Innovation, development and COVID-19: Challenges, opportunities and ways forward

 A global perspective

At the same time as causing a huge impact on health and livelihoods around the world, COVID-19 has a created fertile breeding ground for novel solutions and approaches (OECD Observatory of Public Sector Innovation, n.d.[2]). The most comprehensive survey of global research and development (R&D) funding commitments for COVID-19, undertaken by the US-based Policy Cures programme, shows that investment in health-related innovation has been unprecedented (Policy Cures, 2020[3]). The scale of innovation resources mobilised globally is remarkable: USD 9 billion in seven months. By comparison, the total global funding disbursed for Ebola R&D between 2014 and 2018 was USD1.9 billion.

The nature of the innovation processes that have been deployed is also notable. In the six months since the outbreak began, the US Food and Drug Administration (FDA) has approved almost 100 COVID-19 tests, in contrast to the three months the FDA took to approve the first Ebola test during the 2014 West Africa outbreak. The first COVID-19 vaccine entered into human trials within a record-breaking 69 days of identifying the causative agent of the outbreak1 – a remarkable achievement, considering that it took 25 months for the first vaccine to reach the human trial stage during the previous global coronavirus outbreak (SARS in 2002–04).

As a result of the unfolding and changing nature of the pandemic, decisions about innovation efforts – as with the response as a whole – need to be taken amid uncertainty and at times based on conflicting evidence. For example, despite the need for more basic research to better understand COVID-19 and underpin the design of new innovations, the overt focus of global health innovation funding has been on new product development. Analysis undertaken in August 2020 shows that less than 3% of COVID-19 R&D has gone to basic research, compared to almost 17% across the Ebola and Zika outbreaks.

This means product development has happened without addressing a number of basic scientific and operational questions, which can create downstream risks. For example, because a number of the most advanced vaccine candidates are based on novel technologies, there is still limited understanding of the next steps, with questions yet to be answered about the scope for manufacturing scale-up, long-term patient safety and appropriateness.

Health-focused innovations are only the most visible forms of innovation that have taken place, and are often easier to define and quantify in financial terms. There have been many innovations to deal with the indirect or secondary impacts of the pandemic. These include the wide range of public policy measures taken to aid hard-hit businesses and vulnerable households; grassroots innovations led by citizens and communities to provide mutual aid and strengthen social solidarity; and organisational innovations undertaken across the public, private and not-for-profit sectors to maintain and sustain critical operations in the face of national and global lockdowns, such as the growing use of online working practices, the introduction of a swathe of ‘COVID-19 safe’ business processes and business resilience measures.

It is clear that the urgency of the crisis has been a catalyst for creative and novel approaches, driving decision makers to act fast and decisively. At the same time, urgency can mean that policy makers choose to take decisions without sufficient consultation with relevant stakeholders. There is also considerable uncertainty surrounding the virus and its impacts, how it spreads, how best to prevent and treat it, and how to mitigate the wider impacts.

 A development and humanitarian overview

In low and middle-income settings that are the target of ODA investments, where capacity and resources are more limited, the need for innovation is, according to the United Nations, “more critical than ever… all relevant actors should work together to fund, design and deliver solutions”.2 Given the novel and unknown nature of the virus and its resulting impacts, innovation has played a role in informing appropriate responses to the pandemic from medical, public health and socio-economic perspectives, and also for effective recovery measures.

For many development actors on the ground, the need for creative approaches was clearly apparent from the outset of the pandemic. There have been ongoing challenges around mobility of staff, communications, partner engagement, access and delivery of services, which have continued to affect the response. This has created a rich environment for many donors and partners to adapt and adopt new approaches, form partnerships with new actors, and test new approaches.

Analysis of the USD 9 billion that has been publicly committed (as of 3 September 2020) indicates around 10% -- approximately USD 919 million -- has been pledged by actors with a focus on development and humanitarian work3. Analysing the Policy Cures database, despite its health focus, is instructive as a starting point. By filtering for donors focused on development and humanitarian work, it has been possible to distinguish several kinds of innovation efforts. These have been fleshed out with inputs and insights from innovators, innovation funders, and development co-operation agencies in DAC member countries, as well as desk research. This process usefully reveals the range of innovation efforts that are underway to address the needs of the poorest and most vulnerable communities around the world.

Broadly speaking there are four distinct types of innovation work underway that focus on low- and middle-income countries. The different types of innovation efforts identified are defined in line with the OECD Observatory of Public Sector Innovation (OPSI)’s ‘innovation facets’ model (Figure 1).

 

Figure 1. OECD OPSI facets of public innovation

Notes: 1. Mission-driven innovation starts with a driving ambition to achieve an articulated goal, though the specifics of how it might be done are still unclear or are not set in stone.

1.

