The ethics of “innovation” in global health
UPS (United Parcel Service) recently announced that it is teaming up with a drone company and GAVI (Global Alliance for Vaccines and Immunisation) to use robotic aircrafts to deliver essential medicines to remote areas in developing countries. UPS is partnering with Zipline, a California start-up, to deliver blood products to health centres in Rwanda as part of another partnership with the Rwandan government. This is certainly a great, and perhaps surprising, example of the increasing integration of start-up mentality and tools with international development and global health.
Indeed, it’s hard to avoid the buzzword “innovation” in most professional fields today. In general, the term is associated with positive change and new ways of thinking that have the potential to drastically improve people’s lives and, in some cases, impel important societal change. The global health and development fields are not immune from this widespread appetite for “innovation.” Many universities, such as Yale, Northwestern and Stanford, among others, now even have entire centres dedicated to innovation in global health. Some of these universities host competitions and reward the most promising innovations with seed funding. In 2015, USAID issued a “call for innovation,” noting that “finding innovative solutions to complex challenges” represents the only method of achieving the Sustainable Development Goals.
All of this is certainly exciting and has the potential to produce some important insights in these fields. But it’s also easy to get swept up by the excitement and forget about some key ethical questions that accompany innovation in socially-driven fields such as global health and development. After all, inventing a new way to store vaccines is not the same as creating a new social media platform. The former involves people’s lives and health while the latter is an appealing luxury.
The issue is that new technologies and innovations in global health can come with ethical risks both in terms of failure and even damage to people’s health, and in the possibility of derailing other tried-and-true programs and diverting resources. In other fields, such as medicine, ethical guidelines do exist to ensure that innovative trials do not prematurely displace usual care. The guidelines, called the “regulatory ethics paradigm,” ensure a set of procedures to protect patients.
While such a framework does not exist in global health and development, there are some basic guiding principles that every innovator should follow. For example, there should be some sense of the extent to which the innovation will really improve the situation as compared to “usual” care. While it is impossible to know this for sure, honest projections can be made that may help guide whether the innovation is worthwhile. It is absolutely essential that the innovation is culturally and socially acceptable in the setting in which it is being offered. It is vital not to get swept up in the benefits of new technologies without ensuring that those technologies actually make sense in the setting in which they are to be distributed.
The innovation should also be set up to address areas of significant burden, especially if the technology is expensive and involved. Replacing age-old public health interventions known to benefit millions of people with expensive technology that may only feasibly affect a few hundred people is not an acceptable use of resources. The innovation should address key issues and have the potential for widespread impact. Funders should ensure that appropriate and relevant impact metrics are being collected on all innovative interventions.
Despite potential ethical issues, there are a number of ways in which bringing a “start-up mentality” to development work can be beneficial. For example, start-ups are used to moving quickly and keeping the end user in mind. International development can be far too slow to react to problems on the ground and sometimes be too far removed from people to really understand the issues they are facing. Some of the “tenets” of Silicon Valley might be very useful for international development, as long as they are appropriately adjusted to deal with issues of scale and systems-oriented approaches. A good example of this kind of productive paradigm shift in action is UNICEF’s Innovation Labs. UNICEF’s Labs are essentially set up to ensure that entrepreneurial thinkers with innovative technological ideas are able to systematise and scale their ideas in the wider context of development. This kind of approach takes the best of both worlds and helps ensure that good ideas do not get lost on their way to market.
Innovation in global health and development is undoubtedly essential; but, anyone attempting to implement an innovative idea or technology should be responsible and vigilant about ensuring that the innovation is appropriate, safe, and has real potential for impact. Plus, anyone funding such ventures should be sure to evaluate the innovative idea using some of the frameworks discussed above. Above all, human rights and the right to effective healthcare must be protected at all costs.
Featured image shows a flying drone. Photo from Pixabay.