The University of Manchester is a founding partner of the Kenya-UK Healthcare Alliance, which aims to share best practice and reciprocal training between the two nations, particularly in the area of cancer care. In this article, from our On Cancer publication, Professor Keith Brennan, Dr F. George Njoroge, and Professor Rob Bristow outline how these partnerships can bring both health and economic benefits to all involved.

• The recruitment of overseas healthcare professionals saves the UK up to £60,000 per person in training – but this depletes the capacity of their home countries.
• Bilateral agreements on training, medicine, and equipment bring both health and economic benefits to both nations.
• Policymakers can facilitate these partnerships, including by creating an agreed minimum standard around ethics and data sharing.

International collaborations are one of the cornerstones in cancer research. They enable us to improve how we meet major health challenges through developing reciprocal relationships and sharing learnings with others around the world. Research that crosses international borders is a fundamental building block of ‘precision medicine for all’ – tailoring medicines and treatments to work best according to an individual’s genetic makeup. The wider our research can reach, the greater the number of patients, at home and abroad, who will ultimately benefit. So, what are the barriers to successful international collaborations and what can we do to improve outcomes and take advantage of the opportunities?

Cuts to aid and addressing ethnic inequality

The cut in the UK’s Official Development Assistance (ODA) funding (often referred to as the overseas aid budget), from 0.7 to 0.5% of our Gross National Product, has increased barriers to funding for UK based international research projects. While research investment (for example, the Global Challenges Research Fund) is only one pot of international aid funded through ODA, it has been disproportionately cut back. UK Research and Innovation announced in March 2021 that the reduction meant a £120 million shortfall for projects that they had already committed to supporting. This means that many approved research projects are facing budgets cut or cancellation, and that the amount of support for future proposals has been substantially reduced. The recent announcement that the 0.7% commitment will be restored in Financial Year 2024/25 will do little to address the present impacts and ongoing consequences of the cut, which will be felt across UK international scientific research for years to come.

These funds have historically played a key role in addressing the gap in knowledge about how to treat cancers across different ethnicities. Currently most UK-based cancer research focuses mainly on people of European descent because this accounts for most participants in clinical trials. This leaves the genetic variabilities of different heritages under-explored. The implications are far reaching, for example, certain immunotherapies might be proved effective and safe for patients of European descent, but the same doses might be toxic in African populations. We need to tailor treatments for different populations and use genetic analysis to identify how tumours respond to different methods of treatment.

Funding research that looks at populations with a variety of genetic descent is therefore essential to improved outcomes, not just for other countries but to also better serve our population here in the UK. Progressing this research will move our treatment towards precision oncology for all patients, meaning that patient outcomes should improve significantly and a major health inequality in cancer services will begin to be addressed.

Barriers to research partnerships: practical considerations

One barrier to multinational collaborations is the lack of an agreed set of minimum ethical standards, as the research techniques developed in one country might not be acceptable in another. Ethics approval processes, required as part of any major research project (particularly ones involving health and testing/treating people), take more time than should be the case. The ease with which research ideas and data can be transferred between international partners can also pose an obstacle to research progression. Clear standards relating to the holding, organising and sharing of data and a consistent mechanism for data transfer between countries would allow more proactive collaborations.

Another barrier is healthcare recruitment. The UK currently benefits from recruitment of nurses from overseas, for example from Kenya. Taking trained healthcare professionals to fill shortfalls here saves the UK around £50,000 to £60,000 per person in training costs. However, this relationship depletes the healthcare capacity of their home countries and we need to find ways to give back to these countries in a way that equally benefits them. We could, for example, be upskilling clinical services overseas through education, training and capacity building.

By upgrading cancer services overseas, our economy can also benefit through becoming a provider of training, medicines and equipment like mammography machines. Building diagnostic and treatment capacities in other countries through international partnerships is, at the same time, building a future market for life sciences exports and health technologies developed here. Also, if workforces overseas are scaled up and improved, UK-based companies have more opportunities for placing sites in these areas and scaling up production.

Leading by example: a collaboration with Kenya

Here in Manchester, there are numerous international collaborations committed to improving cancer outcomes here in the UK and internationally. The Manchester Cancer Research Centre’s partnership with The Kenya UK Healthcare Alliance and the Kenyatta University Teaching, Referral and Research Hospital (KUTRRH) is working to improve clinical services for cancer in Kenya by using the ‘hub and spoke’ model developed by The Christie and local cancer services across Greater Manchester. This model enables a centre of excellence (the hospital), to support treatment in a number of other healthcare settings, ensuring the same high treatment standards for individuals across a large geographical area, no matter where they are treated.

Another area of international collaboration focuses on work to understand genetic factors in certain cancers. In Kenya, researchers affiliated to our international collaboration collected samples from prostate cancers in order to sequence Kenyan cancer genomes and understand genetic and environmental drivers of the disease in the country. As a result, we have been able to improve treatment pathways for prostate cancers for patients by taking the genetic differences of Kenyan cancers into account. This is a clear example of our move towards precision oncology for all.

Policy leadership for international success

The practical issues facing international collaborations require national leadership to cut through the complexities of the issues. Steps that could be taken include:

1. New pre-approval ethics arrangements. For example, the Manchester Cancer Research Centre negotiated an ‘umbrella’ ethics agreement on the use of patient data with Manchester University NHS Foundation Trust. This granted a provisional pre-approval, based on the research organisation satisfying certain conditions about use and safeguarding of data. UK Research and Innovation is a national body well-placed to lead a work programme exploring the possibility of similar pre-approval ethics arrangements for international collaborations – subject to an agreed set of minimum ethics and data standards.
2. Reconsideration around ODA funding. The current reduction in ODA funding has already negatively affected our ability to create and conduct worldleading international research. The Government’s commitment to returning to 0.7% of Gross National Product is welcome, but will not mitigate the effects of this cut to current research activities. Recalibrating the existing budget, with an immediate compensatory uplift in the research component going forward, is a reasonable and practical step towards safeguarding the valuable work that we have already been able to do.
3. Establish greater equity and equality in reciprocal healthcare arrangements. The Department of Health and Social Care and Health Education England should work together to ensure that the international recruitment of healthcare workers is partnered with reciprocal arrangements for remote training and upskilling for staff in their home countries. A programme could be designed, at minimal additional cost to the taxpayer, that adds a new international equity to an arrangement that benefits our NHS, often to the cost of domestic health services.
4. Be ambitious and explore the opportunities. We must not neglect the mutual benefit and economic growth that international research collaborations can bring to both countries involved. We can show how research funds translate not only into better outcomes at home and abroad, but greater economic opportunities. With leadership from the Department for Business, Energy and Industrial Strategy (focusing on our life sciences sector here in the UK) and the Department for International Trade (looking at export and development opportunities across the world), we could build a consensus between research, industry and policy-makers to turn recommendations into reality.

With greater investment and fewer barriers to international research, the UK could develop new industrial bases and export relationships for our businesses, at the same time as learning more about how to diagnose and treat diseases like cancer. There is no time to waste. The full potential of international research collaborations should be realised.