Lessons from a multi-country research project on climate and health policy integration

Abstract

Introduction

Climate change and public health present interlinked challenges that could be more effectively addressed through stronger integration of climate and health policies. In this case report, we reflect on the process of developing and implementing a complex, multinational climate and health research project on a compressed timeframe. This research examined challenges and possibilities for climate-health policy and involved in-depth interviews with high-level policy stakeholders.

Methodology

Drawing on interviews with our research partners conducted after the project’s conclusion, we describe some of the benefits and challenges of using a centralized “hub and spoke” co-production model to manage international research collaborations.

Findings

While this approach enabled us to balance expediency with collaborative decision-making, it can raise tensions between standardization and adaptability of research methodologies. We also describe external challenges such as accelerated timelines and administrative hurdles and provide insights into our approaches to dealing with these challenges.

Conclusion

We conclude by offering project management lessons for other international research collaborations.

1. Introduction

Collaborative multinational research has been hailed as a necessity for addressing “grand challenges” such as climate change, which inherently transcend the scope of one university, nation, or region, and may be best addressed by bringing together diverse sets of disciplinary expertise [1]. However, this kind of research presents challenges, such as gaining ethics approval in multiple sites, coordinating meetings across time zones, and adapting research protocols to different cultural contexts [2]. Previous research has emphasized the importance of effective leadership, clear communication, patience, and proactive planning in overcoming these challenges [3,4], yet much remains to be learned about more detailed strategies for conducting collaborative multinational research. In this case report, we report lessons learned from a fast-paced, multinational research study on climate-health policy integration [5]. These lessons are generally not exclusive to work on climate and health, but rather may inform future efforts in any multinational research context.

1.1. Calls for developing health scholarship toward multinational and collaborative research

Previous research has observed a rise in multinational collaborations in the area of health research [6], encouraged by initiatives such as the Grand Challenges in Global Health Scheme and facilitated by the post-COVID adoption of remote work technologies. Multinational collaboration may be especially well-suited to health research because it can address complex challenges through diverse expertise, as well as maximizing reach and avoiding fragmentation of efforts (ibid). Furthermore, multinational research can help to tackle health inequities, particularly when collaborators are based in countries with disparate income levels [7]. However, many multinational health research projects are led by researchers in high-income countries [8], raising concerns about the possible exploitation of Global South researchers [9]. This ethical concern is additional to the previously mentioned logistical challenges of coordinating ethics approval, meeting times, and other activities across different cultural and institutional contexts.

Recommended practices for multinational health research collaborations include involving partners from the design stage onwards [10], establishing a clear structure for decision-making [6], creating effective leadership practices that respect the priorities of partners [11], and cultivating relationships, trust, and shared values [12]. While there is as yet little research on best practices for multinational research on topics related to climate change, one case study of a large climate adaptation research collaboration likewise highlights the need for relationships of trust and effective leadership, as well as recommending dedicated project coordinators, multi-level leadership, and flexible funds for arising needs [13].

2. Case presentation

2.1. Project overview

In this study, conducted between Fall 2023 and Spring 2025, research teams in six countries/regions (Brazil, the Caribbean, Germany, Kenya, the U.K., and the U.S.) conducted in-depth interviews with key climate and health policy stakeholders, with each team seeking to understand barriers and opportunities for climate-health policy integration in their respective geographies. Among the key issues investigated were the advantages and disadvantages of integrating climate-health policy; barriers such as institutional silos, funding shortages, and lack of widespread awareness of the health relevance of climate change; and strategies for climate-health advocacy, policymaking, and policy implementation. The country or regional results from this research are published in this special issue. These coordinated multinational studies were funded by the Wellcome Trust and managed by the U.S. case team based at the George Mason University Center for Climate Change Communication. Fig. 1 summarizes the project timeline.

Fig. 1.

Project timeline.

