Increasing Effectiveness and Equity in Strengthening Health Research Capacity Using Data and Metrics: Recent Advances of the ESSENCE Mechanism

**Background:** The ESSENCE on Health Research initiative, coordinated by the WHO Special Programme for Research and Training in Tropical Diseases (TDR), established a Working Group on Review of Investments in 2018 to improve coordination and collaboration among funders of health research capacity strengthening in low- and middle-income countries (LMICs). The Working Group comprises more than a dozen ESSENCE members with diverse representation by geography, country income level, the public sector, and philanthropy. The overall goal is increased research on national health priorities, improved pandemic preparedness, and ultimately fewer countries with very limited research capacity.

**Methods:** The Working Group developed a basic set of metrics for national health research capacity using three widely available indicators averaged over 2018–2020 for all countries with a population greater than 100,000 (N=180): (1) number of clinical trials in the WHO ICTRP; (2) number of research activity records in NIH World RePORT; and (3) number of publications with an author affiliation in the country in Scopus. Country rank percentiles for each indicator were averaged to create an overall metric. The group also assessed different models of coordination and collaboration, conducted deep dives into eight countries to characterize national research capacity, and held a virtual meeting on November 1–2, 2021, with more than 100 participants representing funders, researchers, and stakeholders from higher- and lower-income countries worldwide.

**Key Results:** Univariate analyses showed highly skewed distributions with differences among countries by geographic region and income group. Kendall's Tau test showed strongly positive correlations among the three indicators, with values ranging from 0.60 to 0.78, suggesting good internal consistency. Correlation tests between the aggregate metric and sociodemographic indicators found moderate to strong correlations with overall GDP (tau=0.78), total population (tau=0.56), disability-adjusted life years per capita (tau=-0.34), Human Development Index (tau=0.31), and GDP per capita (tau=0.25). The analysis confirmed that larger, higher-income countries tended to have greater research capacity, but many smaller, lower-income, and less-developed countries also demonstrated good research capacity. In Africa, research productivity increased by 96% per US$1 increase in a country's GDP, and for every single increase in the number of postgraduate training institutions, research productivity increased by 298%. English-speaking African countries produce more scientific articles compared to countries speaking French, Portuguese, or Arabic.

**Clinical Implications:** The paper identifies ten critical elements for sustainable health research capacity strengthening in LMICs: (1) training diverse cadres in research methodology and writing; (2) establishing infrastructure with research clinics, laboratory testing, biorepositories, data management, biostatistics, and research ethics review; (3) research support centers including grant and financial management; (4) equitable North–South and South–South partnerships; (5) mentorship networks with local, regional, and international advisers; (6) regular scientific meetings; (7) diversification of research funding sources with increased LMIC government and private sector funding; (8) country-led research agendas; (9) community engagement; and (10) data- and milestone-driven monitoring and evaluation frameworks. The paper emphasizes that no global framework currently exists for assessing and strengthening capacity to develop, approve, manufacture, and deploy medical countermeasures, and that R&D is not explicitly integrated into WHO International Health Regulations or the Global Health Security Agenda. The authors conclude that an intentional data- and metric-driven approach emphasizing coordination among funders, local leadership, and equitable partnerships will enhance health systems of resource-poor countries and global pandemic preparedness.