When a delegation of scientists from Japan recently visited Harvard University in Cambridge, Massachusetts, they asked their hosts a familiar question: what are the secret factors that make the Boston area, which includes Cambridge, such a hotbed for health-sciences research and innovation? In response, George Daley, dean of the Faculty of Medicine at Harvard Medical School, gave the half-joking answer he normally uses when asked similar questions: “Just incubate two of the most important educational institutions on the planet, support them for 200 years, and watch the magic happen.”

The Boston area is home to a critical mass of leading universities, hospitals, biotechnology and pharmaceutical companies, and independent research institutions that all interact synergistically, says Dan Barouch, an immunologist at Harvard Medical School and director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston. “The quality, depth and sheer breadth and scope of research in Boston is just astounding.”

Nature Index 2024 Science cities

It’s no surprise, then, that the Boston metropolitan area leads the Nature Index Science Cities rankings in health sciences, based on 2023 research output in journals tracked by the database. According to the findings, the New York City metropolitan area ranks second after Boston, followed by the urban area formed by Baltimore and Washington DC; London; the San Francisco Bay Area; Beijing and Shanghai.

Science cities is tracking health sciences for the first time this year after data from journals in the subject were added to the Nature Index in 2022, but already, the data reveal some new trends. For one, US cities and London take the top five positions, whereas for most other tracked disciplines — including chemistry, physical sciences and Earth and environmental sciences — China now dominates the top positions.

Science cities rankings are not adjusted for population size, which means large cities such as Beijing and Shanghai — with populations of 21.5 and 26.3 million, respectively — have strong advantages for research output. But this also highlights the oversized contribution to health-sciences research by smaller leading cities such as Boston, whose greater metropolitan population is just 4.9 million. Boston is clearly “still very dominant in this area”, says Yiming Dong, a Chinese studies researcher at King’s College London. But this could change soon, with Dong emphasizing that China is moving quite quickly in the subject.

A tremendous anthill

Lots of cities around the world have good universities, smart people and some industry and capital for research, but few possess “this alchemy that creates, effectively, gold out of these regular materials”, says Paul Sagan, a senior adviser at General Catalyst, a venture-capital firm founded in Cambridge, Masachusetts. Scale, in terms of a concentration of elite scientific research institutions, and repetition, in terms of spinning out a continuous stream of new ideas — some of which succeed and spawn new biotech companies, are key to transforming a city into a true hub of excellence for science and innovation, Sagan continues. Among such hubs for health sciences and biotechnology, he adds, it’s clear “that Boston has sped ahead of everyone”. There are several probable reasons for this, he continues, including the presence of elite research institutions, start-ups and international companies with headquarters there, and a number of government initiatives over the years that have promoted and supported biotech research.

The Boston metropolitan area contains a familiar list of the leading institutions in the health sciences. Harvard University ranks first in the world in the Nature Index for the subject by a large distance and the leading two health-care facilities — Brigham and Women’s Hospital and Massachusetts General Hospital — are located nearby. Boston’s biotechnology sector is also growing quickly, Daley says, and most of the top pharmaceutical companies have established major research centres there.

A large and growing pot of venture capital also fuels health-sciences innovation in Boston. “Because drug development is so expensive, public research funding will never carry all the costs,” says Andrea Braun Střelcová, who studies science policy and research collaboration, with an emphasis on China, at the Max Planck Institute for the History of Science in Berlin. “So, the role of the market is really important.”

Although California has a strong venture-capital presence, too, “the big difference” for the Boston area is the presence of leading pharmaceutical companies — many of which are just a walk from the Massachusetts Institute of Technology (MIT) and Harvard, says Nobel laureate Phillip Sharp, who holds an emeritus position at MIT’s Koch Institute for Integrative Cancer Research.

The size of Boston’s talent pool is also notable, Daley says. Harvard’s full-time medical faculty alone numbers 10,000-plus — more than three times the size of other large medical schools in the United States. Considering all the other Boston-area health-sciences institutions, “you’ve got tens of thousands of clinicians and scientists working towards common goals in confronting disease and solving fundamental biomedical questions”, Daley says. “That’s just a tremendous anthill of activity all within a very small radius.”