This report highlights both successes and difficulties in organizing and implementing a multinational research effort quickly, adding to a literature on best practices for collaborative multinational research. In addition to summarizing the structure and substance of the research process, we draw insights from semi-structured exit interviews with the most senior research partner (principal investigator, or PI) in each of the six countries. The PIs included professors, research associates/fellows, and center directors. The six interviews were conducted by a consulting investigator working with the U.S. coordinating team between June and July 2025, after all project deliverables were completed and all subaward funds had been dispersed. To allow for frank discussion of strengths and weaknesses in the coordinating team’s approach to this project, interviews were conducted confidentially. Interviews lasted between 30 minutes and one hour each, and focused on a holistic debrief of project challenges, successes, and suggestions for improvement. Please see the Supplemental Information for the interview protocol. In the following sections, we discuss both our own reflections on the project (as coordinating team members) and interviewees’ reflections. Where not otherwise specified, the insights presented represent our own reflections.

2.2. Coordination approach: Hub and spoke structure

While many multinational research projects emerge from conversations within networks of existing researchers, this research project was implemented quickly, in about three months, in response to funder priorities for knowledge generation. The time from initial funding approval to completion of full reports in each separate country/region was initially 13 months, though this timeline was later extended to 18 months. By necessity, the "sprint" nature of the project required a “hub and spoke” structure, with hierarchical leadership by the coordinating team, rather than a “network” model that democratized most critical research decisions across the global project team. However, the coordinating team provided opportunities for input from the partner teams prior to key decisions.

In the coordinating team, the PIs’ responsibilities included obtaining funding and making final decisions about methodology and project management, and the other researchers’ responsibilities included providing input on methodology and project management, serving as the primary contacts for the partners in the “spoke” teams, conducting the U.S.-based research, and writing synthesis reports. In the partner teams, PIs handled project management decisions for their teams (e.g., obtaining human subjects permissions and setting internal deadlines), hired staff, and oversaw the data collection, analysis, and reporting, and researchers had varying duties including gathering national/regional data, managing and analyzing the data, and writing up and presenting national/regional reports.

First, initial funding and research conceptualization tasks were conducted by the coordinating team in partnership with the funder. The coordinating team was then responsible for rapidly recruiting a global team of experts to launch and analyze national research studies in their respective regions or countries, but only after funding was approved. The coordinating team first identified relevant researchers in target case study countries through online searches and personal research networks. After initial indications of interest, the coordinating team held calls with potential partners to explore their interest and availability and address any potential concerns. Once partners committed to the project, the coordinating team began the process of engaging institutional financial and legal departments. Researchers seeking to engage in international collaborations should not underestimate the logistical hurdles involved at this stage, which can occasionally take many months to resolve and will almost inevitably delay research timelines (see Section 2.3). The final multinational team included a total of 33 researchers across seven countries/regions. Each country/region-based team consisted of a diversity of researchers of different disciplinary backgrounds related to climate and/or health, as well as at different career levels.

Members of the global research team had mixed levels of previous experience with multinational research projects. Some had been part of multiple “many lab” efforts previously while, for others, this project was their first experience with a complex cross-national research collaboration. Even for those with previous collaborations, this project was among the most centralized efforts they had experienced, given the hub-and-spoke structure of the research team. Likewise, national partners reported being engaged in the overall effort somewhat later in this research process than was the case in the previous work.

Beyond the speed with which the global team needed to be assembled, this research effort required bringing experts together who had not previously been collaborators or even colleagues. Additionally, many researchers within the partner teams had few prior relationships with one another. Even the coordinating team had not previously conducted research with any of the national PIs, and had prior professional relationships with only a few. Research partners did share second-degree contacts (e.g., shared organizational membership or professional contacts), which was often the basis for the coordinating team to contact potential country-level partners. Given the speed and ambition of the overall project deliverables, the more hierarchical spoke and hub model of research coordination was viewed as necessary by the coordinating team. National PIs felt this was not a barrier, and all offered positive evaluations of the project management style used by the coordinating team.

This leadership was explicitly anchored around prioritizing the ability of national collaborators to have input into key decisions, while also conducting the research according to the relatively swift timeline desired by the research funders. As a way of routinely seeking national collaborators’ input, the coordinating team organized calls every two weeks to deliberate on research decisions and conducted individual discussions on an as-needed basis. This included designing the research questions and approach to answering them, numerous aspects of the methodology, and how to engage with external stakeholders throughout the research process. These every other week meetings lasted at least one hour and brought as many of the researchers as possible together despite global time zone differences. Each call began with check-ins from each partner team and then pivoted to discussion of current tasks (e.g., issues with IRB applications, challenges emerging in recruiting interviewees, and decisions about how to code the qualitative interview data). Meetings ended with free question periods where any global attendees could discuss their priority issues with members of the coordinating team.

