Reason and Starting Point

With the breakout of the COVID-19 pandemic in March 2020, many research activities unfolded quickly across Germany. However, these were, for the most part, very fragmented and uncoordinated. In contrast to other countries, Germany had not yet established structures to collect and share data from routine clinical care or prospective clinical studies for COVID-19 research across the 36 German university hospitals.

To establish these research infrastructures and to coordinate COVID-19 research across university hospitals, in April 2020, the Network of University Medicine (NUM) was launched. The NUM was funded via the Federal Ministry of Education and Research (BMBF) grant. Within the first funding period (April 2020 to December 2021, funding volume EUR 150 million), scientists from all university hospitals worked together on 13 multi-center projects.

The second funding period started in January 2022 (funding volume EUR 240 million until June 2025). The NUM's research activities have made essential contributions to the fight against the COVID-19 pandemic. In addition, the NUM has established various research infrastructures that enable and support the joint research of all 36 university hospitals involved in the NUM. In forming the NUM, pre-existing research infrastructures were integrated as far as possible into the structure, e.g., the study platform of the German Center for Cardiovascular Research (DZHK), the emergency admission registry AKTIN or the data integration centers of the Medical Informatics Initiative (MII).

Objectives

• Establish a nationwide, comprehensive study and data room for clinical research that includes data from routine patient care documentation as well as additional data collected, for example, in prospective clinical and clinical-epidemiological studies
• Optimally preparing the biomedical research landscape for future pandemics and other major public health crises
• Creating a central point of contact for clinical research at a national level that provides stakeholders with fast and efficient access to the entire German university medical system

Cooperation instead of competition

The NUM only supports cooperative and infrastructure-related research projects involving as many university hospitals as possible. This collaborative character and coordinated approach are characteristic of the network. Usually, scientists from two different sites are jointly leading a project. Often, the competencies of all the locations involved build on and complement each other to maximize their potential. A total of 38 collaborative projects have already been initiated under this premise. Seven have developed into permanent research infrastructures that can be used for various research purposes and are being continuously adapted and developed. Such infrastructures or platforms are the prerequisite for the shared, cross-site use of research data and the implementation of large-scale cooperative research projects. These are designed to support research across the entire spectrum of medicine and are, therefore, to be used in the future for other clinical areas beyond COVID-19.

In cooperation with numerous partners inside and outside the NUM and by integrating existing infrastructures, in just a few months, the network succeeded in creating a platform that enabled the 36 academic medical centers to coordinate their activities on COVID-19 and conduct joint research. To this end, infrastructures for administration, monitoring, and coordination have been set up at the national level. As a result, for the first time, all 36 German university hospitals in the NUM are networked, working together to conduct research in a structured manner.

Pandemic Preparedness

The pandemic has shown that numerous challenges could be better met if the university medical centers nationwide cooperate and share their knowledge and expertise with other partners such as non-university research institutions or public health authorities. During the COVID-19 pandemic, the NUM has facilitated rapid and effective collaborative research through intensive coordination and cooperation. Through continuous exchange and learning from and with each other, the NUM has contributed to advancing knowledge on COVID-19, thereby helping to optimize patient care and coordination in many care regions. It also became evident that cooperation between many partners only works if it can be based on suitable and widely accessible research infrastructures. These were not available to the necessary extent at the beginning of the pandemic and were, therefore, set up within the NUM. These methodological, technical, and organizational platforms, along with the associated governance concepts and legal bases, will continue to be provided by the NUM permanently. They will be continuously used and further developed in individual research projects. At the beginning of the pandemic, Germany had noticeable weaknesses in its preparedness. With its newly created structures, the NUM is helping to ensure that the German health research system and, thus, the health care system are better prepared for further pandemics and other crises. However, this requires long-term commitment and close cooperation between science, healthcare providers, and politics. After all, ensuring preparedness in the long term will mean preserving and developing the newly created structures while not forgetting the lessons learned from the pandemic.

Outlook

Within a short period, the NUM significantly changed the cooperation of German university medicine. It filled a gap in the biomedical research landscape with its structures designed for nationwide and cross-disciplinary collaboration. Sustainable research infrastructures that contribute to pandemic preparedness have been established and can now be applied to disease areas or research questions beyond COVID-19. These platforms, which were created through and for joint research activities, need to be operated permanently and continuously developed to promote Germany as a research location, e.g., in the field of clinical trials, and to maintain the networking that has been created throughout German university medicine. For this reason, the BMBF is pursuing a continuation of the network beyond the current funding period.