The Liberal government's decision not to renew the National Strategy on AIDS -- along with its indecision about how else to tackle the disease -- has clearly placed AIDS research in jeopardy in this country.
The Liberals in Power
As official opposition, the Liberal Party was consistently critical of the Conservative's record on funding AIDS research. On Apr. 2, 1990, David Dingwall complained about the government's extensive delay in announcing a national AIDS strategy, urging "the minister (for Health and Welfare) and the prime minister to take their responsibilities seriously and move forward with a national AIDS strategy immediately."
The Conservatives launched the National Strategy two and a half months later, but Dingwall found the initiative itself to be unsatisfactory and inadequate, calling it a "tremendous disappointment" and "only a reshuffling of old money."
The Liberal government has not, however, fully lived up to the demands it made as official opposition. For one thing, the Liberals never raised the strategy's annual budget from the $42 million that their Conservative predecessors had pegged it at. And more importantly, the Liberals have decided against renewing the National Strategy's second phase beyond its Mar. 31, 1998 sunset date.
The absence of any clear indication by the Liberal government of what will happen to AIDS research and education in this country beyond 1998 has greatly angered and frustrated many AIDS activists and researchers. Prime Minister Jean Chrétien's decision not to make an appearance at this year's International Conference on AIDS, held in Vancouver, just added insult to injury, and left Health Minister David Dingwall to face the AIDS community's anger.
Dingwall has, for his part, made it clear he is "not comfortable" with cabinet's decision to eliminate the National Strategy and has stressed that this decision was made during Diane Marleau's tenure as health Minister. He also wrote to the prime minister in May urging him to attend the Vancouver conference. He pointed out to Jean Chrétien that "If you choose not to attend, Canadians and representatives from other countries will still receive a signal, but it will be a signal that Canada is less than committed to fighting this disease."
At the outset, medical research into Acquired Immunity Deficiency Syndrome (AIDS) was initially funded by pre-existing programs, but it soon became clear that the seriousness and lack of scientific knowledge of the disease required a more focused approach.
In 1986, the Department of Health and Welfare announced its first five-year plan to support activities dealing with AIDS in Canada, allocating $39 million to the effort. Funding was increased by $129 million in 1988, and then again by $3.8 million in 1989.
The National Strategy on AIDS
In June of 1990, Health and Welfare unveiled its National Strategy on AIDS. Though the strategy provided no new funds, it sought to bring the plethora of separate research projects together and open the lines of communication between the various departments in which they operated.
Though led by Health Canada, the strategy was a "collaborative effort involving different levels of government, voluntary and professional non-governmental associations, the academic and private sectors, and the AIDS community."
The strategy was broken into five major components: education and prevention, biomedical research, program coordination and collaboration, support to NGO's and care, treatment and support.
Biomedical research received the lion's share of the funding with money allocated to various government departments but predominantly to Health and Welfare. Of those funds distributed by Health Canada, most were divided among two major research agencies, the Medical Research Council (MRC) and the National Health Research and Development Program (NHRDP). The vast majority of this extra- mural research takes place in Canada's universities.
The MRC has funded 41 projects since 1990. Of these, 35 have been based in Canada's universities. During the National Strategy's first three-year phase, these projects garnered $5.1 million in federal funding. As the more significant contributor to extra-mural AIDS research, the NHRDP has funded a total of 263 university-based AIDS research projects since 1986, 115 of which are still receiving funds.
Between 1986 and 1989 (prior to the initiation of the National AIDS Strategy), the NHRDP provided $10.6 million for university- based AIDS research, and $5.5 million between 1990 and 1992 (the first four years of the strategy).
As these figures illustrate, the advent of the National Strategy on AIDS was, at least in its first phase, essentially an administrative reform that actually saw a significant reduction, rather than increase, in the amount of funds the NHRDP made available to university researchers.
The administrative re-organization involved in the advent of the National Strategy was, however, of considerable benefit. In a paper delivered at the recent International Conference on AIDS in Vancouver, Leo Lehtiniemi of Health Canada indicated that the preparation of an evaluative framework involved in creating the strategy "helped managers and clients clarify and focus the objectives of programs, and identify what information was needed to demonstrate the results."
In any case, when the Conservative government renewed the strategy in March 1993, it added more funds, augmenting Health and Welfare's core funding with new, strategy-based monies. Phase two of the strategy, due to end in 1998, increased overall funding for AIDS research and education by roughly 10 per cent (from $37.3 million a year over three years to $42.2 million a year over five years) and funding for AIDS research by roughly 25 per cent (from $14.1 million to $17.8 million a year).
University AIDS researchers funded by the NHRDP have nevertheless benefited from the new influx of funds. Canadian universities received $10.3 million in funding for AIDS research within the first three years (1993-1995) of the current five-year plan alone.
To put this figure in perspective, while pre-strategy NHRDP university-based AIDS research monies averaged $2.6 million annually, dropping 30 per cent to an average $1.8 million annually during the strategy's first phase, the first three years of the current plan have provided an average of $3.4 million in NHRDP spending on university-based AIDS research, up 46 per cent from 1990-1992 spending levels. At least $4.6 million of funding has been guaranteed for university researchers in 1996/97, while $2.7 million has already been earmarked for the 1997/98 year.
The MRC also profited from the richer second phase of the National Strategy, and assigned university researchers $7.9 million worth of AIDS research between 1993 and 1996, for a yearly average of $1.96 million, up 14 per cent from the previous 1.7 million annually. It is true, however, that the MRC's support for university research has been steadily declining from a peak of $2.5 million in 1993 to a low of $1.2 million in 1996.
So what will happen now to funding for AIDS research in Canada? No definite answer to this question is currently available, nor will there be until the federal budget of spring 1998 is brought down. It seems likely the increased funding level maintained between 1993 and 1998 will disappear along with the organizational structure that gave cohesion to the strategy. Some AIDS research will no doubt continue but at a much reduced level.
The lack of federal leadership and the uncertainty may precipitate the decline even before the 1998 budget. For although the strategy does not officially end until 1998, all funding allocated (over the whole 5 years) for AIDS research has already been spent, and thus no new proposals for research projects are currently being considered.
There are, of course, many AIDS research projects still in process, and many that will receive funds right up to the 1998 sunset date, but these projects may have been approved as many as six years ago. AIDS researchers with innovative or simply necessary new research projects must already look for funding elsewhere than the federal government.
This current (relative) stagnation of research and uncertainty about future funding is already having negative effects on Canada's AIDS research community.
Dr. Martin Schecter and Mark Wainberg, two prominent AIDS researchers, held a press conference in June of this year at which they raised concerns that without a secure guarantee of funding for AIDS research, drug companies may decide against testing new drugs in Canada. They also foresee that many Canadian scientists may be drawn to other countries in search of better funding opportunities.
Such a "brain-drain" is a well-known phenomenon in other research fields in Canada, and it would be a great shame if it were to afflict an area in which this country has earned an international reputation as an important (if cash-starved) contributor to the fight against AIDS.
Keith Haysom is a Political Science student at Dalhousie University.