation in Chronic Disease

(i) Health Challenges in Chronic Inflammation Initiative

Inflammation is a physiological process that normally helps fight infection and aids in tissue repair. Dysfunctional inflammatory responses, however, contribute to the development and progression of several common chronic diseases including asthma, Chronic Obstructive Pulmonary Disease (COPD), and chronic bronchitis – key research areas under the ICRH mandate. Inflammation also contributes to the development and progression of a number of other diseases such as cardiovascular disease, arthritis, diabetes, neurodegeneration, neurological and neuropsychiatric disorders, and cancer. These and other diseases with underlying inflammatory pathology are placing a burden on health care costs and human suffering across the globe. However, our understanding of how chronic inflammation is involved in the development and progression of disease remains limited, and the remaining scientific challenges are enormous.

The aims of this Roadmap Signature Initiative is to identify commonalities between diseases in which inflammation plays a role, an approach that may hold the potential for understanding physiopathology most accurately as well as providing earlier diagnosis and more effective treatment alternatives. To help address these goals, which also directly relate to one of ICRH’s former priorities (2006–2010 Strategic Plan), the Institute will provide funding for applications that address research on inflammation as related to respiratory health.

(ii) Transplantation Research Initiative

Closely related to the chronic inflammation signature initiative, and involving many of the same stakeholders, is an initiative focusing on transplantation, which in itself is largely influenced by inflammation. As ICRH’s research community identified transplantation as one of its research priorities (ICRH Strategic Plan 2006–2010), ICRH will continue working with the CIHR-Institute of Infection and Immunity and other partners to establish a national transplantation consortium. By bringing together the country’s best brains, sharing platforms and resources, and creating transplant teams and networks, it is hoped that this initiative will transform transplantation research in Canada, leading to an increase in the quality and the quantity of donor organs, and improved long-term health outcomes for transplant patients.

B) Personalized Medicine

According to Canadian science and technology experts¹⁷, personalized medicine is one of the top emerging science and technology areas where Canada is positioned to be a global leader. Notably, the topic of ‘biomarkers for chronic disease’ has been one of ICRH’s top priorities since 2006. To further support the discovery, validation, and translation of biomarkers as they relate to the ICRH community, the Institute joined the Genomics and Personalized Health program – a component of the Personalized Medicine Signature Initiative. ICRH is committing specific funds to support projects that directly align with any of the four ICRH Emerging Networks; it is our hope that the ICRH-relevant team/s supported through the Genomics and Personalized Health competition will establish strong links and collaborations with the newly emerging ICRH Emerging Network/s, some of which are expected to have a strong biomarkers component to their research program.

C) International Collaborative Research Strategy for Alzheimer's Disease

As vascular disease plays as important of a role, if not a more important role, in the development of cognitive impairment than does Alzheimer’s disease¹⁹, and because ‘aging and the cardio-respiratory system’ has been identified as a research priority (ICRH 2006–2010 Strategic Plan), ICRH will work closely with the Institute of Aging to develop this initiative that will network together a number of groups with expertise in Alzheimer’s disease. The ICRH will contribute funds over five years to support the development of an integrated consortium-based research program which will incorporate the appropriate vascular elements (a mandate of ICRH) and their role in the development of cognitive impairment.

D) Community Based Primary Health Care Signature Initiative

To achieve better balance across the four CIHR research themes and address the identified need for more research in health systems and services as related to the ICRH mandate, ICRH intends to participate and contribute to the Community Based Primary Health Care (CBPHC) initiative. The Institute’s contributions will be forged through unique collaborations with Pfizer and the HSFC. Together, ICRH and the above partners will develop a program that will provide support to teams funded through the CBPHC signature initiative and whose research focuses on cardiovascular health. In order to increase the capacity to do CBPHC research relevant to ICRH’s mandate, the development of common training and early career development programs in partnership with the CIHR Institute of Health Services and Policy Research (IHSPR) will be an ICRH priority.

E) Pathways to Health Equity for Aboriginal Peoples

ICRH, through the cohort harmonization and enhancement initiative (ICRH’s third priority area), seeks to develop, in collaboration with CIHR’s Institute of Aboriginal Peoples’ Health (IAPH), a two thousand reserve-based aboriginal cohort. As part of this initiative, ICRH will work with its community, the Heart and Stroke Foundation, and an expert committee from IAPH to support the development of this sub-cohort that will aim at thoroughly phenotyping a sample of First Nations individuals living on reserves, including contextual phenotyping. This undertaking will create an important resource that will be used to conceive and evaluate programs designed to improve the health and health care of these communities. Importantly, the data collected through the sub-cohort could be of great value to researchers and programs that will be developed through the CIHR Pathways to Health Equity for Aboriginal Peoples’ Signature Initiative.

F) Environments and Health

In partnership with CIHR Institutes of Population and Public Health; Infection and Immunity; Human Development, Child and Youth Health; and Nutrition, Metabolism and Diabetes, ICRH will contribute to the development of the Environments and Health Signature Initiative. This program will examine the effects of physical (natural and built), chemical, social and cultural environments and their interactions on health and disease. For ICRH, topics such as air pollution, chemical exposure, and built environment are particularly relevant to respiratory and cardiovascular health. Aligning with the cohort harmonization and enhancement research priority, we will support studies that will focus on enriching existing cohorts with new generic and specific environmental data. Ultimately, this work will allow researchers better appreciate how different environments impact health as well as understand how to optimize inter-sectorial systems so as to prevent, reduce, mitigate or enhance resilience to environmental threats.

5. Conclusions

Over the next few years, by operationalizing this strategic plan, ICRH will attempt to reverse the progressive relative loss of research capacity in many of its communities. The Institute proposes to accomplish this challenging task by supporting early career development and fostering the development of platforms; this approach will serve to attract researchers to the various fields within its mandate as well as help assure their success. Specifically, ICRH identified three major strategies to achieve these goals. The first initiative will focus on the development of a series of thematic Networks that will bring together the best minds to address knowledge gaps and create opportunities for leveraging resources through partnerships. The second strategy - cohort harmonization and enhancement - will involve coordination among multiple CIHR Institutes and partners; it is our hope that this approach will enable ICRH to attract health systems and population health researchers to areas relevant to the Institute’s mandate. Finally, ICRH participation in and contribution to various CIHR Roadmap Signature Initiatives will create multiple opportunities for our community to reach out and partner with other strong teams and groups with similar interests within the Canadian community.