Key messages University Medicine Network (NUM)

1 Occasion and initial situation

When the COVID-19 pandemic broke out in March 2020, numerous research activities quickly emerged. However, these were largely very fragmented. In contrast to other countries, Germany had not yet established any structures to collect and share routine clinical or study data for COVID-19 research across the 36 university hospitals nationwide. In order to establish these research structures and coordinate COVID-19 research at university hospitals more closely, the University Medicine Network (NUM) was launched in April 2020 and funded by the Federal Ministry of Education and Research (BMBF). During the first funding period (April 2020 to December 2021, funding volume EUR 150 million), the scientists worked together in 13 cross-location sub-projects. The second funding period started in January 2022 (funding volume EUR 240 million). The NUM's research activities to date have made important contributions to combating the COVID-19 pandemic. In addition, a considerable amount of research infrastructure has been created to support the joint research of all 36 university hospitals involved in the NUM. As far as possible, the NUM has built on existing structures, such as the study platform of the German Center for Cardiovascular Research (DZHK), the emergency admission register AKTIN or the data integration centers of the Medical Informatics Initiative (MII).

2. cooperation instead of competition

The NUM exclusively supports cooperative and structure-building projects in which as many university hospitals as possible are involved. This collaborative character and the joint and coordinated approach are characteristic of the network. As a rule, two sites are in charge of the projects. The competencies of all participating locations often build on each other, complement each other and only develop their full potential together. A total of 38 joint projects have already been initiated under this premise. Seven of these have developed into permanent research infrastructures that can be used for various research purposes and are continuously adapted. Such infrastructures or platforms are the prerequisite for the joint, cross-location use of research data and the implementation of large cooperative research projects. They are designed for questions across the entire spectrum of medicine and will therefore be used for other diseases in addition to COVID-19 in the future.

In cooperation with numerous partners inside and outside the NUM and with the involvement of existing infrastructures, the network succeeded in creating structures in just a few months so that the University Medicine Network sites could coordinate their COVID-19 activities and conduct joint research. A steering and coordination infrastructure was set up at national level for this purpose. This was the first time that all 36 German university hospitals were able to network across the board and collaborate on research in a structured manner.

3 "Pandemic Preparedness"

The pandemic has shown that numerous challenges can be met more effectively if university hospitals across Germany work together and share their knowledge with each other and with other partners, such as non-university research institutions or the public health service. The NUM has enabled rapid and effective collaborative research during the COVID-19 pandemic through intensive coordination and cooperation. Through continuous exchange and learning from and with each other, the NUM was able to contribute to the progress of knowledge on COVID-19 and thus optimize patient care and coordination in many care regions, among other things.

It also became clear that cooperation between so many partners only works if it can be based on suitable, jointly usable research infrastructures. These were not available to the necessary extent at the beginning of the pandemic and were therefore established in the NUM. These methodological, technical and organizational platforms with the associated governance concepts and legal bases will continue to be maintained in the NUM on a permanent basis and will be continuously used and further developed in individual research projects.

Germany had recognizable weaknesses in pandemic preparedness at the beginning of the pandemic. With its newly established structures, the NUM is helping to ensure that the German health research system and therefore healthcare as a whole is better prepared for further pandemics and other crises. However, this requires long-term commitment and close cooperation between science, healthcare and politics. After all, ensuring preparedness in the long term means staying on the ball, maintaining the newly created structures and not forgetting the lessons learned from the pandemic.

4. outlook

The NUM has significantly changed the way German university medicine works together within a short space of time and fills a gap in the biomedical research landscape with its structures designed for nationwide cooperation. Sustainable research infrastructures have been established that contribute to pandemic preparedness and are now also being used for disease patterns or research questions beyond COVID-19. These platforms created through and for joint research are to be operated on a permanent basis and continuously developed further in order to maintain the network that has been created throughout German university medicine and to strengthen Germany as a research location, for example in the field of clinical studies. The BMBF has therefore promised to continue the network beyond the current funding period.