Good morning, and thank you very much.
My name is Salim Yusuf. I was born in India and trained in medicine in India, and then received a Rhodes Scholarship. I went to Oxford and then worked in England, doing both clinical medicine and research for eight years. Then I moved to the U.S. NIH and worked there for eight years, involved in some national and global programs in heart failure.
In 1992 I moved to Canada, and I've been here ever since, for 26 years. The point I wish to make is that having worked in four countries, I have a global perspective on research. In addition, our current work involves 101 countries and more than 89 projects. It's very broad, very deep, and we have made a major impact in the prevention and treatment of cardiovascular disease that which has saved millions of lives.
The point I want to make here is not to give you a perspective on any single type of research or on any single discipline, but—as a researcher reflecting the voices of researchers across the country—to tell you about what we see as the needs.
The first is that we all agree that biomedical research is essential to improving the health of Canadians and developing a knowledge-based economy. Therefore, we have to invest in biomedical research and research as a whole.
Second, compared to other OECD countries, Canada's investment is substantially lower. It has remained the lowest for the last 15 years, and it's declining.
The third is that we need research that discovers better preventive and treatment strategies. Some of these originate in the laboratory and others originate by observations in humans, just as we heard, but all of them need to be tested in people if we need to translate discoveries into practice. Then, after finding that they are effective, we need to adapt them to our own health care system.
Unfortunately, our current pipeline of research is bottlenecked at stage one. All stages of research are underfunded in Canada, but even more so is the translation of findings into humans and from humans into the health care system.
We need to rethink not only our national strategy related to research and its funding but also its organization and its priority. Undoubtedly all of us will share the goal of creating a broad and world-class effort that's responsive to the health needs of Canadians and beyond, and develop the capacity in Canada to attract partners and also attract the best minds.
The first perspective I want to share with you is that discovery and invention are not the same as innovation and improving health. There is an overlap, but they're not the same. Only 5% of discoveries in the laboratory ever translate into improved human health. Investments across the entire spectrum are needed, especially in the second and third phases of research, and that's where Canada has failed miserably.
It is a long process to take discoveries from observation, from confirmation, to human health and ultimately into the system.
I'll give you three types of discoveries that have dramatically improved human health, all of which are known to you.
The first is penicillin. It was a serendipitous finding by Fleming, who thought certain fungi were killing bacteria in a petri dish in his lab. It would have remained there had it not been for the work of Florey and Chain, who synthesized it, isolated the active molecule, and did human studies that led to medium-sized production. Then it was taken by industry, and that was the era in which antibiotics were born. Hundreds of millions of lives have been saved since then. It would have remained in the petri dish had it not been for the translational work of Chain and Florey.
Blood pressure causes strokes. Reducing blood pressure reduces strokes and heart attacks. How was this discovered? It was discovered by taking 5,000 people in a little town in Massachusetts called Framingham, where they measured blood pressure and observed people and found those with higher blood pressure had more strokes. This was then taken by various companies who produced blood pressure-lowering drugs.
This was then tested in humans in large clinical trials that showed that lowering blood pressure was feasible, that it could be safe and that it saved lives, and now this is one of the biggest health impacts that has happened. It's the combination of basic science and population science and discoveries by industry that have led to improved human health.
We all know that tobacco is the number one killer in the world. It killed a hundred million people in the last century. It's projected to kill a billion people in this coming century. We do not understand the basic cellular mechanisms as to why tobacco causes cancers, heart disease, and 21 other diseases, but we know if people stop smoking, or if they avoid tobacco entirely, we will save tens of millions of lives, if not hundreds of millions. This is entirely population research, yet there is a schism in the level of funding for population and clinical research compared to biomedical research. I want to stress that everything is underfunded, but the first two are substantially more underfunded.
We just heard from Dr. Fowke. For him to make his discoveries come to reality, he has to do large clinical trials, and they cost money. They're in people, but they're essential.
The next slide, which is handout 4, shows you the overall funding in various countries and Canada. It is low. In the U.S. about $120 billion was spent in 2012. In western Europe it was about $82 billion; Japan, $37 billion; Australia, $6 billion; South Korea, $6 billion; Canada $5 billion.
The next handout tells you that as a proportion of the per capita funding or the GDP, Canada is about one-fourth of the U.S. and one-half of the U.K., so relative to the size of our economy, relative to the population, we are underfunded from public sources.
The next handout, which is number 6, shows you the decline in funding in Canada compared to other countries. You will see that between 2007 and 2012 in Canada, there was a 2.6% decline in inflated, adjusted growth rate. Compare that with China at the bottom, at 33%. Of course, China started low, but take Australia, which is a country similar to ours, smaller than ours. They went up 7%. Singapore went up 10%, South Korea 11%, Japan 6%. Even tiny Taiwan went up more.
During this period there was a decline in the U.S., but far less than in Canada, and they started at a much higher level. In Europe it was essentially flat. Canadian funding was low up to 2012.
What has happened since 2012? The situation has gotten worse. This is handout number 7. You will see that in the U.S. in 2012, 2.7% of the GDP was spent on research in the country. In 2016-17, it was the same. You will see that's more or less the case in the OECD countries. In Japan and in Australia there was an increase, and in South Korea there was an increase. Contrast that with the bottom line. In Canada there was a substantial decline over this period, with 1.8% going down to 1.5%.
Over the last decade and a half, we started low, we remained low, and we are declining. No wonder our global competitiveness has gone down and no wonder we're having difficulty attracting money from industry.
Handout 8 tells you the distribution of federal funds by various themes. This tells you that—