Perspectives on Contemporary Challenges in Global Health Research and Its Governance by Dr Tikki Pang

The three main challenges to effective health research are unethical conduct, poor transparency and accountability, and inequitable access to the benefits of research, said World Health Organization (WHO) Geneva’s director of research policy and cooperation Dr Tikki Pang at a recent seminar on contemporary challenges in global health research and its governance .

Unethical conduct

Dr Pang said that while more money is being pumped into medical research than ever before, the number of new drugs produced remains low. In recent years, we have seen a shift of clinical trials to the developing world because it is cheaper and offers a larger pool of participants. However, this gives rise to ethics problems as there remains no regulatory infrastructure in place.

While the impact of research in improving health worldwide is immense, there are instances of research going wrong. Pfizer’s controversial clinical trials for meningitis drugs in Nigeria is one such example. This phenomenon, however, is not merely the fault of pharmaceuticals; individual countries are equally responsible for enforcing ethics regulations. According to Dr Pang, as recently as 2004, 90% of clinical trials in China had not been subjected to ethical review.

Poor transparency and accountability

Publication bias continues to be a problem as there is a strong inclination to publish positive and conclusive studies while ignoring or sidelining the negative or inconclusive in health research outcomes. This often leads to studies hiding the evidence of adverse drug effects or omitting vital drug safety information. Dr Pang also said that research has indicated that studies supported by pharmaceutical companies have a significantly better chance of a positive result being reported than studies supported by a non-governmental organisation.

Inequitable access to the benefits of research

There is thus a need to focus on the 3As: availability, access and affordability. The low amount of resources devoted to addressing tropical diseases of the developing world indicates that pharmaceutical companies remain less inclined to make drugs for segments of the population that cannot afford treatment. Statistically, inequitable access to medicines, technology and care is also more pronounced for less privileged sections of any population.

Would better governance of health research help address these challenges? Dr Pang argued that all three challenges are transnational, global issues central to improving health outcomes and that all three would benefit from better global governance in health based on stronger international cooperation.

WHO would play an integral role as it is the only organisation capable of providing a facilitating platform for cooperation between various stakeholders, providing guidelines on biomedical research, and developing international standards for ethical research and review. The WHO has already initiated projects to overcome the aforementioned challenges such as the International Clinical Trials Registry Program (ICTRP) and the HINARI Programme .

Dr Pang’s analyses of the challenges faced by global health research are significant to the promotion and assurance of health security worldwide. Overcoming them will not only result in a  more integrated and efficient research sector rooted in public-private cooperation and collaboration, but also one able to deliver ethically sound results in an equitable, responsible and accountable manner.