The major challenges of research and innovation in health

The biology-health sector covers a wide range of disciplines: biology, physiology, medicine, epidemiology, pharmacy, biotherapies, health technologies, public health, human and social sciences. Research in these disciplines accounts for heart of health research and innovation. Their common thread: improving the quality of life and care provided to patients.

Cancer, chronic diseases, immunology, neurodegenerative diseases, rare diseases, gene therapy and cell therapy, nanotechnologies, the fight against antibiotic resistance, “One Health”: these are all major public health issues that the arrival of SARS-CoV-2 in 2019 should not obscure.

In France, cancer is the leading cause of death in men and the second leading cause of death in women. In 2018 the French National Cancer Institute (INCA) recorded 382,000 new cases and 157,400 deaths. And while the standardised mortality rate fell by 2% per year in men and 0.7% in women between 2010 and 2018, 40% of cancers can be avoided if the four main risk factors are tackled: tobacco, alcohol, unbalanced diet and excess weight. Upstream of prevention, screening and treatment (with new specific immunotherapy drugs including immune checkpoint inhibitors and CAR-T cells, cell and gene therapy drugs), research plays a major role in improving patient care.

Unveiled on 4 February by the President of the Republic, the ten-year cancer strategy 2021-2030 has been allocated nearly €1.74 billion in funding for the next five years, of which €634 million is dedicated to research - a 20% increase compared to the 2014-2019 Cancer Plan. In parallel with the “High Risk-High Gain” call for projects for research into cancers with a poor prognosis and paediatric cancers, the first applications of the data platform will be launched in the coming months to use artificial intelligence to develop treatments. These actions complement the 11 Integrated Research Action Programmes (PAIRs) launched in 2009 by the INCA in partnership with the Cancer League and the ARC Foundation for Cancer Research, and the 8 SIRICs (Integrated cancer research sites) which bring together medical services, multidisciplinary research teams, resources and efficient shared services.

Improving the management of chronic diseases

In France, 20 million patients suffer from chronic diseases, which cause many serious complications, disabilities and physical and moral suffering. Supported by the AP-HP, the ComPaRe research patient community relies on a large e-cohort of 100,000 adult patients with one or more chronic diseases to study the general management of chronic diseases and multimorbidity, to answer specific

© Ministère de l’Enseignement supérieur, de la Recherche et de l’Innovation

questions about certain chronic diseases through the creation of specific cohorts and to place the patient at the heart of the research. Participants will be followed for 10 years.

ComPaRe is very active on the editorial front. Let us quote a ComPaRe Vitiligo study, published in the Journal of the American Academy of Dermatology in March 2021, a ComPaRe Asthma study on asthma and Covid published in the Journal of Asthma on 10 June 2021 or a study involving 1,022 patients suffering from long Covid published in Clinical Infectious Diseases on 29 April 2021: researchers have used an original method to develop and validate the first scientific measure of the severity of the disease and its impact on the life of the patients.

Priority programmes and equipment for exploratory research

Health was at the heart of the call for programmes “Priority programmes and equipment for exploratory research” (PERP). Built on the lessons learned from the “Structuring equipment for research” and “Priority research programmes” actions of the P.I.A. 3, this action of the fourth future investment programme (P.I.A.4) and the France Relance plan aims to build or consolidate French leadership in priority scientific fields likely to be linked to a transformation, particularly in health. 67 letters of intent were submitted by the end of May 2021 and the first selected exploratory PEPRs were announced in September 2021. It is planned to launch around twenty exploratory PEPRs in the first three years of the P.I.A.4 for a total amount of one billion euros. A second wave will be launched in the third quarter of 2021. The State has also defined strategic priority fields, including some in health: public health, mental health, cellular destinies, chemical exposome and EcoHealth. The PERPs have two objectives: to prepare the emergence of future areas of expertise and scientific leadership for France on the international stage; and to structure the scientific communities as widely as possible. This call for proposals should find a favourable echo among the major research players such as Inserm, IHUs (university hospital institutes), CHUs (university hospital centres), the C.N.R.S.-INSB, the C.E.A.- SDV, InCA, Institut Pasteur, Institut Curie, Institut Gustave Roussy, Genopole, higher education establishments, pharmaceutical laboratories... But also the facilitators of partnership research and innovation which include SATTs (technology transfer acceleration companies), Bpifrance (Public Investment Bank), Carnot institutes, competitiveness clusters and other incubators.

Making France the leading innovative and sovereign European nation in health

Producing and making available to patients and carers the health innovations

Key figures for research and innovation in France

- 51.8 billion in domestic R&D expenditure, or 2.20% of GDP - 65.5% of R&D work carried out by companies, amounting to €34bn - 305,000 researchers in FTE (2018) - 8th place in the world in terms of scientific publications (2019) - 5th worldwide in the European patent system (2019) - 4,000 young innovative companies benefited from €203m in 2018 - 7,900 companies benefited from €254m of innovation tax credit in 2018 - 6.5 billion euros in research tax credit in 2018 - 910 M€ of research and technology transfer budget for local authorities.

Source: « L’état de l’Enseignement supérieur, de la Recherche et de l’Innovation en France (n°14 - Avril 2021) » from the Ministry of Higher Education, Research and Innovation. of tomorrow: this is the challenge of the Innovation Competition (i-Lab, i-PhD, i-Nov). Organised by the government, this annual event promotes the creation and development of innovative companies born of advances in French cuttingedge research. Its 2021 edition honoured 243 prize-winners from all fields. For example, Manuel Blanc was awarded one of the 10 i-Lab 2021 Grand Prizes for Glunozumab, an innovative biotherapy aimed at treating cerebral vascular accidents and multiple sclerosis. He will be supported by a sponsor to develop his future company, thus joining the 2 155 innovative technology companies created thanks to the i-Lab competition between 1999 and 2021.

Health Innovation Strategy 2030: a €7 billion plan to make France the leading European health industry

The result of the work of the Strategic Council of Health Industries (CSIS), this strategy, which is part of the PIA, has set out seven measures for innovation in health (strengthening biomedical research capacity, supporting the three sectors of the future of the health industries, making France the leading country in Europe for clinical trials, etc.), to allow equal access to care and offer innovations an accelerated and simplified market access framework, to offer a predictable economic framework consistent with the objective of health and industrial sovereignty, to support the industrialisation of health products on French territory and to accompany the growth of companies in the sector, to create a health innovation agency) as well as 3 acceleration strategies: biotherapy and bioproduction of innovative therapies, digital health (AI, IoT... in connection with the ParisSanté Campus project), emerging infectious diseases and nuclear, radiological, biological and chemical threats. These are all angles of attack to meet the triple challenge of the efficiency of the healthcare system, economic growth and French health sovereignty.