Entrepreneurial and cool

Other top cities for health-sciences research possess the same features that make Boston stand out —only on a smaller scale. The New York City metropolitan area, for example, has Memorial Sloan Kettering Cancer Center, ranked sixth in the world among health-care institutions in the Nature Index for health sciences, and the Mount Sinai Health System, ranked eighth. Experts at many top-ranked institutions collaborate, too, which amplifies their impact and output. In the health sciences, collaborations between Harvard, MIT, Johns Hopkins University in Baltimore and the University of California, San Francisco, are among the most productive in the world, according to Nature Index data.

Like its US counterparts, London also has top-notch universities and strong biotechnology and pharmaceutical industries, says Rebecca Shipley, director of the Academic Health Science Centre at UCLPartners in London — an organization that brings together universities and health-care providers to accelerate the translation of research into improved outcomes. Unlike in the United States, researchers in London can benefit from the United Kingdom’s National Health Service, which operates across the country and makes it easier to obtain patient data and run clinical trials. Shipley predicts that London will continue to hold its spot among the leading five science cities in health sciences and has the potential to rise even higher. For example, the UK National Institute for Health and Care Research, which is the major funder of research to improve the population’s health, has awarded nearly £800 million (US$1 billion) in funding over 5 years to 20 university-hospital research centres around the United Kingdom — seven of which are in London — to translate basic discoveries into real-world patient care. There is also an increasing investment in London and nationally to build infrastructure to make patient data better available for research and innovation, Shipley says. This includes secure access for researchers to NHS patient data on a national level through a specialized platform, as well as a London-specific information-sharing hub called OneLondon that connects health and care staff to patient records, among other things. “There’s a real appetite in London to be innovative and build on this momentum,” Shipley says.

Indeed, for any sort of innovation hub to take off, there has to be a culture of entrepreneurialism and a mindset of “not being afraid to fail”, Sagan says. To attract and retain talent, the hub itself also must be somewhere that people want to live. “There are great research universities that might have some innovation, like the University of Illinois Urbana-Champaign, but by and large, that’s not a place where people aspire to live because it’s a small town, and small towns are limited, by definition,” Sagan says. “Not to demean small towns, but most ambitious entrepreneurs and researchers want to go to top-tier cities like New York City, Boston, or Silicon Valley because they are places where their partners can also get good jobs, their kids can go to great schools and their community offers great cultural diversity — and it’s just cool to be there.”

Surprising slips

The United States is showing some puzzling trends for health-sciences research output, however. Unlike the Boston metropolitan area, which increased its adjusted Share in the Nature Index by 6.6% from 2022 to 2023, the other leading four US cities lost ground. The San Francisco Bay Area experienced the steepest decline of 13.2%.

One explanation is likely to be that the Nature Index represents a relatively fixed set of research articles. If cities in one part of the world, such as China, are rapidly increasing their Share then others must fall to compensate. This makes Boston’s performance even more remarkable.

Stacie Bloom, the vice-provost for research and chief research officer at New York University, says she is surprised by New York’s results and that “all the messaging we get indicates that things are going in a more positive direction”. Daley also says that his perspective is that the US cities experiencing a drop in adjusted Share remain strong. “New York City has been on fire, and the Baltimore–Washington DC corridor is a hotbed of innovation,” he says. The San Francisco Bay Area also remains Boston’s “main competition” for cutting-edge biotechnology.

Daley adds that another explanation is health-sciences research from 2022 to 2023 was probably still affected by problems linked to the COVID-19 pandemic. The pandemic caused significant supply-chain issues for biomedical materials, he says, and across many industries, including in science, some people changed careers or took a while to return to work. Boston was probably more insulated from these impacts than other US cities, he adds, because of its higher density of people and institutions.

Daley expects that any decline in top US cities’ health-sciences research output will be “a momentary blip”, and that those hubs of innovation will “return to productivity and growth very soon”.

