FLASH AUDIT
FUNDING
FOR PUBLIC RESEARCH
IN THE FIGHT AGAINST
THE
COVID-19 PANDEMIC
July 2021
This document, which was subject to a right of reply from the recipients concerned, was deliberated by
the Court of Accounts on 17 June 2021
2
CONTENTS
THE STATE OF FUNDING FOR PUBLIC RESEARCH IN THE FIGHT AGAINTS
COVID 19
..........................................................................................................
8
1 NATIONAL FINANCING
....................................................................................
8
1.1
Emergency budget appropriations
.............................................................
8
1.1.1 Funding from the Ministry of Higher Education and Research
(MESRI)
..............................................................................................
8
1.1.2 Mobilisation of the Ministry of Solidarity and Health (MSS)
..................
9
1.2
Calls for projects from the National Research Agency (ANR)
..................
10
1.3
The Future Investment Programme
.........................................................
12
1.4
Redeployment of resources by research organisations
..........................
13
1.4.1 Funding effort mainly provided by the National Centre for Scientific
Research (CNRS) and Inserm
...........................................................
13
1.4.2 Financing provided by Pasteur Institutes in Paris and Lille
................
16
1.4.3 Other financing: the AFD and CEA
....................................................
17
2 LOCAL INITIATIVES LED BY UNIVERSITIES AND CHUS
.............................
19
2.1
A significant participation of universities in the research effort
................
19
2.2
Clinical research conducted by the CHUs
..............................................
21
3 SUMMARY OF FINANCING MOBILISED
........................................................
22
4 SOME ELEMENTS OF INTERNATIONAL COMPARISON
..............................
23
AN INITIAL REVIEW OF RESEARCH FUNDING AS PART OF THE FIGHT
AGAINST COVID 19
........................................................................................
27
ANSWERS OF THE ADMINISTRATIONS AND BODIES CONCERNED
...........
46
3
PROCEDURES AND METHODS
Court of Accounts reports are produced by one of the Court's six chambers or by a
group involving several chambers and/or several regional or territorial chambers of accounts.
Three fundamental principles govern the organisation and activity of the Court as well
as of the regional and territorial chambers of accounts, thus the performance of their audits
and investigations as well as the preparation of the resulting public reports: independence,
review and collegiality.
The
institutional independence
of the financial courts and the statutory independence
of their members ensure that the audits conducted and the conclusions drawn are done with
complete freedom of assessment.
Review
implies that all findings and assessments made during an audit or investigation,
as well as all subsequent observations and recommendations, are systematically submitted to
the heads of the authorities or bodies concerned; they can only be made final after taking into
account the responses received and, where appropriate, after hearing the views of the officials
concerned.
Except for reports made at the request of parliament or the government, the publication
of a report is necessarily preceded by the communication of the draft text that the Court
proposes to publish to ministers and officials of the bodies concerned, as well as to other
directly interested legal or natural persons. In the published report, their responses are
presented in the annex to the Court's text.
Collegiality
intervenes to conclude the main steps of the audit and publication
procedures. All audits and investigations are entrusted to one or more rapporteurs. The
investigation report, as well as subsequent draft observations and recommendations,
provisional and final, are reviewed and discussed on a collegial basis by a group involving at
least three judges. One of the judges acts as quality reviewer and ensures the quality of the
audits.
*
**
4
This audit, in a new format known as "flash", focuses on a current topic and a period
under review of fifteen months. It prepares a comprehensive inventory of all public and private
resources involved in public research from 1 January 2020 to 1 March 2021. The financial
resources and procedures used to administer them are assessed. Having been the subject of
an accelerated procedure, its investigation lasted four months, during which 13 notifications,
with reference to Article L 111-3 of the CJF, were carried out as well as around thirty interviews.
Brief questionnaires were sent to all relevant ministries, research organisations and funding
institutions, French embassies in the United States, the United Kingdom, Germany, the
Netherlands and Permanent Representation to the European Union. A specific questionnaire
was sent to all universities. The response rate was 92%. Finally, 25 CHUs out of 32 were
questioned through the Conference of CHU Directors General. The Court underlines the care
taken by everyone in responding to these requests, allowing it to present a comprehensive
and timely situation report. In order to adapt the deadlines to the circumstances, the right of
reply period was reduced to two weeks.
The reliability of the proposed tallies calls for several methodological precautions:
- The sequence that leads from the establishment of appropriations to actual expenditure is
not linear and raises the question of when a resource can be validly counted as such. As a
result, the Court, because only these data are now available, has chosen, the delegation of
appropriations as the operative event and not the implementation of the expenditure.
- The resources counted are mainly from public funds but also from private sources. The origin
of the loans assigned or reassigned may be national or European. The Court therefore
selected in its assessments all the resources allocated to French public research and
earmarked as contributions to the fight against the pandemic.
- The payroll of researchers and teacher-researchers in the civil service who participated in
the research effort is not taken into account. The funds used are mainly intervention funds.
Under these assumptions and conditions, the financing flows that may have escaped
the analysis are, by their very nature, a cause of marginal error. The concept of "resources
mobilised" here refers to all the funding brought together or collected to engage in research
related to the pandemic, whether this represents resources redeployed within research
organisations, public subsidies or private funding bodies. After making as comprehensive as
possible an inventory of the funding, corrections were made to neutralise the risk of double
counting. A summary table presents the aggregated and corrected data.
The draft report was deliberated on 10 June 2021 by the third chamber chaired by Mr.
Louis Gautier, composed of Messrs. Tournier, Guibert, Mousson, Feller, Miller, Bouvard, Ms
Delétang, Senior Counsellors, as well as, as rapporteurs, Mr. François Saint-Paul, Senior
Counsellor on Extraordinary Service, Mr. Emmanuel Roux, Counsellor in Extraordinary
Service, Ms. Béatrice Blondel, Temporary External Auditor, Mr. Patrick Netter, expert adviser,
and, as quality reviewer, Mr. Philippe Rousselot, Senior Counsellor, President of division.
It was examined and approved on 17 June 2021 by the publication and planning
committee of the Court of Accounts, composed of Mr. Moscovici, First President, Mrs Camby,
General Rapporteur of the Committee, Messrs. Morin, Andréani, Terrien, Charpy and Gautier,
Presidents of Chamber,Mr. Le Mer, President of division at the 2
nd
Chamber, Ms Hirsch,
General prosecutor, whose opinions were noted.
5
EXECUTIVE SUMMARY
In the context of the health crisis, the Court decided to initiate an audit that, while
respecting its professional standards, is noteworthy for the speed of its investigation. This work
is presented as an initial assessment of the financial effort made to support public research in
the fight against the pandemic.
The first part provides an inventory of the resources generated by the main funding
bodies (departments, financing agencies, Europe) and the resources mobilised by the main
operators, whether they are research institutions, universities or university hospital centres
(CHU).
Over the period from January 2020 to March 2021, the total amount of resources put in
place is around €502 million, or €530 million with Europea
n funds. This effort is less, in absolute
terms and relatively, than that of other European countries with comparable scientific
resources and infrastructure. The assessment carried out by the Court illustrates the plurality
and heterogeneity of financing channels.
The second part puts this assessment into perspective. Despite the particularly
meritorious efforts of all the stakeholders in the French research system, and despite the
internationally recognised qualities of our researchers, the results do not meet expectations.
The dispersal of initiatives, the difficulty in fine-tuning priorities, the unpreparedness to take
risks and administrative burdens hindered the creation of a coherent and effective response
system.
A research strategy in which every participant could recognise themselves in the place
they occupied, was missing. In particular, the lack of a lead manager for the implementation
was detrimental. In addition to assessments of the amounts of finance released in critical
situations and observations on organisational flaws in times of crisis, the audit highlights
structural flaws that need to be corrected.
6
The main findings of the survey
The total amount of resources allocated to French public research on COVID-19
amounts to €530.17
million, including European funds, or €502.48 million without these
funds. This is a significant effort, but markedly lower than what was provided in Germany or
the United Kingdom.
The Ministry of Higher Education, Research and Innovation (MESRI) and the Ministry
of Solidarity and Health (MSS) have acted to fund calls for projects (CFPs), either directly or
through funding agencies, such as the National Research Agency (ANR). In addition, the
beneficiaries, whether they are research organisations, universities, University Hospitals
(CHUs), have obtained, in varying but often significant proportions, European or private
funding and used their own resources to finance the projects. The mobilisation of the various
streams of funding was carried out through
ad hoc
processes in the short term (accelerated
calls for projects, creation of an emergency fund,
top down
financing, mobilisation of internal
resources).
The funding proved to be too dispersed to meet the challenges of the crisis, particularly
in terms of vaccine research. The lack of organisation exacerbated this dispersal. Unlike
other countries with a strong scientific tradition in biomedical matters, the overall strategy,
oversight and structuring was insufficient. This situation was amplified by the absence of a
leader recognised by all. The organisational efforts expected from the creation of the ANRS-
MIE (ANRS | Infectious emerging diseases) took place late and without immediate
resources. Finally, these exceptional financing efforts could not compensate for the funding
shortfall prior to the crisis, particularly in the biology-health sector. The success and failures
of the research are achieved over the long-term.
7
INTRODUCTION
This note, devoted to the financial resources mobilised for public research as part of
the fight against the COVID-19 pandemic, results from a survey carried out in the particular
context of the health crisis. It is inspired by the models chosen by other senior foreign
supervisory institutions. It is noteworthy for having been carried out within a tight period of four
months.
In the face of the global health crisis created by the COVID-19 pandemic, public research
around the world found itself on the front line and under an urgent obligation to respond quickly
and effectively. French research took part in this broad movement. The Court observed the full
commitment of the scientific community, in all disciplines, not only in the life sciences field, but
also computer science and in the humanities and social sciences. The scientific response
covered all research segments, whether fundamental, translational
1
or clinical and at its
various scales, administrations, research organisations, laboratories and researchers. It
considered a large number of problems related to the virus, whether it was the search for its
origins, its detection or its treatment, and also analysed all the collateral damage it was able
to produce and the consequences it may have had.
This analysis covers a period from January 2020 to March 2021. It provides an initial
review of funding for French public research as part of the fight against the pandemic and
describes how these resources were mobilised in the emergency (first part)
2
. In addition to this
review, it also seeks to understand the strategies governing their deployment, assess the
management and coordination of the whole, and suggest initial conclusions (second part).
1
Translational research (or transfer research) is located at the interface between fundamental laboratory
research, which is used to understand fundamental biological mechanisms, and clinical research that is
carried out directly with patients. The patient-oriented areas of this research are the development of
innovative therapies and diagnostic techniques.
2
The scope of the questioning has significantly exceeded that of the recent budget implementation note
issued by the Court, which related only the budgetary appropriations for the interministerial research
and higher education mission.
8
THE STATE OF FUNDING FOR PUBLIC RESEARCH
IN THE FIGHT AGAINTS COVID 19
The Court estimates at €530.17
million, by integrating European funding (or
€502.48
million for national funding alone), the total financial resources allocated to French
public research as part of the fight against the pandemic.
1 NATIONAL FINANCING
1.1 Emergency budget appropriations
Three ministries mainly contributed to the funding of research during the health crisis
(€121.8
million): the Ministry of Higher Education for Research and Innovation (MESRI)
(€51.8
million) and the Ministry of Solidarity and Health (MSS) (€60.6
million) and, more
marginally
, the Ministry of Armed Forces (€9.47
million).
1.1.1 Funding from the Ministry of Higher Education and Research (MESRI)
As a central player during the period of the health crisis, MESRI, through its Directorate-
General for Research and Innovation (DGRI), first
unblocked in March 2020, €50
million from
a freeze on the 172 programme, then an additional €1.8
million directly delegated at the end
of the 2020 management period, for a total of €51.8
million (see Appendix 1, Table 1). The
largest elements of the financing were paid in the form of additions to existing calls for projects
(
€16
million to the ANR
, €1.2
million to the ANRS), in addition to the direct financing of certain
projects, according to a variable and non-
formalized process (€12.3
million), such as the
detection of contamination
clusters
(€3
million for the deployment of the Obépine network, with
the objective of conducting the research needed to deploy a virus surveillance network in
wastewater) or understanding the epidemic and its health and social consequences
(€5.1
million for EpiCov and SAPRIS).
The DGRI also devoted €10.8
million to vaccine
research projects (€
5.5
million for three projects, €3
million for the development of the
Covireivac platform for the coordination and monitoring of vaccine tests). These resources
were able to take the form of co-
financing with the MSS (€2.3
million to carry out comparative
vaccine tests
3
), or with
local authorities (€
1 million for the Grand-
Est Region, €1 million for the
Hauts-de-France region). Finally, funding packages could be paid at the request of the ESRI
Minister's office
4
, without any form of call for projects. In addition, in March 2020, an enhanced
coordination instrument between crisis management structures was established between the
MESRI and the MSS. The objective of this interministerial unit was to monitor research
involving human persons (MSS) and fundamental and pre-clinical research (MESRI). It was
also responsible for implementing the
ad hoc
steering committee on therapeutic trials
(CAPNET), aimed at prioritising Covid 19 therapeutic trials. It followed the work of the ANRS-
3
MSS
cofinancing also covered the Covireivac and Epicov projects.
4
For example, €1
million on a project concerning the role of interferon in the immune response to
COVID-19.
9
MIE (after the merger of ANRS and REACTing, see
below
) in order to supervise the production
of vaccines
5
. MSS cofinancing also covered the Covireivac and Epicov projects.
1.1.2 Mobilisation of the Ministry of Solidarity and Health (MSS)
The MSS has rapidly introduced specific procedures to shorten the review periods for
conducting calls for projects related to the study of COVID-19, mainly as part of the clinical
research hospital (PHRC) programmes. Priorities were established through accelerated
selection, entrusted to an
ad hoc
peer panel in two waves between March and June 2020. The
first wave was intended to select priority projects for the treatment of the epidemic; the second
was reserved for those falling within the priority areas established by the World Health
Organisation (WHO). At the same time, it was possible to finance some projects that were not
part of the CFP process but were of special interest to public health through the Ministry on an
ongoing basis or by way of derogation, between March and April 2020, in agreement with
REACTing.
An exceptional procedure, known as
fast track
6
,
was set up by the MSS, particularly for
priority projects, to reduce the time limits for the opinions issued by the National Medicine and
Health Product Safety Agency (ANSM) and by the Ethics Committee [Comité de protection
des personnes], which is essential for the launch of clinical research projects. It removed the
random selection intended to ensure impartiality of the opinions rendered that led to the
involvement of practitioners on a volunteer basis
7
.