Enhancement-oriented innovation often starts with the question of ‘How might we do X better?’ It is not about questioning what is being done, but rather how it is done and whether it can be done differently, and better.

2.

Adaptive innovation starts with the question ‘How might our situation demand changes in how we do X?’ Adaptive innovation builds on the realisation that things are happening on the ground that don’t fit with what is expected, but could be beneficial.

3.

Anticipatory innovation is essentially about recognising and engaging with significant uncertainty about not only what works, but also what is appropriate or possible.

Source: OECD Observatory of Public Sector Innovation (n.d.[4]), Public Sector Innovation Facets, https://oecd-opsi.org/projects/innovation-facets/.

Applying this to analyse COVID-19 innovation efforts provides a deeper understanding of the different kinds of investments that can be observed. It also enables sharper strategic thinking about the overall innovation effort.

• Mission-driven innovation – The most obvious example here is the development of a COVID-19 vaccine, and related arrangements for fair and widespread distribution. Also in this category are the much-publicised efforts to develop ventilators for managing acute COVID-19 cases. While the bulk of these innovation efforts are not focused on developing countries, there have been notable exceptions. For example, a unique public-private partnership to develop a USD 1 COVID-19 test has brought together the United Kingdom government, a global diagnostics firm, and the Institut Pasteur de Dakar (IPD) in Senegal, as well as a number of collaborating academic institutions around the world that have undertaken evaluation and validation at numerous stages of development (Institut Pasteur, 2020[5]). The work has involved adapting an existing IPD innovative diagnostic (for dengue fever) for use with COVID-19. Other large-scale innovations at policy level include furlough and insurance schemes that have been put in place to support businesses and workers during widespread lockdown measures.

• Enhancement-oriented improvements – Many of the efforts in COVID-19 infection control and management fit into this area. For instance, the approach being taken around the world to tracking, tracing, quarantining and shielding vulnerable groups builds on lessons learned from previous epidemic responses, with adjustments made for the specific epidemiology of COVID-19. Some of these have seen novel processes, which upend the traditional development model of global North–South transfer noted above. The track and trace model used in the US State of Massachusetts (Commonwealth of Massachusetts, 2020[6]) has learned extensively from work in Africa, led by international non-governmental organisation PATH. Much of the technological innovation has also focused on incremental innovations. For example, there are numerous examples of medical devices – from ventilators to scanners – that have been simplified and made cheaper for both developed and developing countries. In some cases this has been through repurposing existing solutions or by rethinking existing problems: consider how waste plastic is being recycled and used to produce face visors in Dar es-Salaam in the United Republic of Tanzania. There are also widespread examples of digital innovations that have helped address a wide range of problems, from supporting household-level social protection mechanisms to modernising business finance facilities.

• Adaptive innovations – This refers to original, simple, locally generated ideas that enable results that would not otherwise be attainable. These grassroots innovations have emerged in environments where scarcity of resources compels human ingenuity. Some of these highly localised efforts are based on specific aspects of COVID-19 responses, such as low-cost and frugal production of effective PPE (e.g. the M-19 Initiative in India) (Maker's Asylum, 2020[7]). In other settings, entire approaches to the response have emerged from local understanding and practices. For example, in Kerala, India, the response was led by the state-level government, whereas in the city of Bhopal in Madhya Pradesh, community-led innovations have underpinned efforts to support the extremely vulnerable survivors of the 1984 gas poisoning disaster.

• Anticipatory efforts – In the COVID-19 context, governments around the world are trying to rethink how the post-pandemic world should look. These include efforts focusing on a comprehensive ‘global reset’ of the international economic system that created such dramatic vulnerabilities to the pandemic, and on ensuring a ‘green recovery’. Much of this work is focused on policy-level innovations so that the global economy is re-established on a more sustainable footing, as well as the related organisational and technological innovations that might support these broader changes in societal and economic life. For example, in Viet Nam the government took a multi-pronged approach to the pandemic that addressed the immediate health impacts, the secondary economic impacts, but also placed an emphasis on social solidarity and civic participation, through both new and adapted technologies and processes, all at relatively low cost.

Based on the innovation portfolio framework, and drawing on evidence from the consultation process, Table 1 sums up innovation efforts in each area, what they indicate and the potential benefits and risks.

 Message 1: Innovation for development efforts have been more narrowly focused on improvements to products and processes

As noted above, the pandemic has placed considerable demands on development and humanitarian organisations, which can also be seen as presenting a range of opportunities for innovation. However, for the most part, this opportunity has not been capitalised upon. Most organisations have put in place processes and mechanisms that have enabled them to ‘stick to the basics’: sustaining and re-emphasising existing business models and approaches, rather than questioning and reforming them.