China rising

For now, cities in the United States, alongside London, still lead in health sciences, but experts predict that China will continue to gain ground. Logistically, this makes sense, says Yu-Xuan Lyu, a scientist at the Southern University of Science and Technology in Shenzhen, who studies ageing. It’s only in the past 10 to 15 years that China rapidly expanded its international research presence and rose to the top in natural-science subjects such as chemistry, which don’t require a close collaboration between universities, hospitals and industry. It has taken a bit more time for China to lay the structural groundwork to conduct world-class health-sciences research, but now that that is beginning to take shape, “the conditions are really good for China to start performing even better”, Střelcová says.

Beijing increased its health-sciences research output in the Nature Index by 17.6% between 2022 and 2023, while Shanghai’s contribution rose by nearly 4%. The southern city of Guangzhou, which is currently ranked 12th in the world for health-sciences research, is also growing quickly, with a 32.4% increase in the year to 2023. This growth is largely because health care and health-sciences research are priorities for the Chinese government, Dong says. “They’re spending a huge amount of money on this.” Health-sciences research accounted for 36%, or 97.6 billion yuan (US$13.8 billion), of the 2024 budget for the National Health Commission — an executive department under the State Council that’s responsible for health policies and health-related emergency management in mainland China.

Scientific advancement in health research is a key pillar of the Healthy China 2030 plan, a set of strategic public health goals first published in 2016. The country’s 14th five-year plan — which outlines overall objectives for long-term domestic economic development and innovation — also includes health-sciences goals, including specific plans to address China’s ageing population and improve health care. China’s National Health Commission’s science strategy also highlights similar goals, and the government is additionally investing in studying and developing traditional Chinese medicine. Some of the largest research grants in the health-sciences field in China are currently being given by the Ministry of Science and Technology and other public funders to university–hospital collaborations for translational research in service of these goals, Lyu says.

In 2022, construction also began in Shanghai on the first of a nationwide network of hospitals that are intended to act as comprehensive national medical centres. Some of the people who work there are likely to be expat Chinese scientists who are being attracted back from the United States or other Western countries, Dong says, through more than 100 talent-recruitment programmes operating at the national, provincial and city level, and also by high salaries offered by Chinese universities and research institutions. Many of these experts have left corporate positions abroad or vacated tenured roles at top-tier American universities, Dong says, including Harvard and MIT.

China’s provinces and cities can also introduce their own targeted priorities, and in both Beijing and Shanghai, that includes biosciences, says Glen Noble, the founder and director of Noble Endeavours, a London-based consultancy focused on research and academia in the United Kingdom, European Union and China. Both cities have “huge amounts of leeway and resources” to implement things such as tax breaks, subsidies, talent-recruiting programmes, science parks and research funding, Noble says. This allows health-science researchers to tap into support from multiple initiatives and levels of government.

Collaborations in China between academia and industry have also started “booming” over the past year or so, Lyu says, and grants are specifically set up to encourage and enable these partnerships. China still has issues regarding intellectual property (IP) protections that draw criticism from the United States and the West, Střelcová adds, including concerns over IP theft and economic espionage. On the other hand, she continues, over the past decade or so, China has “improved and professionalized” the IP protection landscape compared with the past, especially through its regulatory framework and enforcement. “The caveat is that the intent is not confined to intellectual-property rights protection itself, but rather to the overall desire to strengthen national security and increase the country’s competitiveness,” Střelcová says. Regardless of the intent, though, this is a boon for innovators, Dong says, because of the size of China’s market.

Regardless of whether Chinese cities do overtake locations in the United States and other Western cities such as London in health-sciences research, Noble hopes that researchers around the world will be able to maintain strong international collaborations despite political tensions. Currently, however, policies around research security in the West “are primarily calibrated around preventing China accessing Western technology — as if China wasn’t already a scientific power in its own right, across many disciplines”, he says. “Increasingly, we need the science happening in China to be disseminated back to us in the West.”