Through these discussions, the coordinating team sought to have some degree of methodological consistency to enable cross-comparisons of countries/regions while also providing flexibility to allow research partners to use their own cultural and situational expertise when conducting interviews and analyzing data. Two interviewees mentioned this balance between consistency and flexibility, and felt that they had sufficient freedom to tailor their efforts to local contexts. Central decisions made by the coordinating team included finalizing the research questions, setting a minimum number of interviewees per geography, constructing qualitative code groups corresponding to the research questions, deciding the overall analysis approach, and establishing a shared structure and format for the reports. The coordinating team also made some trivial decisions (e.g., templates for visual formatting of the reports), judging that full consideration by the partner teams was unnecessary and overly burdensome. Dimensions left flexibly up to the teams included forming their own team and deciding roles; language choice for conducting interviews; breakdown of interviewees by focus and professional role; inductive codes nested under each code group; content of the reports (partners also weighed in on the synthesis report to make sure their nation/region was accurately represented); and finding additional opportunities to present results.

The result was a project where similar research protocols were rapidly used across different locations and cultural contexts. PIs reported that synthesis and integration was also aided by the staggered timeline of the project. The coordinating team was several months ahead of other teams in their work on the U.S. case and their analysis of that case. This allowed the coordinating team to share drafts of the analysis and interim results that served as a potential model for the other national teams. Teams found these concrete model outputs helpful in efficiently structuring their mirror research efforts in the other country locations. At the same time, the coordinating team was careful not to share all results too early to avoid biasing the results of global research partners.

While the research model allowed rapid global deployment of a research protocol, this same hub-and-spoke approach was also linked to the main weaknesses of the effort. As a result of the compressed timeline, there were no in-person meetings among the full group (although some researchers did meet in person at events they were both attending.) National team members expressed regret that they had not developed closer relationships with other country leads and were not sure they had developed the social capital needed to develop bilateral or separate proposals in the future with non-coordinating team members. This meant that a secondary goal of the research effort — to help build an international community of researchers in this subject area — had more mixed results. While the research successfully generated important and standardized global knowledge, the structure and funding limited the degree to which it may have catalyzed a truly networked global community of scholars working on climate policy and health policy integration.

Creating a midpoint in-person meeting of key project personnel across countries could have deepened the hub and spoke structure into an incipient network of global scholars to leverage future research and policy opportunities. This is particularly the case since most of the teams did not know each other in advance of the work, and only two of the teams had any sustained relationships with the coordinating team. As an alternative, the coordinating team gave feedback on draft reports for other teams, but there was no opportunity to sponsor cross-team learning through workshops or formal peer reviews as a result of these time constraints. Additional funding for post-award efforts to deepen the policy impact of the research findings also would have benefitted country leads.

2.3. External challenges: Time-delays and government pushback

Given the ambitious research timelines, which inevitably ran into the time delays associated with diverse bureaucratic and ethics approval processes across countries, the ambitious project timeline also had some mixed results. For instance, it took longer than expected to establish and sign the contracts to disburse the funding to the partner teams, since this involved coordination between institutions’ legal teams. Additionally, obtaining Institutional Review Board (IRB) human subjects approval was time-consuming because each nation/region required its own IRB approval process, some of which were slow-moving and labor-intensive. The need for compliance with the European Union General Data Protection Regulation (GDPR) also slowed the coordinating team’s work on the IRB process, since they were U.S.-based and not initially familiar with GDPR restrictions. Furthermore, a partner team that was based at a think tank rather than a university did not have a pre-existing IRB process. Another obstacle was the inconsistent availability of research participants, especially before elections, when policy stakeholders were often too busy to take part in the research. Finally, the timeline was delayed due to discrepancies between different nations’ vacation schedules, particularly across global North vs. South geographies.

