Improving alignment and coordination between the Medical Research Future Fund and Medical Research Endowment Account

• Currently there is a lack of national priority and planning in medical research. The two distinct schemes have overlapping priorities and as independent structures are inappropriate for establishing a national priority for planning to optimize the balance of fundamental research through to translational and clinical outcomes. The merger of the two schemes is required to achieve this goal.
• The two schemes duplicate some areas of funding whereas other areas of medical research are grossly under-resourced. Co-ordination and integration of the two schemes is urgently required to rectify this issue.
• For the MRFF, transparency of decision-making for selection of priorities and for awarding grants is not clear, which has raised major concerns. Transparency is very importance for the research and the broader community to ensure due processes and integrity in the distribution of research grants. The alignment of the schemes to standardize the decision-making process will provide the opportunity to generate a consistent and transparent process.
• Substantial MRFF funds has been previously awarded directly from the Minister’s office as one-off grants. It is essential the new governance removes the potential for MRFF grants to be awarded directly by the Minister of the day for political purposes.
• Over the past 10 years there have been ever decreasing funds for basic medical research, especially from MREA. This represents a severe gap in funding. Fundamental medical research is enhanced by discoveries that arise from the boundaries of disciplines, particularly biology chemistry and physics. Amalgamation of the two schemes is required to rectify this gap and remain competitive.
• ECRs especially non-clinical have a hard time obtaining fellowship support with low success rates. Non-clinical ECR are essentially excluded from MRFF funding. This gap needs to be rectified for the long-term strength of the medical research workforce. Amalgamation of the two schemes provides the opportunity to do this.

Given the major deficiencies in the current system, Model 3 is the model which has the potential to provide the flexibility to ensure there is appropriate structure to respond to the national priorities and to remain nimble and flexible. Model 3 will provide the best system to co-ordinate and distribute funding across the sector which is best aligned with national priorities and to adjust the distribution arising from future changes in the relative budgets of the MRFF and the NHMRC. This current process is a rare opportunity to begin from scratch: not to be hampered by the existing governance and preconceptions of the current schemes. A fresh start. Model 2 only goes part of the way to achieve these outcomes, and would be far less flexible in responding to changes in the specific funding levels of either MRFF or NHMRC.
Model 3 provides the option to align MRRF and NHMRC funding and to re-distribute the current level of NHMRC and MRFF funding to ensure medical research is appropriately supported and ensure there is a strong pipeline from fundamental discoveries to future transitional and clinical opportunities to improve health outcomes

The current systems are fragmented and many in the sector have lost confidence in the system.
Information and communications flowing from the NHMRC is generally very good and either models 2 or 3 should be able to ensure communication channels are preserved.
In broad terms, the peer review system is robust in the NHMRC, however, the removal of GRP has eliminated an important aspect of the system and reduced confidence.

• Pipeline for translational outcomes is not supporting medical research at the base/beginning translational pipeline. Monitoring of the quality of translational outcomes is unclear. Model 3 has the potential to include new structures to oversee and monitor the quality of translational outcomes
• The top down approach to fund ~24% of MRFF on specific missions raises concerns whether (1) money will be spent on the highest quality research and (2) misses the opportunity to support innovations from other areas which may subsequently impact on a range of research disciplines. Model 3 can provide an unifield approach to ensure funding for specific missions are underpinned by quality science.
• Given the non-transparency of the funding allocation for MRFF, it is not clear if the successful grants for any given mission/scheme are of an internationally competitive standard, or whether they represent the best Australian application for a very defined area. That is, it is money well spent? Again, structures are required to ensure that only internationally competitive standard is applied to specific missions.
• Support for the research workforce needs to be extensively reviewed to provide pathways for careers. This especially applies to ECRs.
• Currently there is little advocacy for basic biomedical research on the governing bodies. For example, from 26 members of the NHMRC Council only ONE is a basic researcher (Liz Harland) which highlights the lack of voice for fundamental science on the NHMRC council. It is essential that the new goverance structures include senior scientists from the basic biomedical sector and there are many that could be called upon. In addition, ECRs need to have a voice on the governance structures to feed through concerns from the emerging leaders in the field.

Currently fundamental biomedical research is predominantly funded under NHMRC Ideas grant. However the majority of successful Ideas grants are translational, partly due to low success rates and the need to tick as many boxes in the category chart to be successful. A defined level of funding needs to dedicated to fundamental (and not translational) biomedical research.
• Early Career Researchers (ECRs) are our future leaders in medical research and it is vital that we support them in the first stages of their academic careers. The low success rates particularly EL2 and L1. (10-12%), and which represents the establishment phase of a research career, is a deterrent to many of our talented researchers.
• To re-iterate comments above, there needs to be better representation of the sector from the (active) basic biomedical scientists in the governance and advisory structures. Currently this part of the sector is poorly represented.
• I have concerns that the current process is the wrong way around. How can the most appropriate goverance structures be established without knowledge of the national strategy and priorities?