Fahad Razak is an internist and holds the Canada Research Chair in Data-Informed Healthcare Improvement at St. Michael’s Hospital and the University of Toronto. Amol Verma is an internist and the Temerty Professor of AI Research and Education in Medicine at St. Michael’s Hospital and the University of Toronto.
In the face of a dramatic shift in our relationship with the United States, policy makers are rightly focusing on reducing internal economic barriers and strengthening our domestic capabilities.
The vast quantities of data that are produced in health care every day – from doctors’ notes to radiology images – are a nearly untapped resource for innovation and economic growth. But provincial-territorial barriers to data flow, siloed repositories, and antiquated governance mean that these data are largely inaccessible beyond limited applications for patient care.
Health data would have significant economic and health benefits for Canadians if harnessed for applications like clinical trials and AI. Clinical trials can be up to 80-per-cent more efficient by using data that are generated routinely in care, rather than requiring new data collection, and AI algorithms can be trained more accurately on these very large and detailed datasets.
Canada can build one of the most valuable health databases in the world. As a general principle, scientific findings are most applicable to the types of people who are represented in the data used for research. Canada is the most diverse high-income country on Earth, and our health system is inclusive of all people regardless of health insurance. That diversity and inclusiveness means that clinical trials and AI developed here have relevance to markets globally. With 40 million people, unified Canadian health data would be one of the best resources for R&D globally.
Canada already has the world-leading talent to use these data. Our scientists have the third-highest output of high-impact clinical trials globally, but most of those trials are conducted in patients outside of Canada. Geoffrey Hinton’s Nobel Prize, and the global leadership of Canada’s AI institutes, speak to the country’s AI prowess. In combining data with scientific excellence, Canada can emerge as the best jurisdiction globally for health care innovation.
The market opportunities are massive. Over the next 10 years, global spending on clinical trials will exceed US$150-billion, and the global health care IT market is projected to be worth US$1.4-trillion by 2034. Today, one in four U.S. venture-capital dollars invested in health care technology is going to health AI, according to the Silicon Valley Bank.
But Canada’s share of clinical trials dropped by 50 per cent from 2010 to 2022, reflecting $2-billion of lost investment annually. A major reason is because other countries are harnessing their health care data and working with the private sector. For example, U.S. company Grail Therapeutics is working with Britain’s public National Health Service to study the early detection of cancer using a simple blood test; Pfizer was given the kind of public infrastructure support it needed to rapidly test its cutting-edge mRNA vaccines for COVID-19 in Israel; and Sanofi is working with the Danish government’s health data to evaluate the company’s latest flu vaccines.
These trials are leveraging private-public partnerships and using health system data to accelerate research at scale. But beyond their clear economic value, these trials also give Danes, Brits and Israelis first access to potentially life-saving technologies. Ensuring access for Canadians is a question of sovereignty.
Even in the AI sphere, where Canada can credibly claim global scientific leadership, we are behind in health. Of 86 randomized trials completed around the world in health AI between 2018 and 2023, only one was conducted in Canada – the common barrier is the lack of access to health data for R&D.
Sharing health care data across provinces and territories is complex, mainly owing to differences in provincial regulations about how personal health information can be handled. But if Canada allows these data to remain fragmented, we will never have the scale to compete globally.
Fortunately, these barriers are surmountable. We already have a strategy for pan-Canadian health data sharing, and national agencies that can hold data across provinces and have expertise in data interoperability. Canada is also a global leader in privacy protection, and has made recent major investments in AI safety, pairing innovation with appropriate guardrails to protect sensitive information and patient autonomy.
Leadership in this sector is not a matter of significant new investment but rather political and public will. In fact, Canada simply can’t outspend its global counterparts; consider the U.S. Stargate investment of US$500-billion in AI. Rather, the only winning strategy is to capitalize on the intrinsic strengths that make Canada uniquely competitive: its population, its data and its talent.