On the one hand, the timeline created clear milestones that led to project execution faster than many partners believed would be feasible. However, it also meant that there were less attention and resources available for dissemination and profiling research results at the national level in very specific policy contexts identified through the research by national PIs. These challenges largely required more time and resources to solve, though project participants felt that these could have been addressed with only a modest set of additional resources.

In addition, we encountered an unexpected challenge that resulted in one team that had initially been part of the project not being able to publish their results. This team encountered an equivocal response from an environmental agency towards the research, followed several months later by definitive opposition from a medical research body. This experience highlights the possibility of censorship by government agencies, especially when research critically examines governance. It further exemplifies the long timeframes over which censorship may elapse, which pose a problem for fast-paced, coordinated research. The coordinating team handled this issue by initially pushing back publication deadlines, then publishing with the understanding that the publication would later be modified to include the team’s results if permission were granted.

3. Discussion

Our experience in conducting this study underscores previous warnings of the barriers that may be encountered in multinational research, including both internal challenges (such as coordinating schedules across regions) and external challenges (such as reconciling institutions’ different requirements and capabilities). More specific to our research context was the unexpected opposition we encountered from government authorities in one nation (see Section 2.3). This experience suggests that, when researching politically contentious topics such as climate policy, it is important to allow even more time for institutional approval than would otherwise be necessary. Another constraint specific to our situation was the funder’s desired project structure and timeline, to which the coordinating team was bound, and which precluded involving all partners in the early stages of the project design (a recommended best practice). Our collaboration was ultimately relatively successful, however, and demonstrated that it is possible to achieve some degree of democratic decision-making despite certain foundational decisions being made in a top-down fashion.

The main suggestion for improvement that our partners voiced was allocating more time and resources to allow for network building and reciprocal learning among the partner teams. While having at least one in-person meeting might be optimal for achieving these goals, it has the drawback of carbon emissions, as well as expense. Other possibilities include offering regular opportunities for cross-team brainstorming, peer review, and informal conversation; holding a virtual retreat; arranging in-person meetings around other events that team members happen to be attending in each other’s regions; and creating group chats accessible to all team members.

4. Conclusion

The experiences of the project leaders in successfully organizing and implementing this multinational collaboration offers valuable lessons for other international research collaborations. When building a research team, it is crucial to define and agree to key deliverables, timelines, and expectations. Finding the right balance between collaborative decision-making and centralized leadership can be unclear and requires careful consideration throughout a project. Beyond research outputs, offering opportunities for research partners to network with one another can be an added benefit of participating in collaborations. In-person meetings, even if held only occasionally or once, may help facilitate stronger relationships among research partners than relying only on virtual calls. Project organizers should also anticipate substantial administrative and logistical hurdles, especially when operating on a fast timeline. Overall, coordinating multinational research collaborations can be an ambitious and challenging undertaking; however, doing so offers many rewards, including exposure to diverse perspectives, increased impact and reach, and the opportunity to build rich professional and personal relationships with scholars around the world. Moreover, multinational research collaborations may be essential to build the evidence base that will support work on a complex, international problem that must be addressed across multiple, diverse geographies.

CRediT authorship contribution statement

Joshua Ettinger: Writing – review & editing, Writing – original draft, Conceptualization. Julia Fine: Writing – review & editing, Writing – original draft, Conceptualization. Matto Mildenberger: Writing – review & editing, Writing – original draft, Investigation, Conceptualization. John Kotcher: Writing – review & editing, Project administration, Funding acquisition, Conceptualization. Edward Maibach: Writing – review & editing, Project administration, Funding acquisition, Conceptualization.

Declaration of competing interest

Three of the authors are guest editors for this journal and were not involved in the editorial review or the decision to publish this article.

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:

All authors received funding from the Wellcome Trust.

JE reports an honorarium from the Columbia University Mailman School of Public Health.

JK reports funding from the Energy Foundation, the Kresge Foundation, and the Commonwealth Fund.

EM reports grants from the Robert Wood Johnson Foundation, the Energy Foundation, and the Kresge Foundation; an honorarium for teaching at the University of Colorado; support from the Climate and Health Foundation to attend New York City Climate Week; and his role as a board member of the Global Climate and Health Alliance.