The total amount of research funding by the MSS can be estimated at €60.6
million (see
Appendix 1, Table 2). In terms of financing,
€11.6
million
8
for projects deemed to be a priority
outside CAPNET. The MSS also funded 30 CHUs carrying out research on COVID-19 through
calls for projects (€49
million). The AP-
HP benefited from a total of €24.3
million, or nearly 49%
of funds granted through this channel. The Lyon civilian Hospices received a budget of
€6.3
million, Bordeaux's CHU €5.1
million and the AP-
HM. €1.9
million. The other 26 CHUs
shared the remaining €12.5
million.
Projects labelled "national research priority" by CAPNET gave rise to a forecast
commitment of €10 million by the MSS and €10 million by the MESRI in September 2020
9
.
Since the end of this survey, the MSS and MESRI have indicated that €14 million and
€8.5
million were committed and that an additional €52
million forecast has been recorded for
financing these projects
. These €52
million came from unblocking the €31
million from the
programme 172 of the interministerial research and higher education mission (MIRES) and
€21 million from the MSS through an increase in
teaching, research, reference and innovation
(MERRI) missions.
5
The duties of the unit were specified by the Prime Minister's office in April 2020 and expanded to take
account of the evolution of the epidemic. The focus was particularly on vaccines, through monitoring the
work of the Scientific Committee on vaccines and the Covireivac project and the coordination of research
through CAPNET steering.
6
Fast track
–
procedure to reduce review periods through a short decision-making cycle.
7
The practice of random selection has been criticised by some researchers due to the lengthening of
the processing times it incurs.
8
Covireivac (a vaccine test platform for €4.2
million), COVICOMPARE tests conducted by the AP-HP,
prior to the marketing of the Moderna and Pfizer vaccines, for €2.5
million and the EpiCov study, which
measures the consequences of the health crisis on the
population (€4.9
million).
9
This amount was recorded at the informal
interministerial meeting (RIM) on 29 September 2020.
10
It was noted that the Ministry of the Armed Forces stated that it had funded 34 projects
selected as part of the call for projects launched by the Defence Innovation Agency (AID) in
the field of research in the fight against the COVID-19 pandemic, for a total amount
of
€9.47
million.
1.2
Calls for projects from the National Research Agency
(ANR)
The ANR contributed to the funding of research through three calls for projects (CFPs).
Only the first two, whose publication ended before 1 March 2021, were taken into account in
this audit. The first, Flash COVID-19, was launched reactively on 6 March 2020, a few weeks
after the epidemic was declared an "international public health emergency" by the WHO. In 48
hours, the 44 projects considered most urgent by the Scientific Committee were each able to
benefit from a seed budget
of €30,000. For the others,
an evaluation was carried out within
two weeks. The second CFP, Research-Action COVID-19 (RA-COVID-19) was launched on
20 April 2020
10
. More generally,the 2021 ANR action plan has a general "COVID-19" priority
across all of the 2021 generic call for projects (AAPG 2021).
Graphique n° 1 :
"chronology of funding for calls for projects
financed by the ANR during the health crisis"
Source:Court of Accounts based on ANR data
At the international level, the ANR, which was one of the agencies that quickly mobilised
funds, decided to partner with European or foreign partners within the framework of existing
CFPs, in order to avoid launching new bilateral or multilateral calls and lengthening deadlines.
At the national level, the search for new partnerships during the health crisis has avoided a
dispersion of resources and increased their impact. This approach is in line with the Court's
recommendations made during previous audits
11
.CFPs specific to COVID-19 have an average
budget ranging from €114,000 and €
153,000 per project, less than that granted on average to
projects generally supported by the ANR (€357,400
12
)
13
. On the other hand, the success rate,
10
Note the existence of a last CFP initiated on 18 December 2020, Resilience COVID-19, ending on
2 March 2021, with a maximum budget
of €80,000,
the publication of which is scheduled for the second
half of April 2021. It will cover new fields such as "the impact of COVID-19 on mental health" or "long
covid".
11
Report for integration to annual public report on the national research agency, 2010, p. 25.
12
Activity report ANR 2019, p. 12.
13
It should be noted that the CFPs specific to COVID-19 aim to support projects with a duration of
between 12 and 18 months, while the average duration of projects usually supported by the ANR is 3 to
4 years.
Covid
declared
"internatio
nal public
health
emergency
"
January
2020
Set-up of
financing
by
REACTing
10
February
Launch of
Flash
COVID-19
6 March
Publication
of CFP
results
9 April
Launch of
RA APP -
COVID-19
20 April
11
particularly for the Flash COVID-19 CFP (41%), is higher than for other ANR projects, which
is 18%
14
on average
15
.
Table n° 1 : resources distributed by the ANR as part of COVID-19 calls for projects
CFP
COVID-19
Selected
projects
Amount (€
million)
Success
rate
Average budget
in thousands of
€
Flash
COVID-19
106
*
€17.6
million
40.9%
153
RA-COVID-19
(2020-2021)
128
€14.6
million
20.7%
114
Total
234
€32.2
million
Source: Court of Accounts based on ANR data (
*
: of which 9 were started and not taken into account)
The coordination of strategic financing priorities strengthened during the health crisis.
Flash COVID-19 and RA-COVID-19 calls were drawn up on the basis of WHO
recommendations and then approved by an
ad hoc
scientific steering committee within the
ANR, in conjunction with the MESRI and REACTing in order to define a common financing
strategy. Clinical research, funded by the MSS, and the development of vaccines, given the
importance of the funding they require and the scope of intervention of the ANR, were excluded
from the scope of these CFPs.
For reasons relating to the specific characteristics of certain co-funders and speed of
appropriation of funds, all co-financing (regions, Fondation de France, Fondation pour la
Recherche Médicale) were not managed by the ANR but some was made directly to laboratory
supervisors without passing through the ANR. They have also sometimes given rise to the
provision of funds without waiting for formalisation through an agreement or accelerated
agreement. However, this procedure used on an exceptional basis did not go beyond the
traditional mode of project selection and evaluation, in order to avoid any breach of equality
between applicants. The researchers interviewed by the Court confirmed this rapid provision
of resources for most of them.
Table n° 2 : source of financing used by the ANR
MESRI
ANR
(intervention
budget)
Fondation
pour la
Recherche
Médicale
Fondation
de France
Regions
Total
amount
(€ million)
€16 million
€6.4 million
€4.7 million
€3 million
€2.1 million
€32.2 million
Source: Court of Accounts based on ANR data
14
Analysis note on the budget implementation of the Research and Higher Education Mission (MIRES)
2020.
15
Activity report ANR 2019, p. 12.
12
1.3
The Future Investment Programme
As part of the 3
rd
"Future Investment" Programme, with funding of €10
billion, budget
programme 423
Acceleration and modernisation of companies
was used to the extent of €249
million. Based on information provided by the General Secretary for Investment(SGPI)
in the
context of the right of reply, without further details, however, this amount almost doubled and
would amount to €528.3
million at 31 May 2021.
As part of the "Structuring research and development projects for competitiveness"
initiative of PIA3, operated by Bpifrance, a call for projects "Structuring Projects for
Competitiveness (PSPC) COVID-19 special" was launched at the end of March 2020, in order
to support companies and public partners that offer therapeutic solutions against COVID-19,
by financing clinical trials on French soil, to the extent of €50
million per project. As of
1 June
2021, Bpifrance counts seven projects, representing €84 million in aid for covid R&D.
In addition, the "Support and transformation of sectoral linkages" initiative, also implemented
by Bpifrance, includes a call for expressions of interest (AMI) intended to identify and support
innovative projects, whose potential is based on the development of new French
manufacturing and production capacities for drugs involved in treating patients with COVID-
19. As of this date, 18 projects were selected for a total
of €165
million
16
.
The ANR, also operating the Future Investment Programme (PIA)
17
, did not initiate a call
for specific "COVID-19" projects in this function, the CFPs mentioned above being those
provided for under the supervision of the MESRI. However, many ongoing projects managed
by this operator, funded by the investment programme of the future, have reoriented their
research activities to combat the COVID-19 pandemic by mobilising funding previously
obtained from the ANR
via
Flash calls. This is the case, for example, for F-CRIN the National
Platform for Clinical Research Infrastructures funded by PIA 1, which participated in research
on COVID-19 via its network, or IHU-Méditerranée Infection, which is dedicated to the fight
against infectious diseases. This financing, already taken into account in the amounts
mobilised by the ANR for Flash COVID-19 calls, is not included in the table below. The same
applies to the interests of the non-consumable endowments that finance these structures of
excellence.
Table n° 3 : PIA research funding during the health crisis
Types of projects funded
Amount (€ million)
Special COVID-19 PSPC
€84 million
AMI "Capacity Building"
€165 million
Total
€249 million
Source: Court of Accounts based on Bpifrance data
16
This is the amount of aid granted to the projects supported during this period and differs from the total
project base.
17
The Future Investment Programme (PIA), led by the General Secretary for Investment (SGPI), has
been put in place by the State to finance innovative and promising investments in the region, in order to
enable France to enhance its growth and employment potential. It is broken down into 4 successive
waves, which correspond to the commitment of new funds to continue the deployment of innovation and
growth potential in France (2010: PIA 1: €35
billion; 2014: PIA 2: €12 billion; 2017: PIA 3: €10
billion;
2020: PIA 4: €20
billion, including €11
billion included in the French recovery plan).
13
1.4
Redeployment of resources by research organisations
1.4.1 Funding effort mainly provided by the National Centre for Scientific
Research (CNRS) and Inserm
Inserm, drawing on the REACTing consortium
18
, which it coordinates, and assisted by
the AVIESAN Alliance, which it chairs, guaranteed the funding of research projects and defined
a strategy in conjunction with the ANR and the interministerial unit MSS/MESRI.
Although REACTing participated in the selection and funding of research projects
considered to be high-priority, Inserm was also able to benefit from funding, through the
success of CFPs of the ANR, the MSS and the European Union, or its Joint Research Units
(UMRs).
The financing of projects via REACTing was supported by MESRI's emergency fund
loans mobilizing a budget of €1.7
million to provide financing in full or in the form of seeding.
Within this framework, 20 projects were financed
19
. In addition, nearly €14
million from this
fund was allocated for Covireivac projects (€5.3
million), EpiCov, SAPRIS (€4.5
million) and
the Covid-
South CFP (€1.2 million). Other partners (regions, AFD) as well as priv
ate partners,
such as the Medical Research Foundation, have also allocated funding within this framework.
Finally, it should be remembered that Inserm teams have obtained funding in the context of
calls for projects from the ANR or the European Union.
In t
otal, Inserm believes that it has mobilised €55.7
million for research carried out in the
context of the health crisis. This amount includes both the financing received by Inserm as part
of its financing missions, through REACTing, as well as what was received as part of the RNA's
calls for projects by its UMRs and the amounts mobilised for the extension of doctoral
contracts. However, it does not include the payroll of its research staff.
More specifically, this amount is €31.1
million, excluding the financing of the ANR, AFD,
budgetary appropriations, already recorded in other sections of this audit and doctoral
contracts excluded from this study (see
below
, summary table)
Table n° 4 : financing committed by Inserm to research during the health crisis period
(in € mill
ion)
Type of financing
Amount (€ million)
Public financing
€30.4 million
Private financing
€2.9 million
European financing
€22.4 million
Total
€55.7 million
Source: Court of Accounts based on Inserm data
18
The REACTing consortium is a multidisciplinary consortium bringing together teams and laboratories
of excellence, in order to prepare and coordinate research to address health crises related to emerging
infectious diseases.
19
Since all of these funds were not consumed for project financing, a reorientation aimed at
supplementing the 2021 operating budget for the ANRS-
MIE agency was carried out for €978,000.
14
In addition to this funding mission, Inserm, via REACTing then the ANRS-MIE, plays
an important role in defining priority research areas within CAPNET, of which it is a member.
Inserm also participates in the development of European clinical trials, such as
Discovery
20
, in
treatments through the implementation of cohorts for SAPRIS and EpiCov projects, in the
development of vaccines through its links with the COVID-19 Vaccines Committee, and in the
coordination of the Covireivac platform, which is responsible for organising vaccine trials
throughout the country.
In addition, the former National AIDS and Hepatitis Research Agency (ANRS), an
autonomous agency of Inserm, also mobilised itself and, drawing on its network and
experience in the fight against AIDS, launched a first "flash" call for tenders on 1 April 2020, to
fund research projects for countries in the Southern hemisphere (West Africa and South East
Asia). This call for projects was supported by €1 million from the Ministry of Europe and Foreign
Affairs, €1.2 million from MESRI's "Covid
-South" emergency fu
nd and €4 million deducted from
the ANRS budget. In proportion to the amount allocated to other calls for projects at national
level, in particular by the ANR, this effort is significant. Without questioning the merits of this
initiative, however, it raises questions about the consistency, definition and coordination of
tenders at the national level.
In January 2021, following a process planned in April 2020, 9 months earlier, by the
stakeholders concerned and the Analysis, Research and Expertise Committee (CARE),
REACTing and the ANRS came together to form a new agency, the ANRS | Emerging
infectious diseases (ANRS-MIE). This agency has its own resources previously allocated to
the ANRS to fund research on HIV and REACTing. As of the date of this audit, this new
agency had not received any additional appropriations and therefore relies on the budget
initially allocated to the ANRS and mainly dedicated to HIV research
21
(€4
million) and
REACTing/Inserm (€39.8
million in subsidies for public service costs) and additional and
exceptional resources to ensure its operation in an indefinite manner.
In the coming months, the increase in the ANRS-MIE budget will be a major issue in
the fight against the pandemic. A priority research equipment project (PEPR) "Emerging
Infectious Diseases" within PIA 4, amounting to €80
million over 3 to 5 years, has been
approved and will be accompanied by a reflection on how it is managed by the ANRS-MIE.
Other funding is under discussion but is still awaiting confirmation on several points. Such
prospects, if fulfilled, should help strengthen the ANRS-MIE in the execution of its mission.
Like the ANR, Inserm has adapted its procedures to enable a faster project launches
by making cash advances without waiting for the finalisation of the agreements between the
project sponsors of the ANR or the European Union. In parallel to this procedure, some projects
were placed into a state of dormancy, these being subject to extension amendments. Inserm,
however, notes the need to provide a funding channel for EPSTs (public scientific and
technological institutions), carrying out research on human health, but which are not healthcare
organisations, for the benefit of the PHRCs without having to enter into an emergency
agreement with the CHUs (which requires a decision from the MSS beforehand, then a
20
Launched in March 2020 under the auspices of the WHO's Global Solidarity clinical trials,
Discovery
is a clinical trial of efficacy and tolerance. This is the only large-scale European academic trial on COVID-
19 treatments (source: Inserm website).
