Research sustainability: Lessons and opportunities for global biomedical research institutions.

Biomedical research and development (R&D) remains universally underinvested, especially in low- and middle-income countries (LMIC), despite LMIC investigators' significant scientific contributions. To address these challenges, various approaches aim to empower individuals and institutions to generate R&D within this ecosystem. However, limitations within these approaches persist, most notably their focus on individual capacity building and lack of a systems approach that adequately incorporates science management and operations. Considering the successes and gaps in the field, we propose research sustainability as a dynamic and context-specific process for institutions to maintain an enabling environment for strategic, locally pertinent research that contributes to the global evidence base. To examine the implementation of research sustainability, interviews were conducted with investigators and leaders at LMIC biomedical research institutions across the world. Deductive coding and descriptive analysis revealed that institutions might benefit from a framework encompassing intellectual, operational, and financial capacities to undertake rigorous sponsored research effectively and produce outputs critical for scientific advancement. Coupled with evidence from the literature, we present lessons learned-such as improving and stabilising national financial investments, increasing value and integration of investigator input, and prioritising operational support-and opportunities for cultivating ideal, enabling research environments that lead to research sustainability.