Dept. of Big Bets: A Global Approach to Tackling Cardiovascular Disease

Cardiovascular disease is a worldwide killer. According to the World Health Organization, 18 million people die of this disease every year—and that number is continuing to rise. The British Heart Foundation (BHF) is launching an initiative to change that.

Last month, the foundation announced that it’s launching the Big Beat Challenge, a research award that will throw £30 million—nearly U.S. $40 million—behind an innovation that could change the future of cardiovascular medicine. This grant is one of the largest ever awarded for a single biomedical research project. 

The move comes as global health funders, most notably Bloomberg Philanthropies, are giving new attention to noncommunicable diseases—a departure from a longstanding focus among grantmakers on infectious killers like malaria and HIV/AIDS. In fact, NCDs claim the most lives around the world, and these diseases tend to be far deadlier in poorer countries without strong health systems. 

On its site, the BHF calls the Big Beat Challenge an award “for the world’s greatest minds to tackle the world’s biggest killers.” The foundation is calling for ideas that are radical, ambitious and diverse.

The BHF is extending the challenge to scientists, clinicians, innovators and entrepreneurs—any team from any country, sector or discipline has a shot at the prize. But, said Nilesh Samani, medical director for the BHF, proposals must be transformative, clinically relevant and require a multidisciplinary approach that calls for the funding.

“The time is right for a radical approach,” Samani said. “With recent advances in areas all the way from genome editing to artificial intelligence, we have an unprecedented opportunity to exploit new ways of doing research that moves beyond incremental gains and accelerates breakthrough.”

A Global, Transdisciplinary Approach

The BHF is strongly encouraging international collaborations that address the global burden of cardiovascular diseases. The grant is also designed to motivate researchers to work across disciplines. Cardiovascular problems are often associated with other disorders—for example, kidney and lung diseases— so an approach that cuts across disciplines is important. Samani says that applications could also include researchers outside the fields of medicine and biology: For example, AI researchers could develop tools that predict the risk of cardiovascular disorders. 

The BHF is assembling an international, multidisciplinary expert advisory panel to oversee the Big Beat Challenge. A call for outline applications will open at the end of 2018 and close in mid-2019. 

Shortlisted applications with the most promising ideas will receive seed funding, and teams will then have around six months to develop their final proposals. Peer reviewers will assess these full applications and the panel will recommend the winning research programme.

“Moonshot” Level Funding

The grant carries with it a substantial amount of money—but it is not entirely without precedent, even in the field of cardiovascular research. In 1999, the Donald W. Reynolds Foundation in Las Vegas, Nevada, began distributing more than $159 million to four university centers for cardiovascular clinical research. One of the centers received $53 million, which funded research on a new class of cholesterol-lowering drugs, but the Reynolds program ended in 2010.

More recently, in 2015, Google Life Sciences (now Verily) and the American Heart Association announced a $50-million award for research into preventing coronary heart disease. Pharmaceutical company AstraZeneca later climbed on board as well, adding an extra $25 million to the pot.

In Europe and the United States, the main funding model for biomedical research has traditionally been public funding. However, as many researchers have noted, traditional research funding models are often incremental and piecemeal. Money is typically spread among many researchers, and the award levels often hover around the $250,000-a-year range and require time-consuming grant writing to maintain. 

Unlike previous funding models in which money is spread around to many teams, the new BHF money will go to a single team for five years of research. The hope behind large grants is that, if structured correctly, they can force researchers to think about problems in completely different ways. BHF, unlike the Google Life Sciences and the American Heart Association grant, will not restrict the scope, and instead give researchers leeway to pitch any project related to heart and circulatory disease. “We really trust the research community to come up with the best ideas,” says Samani. “I’m not aware of any other major grant of this scale which is that open.”

Not All Are Convinced

For all the hype, skeptics remain. The idea behind the “war on cancer” was that a deep understanding of the basic biology of cancer would lead to targeted therapies and a cure. Unfortunately, although we know far more today than we did 40-plus years ago, the statistics on cancer deaths have remained incredibly stubborn.

Others question how truly innovative this project can be, since a grant of this size is likely to go to a team led by well-established, senior scientists who might not be the best source of exciting ideas. Amitava Banerjee, a cardiologist and data scientist at University College London, says that medicine needs to move away from this form of “eminence-based” research, and instead take cues from other industries, in which novel and radical ideas often come from people at a much earlier stage of their careers.

In addressing these concerns, The BHF stresses that all applications will need to include diverse teams no matter who the applicants are, and they must be prepared to take a “high-risk, high-reward” approach.

This grant marks “a very different, radical way of doing things,” says Samani. The BHF currently funds £100 million a year on cardiovascular disease research, in grants of up to £3 million. The £30 million award will come on top of the foundation’s usual research investment. Samani says that the aim of the new grant is to fund a big idea that could directly improve the lives of many people.