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10 February 2022
Thematic Public Report
A major challenge that is not sufficiently managed
Dedicated to diseases long considered to be treated by the antibiotic and vaccine response,
or confined to developing countries, infectious diseases research has returned to the
forefront. In this report, the Court of Accounts focuses on the resources allocated to
research in infectiology, as well as its management and coordination. While the SARS-CoV-
2 health crisis has reminded us that emerging infectious diseases constitute a universal
threat, it has also highlighted the lack of preparation, anticipation and priority given by
France to the fight against these diseases. While French research had succeeded in
demonstrating its success in the fight against AIDS, particularly in terms of coordination and
funding, the rest of research in infectiology did not benefit from the same structures, despite
signs of early warning consisting of recurrent epidemic episodes at the global level (such as
H1N1 and Ebola). To ensure that research on infectious diseases can ultimately be made a
national priority, the Court makes five audit recommendations.
Renowned infectiology research but insufficient priority given to emerging and re-emerging
infectious diseases
In international rankings, French research in infectiology is at a very honourable level. However,
and despite the recurrence of epidemic episodes over the past twenty years, no structuring
movement in the field of infectious diseases has been initiated. Indeed, infectious diseases
research has not been able to rapidly produce a vaccine or drug prophylaxis against Covid-19.
Moreover, the overall funding granted to this research is not subject to any specific monitoring
by the ministries responsible for research and health. While there has been a slight increase in
this area - around 14% between 2015 and 2020 - these resources have not been the subject of
a marked priority.
Weaknesses in terms of management and attractiveness of the research profession
Like the rest of biomedical research, research in infectiology suffers from insufficient
management of the many stakeholders involved. The plurality of research organisations, each
of which has its own computer-based systems and management rules, makes the coordination
of research units more complex. This complexity, also fuelled by the growing share of calls for
projects, directly affects the work of researchers. The latter devote a reduced amount of time
to research, which, combined with remuneration at a lower level than the standards of
comparable countries, reduces the attractiveness of French laboratories. If the reaction of
French research in infectiology at the time of the health crisis was rapid, the absence of
strategic management led to a dispersion of funding and clinical trials, to the detriment of the
most promising projects - as pointed out by the Court in the flash audit of July 2021 devoted to
the funding of public research in the fight against the pandemic.
A transition between research and innovation hampered by the lack of coordination of
stakeholders and the lack of maturity of the public-private ecosystem
The continuum between basic research, clinical research and innovation is still insufficiently
developed. The links between public research and industry must be improved. Above all, the
transition from research to therapeutic innovation encounters a specific difficulty in the
infectiology sector: infectious diseases, concentrated in low-income countries, suffer from a
lack of interest on the part of industrialists, for lack of profitable business model. In addition,
research into breakthroughs should be encouraged.
Strengthen the management, resources and coordination of research on infectious diseases
The Court considers that the extension of the scope of jurisdiction, carried out in January 2021,
of the ANRS (National Agency for Research on AIDS and Viral Hepatitis) to emerging infectious
diseases (ANRS-MIE) constitutes a first response to the lack of coordination of funding and
projects during the health crisis. However, this extension must go hand in hand with the
granting, marking and traceability of a permanent and constant financial allocation for the
exercise of this expanded mission and, in the long term, with the attribution of the role of leader
of research in infectiology to this organisation. Lastly, the role of the future health innovation
agency appears essential to encourage public and private investment in research on emerging
infectious diseases.
Read the report
Emmanuel Kessler
Director of Communications
01 42 98 97 43
Julie Poissier
Head of Press Relations
01 42 98 97 43
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