21
The Aides and Sidaction associations claimed €76
million in state subsidies in 2021, or €36.2 million
more than the ANRS budget for AIDS and hepatitis research, at the launch of ANRS-MIE (AEF, dispatch
no. 642420). Professor Barré-Sinoussi, then Chair of the CARE Committee, also recalled the need to
provide satisfactory support to the new agency that had been created (hearing before the Senate Social
Affairs Committee on 7 May 2000).
15
payment to the ARS), as was the case for the Lyon CHU (for the
Discovery
trial) and the
Bordeaux CHU.
The CNRS, taking advantage of its multi-disciplinary nature, intervened on various
research themes: building models to monitor the evolution of the pandemic (for example,
through the analysis of wastewater
–
Obépine project); implementation of decision support
tools; coordination of studies, mainly in the humanities and social sciences (SHS), related to
the social, political and economic impacts of the crisis (effects of lockdown on the mental health
of populations, or on the phenomena of discrimination) or in the economic or legal field (for
example, studies of organisational factors in crisis management, the adaptation of the law, or
the resulting major economic upheavals at the global level).
In terms of organisation, the CNRS relied on "G5 research", composed by the chairmen
of the CNRS, Inserm, INRAE, INRIA and the CEA. It also approached alliances such as
ATHENA (SHS), AVIESAN (Life and Health Sciences) and AllENvi (environmental research),
in order to create a number of common initiatives and avoid redundancy.
In terms of funding, there were many contributions. The ANR thus allocated
€3.7
million
to CNRS project sponsors as part of its COVID-19
22
calls for tenders. The CNRS has benefited
from €2.7
million from the MESRI to set up platforms and programmes, in the management of
several of its institutes, which constitute investments for possible future epidemics. The CNRS
has finally committed financing from its own resources, which have been spread across several
institutions, for a total of €360,000 in addition to the usual laboratory allocations. Part of this
has been redeployed as a result of savings in other areas of activity, particularly expenses
related to missions and conferences.
In total, the CNRS mobilised €9
million during the health crisis.
Table n° 5 : CNRS research funding during the health crisis
Type of financing
Amount (€ million)
ANR
€3.7 million
MESRI
€2.7 million
Own resources
€0.36 million
External financing
€2.3 million
Total
€9 million
Source: Court of Accounts based on CNRS data
22
For the ANRS-2020-COVID-19 SOUTH CFP: 1 INSB (UMR5308), 2 INEE projects (CNRS 5290), 2
INSHS projects (UMR8007, UMR5151).
16
1.4.2 Financing provided by Pasteur Institutes in Paris and Lille
The two Pasteur Institutes were particularly active during the health crisis. The Pasteur
Institute Paris has, in part, focused its efforts on vaccine research
23
, while Lille has been
involved in the search for therapeutic drugs.
At the Pasteur Institute Paris, an action and research group composed of experts from
multiple disciplines was set up in January 2020. This action group coordinated the engagement
of more than sixty teams and at least 450 people directly involved in several areas of research,
including knowledge of the virus, research into therapeutic strategies and vaccine
development. It also launched calls for projects so that research work can align the major
priorities of the fight against the pandemic with the expertise of the research teams at the
Pasteur Institute Paris. However, as this group remains internal, the Institute acknowledges
that it is necessary to consider the construction of an epidemic preparedness structure,
particularly in relation to the ANRS-MIE.
The essential contribution of the CNR of respiratory infections viruses at the
Pasteur Institute Paris
The National Reference
Centre (CNR) of respiratory infections viruses of the Pasteur Institute
Paris played a decisive role in the response to the COVID-19 crisis. In particular, it allowed
the first complete sequencing of the SARS-CoV 2 genome in Europe, from 29 January 2020,
as well as the development of the first diagnostic tests (RT-PCR) and serological tests used
today by hospitals and laboratories throughout France. In addition, the
CNR is one of the
leading large-scale genomic monitoring stakeholders in relation to SARS-CoV-2, enabling
identification of the emergence and development of new variants, as part of the EMERGEN project
led by SPF and the ANRS-MIE.
Out of total operating expenses of €307
million in 2020, the Pasteur Institute Paris has
devoted significant resources to the fight against the COVID-19 pandemic, committing more
than €12 million in internal financing, out of a total of more than €30 million.
23
Other research by the Pasteur Institute Paris also focused on the development of new diagnostic and
serological tools, epidemiology and modelling to set up monitoring of the epidemic, and the search for
therapeutic strategies.
17
Table n° 6 : research funding from the Pasteur Institute Paris during the health crisis
Type of financing
Amount in € million
Public financing
€5.7 million
Donations and patronage
€8.1 million
Own resources
€12.1 million
Other financing
€4.3 million
Total
€30.2 million
Source: Court of Accounts based on Pasteur Institute Paris data
A different approach was observed from the Pasteur Institute Lille. Under the same
functional and scientific direction, the work carried out brought together medicinal chemists,
microbiologists, virologists, structural biologists and clinicians representing all the expertise
required for the rapid identification of therapeutic solutions needed to manage diseases caused
by emerging pathogens. The Pasteur campus in Lille, which brings together the Pasteur
Institute Lille, the University of Lille, Inserm and CNRS, is, due to its specific features, an
especially propitious place for developing such a centre specialising in innovative treatments
against emerging infectious diseases. Joint work focused on identifying an effective molecule
against COVID-19 among drugs used for other pathologies with an antiviral activity
24
. The
Institute was strongly supported by the private sector, with the LVMH Group giving it €5
million
in October 2020 to finance its research. This funding alone represents a large part of the
amounts committed by the Institute during the period under review.
Table n° 7 : research funding from the Pasteur Institute Lille during the health crisis
Type of financing
Amount (€ million)
Public financing
€2.1 million
Own resources
€0.02 million
Private financing
€5.8 million
Total
€7.9 million
Source: Court of Accounts based on Pasteur Institute Lille data
1.4.3 Other financing: the AFD and CEA
These two operators played a significant role in research funding during the health
crisis.
1. The French Development Agency (AFD) Group
is a public institution that
implements France's development and international solidarity policy. It contributed
€24.4
million to support developing countries in the context of the COVID-19 crisis, mainly in
the African continent (€15.67 million), this being is 64% of the amount committed, far ahead of
24
In addition to these research activities, the Pasteur Institute Lille has also been active in providing
healthcare by making all of its health staff, doctors and nurses available to the ARS, as well as the
premises of its prevention centre. In addition, the Institute worked, in partnership with the Synlab Biology
Laboratory located on the campus, to set up a "corona drive" which enabled a large number of COVID-
19 tests to be carried out very quickly.
18
Asia, the Pacific Ocean and the Indian Ocean, which represent 8.19% and Haiti 11.26%. The
aim of this funding was to support actions carried out by the AFD's health and research
partners, such as Inserm (operational response to COVID-19 in French-speaking Africa,
APHRO-COV), the International Network of Pasteur Institutes (reference laboratory
mandates), the IRD (ARIACOV project in Africa)
25
or the Indian Ocean Commission (IOC).
Graphique n° 2 : distribution of the AFD's research funding during the health crisis
Source: Court of Accounts based on AFD data
2. The French Atomic Energy and Alternative Energy Commission (CEA)
quickly
got involved in research activities during the health crisis.
Excluding financing obtained as part of the Flash COVID-19 and RA-COVID-19 CFP
of the ANR and the funds granted by the University of Paris Saclay already recorded in other
developments, the amount of funding allocated by the CEA to research during the health crisis
amounted to €5.34
million. However, although only two CEA projects were financed by
European funds (H2020), the amount involved remains higher than the public funds committed.
Table n° 8 : the CEA's research funding during the health crisis
Type of financing
Amount (€ million)
Public financing
€2.24 million
Private financing
€0.6 million
European financing
€2.5 million
Total
€5.34 million
Source: Court of Accounts based on CEA data
25
On the work carried out by the IRD in the context of the health crisis, see Court of Accounts, 2021
annual public report, "The IRD - indispensable strategic choices".
19
An illustration of the complementarity of financing
In mid-March, some of the CEA-DRF teams were selected by REACTing's scientific
committee to develop an experimental model of SARS-CoV-2 infection in non-human
primates for preclinical research on preventive or therapeutic approaches, which received
funding of €40,000. This pro
ject also received funding from the ANR, as well as European
funding. This model was used to carry out one of the preclinical studies led by the national
biology
and
health
infrastructure
IDMIT
(CEA-DRF)
which
demonstrated
that
hydroxychloroquine had no antiviral effect on COVID-19. The study carried out was
published in
Nature
magazine in record time. Although the scattering of COVID-19 research
funding is frequently highlighted, this example illustrates the need to combine several
sources of funding to obtain publications in prestigious journals.
2 LOCAL INITIATIVES LED BY UNIVERSITIES AND CHUS
2.1
A significant participation of universities in the research
effort
The survey mapped the financial efforts of universities that invested in research into
COVID-19. Many institutions were involved, varying in size. They were supported by the ANR,
whose cumulative payments amounted to €8.5
million, or 24% of the total funding allocated by
universities as a whole into research undertaken in the context of the health crisis.
Several universities undertook research from their own resources for an amount
exceeding €3 million, by mobilising, where appropriate, IDEX or I
-site funds when the institution
had them (for a total of €1.6
million). Local governments played an active role in providing
finance, particularly the regions, which are very much involved, and often significantly so, in
the financing mechanism, amounting to €5.3
million in total. Some universities particularly
benefited from this (Clermont Auvergne, €863,580; Bordeaux, €739,350; Lorraine, €595,985;
Limoges, €589,125; Corsica, €344,000).
Conversely, there are few traces of European loans, which are often more difficult to
mobilise over short deadlines and have complex award procedures (cumulative amount of
€2.4
million). On the other hand, universities received support from the private sector:
companies provided financing of close to €2.8 million and sponsorship initiatives of more than
€490,000
were declared. Academic or partnership foundations were sometimes approached
with requests for funding, totalling close to €550,000, when their activity lent itself to this.
However, academic research remains largely supported by public funding, to the extent of
86%.
20
Carte n° 1 : Distribution of the main funding allocated by universities to research in
the context of the health crisis
Source: Court of Accounts based on data collected from universities
Regardless of their area of focus, universities have demonstrated a high degree of
responsiveness and an often pragmatic attitude to conducting research aimed at solving
practical problems. This made it possible to establish partnerships with companies to create
protective visors (University of Nantes) or hydro-alcoholic solutions (University of Orléans).
While financial support for biomedical research accounts for the majority (57%, mainly driven
by universities with strong research capacity
26
), it should be noted that 43% of funding has
been directed into the humanities and social sciences sector. In this area, the work focused,
for example, on the psychological effects of the health crisis and the peripheral behaviours it
imposed: the problem of hand washing, the effects of the epidemic and lockdown on the
mourning of a close relative (University of Strasbourg), characterization of the effects of the
lockdown on sleep and physical activity (University of Grenoble) and the consequences of
remote working (Clermont-Ferrand University). Several legal studies (the issue of domestic
violence, the possible legal causes behind the lateness of French laboratories in producing a
26
Where Aix-Marseille University, Sorbonne University, Claude Bernard Lyon-I University, Côte d'Azur
University, Bordeaux University, Paris University, Strasbourg University, Grenoble Alpes University and
Paris-Saclay University are mainly found.
Funds
committed (€
thousands)
University of the
Littoral
1,000
2,000
3,000
4,000
Rouen
University
Lille
University
Reims
University
Strasbourg
University
University of
Caen
University of
Rennes-I
University
of
Orléans
University of
Lorraine
University of
Haute-Alsace
Poitiers
University
University of
Clermont Auvergne
University of
Lyon-L
University
of
Limoges
University of
Bordeaux
University of
Saint-Etienne
Grenoble Alpes
University
University of
Montpellier
University of
Pau
University of
Aix-Marseille
University of
Nice
University of
Corsica
21
vaccine at the University of Paris 2) and studies in the economic and management sciences
(for example, studying the economic impact of the crisis, particularly on the default rate of
companies at the University of Paris-Dauphine) were also undertaken.
In the end, the total funding by universities (more than €35
million) shows that they
were able to fulfil their role as research operators, like the national bodies and often in contact
with them through their UMRs (see Appendix 1, Table 4)
Table n° 9 :
research funding from French universities during the health crisis
Type of financing
Amount (€ million)
Public financing
€25.2 million
Private financing
€3.9 million
Own resources
€6.1 million
Total
€35.2 million
Source: Court of Accounts based on data collected from universities
2.2
Clinical research conducted by the CHUs
The University Hospitals (CHUs) have played a central role in the fight against the
pandemic. The organisations established, which the Court was able to study through data from
a census carried out by 25 of the 32 existing institutions
27
, showed that they played a leading
role in clinical research, in connection with translational
28
and fundamental research, seeking
to develop or strengthen their links with universities, research organisations or industry.
Major clinical research studies have been conducted on a regional or even national
scale to include as many patients as possible (trials conducted for priority studies, such as
Discovery
or French Covid). In addition, the CHUs responded to the many CFPs related to
therapeutic trials, which included assessing different strategies, understanding the
mechanisms of the virus and disease, and identifying risk factors among vulnerable
populations
29
. They also developed, on their own initiative, related projects to explore all
aspects of the pathology, including care and organisation. Complementary to national projects,
27
List of 25 CHUs concerned: CHU Amiens-Picardie, CHU Angers, CHU Bordeaux, CHRU Brest, CHU
Caen, CHU Dijon, CHU Grenoble, CHU La Réunion, CHU Lille, CHU Limoges, AP-HM, CHU de
Martinique, CHU Montpellier, CHU Nancy, CHU Nantes, CHU Nice, CHU Nîmes, AP-HP, CHU Poitiers,
CHU Rennes, CHU Rouen, CHU Saint-Etienne, CHU Strasbourg, CHU Toulouse, CHU Tours.
28
Translational research (or transfer research) is located at the interface between fundamental
laboratory research, which is used to understand fundamental biological mechanisms, and clinical
research that is carried out directly with patients. The patient-oriented areas of this research are the
development of innovative therapies and diagnostic techniques.
29
Between 2020 and 2021, the CHUs facilitated 73 category 1 research studies involving the human
person (RIPH): 37 are in progress at the date of this audit (in the process of inclusion, monitoring or
analysis), 16 have been stopped or suspended, 11 are completed and 9 are in the process of being
launched or awaiting regulatory approvals. (source:
CHU's Conference of Directors General
, April 2021).
