The new market builders for health innovation

We often criticize the fragmentation of global development into isolated silos: education, governance, agriculture, environment, humanitarian assistance, economic growth. Even within the silos, there are silos. Health funding flows in vertical streams to nutrition, maternal and child health, communicable diseases, noncommunicable diseases, and while practitioners dive deep into their respective areas of expertise, they often struggle to notice the places where global challenges intersect. Innovation can be subject to the same kind of detachment from what is occurring around it, either because developers become enraptured with the innovative product itself, or because experts look for solutions to one particular problem, rather than solutions that can move the needle for many. But that is where game-changing innovation happens, at the intersections. Ideas emerge from unexpected places, and it sometimes takes a wide-angle lens to notice how groundbreaking they might really be. Chicken distributors did not realize that in tracking the temperature of their product as it traveled from factory to store they had also happened upon a simple technological solution to a problem plaguing global vaccination efforts. Vaccines can endure a limited combination of time and temperature exposure. The higher the temperature they are exposed to, the less time they remain viable. Distributors were forced to err well on the side of caution, to ensure none of the individual vaccine vials within an entire shipment exceeded its exposure limit. If transport complications — hardly unheard of in many places where vaccination initiatives operate — disrupted the delivery plan and risked spoiling any of the vaccines, large numbers of them would have to be discarded. Health practitioners couldn’t risk exposing patients to a compromised vaccine dose, even if those patients had walked miles to receive it. Raw chicken presents similar challenges. Too much exposure or improper refrigeration breeds dangerous bacteria, but chicken distributors devised a clever solution: tiny, color-changing sensors affixed to the sides of packages that enable distributors and grocers to track whether their meat has experienced thaw. PATH, a Seattle-based health nonprofit, adapted the technology to vaccine vials. It’s now been used over 5 billion times, and PATH estimates the added transportation flexibility and assurance has saved millions of lives. But for innovation to consistently transform the development landscape into one that operates more effectively and more efficiently, taking advantage of new technological possibilities requires more than happy coincidence or a stroke of luck. It takes building an ecosystem that can support the entire lifecycle of innovation, from crowdsourcing ideas to building prototypes and designing pilots to creating markets at scale — not just once, but through an ongoing, deliberate process. How can the health innovation world move from building health widgets and hoping they catch on to building health markets that demand innovative products and sustain them? The question is motivated by broader trends in the health and development finance space. At the recent International Conference on Financing for Development in Addis Ababa, Ethiopia, negotiators sent a strong message that global development’s future resides with domestic tax resources and private investment, not with foreign aid. That means the market for global health innovation is shifting too. “I think that the next 15 years, and the success of better health for the world … is going to be more defined by our success on the financing front than anything else,” Amie Batson, chief strategy officer at PATH, told Devex. “The decisions around which innovations you introduce into your program can drive your cost curve ... It becomes extremely important for countries to be thinking through how do they get more affordable and accessible and effective health interventions in a way that’s going to fit within their domestic envelope,” she said. How should national ministries — of health and finance — make those decisions? What is the supporting architecture that’s needed to surface innovations from a broad array of thinkers and designers and inventors and feed those ideas into a pipeline for evaluation and investment? It comes down to “line of sight,” Batson said, a shift in perspective from one-off encounters with innovative ideas and products by people who aren’t necessarily talking to each other, to full awareness of the innovation value chain, from beginning to end. Crowdsourced innovation competitions like the Grand Challenges, originally conceived by the Bill & Melinda Gates Foundation 15 years ago, offer a glimpse of how problem-solving through innovation might be democratized. These challenges put out a fairly general call to action — “solutions to improve infection treatment and control” of Ebola, for example — and then solicit creative solutions to achieve it, with sequenced funding for the most promising applicants. “The Grand Challenge really has three core characteristics. First, it’s about innovation with impact. Secondly, it’s about partnerships, and thirdly, it’s about stimulating innovation all over the world,” Peter Singer, CEO of Grand Challenges Canada, told Devex at a Saving Lives at Birth Grand Challenge competition in Washington, D.C. These programs are vital. With small grants, seed funding and technical assistance, they tap creative potential at a time when mainstream investors see too much risk. By investing early and showing some results, traditional grant-makers can help differentiate between what is real risk and what is perceived risk that stems from a lack of familiarity with the health innovation marketplace. “Traditional players who get it need to be continually encouraged and recognized for the critical role that they play early in the process,” Batson told Devex. But even these promising examples need to be linked more closely with an end-to-end vision for surfacing and sustaining innovative solutions. In a perfect world, different actors will pick up the slack at various points along the innovation chain. Traditional donors provide the de-risking capital to get ideas off the ground and to help get market-based investors interested. Clearing one hurdle invites new supporters to the cause, and these in turn can shepherd an idea through to its next proving ground. The challenge is to ensure the right people and organizations are occupying those different roles and that potential investors are getting the right signals and assurances to encourage their involvement in the process. “You get this chain of conditionality that can really work to your advantage … or it can really work to your disadvantage if nobody’s talking to each other,” Batson explained. The earliest stages of development should happen in conversation with the national ministry programs that will ultimately purchase and implement new health products, according to Batson. By opening up the black box of innovation much earlier, developers can ensure their products more easily integrate into national health systems, and therefore enjoy wider use and broader adoption. A bit further down the chain, ministry officials need the tools to evaluate one innovative technology or approach against all the others, to determine whether or not it’s worth spending money on. When working within the confines of a public budget — and particularly as domestic resources foot a larger share of the health and development bill — public officials need clear criteria for separating the best innovation for their particular context from the long list of shiny objects developers eagerly push toward them. That is where the global health community needs to prepare for a massive transformation: from a health innovation landscape that is mostly supply-side driven, with donor-funded programs pushing approved products into the marketplace, to a future where demand originates in national priorities, plans and budgets. “As we start moving [toward] countries graduating from [official development assistance] sources like [the Global Fund to Fight AIDS, Tuberculosis and Malaria], like [Gavi, the Vaccine Alliance], like [the World Bank’s International Development Association] … the countries will be deciding what things get financed, so they are going to be the market makers,” Batson said. “Brave new worlds. This is going to be a huge shock to the global health system.” West Africa’s Ebola crisis drew widespread attention to health systems. Problems escalate in magnitude when they interact with systemic weaknesses in the institutions meant to contain them. Isolated interventions don’t work without a support structure. Recent triumphs and disappointments in health innovation offer a similar lesson, but in a more hopeful light. Expert solutions falter in a vacuum. Groundbreaking innovation emerges from the ground up, with open conversations and a clear line of sight. To read additional content on global health, go to Focus On: Global Health in partnership with Johnson & Johnson.