The response of Canada's clinical health research ecosystem to the COVID-19 pandemic.

Background: The response of Canada's research community to the COVID-19 pandemic provides a unique opportunity to examine the country's clinical health research ecosystem. We sought to describe patterns of enrolment across Canadian Institutes of Health Research (CIHR)-funded studies on COVID-19.
Methods: We identified COVID-19 studies funded by the CIHR and that enrolled participants from Canadian acute care hospitals between January 2020 and April 2023. We collected information on study-and site-level variables from study leads, site investigators, and public domain sources. We described and evaluated factors associated with cumulative enrolment.
Results: We obtained information for 23 out of 26 (88%) eligible CIHR-funded studies (16 randomized controlled trials [RCTs] and 7 cohort studies). The 23 studies were managed by 12 Canadian and 3 international coordinating centres. Of 419 Canadian hospitals, 97 (23%) enrolled a total of 28 973 participants - 3876 in RCTs across 78 hospitals (median cumulative enrolment per hospital 30, interquartile range [IQR] 10-61), and 25 097 in cohort studies across 62 hospitals (median cumulative enrolment per hospital 158, IQR 6-348). Of 78 hospitals recruiting participants in RCTs, 13 (17%) enrolled 50% of all RCT participants, whereas 6 of 62 hospitals (9.7%) recruited 54% of participants in cohort studies.
Interpretation: A minority of Canadian hospitals enrolled the majority of participants in CIHR-funded studies on COVID-19. This analysis sheds light on the Canadian health research ecosystem and provides information for multiple key partners to consider ways to realize the full research potential of Canada's health systems.
Competing Interests: Competing interests:: Christopher Yarnell reports receiving a Vanier Scholarship from the Canadian Institutes of Health Research (CIHR), outside the submitted work. Kathryn Rowan reports holding the role of programme director, Health & Social Care Delivery Research Programme, UK National Institute for Health and Care Research (NIHR), a part-time, paid secondment from the Intensive Care National Audit and Research Centre. Kusum Menon reports receiving salary support from a CHEO Foundation Research Chair in Pediatric Intensive Care Medicine. Dr. Menon has also received a CIHR grant for researching stress hydrocortisone in pediatric septic shock. Dr. Menon is the chair of the Canadian Critical Care Trials Group. Robert Fowler reports receiving a grant from CIHR in support of the COVID-19 Network of Clinical Trials Networks. Alison Fox-Robichaud is the nominated principal applicant and holder of the CIHR Sepsis Canada network grant. As scientific director of Sepsis Canada, Dr. Fox-Robichaud also reports receiving additional support from McMaster University and Hamilton Health Sciences. John Marshall reports receiving support from CIHR in support of the current manuscript. Dr. Marshall has also participated on a data safety monitoring or advisory board for the AM Pharma REVIVAL Trial and the SHIPSS Trial, and is the chair of the International Forum for Acute Care Trialists. Michelle Kho reports receiving support as the Canada Research Chair in Critical Care Rehabilitation and Knowledge Translation and from Sepsis Canada and the COVID-19 Network of Clinical Trials Networks, in support of the current manuscript. No other competing interests were declared.
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