Rapid growth of biomedical research in Peru
Authors: Roger I Glass, Patricia J Garcia, Christopher W Belter, Alicia A Livinski, Fabiola Leon-Velarde
Journal: The Lancet Global Health (2018)

Over the past 20 years, Peru has experienced tremendous growth in biomedical research, evidenced by the number of publications cited in the medical literature. From an in-depth analysis of these publications, we have gained insight into policies and practices that might encourage other countries to reconsider their own investments in research. For the period 1997–2016, we selected all publications from the Web of Science Core Collection Database with at least one Peruvian author or institution, and examined the funding agencies, coauthorship linkages, research topics, and networks of training. 6032 publications met these criteria (appendix), with nine times more publications in 2016 (n=672) than in 1997 (n=75). A third of these publications were linked to University Cayetano Heredia (UPCH), a research university established in the early 1960s.1Porturas Plaza F Origin of the Peruvian University Cayetano Heredia.Rev Med Hered. 1999; 10: 151-166Crossref Google Scholar The founders of UPCH—a group of physicians who trained abroad—returned to Peru emboldened and committed to the concept that research should be an integral part of medical education. Researchers at UPCH have developed and sustained international partnerships and funding, indicated by coauthorship of publications: 56% of papers were written with colleagues from the USA, 13% from the UK, and 12% from Brazil. From the list of the most published authors, we did focus interviews to learn about the researchers' training, links to UPCH, mentored relationships, long-term collaborations, and funding. 17 of the 20 most published authors were Peruvian; 15 of these authors had received some training at UPCH, and 13 had received some research training abroad. Many research projects dealt with topics relevant to Peru. These projects were initially focused on child health, and over time, expanded to include the most prevalent or locally important infectious diseases—eg, tuberculosis, sexually transmitted infections, cysticercosis, leishmaniasis, other parasitic diseases, and high-altitude conditions. The growth in publication numbers also followed the rapid expansion of grants from international funding agencies to Peru, with the US National Institutes of Health being the largest single funder (cited on 28% of publications), followed by the Wellcome Trust (5·2%), and the Bill & Melinda Gates Foundation (2·3%). From this analysis, the government of Peru does not appear to have been a major funder of research, although changes in 2014 to leadership and funding for the Peruvian National Council for Science, Technology, and Innovation (CONCYTEC), might play a role in future research funding and publications.2CONCYTEC2014 Annual Report CONCYTEC: a vision of the future for the science, technology and innovation [Memoria 2014 CONCYTEC: Una visión de futuro para la ciencia, tecnología e innovación].https://portal.concytec.gob.pe/images/publicaciones/memoria2014.pdfDate: 2014Date accessed: January 29, 2018Google Scholar Closer examination of coauthorships indicated the importance of mentoring; several older investigators were the mentors of successful younger mentees. Three international universities (Johns Hopkins University, MD, USA; the University of Washington, DC, USA; and the London School of Hygiene and Tropical Medicine, London, UK) offered training to Peruvian doctoral and postdoctoral students, and maintained long-term and enduring relationships for research and training that allowed nationals to stay and do research in Peru. Our analysis reveals how a robust culture of biomedical research takes root in a low-income country. The successful growth of the research enterprise in Peru, and specifically at UPCH, resulted from: a critical mass of Peruvian physician-scientists, some of whom trained abroad, united by the belief that research and the generation of new knowledge should be a key goal of the medical school and an integral part of medical education; the commitment of an academic institution to value and promote a culture and infrastructure for research that included a curriculum that exposed students to this training; the ability of the research group to build and maintain strong international collaborations, compete successfully for international funding, and support the growth of the next generation of researchers; the instilling of a culture that promoted mentorship of the next generation of biomedical researchers, while providing this next generation with space, support, and small funding opportunities to begin independent research activities at the completion of their training; and focusing research on topics both relevant and somewhat unique to Peru. Over the past few years, faculty from UPCH have left UPCH to seed new research units in other institutions around the country, both in the capital and in settings with health problems, such as the Amazon basin for tropical diseases and the Altiplano in the Andes for high-altitude studies. What are the consequences of this marked increase in research in Peru? This group of scientists have been entrepreneurial, bringing major international funding to the local research enterprise, beyond that available from the government, which has seeded the creation of jobs and improved our understanding and treatment of health conditions that are prevalent in Peru but less common or more difficult to study in other settings. Our understanding of the diagnosis, treatment, and prevention of many parasitic diseases, such as cysticercosis, leishmaniasis, and extensively drug-resistant tuberculosis, has come from research done in Peru. The health consequences of living at high altitude (eg, mountain sickness) in Peru was described among populations who migrated from sea level to high altitude (16 000 ft) each summer to graze their animals and descended in the winter to farm. This generation of researchers has, over time, secured leadership positions in universities, CONCYTEC, and the Ministry of Health. Although a full economic analysis has not been done, the value of the research enterprise and the trained group of scientists to the country has been substantial. Governments of countries of low and middle income should consider the potential effect of increasing their own investments in research and capacity building for science and innovation on the stimulation of the economic growth of their country in the 21st century. With proper management and support, these investments can yield valuable returns in terms of discovery and innovations, economic value from job creation, retention of skilled people, development of leaders, creation of biotechnology startups, and links to health service and biomedical industry that could advance the development agenda and propel the country into what promises to be the century of science.3Garcia P Armstrong R Zaman MH Models of education in medicine, public health, and engineering.Science. 2014; 345: 1281-1283Crossref PubMed Scopus (10) Google Scholar, 4Bloom B Michaud C LaMontagne J et al.Priorities for global research and development of interventions.in: Disease control priorities in developing countries. 2nd edn. The International Bank for Reconstruction and Development/The World Bank, Washington, DC2006: 103-118Google Scholar As Peru becomes a middle-income country, increased support from government would help to leverage the continued expansion of the research enterprise in the future. We declare no competing interests. We thank Kristen Weymouth for assistance in preparing and editing the manuscript. Download .pdf (.32 MB) Help with pdf files Supplementary appendix