22
these projects have integrated research projects in epidemiology, prognosis, diagnostic,
clinical and therapeutic research, and projects in the humanities and social sciences (for
example, on the evaluation of psychological and ethical assistance mechanisms for
resuscitation caregivers, or on the early return home for non-Covid patients). The hospital-
university teams finally distinguished themselves by developing alternative uses for certain
innovations in crisis situations (personal protective equipment, medical equipment, etc.).
The external funding streams received by the 25 CHUs to finance their research have
been numerous and varied (see Appendix 1, Table 3). Half of them emanated from the MSS
(more than €32
million
30
). The rest comes from national agencies and operators (ANR,
Bpifrance, innovation agency of La Défense) and regional health agencies. We also note the
participation of local authorities (towns, cities, departments and regions) to the extent of
€2.7
million, that of IDEX or I-
SITE supported by universities (€2
million), and the major
financing of industrial and sponsor partners (€8
million). The CHUs finally carried out certain
projects from own resources, amounting to €4.5
million.
In the end, the CHUs mobilised nearly €60
million, which positions them well above
universities (nearly €35
million) and made them significant players at the national level.
Table n° 10 : distribution of CHU funding for research during the health crisis
Type of financing
Amount (€ million)
Public financing
€49.8 million
Private financing
€9.6 million
European financing
€0.3 million
Total
€59.66 million
Source: Court of Accounts based on data collected by the CHU Directors' Conference
3 SUMMARY OF FINANCING MOBILISED
The total amount of financing mobilised in the context of the health crisis has been
established at €530.17
million with European funds, and €502.48
million with national
resources alone. The table below presents both results. Compared to the previous tables,
corrections neutralised the double counting. This operation can be performed easily for funding
from the ministries (€121 million) and funding from finance agencies (€289
million). On the
other hand, there remains a marginal risk of error for institutions, due in particular to mixed
research units whose cross-funding is sometimes difficult to unwind.
30
For all CHUs, the amount of CFPs financed by the DGOS stands at €49
million.
23
Table n° 11 : overall distribution of research funding during the health crisis period
Funders
Amount
in €
millions
including
European
financing
Amount
in €
millions
excluding
European
financing
Appropriations from ministries
MESRI
51.8
51.8
MSS
60.6
60.6
MINARM
9.47
9.47
Total
121.87
121.87
Funds mobilised for financing agencies
ANR (Flash COVID-19 and RA-COVID-19)
excluding MESRI emergency fund
16
16
Future Investments Program -PIA3
(SGPI/ Prime Minister)
249
249
AFD
24.4
24.4
Total
289.4
289.4
Appropriations mobilised by research organisations and universities
Inserm (excluding MESRI, MSS, ANR and AFD)
31.1
8.7
CNRS (excluding ANR and MESRI)
2.6
2.6
CEA (excluding MESRI, MSS, MINARM, ANR
and universities)
4.27
1.77
Pasteur Institute Lille (excluding public financing)
5.8
5.8
Pasteur Institute Paris (excluding public financing)
24.5
24.5
Universities (excluding ANR, MESRI and MSS)
26.23
23.74
CHU (excluding PHRC and ANR)
24.4
24.1
Total
118.9
91.21
Grand total
530.17
502.48
Source: Court of Accounts
4 SOME ELEMENTS OF INTERNATIONAL COMPARISON
Comparisons are not easy due to differences in structuring research and differences in
budget presentation. In a pragmatic fashion, the Court has sought to establish orders of
magnitude for 2020 that are as reliable and comparable as possible for the amounts involved,
in particular by excluding costs related to care and the purchase of vaccine doses, as well as
staff payroll. Despite these precautions, these assessments may also be subject to
methodological biases, in particular when taking into account or including, more or less
exhaustively, remuneration and welfare costs. Appendix 2 outlines how these assessments,
which relate to public funding, have been constructed.
24
In 2020,
Germany
committed a total of €1.5
billion in public funding to support
research. It had major advantages, first of all its biotech companies
31
, the first in Europe for
expertise in mRNA vaccines (BioNtech, and Curevac under testing). Germany has resolutely
protect
ed the research effort of its biotech companies (injection of €1
billion) against the risks
of takeover from outside Europe.
A strong prioritisation of clinical trials, through a network which all university hospitals joined
and cooperate with, was set up immediately. One of the strengths of this network was the
speed of its launch (national task force, data exchange platform, selection of 13 priority
research projects)
32
. On average, 20 university hospitals cooperate on a project. Most
clinicians are involved in these projects carried out within hospitals and report experiences and
new findings through the data exchange platform. The project enjoys broad acceptance within
German university hospitals. For the year 2021, in addition to the extension of funding
(€50
million), the Ministry of Research added €240
million for collaborative development from
2022 to 2024. The level of public funding for research also allows heavy concentrations on five
research institutes.
In 2020, the
United States
committed a volume of funds for research on COVID-19 of
$11.6
billion, or €9.63
billion. After the 2001 attacks and the use of the Anthrax, the United
States created the agency BARDA (
Biological Advanced Research and Development
Authority),
a federal agency responsible for supporting the development of medical
countermeasures that the government considers necessary. Administratively, the
BARDA
is
an agency of the
Health and Human Services Department (HHS,
the Ministry of Health and
Social Affairs) in the Office of the
Assistant Secretary for Preparedness and Response (ASPR,
Deputy Minister for Preparation and Response) who has also managed the
Strategic National
Stockpile
since 2018.
The objective is 1) to advise the Secretary (
US HHS);
2) oversee the
research and advanced development of appropriate countermeasures; 3) maintain the
national strategic stock and 4) provide logistical support for the federal response to public
health emergencies. The law "re-authorised" the Agency in 2013 and, with more difficulty, in
2018, parliamentarians and industrialists at the time doubting the commitment of the US
administration to continuing its action effectively. The
21st Century Cure Act
adopted at the
end of 2016 gives the
BARDA
the opportunity to form public-private partnerships. Its
Division
of Research, Innovation and Venture
must leverage the new authorisations granted to
stimulate innovation through two forms of financing: one dilutive (which impacts the structure
of shareholders, that is, the company's capital), the other non-dilutive (which retains current
shareholders, and takes the form of bonds or loans). The idea is to build an innovation
ecosystem, led by industry and entrepreneurs, to address the country's major health threats.
In recent years, the budgets allocated were $1.02 billion (2018), $1.27 billion (2019),
$1.6 billion (2020) and the request for 2021 is $1.4 billion. The portfolio of projects supported
by the
BARDA
against COVID-19 is regularly updated
33
.
The COVID-19 crisis was an opportunity to develop a new public-private partnership
model to allow the public sector to take part of the risk that the private sector could not pre-
finance (
to de-risk
). This is mainly the risk associated with the development of vaccine
31
According to the OECD, biotechnologies or "biotechs" are the application of science and technology
to living organisms, as well as its components, products and modelling, to modify living or non-living
materials for the production of knowledge, goods and services. Biotech companies rely on this scientific
research and technology to develop solutions.
32
For the list of 13 themes:
In normal times, negotiations
between the government and the
Länder
take longer.
33
25
candidates, which is only detected at the time of clinical trials. To make this administrative
centre competitive, it has been equipped with financial resources capable of strengthening the
prioritisation of clinical trials. It is the public-private ensemble that is financed generally.
The
Netherlands
has
committed around €360 million, but by allocating a significant
portion of this investment in international cooperation, which calls for some clarification. The
Dutch contribution
includes a €192 million stake in the multilateral alliance
Access to COVID-
19 Tools
(ACT). ACT is an alliance that includes the WHO, the Coalition for Innovations in
Epidemic Preparation (CEPI), the Global Alliance for Vaccines (GAVI), the Global Fund
Against AIDS, Malaria and Tuberculosis, the Bill and Melinda Gates Foundation, etc. This set
includes four areas of action: diagnostics, therapeutic products, vaccines (COVAX dose
purchase financing), strengthening of health systems. This alliance is therefore not only
research-oriented, but has much broader objectives. If we do not take this contribution into
account, but we do, on the other hand, include the Dutch contribution to the CEPI Coalition,
which focuses particularly on research, including clinical research, this gives a Dutch
commitment to research of at least €165
million.
The Netherlands contributed €50
million to
the CEPI, which is a very substantial commitment to research through the multilateral channel.
In the
United Kingdom
, total research funding (including the preparation of future
production centres) is approximately £1.12
billion, or €1.3
billion. The UK has suitable steering
structures. This is the case with the UKRI (
United Kingdom Research Innovation
), created in
2017-2018, which brings together all the funding bodies involved in the field (the board brings
together the universities, charities, industry, etc.). The creation of the UK Vaccine Taskforce
should be noted. It was headed in 2020 by an experienced figure from venture capital
background in the biotechnology sector. It is also necessary to add a very strong prioritisation
of clinical trials (
Recovery
) accepted by all stakeholders, and, furthermore, the excellence of
the academic laboratories of the golden triangle (Oxford, Cambridge, Imperial College) at the
cutting edge of research, including fundamental research (£130 million injected in 2020). This
ecosystem appears to be well suited to risk-taking.
The European Union has
committed €4.4
billion to support the pandemic research
effort. With no equivalent of the U.S. BARDA agency, the EU had to create a new tool in order
to switch to a risk-taking economic model: the conclusion of anticipated purchase contracts by
the Commission with the manufacturer, before marketing authorisation from the European
Medicines Agency, all financed by the emergency aid instrument of the European budget,
making it possible to reserve subsequent purchase by the Member States. This shift, in which
France was heavily involved, was essential to improve the performance of European research,
that is to say, for European citizens to have access to therapeutic products resulting from this
research and therefore for this European research to not be used only to pave the way for the
success of other ecosystems, admittedly with solidarity but generally competing. To the
standard element of the calls for research projects, funded by Horizon 2020, a second stage
was added (
ERA vs.
Corona
plan) allowing the injection of funding into biotechs (InnovFin,
IMI2, the pilot phase of the EIC).
The most significant innovation was the use of the emergency aid instrument, which,
on the
American
BARDA model but without fulfilling all of its functions, is the administrative
centre of European public risk-taking. The European Union mobilised within a few weeks,
without having the early advantage of the United States, for example, which founded the
BARDA Agency in 2006. However, the experiment remains fragile and needs to be
consolidated and expanded (European Health Emergency Preparedness and Response
Authority project
HERA)
.
26
Table n° 12 : international comparison of the distribution of public
research funding in the COVID-19 crisis
Country
Amount in €billion
Germany
1.5 billion
United States
34
9.63 billion
Netherlands
0.16 billion
United Kingdom
35
1.30 billion
European Union
4.4 billion
Source: Embassies of France in Washington, London, Berlin, The Hague,
PREU.
34
Exchange rates as at 4 May 2021: 1.2044 (Bank of France).
35
Exchange rates as at 4 May 2021: 1.1556 (Bank of France).
27
AN INITIAL REVIEW OF RESEARCH FUNDING AS PART OF
THE FIGHT AGAINST COVID 19
The scientific community was strongly mobilised during the crisis period. However, this
large-scale response should not mask a set of systemic difficulties that most often derive their
origin from the organisation and operation of French research in the biomedical and
biotechnology field.
1. SCATTERING OF INITIATIVES
The considerable number of calls for projects suggests major fragmentation, if not a
lack of overall control, all the more marked in that it was exacerbated locally by the distribution,
according to the same terms, of the funding of
universities, CHUs and regions. This aid thus
sometimes constituted a kind of "second chance" for projects that failed to obtain national
funding. The support provided to researchers by their associated institution, positive though it
is, has often resulted in a dispersal of resources that fails to provide guarantees against
redundancy and fails to encourage synergies. Calls for projects are an undeniable motivating
factor for research. However, their multiplication has limited the emergence of an intelligible
overall strategy. Furthermore, the number of decision-making centres, administrative or
comitological, highlighted the absence of a leader. No institutional stakeholder had any real
power to regulate research priorities and funding during the crisis
36
. Disconnection phenomena
have been observed, in initiatives at both national and local level. The reverse has also
fortunately been observed in a few cases. On the Lyon site, for example, a number of
stakeholders participated in the same research operations in a coordinated manner: university,
CHU, COMUE, region, competitiveness cluster and foundation, which seems to be a
guarantee of greater effectiveness. At the top of the edifice, the MSS and MESRI ultimately
had little coordination of their projects, despite undeniable initial willingness and the
organisation of many interministerial meetings in an unprecedented format. Each ministerial
department finally followed a policy of support for research that was specific to it and did not
necessarily meet the same objectives. The MESRI has therefore put in place a specific
administrative centre policy, with direct funding allocated in a discretionary manner to certain
research laboratories, sometimes without even informing their local supervisor, at the risk of
cutting themselves off from academic governance structures and operating in too isolated a
manner. The MSS also had its own funding strategy, mainly focused on clinical research
hospital (PHRC) programmes.
36
Senate,
Public Health: for a new start - Lessons from the COVID-19 epidemic,
Report
No. 199 of 8
December 2020, Q1, p. 248.
28
The research frenzy that began in early 2020 showed the need for comprehensive and
regularly updated research databases. The development of certain initiatives, such as the
online website WPRN (world pandemic research network), which lists studies in the humanities
and social sciences during the crisis
37
, would, if carried out in the field of biology-health
research, make it possible to improve effectiveness and avoid engaging in dispersed work.
This type of tool should be hosted by the MESRI.
2. INSUFFICIENT PRIORITISATION OF RESEARCH
The launch of calls for "flash" projects on a pathology, while it is already widely affecting
the population, however imperative this may be, is obviously difficult to reconcile with rigorous
structuring of scientific approaches over the long term. In the first analysis, despite the funding
of the Covireivac platform by the MSS and the MESRI, it appears that the funds mobilised for
vaccine research were not the subject of a large-scale and coordinated commitment. Excluded
from the scope of calls for projects by the ANR, vaccine research received overall financing of
€11
million by the MESRI emergency fund, and €7
million directly from the MSS, representing
a total of around €20 million (excluding PHRC). It is difficult to establish the choices, made or
unmade, which are responsible for this situation upstream. In addition, no fewer than 350
therapeutic and clinical trials are listed in July 2020. According to many observers, these tests
would have neutralised each other, notably by drying up the pool and availability of volunteer
patients to participate in the tests. In addition, in order to bring together experimental cohorts
in sufficient numbers of patients, the transition to European level has not been successful,
provided it has been sought.
