It has been a year of constant reminders about what's missing, but 2020 has had no shortage of bubbles. They are suddenly everywhere; some reminders of what we refuse to go without, others by necessity.
Sports bubbles, crafted with military precision so that we may continue to watch, and so that names may be etched onto trophies. State and territory bubbles, shaped by daily infections and factors that predate COVID-19, such as population, distances and governments that were already in place.
Should it be any surprise, then, that the healthcare we receive in Australia can be bubble-shaped, in ways that threaten to pop?
For something set up by the federal government five years ago, the Medical Research Future Fund may seem swollen at $20 billion.
The interest from the fund pays for medical research and, if thought of as a funding bubble, it will soon swell to the size of the original major government funder, the National Health and Medical Research Council.
The Future Fund - that new, growing bubble - is on track to disburse about $580 million in the coming financial year. If that sounds like a lot, it isn't, compared with how much we in Australia spend on health.
With the two major funders combined, the Morrison Coalition government currently pays for health and medical research at about 0.5 per cent of total health expenditure. That is well short of the 3 per cent recommended by a review to the Gillard Labor government in 2011.
While the states enlarge the nation's overall funding bubble by adding their own locally relevant project bubbles, the result is simply not enough research and development for a sector as vast and complex as health.
In an ideal world, there would be more total government investment in Australian health and medical research. There would also be far more data publicly available about where Future Fund money goes.
For instance, less than three per cent of National Health and Medical Research Council funding goes toward rural health and medical research. As for the Medical Research Future Fund bubble, its walls aren't completely opaque; we know, for instance, that of its 79 mission advisory board members, 75 are based in capital cities. One lives in rural Australia.
It's less clear, currently, how many Future Fund research projects are designed to benefit the almost one-third of Australians who live in rural and regional Australia.
The composition of the boards does not inspire optimism. As things stand, the separate bubbles in which rural and metropolitan health exist look set to remain separate, and unequal at the level of systematic research funding.
And yet, murky as it can be, there are things worth preserving about the bubble that is the Medical Research Future Fund. Its parameters. Its malleable walls. Its substance.
Unlike some toxic funding bubbles that shut out innovative ways of improving health - like preventative measures, large-scale behavioural change and research on care - the Medical Research Future Fund nurtures the translation of medical research into improvements for Australians' health.
The nation's 10 health research translation centres feed off the oxygen from within the Future Fund - which is why their work is jeopardised by moves to review programs that rely on it. Critics, such as the Australian Society for Medical Research, talk of the need for something "more competitive". What would that mean?
Firstly, the loss of co-designed research that wouldn't survive this definition of competitive process. Such research by design is not pre-specified in detail and cannot be easily assessed. Community-initiated, designed and led research projects, so critical to heath research in Central Australia, for example, simply cannot compete with the major research organisations in metropolitan Australia.
Fledgling health partnerships would fray and researchers would return to fighting for air within their own bubbles.
Secondly, the big capital city universities that already hold a large proportion of Medical Research Future Fund and National Health and Medical Research Council grants will continue to do well, at the expense of others. And people in rural Australia will continue to lose unless rural targets are included in calls for competitive research.
In this weirdly compartmentalised world that all of us are trying to navigate, governments need to find more creative ways to spread health and medical research funding across Australia, and beyond its major cities to make sure real community needs are met.
The Medical Research Future Fund is making a real contribution to health and medical research. We need our leaders to make sure it doesn't burst.
Christine Jorm is director of NSW Regional Health Partners, an NHMRC-accredited Centre for Innovation in Regional Health.
Warren Payne is executive director of the Western Alliance Academic Health Science Centre, based in Western Victoria.
Chips Mackinolty is director of Central Australian Academic Health Science Network, an NHMRC-accredited Centre for Innovation in Regional Health.
