When a delegation of scientists from Japan recently visited Harvard University in Cambridge, Massachusetts, they asked their hosts a familiar question: what are the secret factors that make the Boston area, which includes Cambridge, such a hub of health sciences research and innovation? George Daley, dean of Harvard Medical School, answered half-jokingly, as he usually does to such questions: "Just incubate the two most important educational institutions on the planet, support them for 200 years, and watch the magic happen."
The Boston area is home to a critical mass of leading universities, hospitals, biotech and pharmaceutical companies, and independent research institutions that synergize with each other, he says Dan Barouch, an immunologist at Harvard Medical School and director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston. "The quality, depth and sheer scale of research in Boston is simply astounding."
Unsurprisingly, the Boston metropolitan area leads the Nature Index Science Cities rankings in the health sciences based on research outputs in journals tracked by the database in 2023. According to these findings, the New York City metropolitan area ranked second behind Boston, followed by the urban area comprised of Baltimore and Washington DC, London, the San Francisco Bay Area, Beijing, and Shanghai.
Science cities is tracking health sciences for the first time this year after data from journals in the field were added to the Nature Index in 2022, but already the data reveal some new trends. First, US cities and London occupy the top five spots, while for most other fields tracked - including chemistry, physical sciences and earth and environmental sciences - China now dominates the top spots.
The science city rankings are not adjusted for population, which means that large cities such as Beijing and Shanghai - with populations of 21.5 and 26.3 million respectively - have a strong advantage in terms of research output. However, this also highlights the over-contribution of smaller leading cities such as Boston, whose larger metropolitan population is just 4.9 million, to health sciences research. Boston has a clear advantage in this area "still a very dominant position", Says Yiming Dong, Research Fellow in Chinese Studies at King's College London. But that could soon change, and Dong points out that China is moving quite quickly in this area.
Huge anthill
Lots of cities around the world have good universities, smart people and some industry and capital for research, but few have "this alchemy that actually creates gold from these common materials." Says Paul Sagan, senior advisor to General Catalyst, a venture capital firm based in Cambridge, Mass. The key to transforming the city into a true centre of excellence for science and innovation is scale, a concentration of elite science research institutions, and iteration, a continuous stream of new ideas, some of which succeed and spawn new biotech companies, Sagan continues. He adds that among such centres for health sciences and biotechnology, it is clear that "Boston outran everyone." There are several likely reasons, he continues, including the presence of elite research institutions, start-ups and international companies based here, and a number of government initiatives that have promoted and supported biotechnology research over the years.
The Boston metropolitan area contains a well-known list of leading institutions in the health sciences. Harvard University is ranked number one in the world in the Nature Index for this field by a wide margin, and two leading medical institutions - Brigham and Women's Hospital and Massachusetts General Hospital - are located nearby. Daley says Boston also has a rapidly growing biotechnology sector, and most of the top pharmaceutical companies have established major research centres here.
Innovation in healthcare in Boston is also supported by a large and growing volume of venture capital. "Because drug development is so expensive, public funding for research will never cover all the costs," Says Andrea Braun Střelcová, who works on science policy and research cooperation with a focus on China at the Max Planck Institute for the History of Science in Berlin. "So the role of the market is really important."
Although California also has a strong venture capital presence, the "big difference" for the Boston area is the presence of leading pharmaceutical companies - many of which are just a short drive from the Massachusetts Institute of Technology (MIT) and Harvard, says Nobel laureate Phillip Sharp, who holds an emeritus position at the Koch Institute for Integrative Cancer Research at MIT.
Daley says the size of Boston's talent pool is also remarkable. Harvard Medical School alone has more than 10,000 full-time physicians, more than triple the number of other major medical schools in the United States. Taking into account all of Boston's other medical institutions, "we have tens of thousands of doctors and scientists working towards common goals to fight disease and address fundamental biomedical questions", says Daley. "It's just a huge anthill of activity that's in a very small radius."