Insufficient cohorts of patients for carrying out vaccine research
In his report "Clinical trials in the epidemic context" dated 7 June 2020, Professor Patrick
Rossignol indicated that to meet the needs of the 98 Category 1 trials (not risk-free) then in progress,
a total of 34,000 patients would have had to be recruited. He noted that "these recruitment objectives
appear unrealistic and certainly counter-productive given competition between studies, some of which
are, moreover, potentially redundant and some scientifically outdated" (report p.14).
The comparative view makes the structural difficulties in France even more salient,
illustrated in the eyes of public opinion by the absence of a vaccine design. As noted by the
Chair of the CARE Committee: "
The establishment of a few small production units outside the
commercial sector - capable of operating in accordance with the standards of Good
Manufacturing Practices (GMP) and backed by universities (as is the case at Oxford University)
or research institutes, would allow us to quickly test new concepts in humans
"
38
. For example,
Oxford University was able to rapidly develop its vaccine candidate due to the existence of a
small production unit, the
Clinical Biomanufacturing Facility
. There is an urgent need to
37
The crisis has also strengthened the already identified need for research in the field of the humanities
and social sciences to inform public decision-making and analyse societal developments. Unlike
experimental research, particularly in life and health sciences, the humanities and social sciences are
less accustomed to CFPs, especially when targeted thematically. Nevertheless, they have shown a
good ability to respond urgently.
38
Hearing by F. Barré-Sinoussi before the Senate Committee on Social Affairs, 7 May 2000. The
success of Pfizer / BioNtech and Moderna vaccines is linked to access to the production of RNA
messengers under GMP conditions, which has enabled this innovative solution to be tested quickly.
29
consider providing some public research centres with the ability to conduct preclinical or clinical
trials in accordance with the best international standards.
Several research units have been able to collaborate with companies, notably through
the support of Technology Transfer Acceleration Companies (SATTs) and companies that
sometimes form part of competitiveness clusters. Public research provides expertise and
access to technology platforms. The links established in this way should be strengthened. In
the same vein, it is also necessary to improve the transfer of fundamental research to industrial
development, by offering better support to researchers in the start-up creation process. This
requires actively supporting the biotechnology infrastructure, which is still underdeveloped in
France
39
.
It is therefore necessary to provide long-term public support to national infrastructures
from the PIAs, as well as to the indicated health biology platforms of public research
institutions.
3. RIGIDITIES
The majority of researchers welcomed the responsiveness of the funders, including the
ANR. However, they regret the administrative burdens which are inappropriate in times of
crisis, especially for obtaining prior authorisations. Given the necessary and irreducible time
between the response to CFPs ("flash" or not), the publication of results, the actual installation
of funds in laboratories and sometimes scarce supplies, the projects could only really start at
the beginning of the summer, or even in autumn 2020. In the mixed research units, which apply
different operating methods according to their multiple supervisory associations, the
collaborative procedures of CFPs have lacked flexibility. Transfers between partners often
proved impossible, except with derogations granted on an exceptional basis, a bureaucratic
ordeal that was wasteful of time and energy. Finally, the crisis highlighted the need to
harmonise the management rules within the UMRs. Research organisations must converge,
with each other and with universities, in order to align their budgetary operating procedures,
thereby offering the simplification demanded by the research community. These structural
difficulties, however long-standing they are, become critical in an emergency situation.
39
According to the Economic Analysis Council, the share of French biotechnology companies is down
and the average financing ticket for these companies by venture capital investors stands at 9 million in
France, compared to 12 million in the United Kingdom and 16 million in Germany. The CAE also
stresses "the slow decline in France" in terms of patents between the mid-1990s and the 2000s", and
points out that Germany devotes 3% of its GDP to R&D, while in France it is 2.2%. See "Pharmaceutical
Innovation, how to close the French lag", CAE Note No. 62, January 2021.
30
An illustration of administrative slowness: the implementation of the CHIP COVID-19
project
1. File submitted to the ANR on 27 April 2020 and accepted on 4 June 2020. Contract
signed on 8 June 2020.
2. ANR agreement received by the University of Paris on 2 September 2020, and
freeing up of money by the ANR on 17
September 2020 (€59,000), or three months after the
signing of the contract.
3. The 100 DNA samples of COVID-19 patients obtained from the French-Covid
(Inserm/REACTing) cohort are delivered late. First request on 9 April 2020, accepted on 23
October 2020, with authorisation to transfer samples signed on 30 October 2020. The Inserm
clinical research centre, however, requested a new transfer agreement on 4 December 2020
(to improve the traceability of samples), finally signed on 25 January 2021. Samples are
unblocked on that date.
4. The application file for 100 samples of COVID-19 patients, submitted to the APHP
on 9 April 2020, has never been accepted, despite numerous negotiations, and the submission
of preliminary data that could validate the scientific approach used.
5. Given all the accumulated delays, the project sponsor is applying for DNA samples
in England in autumn 2020. The application was accepted in less than one month and samples
(approximately 350) are delivered in less than two months. Sequencings start at the end of
2020.
In terms of public procurement, the administrations did not fully take advantage of the
provisions of the Order of 25 March 2020 which covers contracts in progress or concluded
during the state of health emergency. In addition to numerous relaxations of procedure, it
allows a public contract to be awarded without advertising or competition, for reasons of
general interest
40
. This latter provision, generating time-savings, was discovered late by the
research operators, who feared possible litigation due to the fact that the text was too vague.
They generally preferred to apply the less comfortable but better known provisions of the 2015
Order, which, in exceptional circumstances, allows for the reduction of consultation times
(simple emergency) or, exceptionally, the resort to a contract without advertising or competition
(urgent emergency)
41
. Since the notion of imperative urgency is strictly applied, it has seldom
been used during the crisis
42
. In order to be fully exploitable, operators should have been
offered specific support for these exemptions from ordinary law; some operators, such as
40
Provisions of the Order of 25 March 2020 codified in Article R. 2122-1 of the Public Order Code.
41
Order No. 2015-899 of 23 July 2015 on public contracts and its implementing decrees of
25 March 2016.
42
Inserm indicated that it was activated to urgently order FFP2 and 3 masks and to implement the
Discovery
clinical trial.
31
Inserm, recognise that they have been under-used
43
. Similarly, complexities continue to exist
in relation to recruitment and international cooperation.
Academic or hospital research centres have regularly suffered from problems in the supply
of equipment for care facilities, but sometimes they have been assisted locally by civil society
(manufacture of protective equipment, donations of stocks by individuals or businesses). It
must be possible to stimulate the responsiveness of logistics circuits in the event of a crisis by
prior planning and financial support that is as close to the ground as possible.
Universities and research organisations have shown that they are an important regional
network in connection with local governments. The public authorities should rely more on this
group, by also promoting better integration of some researchers or laboratories located in the
regions into international networks.
The historical partitioning between the various operators which are research
organisations, universities and CHUs, and the overly narrowly-focused operation of each of
them, may have been a critical obstacle to providing the appropriate responses quickly.
4. POSSIBLE AREAS FOR IMPROVEMENT
In the coming months, it will be necessary to draw up a catalogue of best practices and
innovations revealed in times of crisis, and to study the possibility of their dissemination.
Attention should also be paid to a few systemic blockages.
-
Organise crisis management governance and appoint a lead manager.
For the
future, it would be necessary for the public authorities to reflect on how scientific research can
be made more responsive in times of crisis. The various stakeholders in the scientific
community are clear. They are already convinced of the need for a single steering structure,
which is responsible for the programming and launch of calls for projects, the evaluation of
proposals received and the allocation of resources. In the field of the life sciences, this mission,
at the national level, could be carried out by Inserm, provided it has more appropriate means
(ANRS-MIE, Alliance AVIESAN)
44
. The MSS refers to the project to create an "Agency for
Innovation", without providing more details at this stage
45
. The lack of steering observed in this
crisis justifies, in addition to rapid clarification, the establishment of a "research continuity plan"
in order to mobilise researchers in the event of a new major health crisis and to reduce the
43
The European strategy as applied deserves an in-depth analysis, based on feedback, to understand
how it worked and how it can be improved. It would be interesting to assess with industry the impact of
this strategy on their commitments in terms of product development in order to increase the
effectiveness of the European approach.
44
The two academic establishments of medicine and pharmaceuticals recall the position that the
Aviesan Alliance should occupy in leading this coordination work (see report "Reforming Research in
Biological Sciences and Health: Part II, the organisation" of the National Academy of Medicine published
in March 2021). The MSS indicates that steering by an agency whose governance is shared between
public institutions, EPSTs and research stakeholders would be more appropriate.
45
This proposal seems to be based on the one carried out by France Biotech (association of all
entrepreneurs in the Healthtech sector: biotech, medtech, e-health, artificial intelligence) in its Health
Innovation Plan unveiled in the autumn of 2020. It would be a new authority, to which the main health
bodies would contribute, and the creation of which should be accompanied by a health programming
law providing three-year or even five-year spending forecasts.
32
bureaucratic burdens that remain despite all the efforts made. In more forward-looking terms,
funding for health research is increasingly required to follow an economic model based on two
principles: public-private partnership, which involves risk-taking, and concentration of
resources.
-
Give priority to fundamental research in the biology/health field.
The lack of
therapies available immediately or in the short-term is partly related to the lack of sufficient
funding in some areas of fundamental research
46
. While it is true that significant and long-
term funding has been given to fundamental research for infectious diseases, such as
AIDS/HIV, hepatitis and tuberculosis, through the creation of the ANRS in 1988, or for so-
called ageing diseases (Neuro-degenerative and Cancer Diseases), the scientific
community agrees that the field of fundamental research has suffered from insufficient
funding in the past two decades, particularly in the area of infectious coronavirus-type
diseases, which have been identified for several decades. The age pyramid and
globalisation have made France and Western countries vulnerable to diseases wrongly
thought to be circumscribed to inter tropical countries. This has been neglected. The
emergence of new vaccine strategies (messenger RNA vaccines in particular) shows that
the therapies of tomorrow have been developing for a long time, through risk financing
and massive investment in their transfer and marketing. A more regular investment in
some areas of fundamental research and hospital clinical research is needed, in order to
have more favourable conditions for the urgent development of therapeutic solutions in
the event of health crises
47
. A long-term effort, if necessary initiated by the Law of
Research Programming (LPR), the Recovery Plan and PIA 4, should be continued to
support research infrastructures and researchers over the long term.
-
Ensure a research continuum in a manner similar to the way that foreign
research is organised.
Foreign examples show that integration between academic
research and industry can be the core of national scientific policy. At the European level,
significant funding is planned for collaborative projects focused on research partnerships.
It is desirable to strengthen the funding of fundamental research at European level, in
support of national contributions, both in the ERC budget
48
and in the budgets dedicated
to collaborative research. At the international level, it would be useful to develop funding
instruments for international collaborative research that will make it possible to combat
pandemics more effectively.
In addition to financing, the regulatory environment is particularly complex in France and
Europe, which can be a barrier to innovation.
46
This observation, valid in France, is also applicable worldwide. The Court has already had occasion
to question the proper allocation of research funding in France, in its June 2013 thematic public report,
"Public funding for research, a national issue".
47
As the Economic Analysis Council [Conseil d’analyse économique (CAE)] noted in January 2021,
public R&D funding for health in France fell by 28% between 2011 and 2018 and now amounts to half
of the public funding in Germany. See also the report of the National Medical Academy of March 2021
(op.cit.), which estimates that the budget for biology-health has decreased by 25% between 2008 and
2020 (Part 1 of the report, p.5).
48
ERC (
European Research
Council) finances individual grants for projects of scientific excellence as
part of the Horizon Europe programme.
33
CONCLUSION
The results produced in this audit seek to give the most accurate and objective reflection
of the amounts committed by France, with the support of European financing, in the fight
against COVID-19, since March 2020. By definition, they are provisional, since new calls for
projects were launched at the beginning of 2021, particularly by the ANR, and are still ongoing.
It will therefore be necessary to carry out a new assessment at the end of the crisis.
However, lessons can already be learned, the foremost of which appears to be that France
has mobilised
€530
million allocated to support research funding during the first period of the
health crisis. However, this large amount is still behind when compared to the funds provided
in Germany or the United Kingdom.
In reality, the difficulty was not to mobilise funding, but rather to set up organisational chains
to allocate it to strategically effective and targeted expenditures, which has often proved to be
problematic with the dispersal of decision-making centres.
Beyond that, the analysis of the crisis period remains incomplete, and even misleading, if
it is not replaced over the long term. The financial resources allocated during this crisis period
should not mask the fact that research is organised very much upstream and is structured
around a policy of prioritisation, significant recurring funding and selective financing, which,
through risk-taking, disruption and development, bring forward innovative treatments for
emerging diseases.
Failing this, exceptional resources - significant though they may be - unlocked on an
emergency basis, may prove to be too late.
34
LIST OF ABBREVIATIONS
CFP
....................
Call for Projects
AFD
....................
French Development Agency
AMI
.....................
Call for expressions of interest
APHM
.................
Assistance Publique-Hôpitaux de Marseille
APHP
.................
Assistance Publique-Hôpitaux de Paris
ANR
...................
National Research Agency
ANRS
.................
National AIDS and Hepatitis Research
ANRS-MIE
.........
National AIDS and Hepatitis Research Agency
Emerging Infectious Diseases
ARS
....................
Regional Health Agency
AVIESAN
...........
National Alliance for Life and Health Sciences
ATHENA
............
National Thematic Alliance Humanities and Social Sciences
AllENvi
...............
National Environmental Research Alliance
CAPNET
............
National Steering Committee for Therapeutic Trials
CARE
.................
Analysis, Research and Expertise
CEA
....................
French Atomic Energy and Alternative Energy Commission
CHU
...................
University Hospital Centre
CHRU
.................
Regional University Hospital
CNRS
.................
National Centre for Scientific Research
COMUE
. Group of Universities and Institutions
DGESIP
.............
Directorate General for Higher Education and Professional
Integration (MESRI)
DGOS
................
General Directorate for Healthcare Provision
DGRI
..................
Research and Innovation Directorate (MESRI)
EPST
..................
Public scientific and technological institution
F-CRIN
...............
French Clinical research infrastructure network
GHT
...................
Territorial Hospital Group
ICAN
..................
Institute of Cardio-Metabolism and Nutrition
IDEX
...................
Initiative of Excellence
IHU
.....................
Hospital-university Institute
INRAE
................
National Research Institute for Agriculture, Food and the Environment
INSB
...................
Institute of Biological Sciences (Institut des sciences biologiques) (CNRS)
INSERM
. National Institute of Health and Medical Research
IRD
.....................
The Research Institute for Development
RPA
....................