The issues of urgency and uncertainty have played out in very specific ways among the development community. In particular, there have been two common reactions. First, there is a general sense that ‘we need to be seen to be doing something’ combined with ‘we don’t want to take any big risks that might come back and bite us’. As a result, much of the work that has been viewed as innovation has been firmly anchored in existing programmes and projects, and resulting assumptions and operating models.

For example, innovation investments in vaccines and treatments, considerable though they have been, have been made far more straightforward thanks to the existence of large, established and trusted players in these areas (Gavi, the Vaccine Alliance, Coalition for Epidemic Preparedness Innovation and others). In many other settings, DAC members have tasked these organisations to propose existing ideas that could be readily repurposed for use on COVD-19. While understandable from a risk-minimising perspective, this confines innovation to working within existing assumptions, operating models and institutional practices. Put simply, the lower the risk, the lower the potential downstream benefits.

This is not to diminish the good work that has been undertaken. DAC members and the donor community as a whole have made considerable investments in innovation in relation to the COVID-19 crisis, as well as ensuring development gains are secured. There have been numerous examples of innovation for development investments in the COVID-19 response, addressing both the direct public health impacts of the pandemic, and the indirect economic and social impacts.

But pressing questions remain about how well individual investments and the overall effort match the considerable needs created by the pandemic. Like the global innovation effort as a whole, the development and humanitarian sectors have emphasised new product development and product improvements over institutional and systemic issues for the same reasons of urgency and uncertainty. This may reflect a wish among donors on the one hand to limit risk taking and preserve oversight; and on the other to associate innovation with high-end technology developed in high-income countries for use in low- and middle-income countries, which can resonate with domestic political and economic interests.

 Message 2: A broader systems-based and transformational perspective is essential

The incremental focus of current innovation efforts is often underpinned by a misplaced set of ideas about how innovations works in reality. Even those innovations that are ‘single point’ – in the sense that they focus on a narrow challenge and involve a technical solution – need to take into account a systemic perspective.

For example, even the simplest of track and trace digital applications needs to be trustable and acceptable; linked to existing information systems; sensitive to inequalities and risks; especially around privacy and data; and provide incentives for citizens to use it, and for governments to support and own it, and make use of the resulting data. Without a systems perspective, even the most straightforward of innovations risk irrelevance at best or being dangerous at worst.

Development actors have frequently played a valuable role at crisis points, facilitating, catalysing and supporting new and transformational ways of thinking and working. Virtually all the major development innovation successes – from Gavi to M-Pesa and beyond – have come about because of a ‘burning platform’ moment where serious urgency created space for alternative, often radical, approaches.

In such efforts, the role of donors includes recognising and supporting the steps taken by innovators towards developing new and important approaches, helping with relationship building and system development, and providing long-term and patient support.

This is a challenge to donors in the current context, with the domestic economic and political challenges the pandemic poses. But a more transformational approach to innovation that looks not just at innovation in products and processes, but at entire paradigms and ways of doing things, is urgently needed. This is not easy at the best of times, but it can be done. It is especially important in the context of longer-term recovery and establishing pre-pandemic development trajectories, albeit on a more sustainable and secure footing.

 Message 3: Innovation in development and humanitarian responses have focused more on mission-driven and enhancement-oriented innovation, and less on adaptive and anticipatory innovation

While enumerating the investments in each of the four areas in financial terms is beyond the scope of this report, it was clear from publicly announced investments, interviews and facilitated discussions that two areas – mission-driven innovation and enhancement-oriented improvements – have been getting the majority of attention and investment. While there have been examples of adaptive and anticipatory innovation, these have tended to be supported by actors outside of the ‘usual suspects’ of development and humanitarian work, such as foundations, philanthropies and the like.

A more focused and balanced approach across these efforts is important for three reasons. First, each of the areas identified is associated with good practices and lessons from the wider innovation community. Being explicit about what is being done by donors and their partners can also create space for more lesson learning about how to do innovation better. For example, there is a wealth of understanding about mission-driven innovation emerging from organisations such as the United Kingdom-based Institute for Innovation and Public Purpose, which should be capitalised upon by the development community. Similarly, much has been done around incremental innovations in the ‘lean management’ business community, which has been used in pockets here and there across the aid sector, but could become more mainstream in the current context.

Second, a portfolio approach can help to better articulate the theory of change as well as the overall strategy behind particular innovations, and how everything fits together. Focusing on mission-driven investments for vaccines at the expense of anticipating and rethinking the system to ensure vaccines get to the poorest could result in a situation akin to previous epidemics such as HIV/AIDS; where medicines are available in the wealthiest countries, but are years away from being made available to the poorest and most vulnerable communities.

