Heart disease remains our biggest killer – does the research funding it receives match its overall cost to the health system?
A limb is amputated every two hours in Australia due to peripheral artery disease, and up to a quarter of all people who have had a heart attack have no known and modifiable risk factors.
These are just two examples of conditions that would benefit hugely from more basic science research, says group leader of the Vascular Complications Group at the Heart Research Institute, Associate Professor Mary Kavurma.
Peripheral artery disease (or PAD) – a type of cardiovascular disease in which there’s reduced circulation of blood to a body part other than the brain or heart due to narrowed or blocked artery – affects nearly one in five Australians. About half of people with PAD have no symptoms, leading to under-diagnosis and under-treatment, Heart Research Institute figures show.
Kavurma, a specialist in PAD, says we need far more clinical insight into a condition that’s believed to affect people primarily aged over 85, 40% of whom are women. However, more recent evidence implies that women may be affected at much younger age groups and at a higher prevalence.
“Women account for just under half of all patients with PAD, yet only 30% are enrolled in clinical trials looking at peripheral artery disease treatments,” Kavurma says. “This means that our understanding of the way new drugs are coming out that affect females with PAD is very limited.”
Women also tend to minimise pain and more often present as asymptomatic than men, she adds. “We don’t know why this is. Basic discovery research for PAD is behind coronary artery disease, and people are suffering for it.” As it stands, there is currently no pharmacological treatment for PAD in Australia. The usually recommended remedy is exercise.
While Kavurma says there is a funding shortage across all disciplines, she believes it’s especially pronounced in heart-related research, with cardiovascular disease accounting for 27% of all deaths in Australia. According to figures from the Australian Institute of Health and Welfare, about 1.2 million Australians have one or more heart or vascular conditions.
Professor Garry Jennings, a senior director at the Baker Heart and Diabetes Research Institute and chief medical advisor to the Heart Foundation, agrees with Kavurma that the “slice of the cake that cardio is getting doesn’t match the burden of disease”.
“Heart disease is the biggest killer and close to our biggest cost in the health system, and has been for some time,” he says.
Professor of Medicine at the University of Sydney Gemma Figtree says cardiovascular health costs Australia $12 billion a year in direct expenditure, a sum that dwarfs the money dedicated to researching how to cure it.
“The commonwealth government has dedicated $220 million over 10 years to the Mission for Cardiovascular Research,” Figtree says. “Whilst this is a terrific boost for our researchers, we need to consider that this equates to $22m a year, or 0.2% of the direct health care costs.”
On a positive note, she adds: “We know that for every dollar spent on fighting cardiovascular disease, $10 is brought back into the economy. With that logic alone, we should and could be investing more.”
A spokesperson for the National Health and Medical Research Council (NHMRC) says that between 2012 and 2021, NHMRC dedicated about $1.15b for research relevant to cardiovascular disease, representing 13.6% of its total expenditure for that period. Data from the council’s website shows funding for cardiovascular disease has fallen from $130m in 2015 to $102.5m in 2021, echoing a similar trend across all disciplines (excepting dementia and mental health).
This funding decline is not solely due to government cuts: as the NHRMC spokesperson points out, the majority of NHMRC funding is investigator-initiated and is not directed by NHMRC to any specific disease, health or research topic.
Jennings says while the success rate for funding cardiovascular conditions is the same as in cancer, the number of applicants is lower, suggesting a capacity problem. “There is nothing wrong with the quality of Australia’s research here – publication citation rates are well over the world average,” he says.
This shortage, however, creates a system where already struggling researchers enrol more PhD students to get assistance, who inevitably face the same problems as soon as they graduate and want to become independent researchers themselves.
Read more: Making a budget for science.
“If you’re a lab head struggling a little bit to get funding for the sort of research assistance you need, you will enrol more PhD students who will become postdocs,” Jennings says. “The problem is once these postdocs are making their next step as an independent researcher, they also apply.
“Funding tends to go to more established, shall we say grey-haired investigators, who have a proven record of providing value for the money invested in them.”
It doesn’t help that the cost of research has gone up 20% since COVID-19 and the Ukraine war, Kavurma adds. Not only are the materials expensive, delivery charges are much higher and supply takes longer.
She also believes that the government’s “push towards translational research” – research that has more immediate commercialisation potential, such as a vaccine, drug or other medical product – at the expense of more basic research, which involves experimenting with cells, animals or tissues, is hindering medical progress.
“Basic research leads to innovation and scientific knowledge, but funding for it has been reduced because it doesn’t have an immediate impact,” she says. “Just look at the COVID-19 vaccine – creating that in a year was no small feat. Yes, the pandemic spurred global cooperation for research, but had we not had previous investment in scientists and research, it couldn’t have happened.”
The NHRMC spokesperson says that between 2012 and 2021, NHMRC spent approximately $3.47b out of $8.43b on basic science research, representing 41.2% of all NHMRC research expenditure in that same period.
Figtree – who is also President of the Australian Cardiovascular Alliance – says Australia needs to foster an ecosystem that translates research into solutions, better serving our health and the economy. Direct measurement of impact and the health and economic benefit of research will help co-commissioned approaches to our biggest challenges, she says.
But Figtree emphasises that basic research is not just “some esoteric thing that we give to clever people who sit in a dark room and do clever things”.
“We need to identify the residual clinical unmet needs and fund basic research to come up with deep solutions. I collaborate in a national team that provides a good example of this – the discovery of a new marker for early coronary artery disease that can be implemented in the community to prevent heart attack.
“This requires the kind of leadership, vision and engagement between government and science that we saw for COVID.”
In 2012, former chief scientist Ian Chubb delivered a speech saying that while Australia “punches well above our weight” when it comes to basic research, research advances (in quality and quantity) have not led to a marked increase in new cures.
“Much of what we now use to treat many common ailments is based on research from years ago,” he said, adding that this “knowledge has not been translated to any new drugs that decrease weight safely and effectively”.
Chubb – who Cosmos attempted to contact – said at the time that NHRMC increased its funding for translational research to about 4% between 2002 and 2011, to a total of about $30m.
For Jennings, things do not look as dire. “There’s a new kid on the block, the Medical Research Future Fund (MRFF), which has pledged $20b over the long-term to support Australian health and medical research. Of that, $220m is going into cardiovascular through the Cardiovascular Health Mission.”
Jennings, who’s a member of the mission’s expert advisory panel, also says there are other “more generic missions” from which some of the funding will also flow through to cardio health.
That can’t happen quickly enough, says Kavurma. “We need to know why 13% to 27% of all patients who have had a heart attack don’t have standard modifiable risk factors such as high cholesterol, obesity etc,” she points out.
Lack of funding also means lack of job security, which is contributing to a brain drain, she says.
“As much as 90% of research doesn’t get funded, and in the meantime, the government is investing money in promoting STEM subjects. There’s not enough money to sustain the current cohort let alone future researchers.”
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Caroline Zielinski is a freelance journalist based in Melbourne. She writes on health, science, social affairs and all issues related to women