Health Research Priority Setting: Do Grant Review Processes Reflect Ethical Principles?

ABSTRACT

Most public and non-profit organisations that fund health research provide the majority of their funding in the form of grants. The calls for grant applications are often untargeted, such that a wide variety of applications may compete for the same funding. The grant review process therefore plays a critical role in determining how limited research resources are allocated. Despite this, little attention has been paid to whether grant review criteria align with widely endorsed ethical criteria for allocating health research resources. Here, we analyse the criteria and processes that ten of the largest public and non-profit research funders use to choose between competing grant applications. Our data suggest that research funders rarely instruct reviewers to consider disease burden or to prioritise research for sicker or more disadvantaged populations, and typically only include scientists in the review processes. This is liable to undermine efforts to link research funding to health needs.

KEYWORDS:

• priority setting
• resource allocation
• research funding
• grant review
• ethics

Acknowledgements

We would like to thank Annette Rid, David Wendler, Steven Pearson, and an anonymous referee for their helpful comments on earlier drafts of this paper. We would also like to thank Benjamin Berkman, Christine Grady, Haley Sullivan, Marion Danis, Robert Steel, and Scott Kim for their feedback on the conceptual design of this project. Finally, we would like to thank attendees of our presentations at the Oxford Global Health and Bioethics International Conference and the American Society of Bioethics and Humanities Annual Meeting for their comments on this work.

Disclaimer

The views expressed are those of the authors. They do not represent the positions or policies of the National Institutes of Health, the Department of Health and Human Services, or the United States Government.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Supplementary Table 1 lists the relevant documents.

2 To verify this, we reviewed 100 successful NIH grant applications from NIH’s ten top-funded institutes. Of these, 88 specified a population the research was most likely to benefit (Supplementary Table 2).