By Ben Ramalignam, Research Fellow at the Institute of Development Studies and Keynote Speaker at the Fourth Global Symposium on Health Systems Research
The science fiction author William Gibson famously quipped the future is here, it’s just not evenly distributed. There is arguably no greater manifestation of our uneven world than that of healthcare. In the wealthiest countries, thousands of people in their 60s and 70s are kept alive with cardiac pacemakers that are remotely monitored over the internet, and adjusted by algorithms with no human intervention. In poorer states, three-quarters of a million children under five are dying each year because of shit in their water.
What can explain such unevenness, and what might be done about it? A scan of the proceedings at the World Health Summit in Berlin, which starts on Sunday, and where technological innovation is one of the major themes, is revealing. “Despite the exponential growth of scientific and technological development, low- and middle-income countries are still largely excluded from access to appropriate and affordable health technologies. Therefore novel technological devices need to be developed that can address health problems and improve quality of life,” reads the blurb for Monday’s keynote session.
Is this “must try harder” assessment correct? Is the solution to stark inequities in global health outcomes, and the enduring exclusion of developing countries from the benefits of innovation, to do more and better innovation?
Certainly, innovation for improved global health is arguably needed more than ever with the need to combat new and emerging diseases from Ebola to Zika and to find better ways of tackling non-communicable diseases such as cancer. But when we look at the innovations made in response to Ebola, we should pause for thought.
One stark example: in November 2014, when the Ebola outbreak was raging through west Africa, the US Food and Drug Administration went through an expedited approval process for a one-hour Ebola test, reducing the time for results by five hours from the previous fastest machines. The problem was that few west African countries had the resources to acquire the $40,000 machines or the skills to run them. They were, however, to be found in many US hospitals.
Or another example: Medécins Sans Frontières (MSF) helped to trial and demonstrate the effectiveness of new tests for TB in low income and humanitarian settings in 2011-12. But the price of the test made it prohibitive for many countries until a large public-private initiative emerged to subsidise the cost of the tests for 145 developing countries that were most affected by TB. Only then could this innovation benefit those who needed it most.
These are far from the only stories of how the poorest are excluded from the innovations that they need most. Once the stories start to accumulate, they turn from a trickle to a river to a flood. And one has to start wondering whether the old adage about famines is not relevant here: famines rarely result from a lack of food, rather it is lack of access to food. Similarly, the inequalities in tackling health problems are not because of a lack of innovation, but because of a lack of access to innovation. The binding constraints, I would argue, are seldom technical but instead related to the political and economic choices, which determine how innovations get funded, resourced and supported, by whom and for whom.
What to do in the face of such a system? The answer is to fight the innovation and political battles at the same time. We have to identify the gaps, and to test and trial the best new ideas that can address longstanding challenges faced by the world’s most vulnerable people, and build the evidence base that these ideas really can make a difference. Political leaders need to ensure that the scaling of new solutions includes those people who need innovation most, and who are most likely to be excluded from its benefits.
In doing so, it is worth looking to the work of organisations such as MSF, which do an admirable job of balancing the scientific and political aspects of advocacy in their Access to Medicines campaign. But we should also remember the work of pioneers, from Florence Nightingale to John Snow, who worked tirelessly to ensure their ideas benefited those in society who needed them the most.
The speakers and delegates at the World Health Summit should remember this pioneering spirit, which fused the spirit of medical discovery with political advocacy. And they should ensure that any statement calling for more and better medical technologies is quickly followed by a statement recognising that technology should at best be seen as a complement to, but never a substitute for, political action.