Enterprising and cool
Other top cities for health research share the same qualities that make Boston stand out - just on a smaller scale. For example, the New York metropolitan area is home to Memorial Sloan Kettering Cancer Center, which ranked sixth in the world among health sciences institutions in the Nature Index for Health Sciences, and Mount Sinai Health System, which ranked eighth. Experts at many of the top institutions also collaborate, amplifying their impact and results. According to Nature Index data, collaborations in the health sciences between Harvard, MIT, Johns Hopkins University in Baltimore and the University of California, San Francisco are among the most productive in the world.
Like its American counterparts, London has top universities and a strong biotech and pharmaceutical industry, he says Rebecca Shipley, Director of the Academic Health Science Centre at UCLPartners in London - an organisation that brings together universities and healthcare providers to accelerate the translation of research into better outcomes. Unlike in the United States, researchers in London can take advantage of the UK's National Health Service, which operates across the country and facilitates the collection of patient data and the conduct of clinical trials. Shipley predicts that London will continue to maintain its place among the top five science cities in the health sciences and has the potential to rise even higher. For example, the UK's National Institute for Health and Care Research, a major funder of research aimed at improving population health, has provided nearly £800 million ($1 billion) in funding over five years to 20 university and hospital research centres across the UK - seven of which are in London - to translate basic discoveries into real patient care. Shipley said there is also increasing investment in London and nationally in building infrastructure to make patient data more accessible for research and innovation. This includes secure access for researchers to NHS patient data at a national level through a dedicated platform, as well as a London-specific information sharing hub called OneLondon, which, among other things, links health and care staff to patient records. "There's a real appetite in London to be innovative and build on that momentum," Shipley says.
For any kind of innovation hub to take off, there must be an entrepreneurial culture and mindset that is "not afraid to fail," Sagan says. For a centre to attract and retain talent, it must also be a place where people want to live. "There are some great research universities that may have some innovation, like the University of Illinois Urbana-Champaign, but for the most part, it's not a place where people want to live because it's a small town and small towns are by definition limited," Sagan says. "I don't want to disparage small cities, but most ambitious entrepreneurs and researchers want to go to top cities like New York, Boston or Silicon Valley because they're places where their partners can also get good jobs, their kids can go to great schools and their community offers great cultural diversity - and it's just great to be there."
Surprising slips
The United States, however, shows some puzzling trends when it comes to health research outcomes. Unlike the Boston metropolitan area, which increased its adjusted Nature Share Index by 6.6 % from 2022 to 2023, the other four leading U.S. cities lost ground. The San Francisco Bay Area experienced the steepest decline of 13.2 %.
One explanation is probably that the Nature Index represents a relatively stable set of research articles. If cities in one part of the world, such as China, are rapidly increasing their share, then others have to decline to compensate. Boston's performance is all the more remarkable.
Stacie Bloomvice provost for research and head of research at New York University, says she was surprised by New York's results and that "all the reports we are getting suggest that things are moving in a more positive direction". Daley also says that from his perspective, U.S. cities that are experiencing a decline in adjusted share remain strong. "New York is on a roll, and the corridor between Baltimore and Washington, D.C. is a hotbed for innovation," He says. Also, the San Francisco Bay Area remains Boston's "main competition" in high-tech biotech.
Daley adds that another explanation is that health science research between 2022 and 2023 was likely still affected by the problems associated with the COVID-19 pandemic. The pandemic, he says, caused significant problems in the biomedical supply chain, and in many sectors, including science, some people changed careers or took some time to return to work. He adds that Boston was probably more insulated from these impacts than other American cities because of the greater density of people and institutions.
Daley expects that any decline in health sciences research output in America's leading cities will be a "momentary blip" and that these centers of innovation will "return to productivity and growth very soon."
