The concept of international collaboration invokes the greatest ideals of science: working together on global issues, aligning the agendas of diverse groups, and developing a more robust understanding of the world. While many research questions could benefit from the breadth of international collaboration, we must consider what constitutes a successful collaboration. What challenges do these researchers and trainees face when building and maintaining complex, multifaceted collaborations? Ultimately, what can be produced from this work that non-collaborative work cannot accomplish?

We seek to answer these questions through the perspective of researchers at different levels of the collaborative process. Dr. Rae Yeung (SickKids, Toronto) is a clinician scientist working in pediatric rheumatology, where she studies rare childhood diseases through the lens of translational immunology. There are few scientists that examine ultra-rare diseases this way, reflected in limited grant dollars globally. According to Yeung, it became apparent that “none of the investigators would move forward unless they all move forward as a collaboration, rather than competition.” With this goal established, collaboration began with biospecimen collection, a fundamental task upon which all their research was built. “If you cannot harmonize the basic foundations of what you do, you cannot collaborate,” Yeung says. Dr. Yeung went on to develop UCAN (Understanding Childhood Arthritis Network), an international translational research federation encompassing 50 countries, in which members engage with one another in shared principles of research. Dr. Yeung leads UCAN and other consortia to achieve her scientific goals, one of which is to bridge the “gap in treatment approaches and support translational research for all children with juvenile arthritis.”

Across the Atlantic, Dur-e-Nayab Waheed (University of Antwerp, Belgium) works full time while pursuing her PhD. Nayab brings together various groups for a common goal: the prevention and treatment of cervical cancer. Part of Nayab’s job is to organize meetings with experts to discuss tools for HPV prevention, including implementing HPV vaccines in low- and middle-income countries. This means collaborating with industry, vaccine manufacturers, and NGOs across continents.

Both Nayab and Dr. Yeung face challenges in the pursuit of international collaboration. According to Dr. Yeung, harmonizing procedures is the most difficult challenge, and the least glorious. It requires tedious work that will not receive high impact attention, and the resulting low-impact publications are not great for career development.

Furthermore, many challenges arise in sharing collaborative data: regulatory, ethical, and legal concerns need to be addressed across institutions and all levels of government. For Dr. Yeung, this necessitated a full legal team to manage 70+ contracts between Canada and the European Union. Language differences are also considered, as patient questionnaires and consent forms must be accurately translated. To overcome these administrative hurdles, Dr. Yeung is supported by full-time project managers, biospecimen teams, funding agencies, a legal team, and “country leads” that are sent to each country to assist in rollouts and personalizing workflows for different sites.

In contrast, Nayab sees fewer challenges. Differing work environments across countries can lead to variable expectations in project timelines. It is difficult to master the nuances of communication and its variable features from culture to culture. Nayab notes that “how you say something and how the other person perceives it can be [different]” and may cross unknown cultural boundaries to result in the loss of collaborator participation in meetings or studies. One example is the promotion of vaccination programs. “You are an outsider coming in telling people what to do. That can come off as offensive.” Nayab and her team must be careful about what language they use and how they position themselves in the conversation, framing meetings as discussion platforms rather than instructional.

Accounting for these challenges, Dr. Yeung and Nayab still find collaboration between researchers to be synergistic for their work. For Dr. Yeung, standardizing protocols significantly aids translational research. The work of UCAN presents a compelling case for international influence on the accessibility of healthcare, in which studying the biology of disease dictates prescribing practices and access to medication. Dr. Yeung describes one example in which Canadian regulations stipulate that her patients must fail cheaper drugs before they can use more expensive ones. In contrast, Dutch physicians prescribe based on perceived efficacy. The Dutch found that prescribing the most expensive drug within a specific window of opportunity leads to a high success rate for treatment and avoided drug dependency. In Canada, this drug cannot be started until a year of failing other drugs. In hopes of promoting equity in healthcare, the window of intervention is missed, leading to lifelong pharmaceutical dependency. Thus, international collaboration highlights differences in regulatory measures and allows doctors to provide data-driven precision medicine, benefiting patients while decreasing lifetime healthcare costs. Dr. Yeung finds this work incredibly rewarding, “seeing the perspective and challenges of other countries opens our eyes to better questions that we can ask, and how to better translate the science.

Nayab finds her collaborative work similarly gratifying: “[the work] feels more meaningful, motivating me to come to my job and do challenging tasks.” The difficulties of collaboration are worth the effort to alleviate the global cervical cancer burden. This endeavor also ensures that groups do not replicate data and devote their resources to novel questions. On a professional level, she now has access to people in organizations spanning the globe, benefiting her network when exploring career options beyond academia.

Both Nayab and Dr. Yeung emphasize the importance of mentorship for those that wish to pursue careers in international collaboration. Nayab notes that personal connections and progress will be highly dependent on your group and a supervisory principal investigator supportive of your goals. She advises to be mindful of how you communicate, and to advocate for your ideas. Similarly, Dr. Yeung encourages prospective trainees to find mentorship that will build their network of collaborators and nurture functional collaborations. Successful international collaborations surmount multiple challenges to provide reproducible and impactful results, with the potential to provide insights that extend beyond the reach of any single institute. It is apparent that those engaged in international collaborations find their chosen work to be fulfilling, worth years of investment to build something that impacts lives across continents.



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Boyd Johnson

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