Third, a portfolio lens enables a more multi-faceted approach to the COVID-19 pandemic, which is vital because the crisis itself is multi-faceted. A series of single-point innovations that does not look at the bigger picture is likely to result in suboptimal outcomes. One of the challenges to adopting a portfolio lens is that there is no agreed form of innovation governance within or across development and humanitarian organisations. This predates the pandemic: on the whole, the innovation for development movement has valued decentralised autonomy over centralised guidance, allowing a thousand flowers to bloom. In the current context, however, a thousand blooming political flowers will not be enough to address the challenges posed by COVID-19. While concerns about overt centralisation are well founded, it is possible to put in place forms of governance that are less directive and based more on intellectual leadership and stewardship. This could be the basis for a more collective, strategic dialogue and evidence-based decision-making process around innovation investments.

 Message 4: Collaboration in innovation investments and associated learning processes must be improved, especially across the global North–South divide

Efforts within the DAC and the wider development community aim to improve the tracking of donor-funded innovations, including the work of the Global Innovation Exchange (Global Innovation Exchange, 2020[9]). This provides information on innovations in a wide range of sectors to incentivise funding from social entrepreneurs.

While this has the potential to become a common tool for information management in relation to COVID-19 innovations, the emphasis is on learning and collaboration for innovation processes that are already underway. However, experience suggests that once an innovation process has been launched, especially with donor funds, it can be hard to maintain openness and flexibility.

There is a need for more upfront collaboration and co-ordination to ensure that innovation investments are coherent, joined up and do not lead to proliferation and duplication in COVID-19 investments. Co-ordinated action has already been undertaken through joint initiatives, such as the International Development Innovation Alliance and the Global Innovation Fund, and more is needed.

A disconnect between the innovation needs and interests of the international and national actors has been a long-standing issue. The innovation for development peer learning exercise synthesis report (OECD, 2020[1]) highlighted the vital importance of more coherent, collective, and locally and nationally grounded innovation efforts. In relation to COVID-19, these issues and tensions have become ever more apparent.

Existing challenges to how DAC members approach and deliver on innovation ambitions risk becoming amplified in the pandemic context. While there are examples of donors attempting to catalyse and support local and national innovation efforts, these have tended to be small scale and highly specific to particular partners. For the most part, international players have dominated formally funded innovation efforts.

However, beyond the development co-operation world, there are many examples of locally and nationally led innovation efforts that demonstrate clearly that innovation need not only originate in donor countries from the global North. Three types of engagement can be distinguished, as shown in Box 2.

Speaking to innovators with a focus on low- and middle-income countries, and on reaching the poorest and most vulnerable, it is apparent that much of their work has progressed without significant external investment or support, in response to local and national needs, often by employing a frugal mind-set and approach. On this last point, it is also clear that frugal innovation principles can help meet pressing needs for quality, simplicity, affordability and sustainability in the context of different health, social and economic needs, in high-, middle- and low-income settings alike.

Despite their merits, however, such efforts do not always receive a great deal of wider attention from the development community. A rebalancing of the development innovation portfolio towards more coherent, strategic and sustained support for locally driven frugal innovation has become critical in the context of the pandemic response. Moreover, it points towards the kinds of changes that have long been called for in development and humanitarian policy and practice. It is also conducive to creating new triangular partnerships, where knowledge is shared equally among all partners with a view to co-creating innovative solutions.

 Message 5: Access to innovation is as much of a challenge as innovation itself

As well as designing and delivering technical innovations, it is vitally important to ensure access to these innovations for those who are hardest to reach: the extremely poor; those who miss out because of their gender, ethnic group or sexuality; and those living in remote areas. This is consistent with many DAC members’ policy objectives. It is also important to move beyond individuals and groups, and consider those regions or countries that are often excluded from the fruits of progress, technological or otherwise. These include fragile and conflict-affected states; and, indeed, deprived areas and regions in high-income countries. Without a concerted effort, innovation will not benefit those most in need.

With this in mind, the World Health Organization has endorsed the creation of a voluntary intellectual property pool whose content could be shared for developing drugs, vaccines and diagnostics, which would particularly benefit developing countries. Also, open access to scientific work has been facilitated, where a large number of data and findings related to COVID-19 have been made openly available to the international community. But more work is needed.

Suggestions include problem analyses that specifically identify how marginalised populations are affected; innovative ideas that are developed and tested in close collaboration and partnership with these groups; and assessments of innovation proposals that examine to what extent and in what ways they benefit the poorest (in line with the G7 Principles) (G7, 2018[11]). For example, the following questions should be asked of each innovation project or initiative, with the poorest, most vulnerable and marginalised populations in mind:

• How does this innovation address the needs, opportunities and interests of the poorest?

• How will they be involved in developing, testing and rolling out the innovation?

• How will the poorest adopt, access and use the innovation?

• How will this innovation have a positive impact on their lives and livelihoods?