China on the rise
For now, cities in the United States still lead the way in health sciences alongside London, but experts predict that China will continue to gain momentum. Logistically, it makes sense, says Yu-Xuan Lyu, a scientist at the Southern University of Science and Technology in Shenzhen who studies aging. Only in the last 10 to 15 years has China rapidly expanded its international research presence and come to the forefront in science fields such as chemistry that do not require close collaboration between universities, hospitals and industry. It has taken China a little longer to establish the structural foundations for conducting world-class medical research, but now that it has, it is beginning to take shape, "the conditions are really good for China to start achieving even better results", says Střelcová.
Beijing has increased its performance in health-science research in the Nature index by 17.6 % between 2022 and 2023, while Shanghai's contribution has increased by nearly 4 %. The southern city of Guangzhou, which is currently ranked 12th in the world in health-science research, is also growing rapidly, up by 32.4 % in 2023. This growth is largely due to the fact that healthcare and health-science research are priorities for the Chinese government, Dong says. "They are spending a huge amount of money on it." Health-science research accounts for 36 %, or 97.6 billion yuan ($13.8 billion), of the 2024 budget for the National Health Commission, an executive department under the State Council that is responsible for health policy and management of health-related emergencies in mainland China.
Scientific progress in health research is a key pillar of the Healthy China 2030 plan, a set of strategic public health goals first published in 2016. The country's 14th Five-Year Plan - which outlines overall goals for long-term domestic economic development and innovation - also includes health science goals, including specific plans to address China's aging population and improve healthcare. China's National Health Commission's scientific strategy highlights similar goals, and the government is also investing in the study and development of traditional Chinese medicine. Some of the largest health sciences research grants in China are currently being provided by the Ministry of Science and Technology and other public sponsors to universities and hospitals for collaborative translational research in service of these goals, Lyu says.
Also in 2022, the construction of the first of a nationwide network of hospitals to function as comprehensive national medical centres was launched in Shanghai. Some of the people who will work in them are likely to be Chinese expatriate scientists who have been attracted back from the United States or other Western countries, Dong says, through more than 100 talent recruitment programs operating at the national, provincial and city levels, as well as the high salaries offered by Chinese universities and research institutions. Dong says many of these professionals have left positions at companies abroad or vacated positions at top American universities, including Harvard and MIT.
Chinese provinces and cities can also implement their own targeted priorities, and in both Beijing and Shanghai, these include life sciences, he says Glen Noble, founder and director of Noble Endeavours, a London-based consultancy focused on research and academia in the UK, EU and China. Both cities have "enormous scope and resources" to implement such measures as tax breaks, subsidies, talent acquisition programmes, science parks and research funding, Noble says. This allows health researchers to benefit from support from various initiatives and levels of government.
Lyu says that academia-industry collaborations in China have also begun to "flourish" in the past year, and that grants have been specifically set up to support and enable these partnerships. She adds that China still has problems with intellectual property protection that have drawn criticism from the United States and the West, including concerns about intellectual property theft and economic espionage. On the other hand, Shooter continues, China has "improved and professionalized" its IP protection environment over the past decade or so compared to the past, particularly through its regulatory framework and enforcement. "The caveat is that this intention is not limited to the protection of intellectual property rights per se, but rather to an overall effort to strengthen national security and increase the country's competitiveness," says Střelcová. Regardless of the intent, however, it's an advantage for innovators, Dong says, given the size of the Chinese market.
Regardless of whether Chinese cities will actually outpace places in the United States and other Western cities like London in health sciences research, Noble hopes researchers around the world will be able to maintain strong international collaborations despite political tensions. Currently, however, policies regarding research security in the West are "primarily aimed at preventing China from accessing Western technology - as if China were not already a scientific power in its own right in many fields," he says. "We increasingly need the science that is happening in China to spread back to us in the West."
nature.com/ gnews - RoZ
The laboratory of Arcaea, a biotechnology company based in Boston, Massachusetts. PHOTO - Boston Globe/Getty
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