Research Programming Act
35
MERRI
...............
Education, Research, Reference and Innovation Missions
MESRI
................
Ministry of Higher Education, Research and Innovation
MINARM
............
Ministry of the Armed Forces
MSS
...................
Ministry of Solidarity and Health
WHO
..................
World Health Organisation
PIA
.....................
Future Investment Programme
PEPR
.................
Priority Research Programmes and Equipment
PHRC
.................
Clinical Research Hospital Programmes
PHRC-I
...............
Interregional Clinical Research Hospital Program
PSPC
.................
Structured Projects for Competitiveness
REACting
...........
REsearch and ACTion targeting emerging infectious diseases
SHS
....................
Humanities and Social Sciences
UMR
...................
Joint Research Unit
SATT
..................
Technology Transfer Acceleration Company
36
APPENDICES
APPENDIX N° 1.
Main financial data in France
....................................
37
APPENDIX N° 2.
International comparisons - financial assessments ... 41
37
Appendix n° 1.
Main financial data in France
Table n° 13 : MESRI research funding during the health crisis
Projects financed
Amount
(in
€million)
Support for calls for
projects from the ANR
CFP Flash COVID-19
8
CFP COVID-19 research initiative of the ANR
8
Top-down
funded
research initiatives
excluding calls for
projects (€12.3 million)
OBEPINE network
3
CNRS and INRAE priority projects related to the
health crisis
2.9
Contribution to financing the development of a
saliva test
0.35
EpiCov and SAPRIS (projects to describe and
understand the epidemic and its national health
and social consequences)
5.1
Project on the importance of interferon in the
immune response to COVID-19
1
Open science and COVID-19
1
MESRI contribution to CFPs of regions most
affected by the epidemic (Hauts-de-
France (€1
million) and Grand
Est (€1 million)
2
COVID-19 vaccine
research (€10.8 million)
Three vaccine projects selected by CARE,
including Inserm, UPEC, IPL, CEA
5.5
Covireivac platform
3
Comparative academic vaccine tests of
immunogenicity ( COVICOMPARE)
2.3
CARE
21 projects on which CARE delivered a positive
opinion
1.6
REACTing
Operation of the REACTing consortium and
pre-financing of projects by REACTing
1.75
Europe and
international
COVID-19 South call for projects 1 to 13 April
2020 (Inserm / ANRS)
1.2
EDTCP (
European and Developing Countries
Clinical Trials Partnership
) (Article 185 of the
Treaty of the European Union) ( call for
international projects launched on 3 April 2020)
1
Funding of the exceptional bonus for research
organisations
4.1
Total
51.8
Source: MESRI
38
Table n° 14 : MSS research funding during the health crisis
Source: MSS
Table n° 15 : the financial resources mobilised by the 25 hospital-university centres
(CHUs) surveyed
Source: Court of Accounts according to CHU's Conference of Directors
Types of financing
Amount (€ million)
Financing of CHUs under existing CFPs
Clinical Research Hospital Program (PHRC)
(wave 1 and 2)
11
22
PHRC-I
4
Accelerated funding of CHU research projects on an ongoing basis,
excluding calls for projects
12
Total funding for CHU COVID research projects
49
Non-CAPNET funding for priority research projects (programme 204)
Covireivac
4.2
Phase 2 studies of immunogenicity (COVICOMPARE Moderna and
Covicompare Pfizer conducted by APHP)
2.5
EpiCov (Health Consequences of the Crisis)
4.9
Total
11.6
Total financing
60.6
Funders
Amount (€ million)
MSS (financing of calls for projects)
32.9
Patronage
5.2
CHU (own resources)
4.5
Bpifrance
3.9
Industry
3
Local authorities
2.7
ANR
2.3
IDEX/I-SITE University
2
Other (scientific societies, EPST, associations, etc.)
1.4
COVID-19 National Administrative Centre
0.8
ARS Regional Health Agency (Agence régionale de santé)
0.3
Europe
0.3
Ministry of the Armed Forces
0.3
GHT
0.06
Total funds mobilised by the CHUs
59.66
Total funds mobilised by the CHUs (excluding ANR and PHRC)
24.4
39
Table n° 16 : the financial resources mobilised by universities
Universities
Total funds
committed
(€ million)
Sorbonne University
5.53
Paris-XII- Créteil-UPEC
4.35
Paris
2.67
Lyon-I
2.22
Bordeaux
1.80
Aix-Marseille
1.69
Strasbourg
1.53
Lorraine
1.33
Paris-I
1.30
Clermont Auvergne
1.21
Paris-XIII Sorbonne Nord
0.97
Grenoble Alpes
0.97
Lille
0.93
Paris-XI- Saclay
0.86
Corsica
0.64
Limoges
0.59
Littoral
0.56
Nantes
0.52
Montpellier
0.48
Paris-Dauphine
0.47
Versailles Saint-Quentin-en-Yvelines
0.47
Reims
0.46
Nice
0.46
Saint-Etienne
0.40
Caen
0.40
Rouen
0.38
Paris-II
0.38
Poitiers
0.32
Haute -Alsace
0.23
Orléans
0.20
Rennes-I
0.19
Pau
0.18
Picardie
0.12
La Rochelle
0.12
Lyon-II
0.09
Dijon (Bourgogne)
0.05
Nîmes
0.05
Paris-X
0.04
Perpignan
0.02
Lyon-III
0.02
Franche-Comté
0.01
Mans
0.00
Artois
0.00
Cergy-Pontoise
0.00
Toulon
0.00
Bretagne Sud
0.00
Chambéry
No response
La Réunion
0.00
Toulouse-I
No response
40
Universities
Total funds
committed
(€ million)
Marne-la-Vallée
0.00
Toulouse-II
No response
Avignon
0.00
Toulouse-III
No response
Havre
0.00
Tours
0.00
Evry-Val d'Essonne
No response
Valenciennes and Hainaut Cambrésis
0.00
Montpellier-III
0.00
Paris-III
0.00
Brest
0.00
Rennes-II
0.00
Paris-VIII
0.00
Angers
0.00
Bordeaux- Montaigne III
0.00
Grand total
35.23
Source: Court of Accounts based on questionnaire responses
41
Appendix n° 2. International comparisons - financial assessments
This table makes it possible to compare orders of magnitude, but also to note that the
organisation in each case was a decisive factor
49
.
Instruments
Date
Operator
Purpose
Recipient
Amount
United States
Coronavirus
Preparedness and
Supplemental
Appropriation Act
6
March
2020
BARDA,
NIAD, FDA
R&D vaccines,
therapies,
diagnostics,
other health
technologies
Public and
private
research
organisations
Coronavirus Aid,
Assistance and
Economic Security
Act
(CARES ACT)
25
March
2020
DOD
Development of
vaccines and
antivirals,
laboratory tests
and purchase of
tests
Public and
private
research
organisations
and test
producers
Paycheck Protection
Program and Health
Care Enhancement
Act
23
April
2020
Public Health
and Social
Services
Emergency
Fund (HHS)
Research and
development,
production
validation,
purchasing and
management
and increased
test capacity.
Federal
agencies
(including
CDC
,
NIH
,
Barda
FDA
)
Total
announcements
2020, package of 21
December 2020
excluded, excluding
purchase of
vaccine doses and
tests
$11.56 billion
i.e.:
€9.63 billion
(€1 = $1.2044
as of 4 May
2021)
49
The figures in the table above, as well as the following comments, are based on evidence that our
embassies in Washington, Berlin, London, the Hague and the PREU sent to the Court.
42
United Kingdom
Calls for research
projects
February
2020
UKRI,
NIHR
Broad call for
projects
($500 million) and
quick-effect
projects
($24.6 million)
Public and private
research
organisations
£524.6 million
Vaccine
University
Research
March-
May
2020
UKRI,
NIHR
subsidies
University of
Oxford, Imperial
College of
London,
University of
Cambridge
£130 million
Multilateral
cooperation
Coalition for
Epidemic
Preparedness
Innovations
(CEPI)
R&D
Research
organisations,
clinical trials, etc.
£210 million
Support for
variable coalitions
of UK operators
DHSC
Universities,
public institutions
,
charities,
intuitu
personae
£32 million
Strengthening of
the research base
for production in
the national
territory
May-July
2020
BEIC
Vaccine
Manufacturing
Innovation Centre
(VMIC)
Cell and Gene
Therapy Catapult
Manufacturing
Innovation Centre
Public and private
research and
production
operators
£231 million
Total
£1,127.6 million
or €1.30 billion
(£1 = €1.1556 as
of 4 May 2021)
43
Germany
Direct support
for
biotechnology
companies
May-
October
2020
BMF, BMBF
vaccines
BioNTech,
Curevac, IDT
Biologika,
Prime
Vector
Technologies
Programme
companies
€1,068 million
Calls for
projects
July
2020
–
6
January
2021
BMBF
Therapeutic
research
Public and private
research
laboratories
€95
million
Participation in
international
initiatives
March
2020
BMBF
Therapeutic
research
CEPI (140)
Solidarity
(WHO)(1.5)
€141.5
million
Coordination
of clinical
research
March
2020
BMBF
Establishment of
a national
network of
medicine for
covid 19
CHU
€100
million
(€50
million
2021)
Länder
action
Therapeutic
research
Public and private
laboratories,
pharmaceutical
and
biotechnology
companies
€130
million
Total
€1,534.5
million
Netherlands
Calls for
projects
March-
April
and 2nd
half
2020
Minsanté,
Minrecherche,
Government
Agencies
Projects with
quick effects
(€6.5
million) and
call for projects
until 2024
(€108.5 million)
Public and private
laboratories
€115
million
International
contribution
CEPI
ACT-
19 (€
192
million, including
a research
portion, but also
the purchase of
diagnostics and
vaccines, etc.)
CEPI (€50
million)
€50 million
Total
€165 million
44
European Union (budget)
Horizon 2020
March
2020
Commission
Call for projects
research
Member State
laboratories
€48.2
million
Horizon 2020
Plan
ERAvsCorona
April
2020
Commission
€816
million
Commission
Pilot Phase
Accelerator
EIC
(European
Innovation
Council)
Calls for projects
SMEs and
start-
ups
(€166
million)
IMI2 Joint
Undertaking
Commission
Partnership with
the European
Federation of
Pharmaceutical
Industry
Associations
Biotechs and
pharmaceuticals
(€117
million)
Commission
InnovFin
Infectious
Diseases
Financial Facility
(IDFF)
and
EIB
interventions
Biotechs active in
vaccines
(€400
million)
Research
Infrastructures
Additional
financing
(11 million)
Call for projects
Commission
Member State
research
laboratories
(€122 million)
(€122
million)
Emergency
aid instrument
Commission
Commission
BR 2 (€1.4
billion), BR 6
(€1.1 billion),
Contribution
from Member
States
(€750
million)
Early purchase
contracts and
treatment financing
(Velkury
€70
million), clinical
trials (€1
million)
UV robots
(€12
million)
Biotechs and
pharmaceutical
companies
€3,250
million
45
Coronavirus
Global
Response
Brussels
Conference
Horizon 2020
4 May
2020
Commission
The Commission has
mobilised €1.4 billion
through the routing of
existing programmes
(horizon 2020, RescEu,
Emergency Support
Instrument, External
Policy Instrument) +
Commission
contribution to the CEPI
and WHO
Horizon
2020
CEPI
European
laboratories,
SMEs and
start-
ups
active in
biotechnology
€100
million
Horizon
2020
EDTCP (European and
Developing Countries
Clinical Trials)
Clinical trials,
partnership with
Sub-Saharan
Africa
€25.5
million
External
policy
instruments
Strengthening
monitoring and
research
capacity in
developing
countries
€170
million
Total
€4,410
million
Source: Court of Accounts based on questionnaire responses
46
Answers of
the
administrations and
bodies concerned
47
Contents
Prime Minister's response
...........................................................................................................
1
Response of the Chief Executive Officer of the National Centre for Scientific Research
(CNRS)
........................................................................................................................................
3
Response of the Chief Executive Officer of the National Institute of Health and Medical
Research (Inserm)
.......................................................................................................................
4
Response from the Chief Executive Officer of the Pasteur Institute
...........................................
6
Response of the Chairman of the Regional Council of Hauts-de-France
...................................
7
Response of the Chairman of the Regional Council of Grand Est
............................................
11
Recipients with no observations
President and Chief Executive Officer of the National Research Agency (ANR)
General Manager of the Office of the Commissioner of Atomic Energy and Alternative Energy
(CEA)
Chief Executive Officer of the French Development Agency (AFD) Group
Director General of the Pasteur Institute Lille
1
PRIME MINISTER'S RESPONSE
I would like to thank the Court of Accounts for its work, which leads to recognition of the full
commitment of French research to the fight against the COVID-19 pandemic. The observations, of
substance and form, which the report elicits from me are set out below,
Research results must be considered over the long term
The absence of a French vaccine at the time of the audit tends to obscure the progress of
other vaccine projects (Valvena, Sanofi, VRI, O and research still underway, and to cast things in
a no doubt more severe light than necessary, as research is by nature an activity that unfolds over
the long term.
In fact, beyond the actions undertaken that it was possible to list in the flash audit project,
the impact of research undertaken during the period of the epidemic should be measured over the
medium and long term, most especially when it has been possible to publish and exploit all of the
results, particularly in terms of technological or social innovation.
In addition to vaccines, the French research effort allowed advances to be made. As
highlighted by the Court, the results obtained, for example, in terms of sequencing and testing
development were remarkable and partly explain the success of the test policy conducted in
France. More generally, the Court's analysis might have included other results, such as the number
of publications produced and their impact.
Revisiting the scope of COVID-19 research funding, particularly in the context of a European
comparison
The Court's analysis only seems to take into account the additional national public funding
allocated in France to public research on Covid. It would be appropriate to add, on the one hand,
the recurring financing granted as well as the effort to support private or international research. The
PIA calls for projects and in particular the capacity-building project, which mobilised very substantial
funding to support private research and production capacity development (nearly €460
million for
this call alone) could have been mentioned in particular.
In addition, the scope used for international comparisons includes, on the contrary, other
types of financing. Thus, the assessment used for Germany includes €1.1 billion in funding
allocated to biotechs, which would therefore deserve to be compared to the efforts carried out by
France in this context. The assessment for the Netherlands includes funding for international
research efforts. Finally, the European Union assessment includes more than €4 billion dedicated
to vaccine pre-purchases, in relation to which France's strong action in launching and structuring
this initiative and these resources could be noted.
