The spirit of Mexico: a decade on.

www.thelancet.com Published online November 16, 2014 http://dx.doi.org/10.1016/S0140-6736(14)61893-6 1 November, 2014, marks the 10th anniversary of the Mexico Ministerial Summit on Health Research, attended by 20 ministers of health and delegations from 51 countries. Convened by the Government of Mexico, the Global Forum for Health Research, and WHO, the Summit endorsed the role of knowledge for better health through the Mexico Statement and a resolution passed at the World Health Assembly in 2005. Initially driven by the strong personal commitment and vision of WHO’s then Director-General, the late Lee Jong-wook, much progress has been made in the past decade; however, substantial challenges remain. Although the Summit emphasised the importance of research to strengthen health systems, can the knowledge-to-action message embodied in the spirit of Mexico help to achieve the goals of the post-2015 sustainable development agenda? Let us begin by reviewing the progress made since 2004. First, substantial improvements have been made in the accountability and transparency of research. WHO established the International Clinical Trials Registry Platform (ICTRP) after the Summit and the WHO Trial Registration Data Set now contains records of roughly 280 000 clinical trials. Major trials registries are now partners of the ICTRP and it has defi ned international standards, leading to the establishment of national registries in countries including China, India, and Brazil, as well as a Pan-African registry. Further support for trial registration was provided by the International Committee of Medical Journal Editors (ICMJE), which made trial registration a requirement for publication of the results of clinical trials. The ICMJE example has been followed by developing-country journals (eg, in China and India), major research funders, and countries that now have legislation for the mandatory registration of clinical trials (eg, Argentina, Brazil, Israel, and South Africa). Second, much progress has been made in the strengthening of links between scientifi c evidence and the development of health policy. To promote such links, WHO established EVIPNet (Evidence-Informed Policy Network), which has since created country teams in 39 middle-income and low-income countries to strengthen research-to-policy links. The value of EVIPNet has become evident—for example, in Burkina Faso, where a national policy on malaria treatment was adopted in response to an EVIPNet initiative. Other, similar initiatives have also been launched—eg, in east Africa. WHO itself, upon realising that many of its guidelines were not strictly evidence-based, acted quickly to establish a Guidelines Review Committee, which has greatly improved the quality and credibility of the many guidelines it produces. Third, the Summit called for countries to establish and implement a national health research policy and to give a higher priority to health-systems research. Many developing countries now have such policies and progress has been noted, for example in research for health-system development in the Latin American and Caribbean region, mostly in the context of improved governance, coordination, policies, and regulations. Where has the Mexico Summit fallen short? First, a key resolution, going back to the 1990 Commission on Health Research for Development, urged countries to invest at least 2% of national health expenditures in health research. A recent review of global health research investments suggested that few countries, even among high-income countries, have been able to reach this target. However, the Mexico Summit has probably been a catalyst for increased investments in health research, which totalled US$240 billion in 2009. Second, a resolution urging networking to promote better collaboration hinted at poor coordination and fragmentation of health research eff orts. An eff ective and inclusive network remains an unattained goal despite proposals to improve governance by merging and consolidating diverse eff orts and provision of a more accurate picture of the research landscape through a global health research observatory. Third, despite developing its own strategy for research in 2010, WHO’s own commitment to research seems to be waning. Its highest level scientifi c advisory body, the Advisory Committee on Health Research (ACHR), has not convened for 4 years, although a meeting for a reconfi gured entity is planned in the near future. Although the global ACHR in Geneva seems moribund, the ACHRs in the regions have been active in the promotion of research (eg, in the Americas, European, and Eastern Mediterranean Regions of WHO). The spirit of Mexico: a decade on