Lastly, the payroll of researchers in the public service who participated in the research effort
is not taken into account in France, as the funds selected are mainly intervention funds, contrary
to the methodology used for some international comparisons. It is therefore estimated that for
similar scopes of action, the costs calculated in Germany are 2.5 times higher than in France. This
comment would deserve to be included in the international comparison section of the audit.
More generally, on funding for research, the Court notes (p. 33 of the version sent) that "the
lack of therapies available immediately or in the short-term"
–
which was said to be "partly related
2
to the lack of sufficient funding in certain areas of fundamental research"
–
is an "observation, valid
in France, [which] is also applicable worldwide."
Long-term commitment of the State and evolving financial intervention tools
In general, in order to have a comprehensive view of the State's commitment and while the
virus is still circulating, it is necessary to complement the current state of the analysis to integrate
all the resources mobilised throughout the period covered by the pandemic.
Indeed, significant amounts were committed after March 2021: the National Agency for
Research (ANR) mobilised 2.95 MG as part of the Resilience Project (39 projects selected out of
147 submitted, or 26%) and resources were raised for the financing of therapeutic trials as part of
the ad hoc steering committee for national therapeutic trials (CAPNET). 34.2 MG was committed
to the budget of 51 MG provisioned in April 2021.
The flash audit highlights the risk of the scattering of initiatives and insufficient prioritisation
of research. Faced with this risk, the ministers responsible for research and health asked Professor
Patrick Rossignol, after the first wave of the epidemic, to draft a report on clinical trials in
epidemiology context.
This assessment led to the creation in January 2021 by the National Institute for Health and
Medical Research (Inserm) of the National AIDS and Hepatitis Research Agency
–
emerging
infectious diseases (ANRS-MIE). The purpose of this agency is to conduct and finance research
on infectious diseases emerging during health crises or during inter-crisis periods, in order to
strengthen the limited capacity available to REACTing.
This also led to the creation of CAPNET in autumn 2020, by the ministries responsible for
research and health. The CAPNET is based on the scientific priorities established by the ANRS-
MIE and on the scientific assessments of therapeutic studies carried out by its Scientific Council.
In addition to funding, it also gives exclusive access to a "fast-track" procedure for reviewing
authorisation files by the Ethics Committees [Comités de protection des personnes (CPPs)] and
the National Agency for the Safety of Medicines and Health Products (ANSM). This fully new
integrated mechanism for prioritisation-financing - "fast-track" has de facto granted the new agency,
from its creation, in collaboration with the Government and the regulatory agencies, resources for
emergency intervention in response to COVID-19.
Thus, it is worth stressing the very high adaptability that the research funding system has
demonstrated: it was able to modify its model in depth once the risks of the scattering of initiatives
had been identified.
Although desirable, the definition of research priorities cannot, however, constitute a
guarantee of success. While calling for prioritisation of appropriations and the development of
selective financing, the Court itself recommends maintaining "significant recurring appropriations"
(page 34 of the version received). This is what the Government focused on by adopting the law on
research programming in December 2020, which aims, among other things, to increase the basic
provision for laboratories, but also to finance priority research programmes and equipment as part
of acceleration strategies on health themes (see below) of the 4th future investment programme
(PIA4).
The Government is preparing for the future.
It should also be noted that it was, in large part, feedback received since the start of the
Covid-related health crisis that led to the "Health Innovation 2030" plan announced by the President
of the Republic on 29 June. As far as research is concerned, this plan will result in a strengthening
3
of our biomedical research capacity (€1 billion), and increased investment in specific areas:
development of biotherapies, so-called 5 P medicine (preventive, personalised, predictive,
participatory and based on proof) and pandemic preparedness, as well as support for the
management and acceleration of the implementation of clinical trials.
In addition, as part of PIA 4, an acceleration strategy was launched on emerging infectious
diseases
–
nuclear, radiological, biological and chemical threats. This strategy aims to understand,
prevent and control the emergence or re-emergence of infectious diseases. It will mobilise
€750
million, of which €80 million will be allocated to the ANRS
-MIE for the implementation of a
dedicated research programme on emerging pathogens and the pathologies they generate. This
funding will increase the budget of the ANRS-MIE and broaden the themes of its calls for projects.
In addition to this financial component, the preparation of legal and practical arrangements that can
be activated in the event of a crisis is planned. The latter component will thus respond to the need
identified by the Court to organise crisis management governance. This strategy will also be
reinforced by the related strategies launched on biotherapies and digital health, which, in total, will
enable nearly €2 billion to be mobilised on these •health challenges, including more than
€200
million specifically for research support.
Finally, the creation of a Health Innovation Agency, also announced by the President of the
Republic, will make it possible to:
Define a national health innovation strategy and ensure its implementation, including
anticipation and responsiveness in the short term and strategic vision by 2030, in line with the
research challenges in which France wishes to invest and in order to anticipate future health crises;
Simplify and clarify existing processes to speed them up, where appropriate, by proposing to
the Government the institutional organisational transformations necessary for this acceleration;
Provide a privileged and well-known interlocutor for the stakeholders in health innovation,
enabling synergy between them, guiding the drivers of innovation and supporting them;
Ensure the implementation of the 2030 health innovation plan and report to the Government
on the proper implementation of all measures, where appropriate by proposing adaptations.
RESPONSE OF THE CHIEF EXECUTIVE OFFICER OF THE NATIONAL
CENTRE FOR SCIENTIFIC RESEARCH (CNRS)
First of all, I would like to welcome the Court of Accounts' initiative in favour of an audit on
the "Financing of public research in the fight against the COVID-19 pandemic", to which the CNRS
and the many teams involved in the matter have committed to answer as precisely as possible
within the allotted time frame.
I would also like to welcome the innovative nature of this flash audit, which is the subject of
an accelerated procedure on a topical issue.
It is of course an important audit for research organisations and their partners as the COVID-
19 crisis impacted the lives and engaged the efforts of laboratories that never stopped their
research during successive lockdowns.
This audit helps to highlight this tremendous national commitment. While it reveals the
strength of the plurality and inter-disciplinary character of the CNRS, which makes it possible to
integrate the dimension of SHS into the handling of this crisis, it does not fail to point out the limits
4
of the French research system, which were crystallised during the crisis in terms of funding but also
management.
We share the finding that there has been too great a dilution of initiatives and of funding
sources and that this has prevented the fully effective implementation of a coordinated control
strategy.
Finally, there remains a question about private sector investment, regarding which it can be
asked whether it is, in terms of research and innovation, able to meet the health challenges and
international competition.
In the end, this audit does not call for further comments from us.
The CNRS remains at your disposal to continue this fastidious work of assessing research
funding, both in health and other fields.
RESPONSE OF THE CHIEF EXECUTIVE OFFICER OF THE NATIONAL
INSTITUTE OF HEALTH AND MEDICAL RESEARCH (INSERM)
Inserm shares many of the Court's findings on biomedical research, whether in terms of
prioritisation and level of funding, which has been stalling for many years compared to our major
international partners, the need to coordinate French research stakeholders throughout the
continuum of fundamental research to clinical and population research, or to build strategic and
long-term national programming by adopting priorities in order to avoid a scattering of resources.
As the flash audit rightly points out, the health crisis we are going through has unflinchingly
illustrated the strengths and weaknesses of French health research, highlighting both the resources
of creativity and commitment of our researchers, as well as the current limitations of our system.
For Inserm, in line with most of the conclusions of this audit, it is now a matter of drawing on these
lessons to drive the necessary changes and prepare to deal with other crises. And as the Court
rightly says, crisis research cannot be separated from long-term research, whether at its funding
levels, to maintain teams and infrastructure at the highest level, in its governance, to take
responsibility for a substantial part of research programming and promote effective mobilisation of
the various stakeholders, or in its administrative processes. Research is therefore structured very
much upstream (priority areas, recurring funding, selective financing to promote risk-taking and
progress on the frontiers of knowledge, etc.), in order to anticipate, in an independent manner, the
challenges with which we will undoubtedly be confronted.
Strengthening fundamental research and innovation
In this way, Inserm will be proactive alongside its governing bodies, in building, defending
and leading, in parallel with free research which is indispensable to the advancement of knowledge,
research supported by major programmes such as the Research Senior Research Programmes
and Equipment (PEPR) targeted in areas with high impact, aligning research forces and societal
challenges. The national position of Inserm, under the dual supervision of the ministries in charge
of research and health, its scope over the entire continuum of research from the most fundamental
to the most applied, or the experience of its subsidiary Inserm Transfer in terms of development
and public-private partnership, make it a solid player on which the State can rely to develop and
coordinate a genuine health research and innovation strategy. Some programmes have already
been entrusted by the State to Inserm, and have demonstrated the concept (anti-bioresistance,
rare diseases, fundamental research component of the Cancer plan, in connection with the Inca…).
5
The PEPR on emerging infectious diseases is also entrusted to it through the ANRS-MIE, an
internal agency of Inserm, created on 1 January 2021. Indeed, in the field of emerging infectious
diseases (EMI), bibliometry elements confirm the risk of French fundamental research stalling.
Already strongly committed to diagnostic, therapeutic and vaccine research, but also in favour of
research in developing countries, the ANRS-MIE, with the support of Inserm, will address this lack
of fundamental research, as the ANRS has done in its historical field of the battle against HIV-
AIDS.
Coordinating research during normal times and in an intensified manner during times of crisis
These programmes will help sustain the momentum towards increasing and concentrating
funding and strengthening leadership, steering and scientific coordination in the areas concerned.
These new non-crisis working arrangements will prepare the stakeholders to work in a more
coordinated manner and with a more clearly defined management orientation during times of crisis.
At the same time as acculturation to new ways of working that focus more on the ensemble rather
than the institutions, it will obviously be necessary to quickly include research in health crisis
management plans in order to anticipate very precisely the roles each stakeholder will play and the
processes considered as a whole. Health crises are often by definition periods of high uncertainty,
in which expertise, that is, a detailed and exhaustive knowledge of the different parameters,
reaches its limit. Research therefore also has a major role to play in this context. Anticipation of
emerging disease risk and the culture of collaboration and coordination that led to the creation of
the ReacTing consortium by Inserm in 2013, in response to the emergence of Chikungunya in the
West Indies, then engaged in work on different epidem
ics: Zika, plague, Ebola…, demonstrate the
potential and legitimacy of our institute playing a coordination role in times of crisis. This multi-
agency consortium proved essential during the crisis, particularly in order to quickly identify priority
research themes, prioritise calls for projects from the ANR and PHRC, support the emergence of
partnership projects, mobilise existing or new infrastructures, in particular cohorts, and inform all
public decision-making. Its merger with the ANRS under the auspices of Inserm strengthens a field
of research on global issues and in which France has a great history, past and still to be written. In
addition to its positioning as the sole public body covering the entire continuum of health research,
the scope covered by Inserm allows the State to potentially better prepare for health crisis
management. Whether dealing with an epidemic, exposure to a poison, a heatwave, Inserm has a
special role to play in coordinating the prioritization and monitoring of health research.
The ability to set up major national trials and to activate European financing, as Inserm was
one of the few stakeholders to do during the crisis linked to COVID-19, based on the audit's data,
should also be the selection criteria for defining a leader. The creation of the CAPNET, whose
missions are transferred to the ANRS-MIE, for the current crisis, is a first step. Inserm is responsible
for demonstrating its effectiveness for the benefit of all and testing this model in preparation for
other crises.
Removing administrative rigidities
Finally, the audit points to administrative rigidities such as the failure of a "funding circuit
allowing EPSTs (…), carrying out research on human health but which are not healthcare
organisations, to benefit from PHRCs without having to enter into an emergency agreement with
the CHUs (…)". It is a challenge for Inserm, which is a coordinator of national, multi
-centre trials,
not to have a direct funding channel with the MSS (which is its governing body) in clinical research.
Discussions are underway in the specific field of emerging infectious diseases with the MSS and
ANRS-MIE. In terms of public procurement, the Court also notes that operators are under-utilizing
the Order of 25 March 2020. This sentiment is not shared by Inserm. The institute has used it
several times in varied ways ranging from ordering masks, Elisa dosage kits, contracts related to
6
the Discovery trial, to the acquisition of a cytometer. Inserm was able to activate it whenever
necessary. These regulatory changes have been very appreciable, as has the fast track put in
place by the MSS, in order to reduce the time frames for opinions issued by the Ethics Committees
[Comités de protection des personnes (CPPs)], which are essential to the launch of clinical
research projects. The experience of the crisis as such has shown that other processes are
possible without altering the final quality of decisions.
In conclusion, there are no big countries without strong biomedical and public health
research. First, this meets the expectations of patients and society in general, but it is also an
economic and sovereignty issue amid tough international competition. Not being at the forefront
means being exposed to living tomorrow with the solutions thought up by others, with ethics, values
or economic ramifications that will not be ours. It's about taking the risk of not being ready when
the moment comes. The post-crisis period is the time to rethink our organisations, and reports such
as this invite us to do so.
Inserm is ready to take its full place in this reflection and the implementation of the new
guidelines that could result from it, as it has already begun to do through the above-mentioned
initiatives and through the ambitious proposals that the Institute is carrying out as part of the
negotiation of its future objectives contract covering the 2021-2025 period
.
RESPONSE FROM THE CHIEF EXECUTIVE OFFICER OF THE
PASTEUR INSTITUTE
We confirm the accuracy of the financial data presented in the table below. These are the
financial resources mobilised by the Pasteur Institute in 2020, that is, consumed during the financial
year.
Table 6: pasteur Institute Paris funding for research
during the period of health crisis
Pasteur Institute Paris
Type of financing
Amount in €
million
Public financing
€5.7 million
Donations and patronage
€8.1 million
Own resources
€12.1 million
Other financing
€4.3 million
Total
€30.2 million
Source: Court of Accounts based on Pasteur Institute Paris data
We note that in the €5.7 million of public financing, €4.6 million is routed to the International
Network of Pasteur Institutes (RIIP) and relates to funds from the AFD, the European Union and
the MEAE. In particular, the latter provided €2 million in financing for the REPAIR project (link).
We also note that the Pasteur Institute Paris received €4.8 million from the AFD (financing
obtained and not necessarily consumed over the financial year) in 2020.
.
7
RESPONSE OF THE CHAIRMAN OF THE REGIONAL COUNCIL OF
HAUTS-DE-FRANCE
As an extension of the letter you sent me, to which extracts from the report of observations
referred to in the subject were attached, please find below the comments that this document elicits
from me.
In terms of the implementation of the dedicated regional research policy, the Region was
contacted from the beginning of the health crisis and organised to support research projects carried
out and coordinated by Institutions (research-clinical) in our territory. In fact, the regional research
teams have mobilised around the search for new therapeutic solutions to counter the emerging
SARS-CoV2 virus responsible for COVID-19. The Hauts-de-France Region supported 11 health
biology pro
jects with a total of more than €2 million.
Summary of research projects supported by the Region (research policy) related to
COVID-19
Project
Sponsor
Amount
Mechanism
CritiSARS2 - Identification of new viral,
inflammatory and immune markers of
critical forms of COVID-19
Lille CHU
I-Site
€199,600
Outside of the
mechanism
FlavoCOV - Isolated flavones of
halophyte plants and synthetic
analogues to combat SARS-CoV-2
I-SITE
€198,180
Outside of the
mechanism
THERAPIDE - Innovative COVID-19
Therapy
IPL
€784,
982
Outside of the
mechanism
COV-NI - COVID-19 treatment: Study on
the effectiveness and safety of adding
Interferon Beta 1b to lopinavir/ritonavir
CHU
Amiens
128,976
Outside of the
mechanism
COVID19BC - Clinical, biological and
evolving profile of patients hospitalised
for COVID-19 at Amiens Picardie
University Hospital
CHU
Amiens
€72,050
Outside of the
mechanism
CORDIAL Flu - Portable diagnostic
device to differentiate influenza virus
from COVID-19
CNRS
€145,166
Resilience
CFP
ODEFRANCE - Optimisation of required
and accessible manufactures made
necessary by a major health crisis
Lille CHU
€151,020
Resilience
CFP
ASSERVIR - A therapeutic alternative to
vaccination to combat SARS CoV2 viral
infections
CNRS
€96,500
Start-AIRR
DiagnoTerra - TeraHertz Diagnosis of
Pathologies by Expired Air Study
CNRS
€99,136
Start-AIRR
8
SENTICOV - sequencing the SARS-CoV2
virus for the mapping and
characterization of SARS-CoV-2 variants
circulating in the Hauts de France
Region
EGID
IPL
€76,016
Outside of the
mechanism
BACOVID - Development of sprays,
based on bacteria, to combat respiratory
viruses such as SARS-COV-2
U Lille
€96,360
Start-AIRR
€2,047,986
Focus on a few flagship projects:
Pasteur Institute Lille
: aid of €784,982 for the THERAPIDE project
- this project finances
innovative COVID-19 therapy. This involves searching for a drug that can be used from the first
symptoms of COVID-19 in order to avoid evolution towards serious forms and limit the time
during which an individual can transmit the infection.
Amiens CHU
: support of €201,026 for 2 projects:
-COVID19BC on the clinical, biological and evolving profile of patients hospitalised for
COVID-19;
-COV-NI: Treatment of COVID-19 via a study on the effectiveness and safety of adding
nebulization of Interferon Beta 1b to Liponavir/Ritonavir.
As part of the beginnings of a major partnership between the Region and the National Research
Agency (ANR), which was subsequently finalised at the end of 2020, it was decided to support
two projects registered on the additional list of the ANR Flash COVID-19 call for projects, by
expanding the emergency plan put in place by the I-SITE of the University of Lille Nord Europe
(I-SITE ULNE) as part of the "Task Force". This aid, in the amount of
€397,780
, supported two
projects:
-CritiSARS2 of the Lille CHU: identification of new viral, inflammatory and immunity markers
for the critical forms of COVID-19;
-FlavoCOV project of the Institut Pasteur de Lille: use of isolated flavones of halophyte
plants and synthetic analogues to combat SARS-CoV-2.
First implementation of the ANR-Region Hauts-de-France protocol validated in October 2020:
the call for ANR-Region Resilience projects in Hauts-de-France allowed the region and the ANR
each to allocate €1 m
illion alongside the State and to adopt 15 selected projects (Total allocated
to the selected projects: €1.75 million).
9
Call for Projects "Resilience Hauts de France"
2020
List of selected projects (in alphabetical order):
Acronym
Project title
AGEPIL
Improvement of the quantitative management of groundwater through
control of the water table
AUDESSA
Impact of the massive increase of the use of disinfectants on
anthropogenic aquatic ecosystems during pandemic periods (AUDESSA)
BIOLANT
Functionalised polysaccharide as a polymer binder for negative Li-ion
battery electrodes
CorDial-FLU
Portable diagnostic device to differentiate the virus from COVID-19
COV-EHP
COVID crisis in EHPADs
GreenAct
Controlling the energy consumption of resilient cloud services
Isorédu
Résiliente et Durable Solidaire Informatique [Resilient and Sustainable
Solidarity-based IT]
MASCOFIL
Development of a high-quality alternative mask for the general public
dedicated to the fight against pandemics, one that is comfortable,
washable, with high-performance filtration and manufactured on automatic
machines
MURDASP
For sustainable mobility adapted to a pandemic environment
NEOSOILID-R
New solidarity and resilience through times of crisis
Odefrance
Optimisation of required and accessible manufacturings made necessary
by a major health crisis
RecyBat-Li
End-of-life Lithium battery stock: a mine of materials for recycled
electrodes
As part of the implementation of regional health and research policies, funding for the
Senticov Hauts de France research project should be noted: a regional project sequencing the
SARS-CoV2 virus for the mapping and characterization of SARS-CoV-2 variants circulating in
the Hauts-de-France region, it is carried out by the Institut Pasteur de Lille.
The SentiCov project aims to quickly establish the sequencing of the SARS-CoV2 virus
at the regional level. Its implementation is based on the creation of a regional operational
network called Senticov Hauts de France, which will have the task of setting up the iterative
sequencing (every week for at least two months) of viral genomes, in order to allow close
monitoring of the spread of the various viral strains present in the Region, and to assist the
authorities in controlling the pandemic. The study will be based on a "random" collection of
samples of nasopharyngeneal samples of people identified as positive for COVID-19 through
PCR testing by city and hospital medical biology laboratories. The SARS-Cov-2 virus
sequencing protocol is in place on the LIGAN high-speed sequencing platform at the Lille
LIGAN genomic centre located at the European Institute of Diabetes Genomics (EGID). The
Pasteur Institute Lille is the sponsor of this project.
The Region participated in 60.32% of the total cost of this study initiative, which is
€252,029. The Region's participation is €152,032 (50% research policy, 50% health policy).
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In addition to the implementation of the regional actions described above, it is also
important to emphasise that, in addition to supporting public research, the Hauts-de-France
Region has also itself invested for students in order to combat COVID-19:
- Distribution of a mask per student via their reporting institution for the 2020-2021
academic year;
- Adaptation of the MERMOZ system (support for international mobility) heavily impacted
by the crisis with the slowdown or sometimes the sudden halt of stays abroad;
- Supplementation of two schemes directly intended for students through regional
student contracts (+ 60%) and Students Relais Santé (matching), with the challenge of
responding to student poverty by providing additional income, provide institutions with
additional health bridge student contracts to boost initiatives to prevent drop-out, combat
isolation, prevent COVID and provide care;
- Breakdown of catering aid in partnership with the 2 CROUS Lille and Amiens;
-
Regional aid of €17
million in the mobilisation and compensation of trainee nurses and
student caregivers (Aide MIAS) who were deployed during the height of the crisis in hospital
services and medical-social institutions.
Within the scope of the health policy, commitments can be highlighted:
- Participation in financing training for anti-covid mediators
As part of the roll-out of the Tester Alerter Protéger strategy, the Government has
decided to strengthen the capacity of the Regional Health Agencies to perform collective
screenings, in addition to the mobilisation of independent health professionals (laboratories,
pharmacies, nurses and independent nurses). These initiatives consist in developing more
targeted screening for the situations and populations at risk. To this end, a training course was
begun for anti-COVID-19 mediators.
In order to roll out this system, the region assisted the Hauts-de-France Regional Health
Agency in financing the training of anti-covid mediators carried out by the Institutes of Training
in Nursing Care (IFSI).
The national target of 12,000 mediators trained by March gives a target of 1,070 people
trained for the Hauts-de-France region.
As such, the Hauts-de-France Region financed 50% of the training courses carried out
by the Nursing Training Institutes (IFSI). The Region's participation in the training system for
these anti-
covid mediators amounted to €40,125.
- Participation in the financing of an experiment with the Science Po Lille inclusivity
programme: cognitive disorders and training for the University of Lille
Cognitive disorders are the primary cause of academic drop-out and truancy, at all ages,
and therefore the first cause of school failure, with the social and economic consequences that
this implies. The health crisis leading to alternative educational methods is intensifying learning
difficulties that require specific handling.
That is why the Region wanted to support Science Po Lille in an experiment that this
institution conducts in terms of inclusive training and prevention in terms of the mental health
of CFA students.
The objective of this experiment is to conduct a wide-ranging awareness-raising, skills
development and resource allocation initiative on cognitive disorders among a broad audience
of teachers from the higher and initial training organisations in the region aimed at transforming
educational practices as part of an innovation and universal inclusivity approach. This initiative,
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initially carried out in partnership with the University of Lille and the University of Polytechnique
Hauts-de-France, is expected to grow throughout the region for the benefit of all higher
education stakeholders.
As such, the Hauts-de-France Region financed 50% of this experiment. The Region's
participation is €25,500.
RESPONSE OF THE CHAIRMAN OF THE REGIONAL COUNCIL OF
GRAND EST
You wished to bring to my attention the excerpts of the audit entitled "The funding of public
research in the fight against the COVID-19 pandemic" and I thank you for doing so.
I have carefully read this document and, in response, would like to provide you with some
information in relation to the "Grand Est Resilience" call for projects.
Background information
Faced with the COVID-19 pandemic, and in addition to emergency interventions aimed
initially at the economy, the Grand Est Region decided, from April 2020, to mobilise the scientific
community to respond to the challenges of the health crisis and assist public stakeholders in
decision-making in the face of future changes.
The scope of a call for projects was then defined by the Region, which, very quickly, following
informal contacts between the offices of the President of the Region and the Minister Frédérique
VIDAL, partnered with the National Research Agency (ANR), mandated by the Ministry of Higher
Education and Research (MESRI), to formalise the partnership.
This association then resulted in a common definition of the specifications of the initiative
between the "Higher Education Research Transfer" department of the Region and the ANR, as well
as the precise framework (launch date, targets, duration of projects, expected budgets, method of
selection, etc.) of the call for projects for a shared initiative "Grand Est Resilience" intended to learn
all lessons for the region from the current health crisis through the mobilisation of scientific
research.
The ANR, for the MESRI, and the Grand Est Region (RGE) then met to create this call for
projects, the initiative for which returned to the Region, a tool for assessing the territorial impact in
the Grand Est of the COVID-19 pandemic on the economy, society and the environment, and for
supporting decision-makers in the evolution of development systems.
This CFP should also encourage collaborations between communities and the various
academic laboratories in the Grand Est to speed up the implementation of solutions to prepare
organisations to cope with these forms of crisis and develop more resilient territories.
As part of the discussions/validations between the Grand Est Region and the ANR, the two
pa
rtners have defined a joint allocation to support projects of €2 million, with shared financing for
the MESRI/Grand Est region (€1 million Region and €1 million State, managed by the ANR
operator).
Implementation
The call for projects was published on 7 May 2020 and closed on 4 June 2020.
The call was addressed to research organisations and public research institutions in the
Grand Est, as well as the consortiums made up of academic and private stakeholders, with this
dissemination being carried out by the departments of the Region.
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Despite a very short deadline left to the institutions, 72 project proposals were submitted.
After studying the eligibility of the files by the Region's departments, these proposals were each
sent to the ANR, in accordance with their own internal procedure, to conduct the evaluation.
This was carried out scientifically by two experts for each case, mandated by the ANR,
organised around five main themes: Biology/Health, Digital/Mathematics, Humanities and Social
Sciences, Biological Resources and Physical Sciences/ Engineering/Chemicals/Energy).
In this context, the Region's departments were able to participate in the evaluation
commissions in early June, involving the experts and evaluators of the ANR.
After transmission of evaluation reports by the ANR, the Grand Est Region organised on
17 June 2020, the presentation of dossiers and evaluations to a regional jury, chaired by the Grand
Est Region / Grand Est Local Education Authority, including the ANR and made up of players from
th
e ESRI (CRT, academic institutions, SATT…) of the Grand Est region.
The jury selected an initial list of 34 projects submitted to the State-Region Restricted
Selection Committee. Based on the scientific assessments and evaluations carried out by the
members of the jury, the Selection Committee (State, Local Education Authority, ANR) then
selected
15 winning projects for a total amount of €1,989,495, of which: €325,639 in
investment and €1,663,856 in operation, distributed with State/Region parity. This choi
ce
was made on the basis of regional priorities.
Among the winners, the domains are represented as follows:
• Biology/Health: two projects;
• Digital / Mathematics: three projects;
• Physical sciences, Engineering, Chemicals, Energy: two projects;
• Ecolog
y, Environment, Biological Resources: two projects;
• Humanities and Social Sciences: six projects.
These winning projects have the following scientific coordinators:
• Unistra and University of Lorraine: three projects each;
• UTT and University of Haute
Alsace: two projects each;
• IHU Strasbourg, URCA, CNRS Alsace, École d'Architecture de Nancy, C
HRU de Nancy:
one project each.
Review of this partnership
• An unprecedented partnership for the Grand Est/State region (in several of its components
MESRI, Local Education Authority, ANR) to respond to a crisis situation, which gives the scientific
community the image of public stakeholders working in a coherent and effective manner to quickly
approve support (less than 3 months between the launch of the initiative and the decision);
•
Support doubled with significant leverage, thanks to the contribution of the MESRI in
addition to the initial budget deployed urgently by the Grand Est Region. From the beginning, for
the sake of simplification, this budget has been mobilised equally on all winning projects;
• The ability of the ANR to undertake the evaluation work, even before any official decision
of the Grand Est Region, to remunerate the Agency for the expertise carried out;
• A recognised ANR evaluation proc
ess that it has been possible able to implement very
quickly and provide representatives of the Grand Est Region with essential decision-
making/selection information for projects. These very favourable conditions for the implementation
of the ANR/Grand Est Region partnership resulted in an agreement in 2021, between the two
partners, to establish a procedure for the evaluation of projects of industry chairs and state-of-the-
art regional infrastructure;
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• The establishment of a joint ANR/Grand Est Project Fi
nancing Agreement, streamlining
project financing procedures for sponsors but it proved impossible to build a single financing fund
within the required timeframe;
•
Post facto and follow-up project evaluation work should be organised later this year in order
to find out the results of the research and determine the impact it has had (economic, social, public,
health, etc.).