Responsible Research Innovation For Global South Healthcare

176

The Global South faces substantial healthcare challenges due to extreme poverty and inadequate healthcare infrastructure. To address these challenges, the development and deployment of advanced healthcare technologies based on new biotechnological approaches are crucial. Governance plays a pivotal role in harnessing these technologies to tackle significant healthcare issues like a high disease burden, import dependency, and unaffordability. This policy brief outlines emerging trends in advanced healthcare technology development and emphasizes the need for a comprehensive framework of ‘Responsible Research Innovation’ (RRI) to govern the development and dissemination of need-driven emerging technologies. This approach can aid the G20 in addressing the substantial healthcare challenges confronting the Global South in a sustainable manner. Finally, this brief presents six key policy recommendations aimed at accelerating progress toward the Sustainable Development Goals for health. Healthcare is a fundamental human right and plays a significant role in shaping a society’s socio-economic development.

However, access to healthcare is unevenly distributed globally, with the Global South experiencing common health challenges, poor health indicators, extreme poverty, resource-scarce healthcare settings, vastly unequal health infrastructure, and market-driven research strategies. The development of advanced healthcare technologies based on new biotechnological approaches holds the key to addressing these healthcare challenges faced by the Global South. Nevertheless, their development and deployment must be accompanied by foresight and governance practices that enable their use to address healthcare challenges specific to the Global South.

In this context, this policy brief advocates for a holistic framework of ‘Responsible Research Innovation’ (RRI) to empower Global South countries to govern their healthcare systems in ways that cater to need-based technological advancements. The RRI framework is designed to facilitate the development of ethical, sustainable, and socially desirable innovations. It holds significant relevance in the governance of science, technology, and innovation, particularly in emerging fields like nanotechnology, synthetic biology, information and communication technologies, and neurotechnologies. The principles of the RRI framework have been incorporated into the European Commission’s sixth framework program, establishing them as crucial concepts and practices in European science, technology, and innovation. Moreover, countries in the Global South, such as China and Brazil, have begun adopting the RRI framework to address the interconnected challenges of science, society, and innovation.

Emerging healthcare technologies encompass advanced biotechnological and biomedical engineering approaches, including gene editing, cell therapies, artificial intelligence, and personalized medicine. These technologies have the potential to revolutionize healthcare delivery by offering innovative solutions in areas such as therapy, diagnosis, and imaging. Gene editing technologies like CRISPR-Cas9 show promise in treating and curing genetic disorders, while cell therapies such as CAR-T cell therapy have achieved remarkable success in certain cancer treatments. Artificial intelligence and machine learning can enhance diagnosis and personalized treatment, and personalized medicine tailors treatments to an individual’s genetic profile.

While these emerging technologies hold great promise, their development and deployment face significant challenges in the Global South. The region currently lags behind in most health indicators due to persistent shortcomings in the healthcare system, including extreme poverty, inadequate healthcare infrastructure, and the burden of existing and emerging diseases. These challenges are exacerbated by two complex policy issues: first, healthcare financing in these countries is shaped by market-driven economic policies that often neglect need-based innovations, resulting in inadequate funding for emerging healthcare technologies. Second, the domestic manufacturing sector’s performance falls short of meeting unmet medical needs, leading to dependency on expensive imported technologies. These challenges continuously undermine the healthcare systems of the Global South, exacerbating ‘grand healthcare challenges’ such as high mortality from communicable and non-communicable diseases, maternal and prenatal issues, low government spending on healthcare, and a significant proportion of out-of-pocket healthcare expenses.

Emerging technologies can effectively address these grand challenges if their development and diffusion align with the specific needs of healthcare systems in the Global South. To achieve this, a comprehensive framework is required that considers the existing challenges faced by these systems and formulates effective strategies for developing and disseminating emerging technologies with a focus on need-based innovations. The challenge-based RRI framework is recommended to address the deficiencies in the healthcare systems of the Global South. The RRI framework can establish a sustainable system for deploying emerging healthcare technologies and enhance their effectiveness in addressing grand healthcare challenges.

The RRI framework offers a comprehensive approach to help Global South countries effectively govern their healthcare systems in response to technological advancements while also addressing societal needs. It aligns innovative processes and outcomes with societal values, facilitating the development of cutting-edge and sustainable solutions that prioritize equity, sustainability, and social justice in addressing grand health challenges. The RRI framework comprises four main elements: anticipation, reflexivity, inclusion, and responsiveness.

Anticipatory governance involves identifying and addressing potential ethical, social, and legal issues associated with emerging healthcare technologies before they become problems. Reflexive governance engages stakeholders and considers their feedback in the development and deployment of these technologies. Inclusive governance ensures that all stakeholders, including civil society members, have an equal opportunity to participate in technology development and deployment. Adaptive governance entails continuously monitoring and evaluating the impact of emerging healthcare technologies and making adjustments as needed.

Each governance element of the RRI framework allows for a system-level analysis that shapes the work of public institutions determining the supply of new healthcare technologies. These institutions include health research funding agencies, public venture capitalists, technology transfer offices and incubators, and health policymakers who control demand through procurement policies, coverage and reimbursement decisions, and health technology assessment programs. By including a wide range of stakeholders early in the process, the RRI framework ensures that emerging healthcare technologies are developed and deployed in ways that are culturally and contextually appropriate, socially responsible, and beneficial to the communities they serve. This is achieved through effective functioning and monitoring of the four governance elements and by creating a regulatory structure that includes various stakeholders such as civil society groups, experts, and state and central government agencies.

The G20, a group of major economies, has a significant role to play in promoting sustainable healthcare, a critical aspect of achieving universal health coverage (UHC) as outlined in the 2030 Agenda and its Sustainable Development Goals. The G20 has consistently emphasized the need for global collaboration on healthcare and has urged member countries to strengthen their national healthcare systems. The G20 recognizes that resilient, inclusive, and sustainable health systems require collective action at the global level.

In light of future disease outbreaks and pandemics, the G20 aims to support research into advanced tools and technologies for predicting and modeling pandemic events. It seeks to leverage existing and emerging technologies, such as electronic technologies and digital service delivery systems, to enhance prevention, risk mitigation, crisis communication, and response measures, utilizing both public and private resources. Additionally, the G20 intends to assist low- and middle-income countries in acquiring competencies and building local and national manufacturing capacities, facilitate data sharing, skill development, licensing agreements, and technology transfers on mutually agreed terms, and invest in inter-operable early warning information, surveillance, and trigger systems aligned with the One Health approach.

The G20’s declarations since 2017, especially following the Ebola outbreak and the COVID-19 pandemic, have focused on strengthening health systems and global health crisis management. The G20 can serve as a platform for collaboration, international cooperation, and knowledge exchange to develop a governance roadmap for emerging technologies. This is crucial in addressing the grand healthcare challenges of the Global South.

Considering the strength of the RRI framework in shaping a sustainable environment for the development and diffusion of emerging healthcare technologies, this brief recommends six key actions for the G20:

Equal Participation: Ensure equal participation of all stakeholders, including civil society groups, in the development and deployment of healthcare technologies to benefit society at large.

Strengthen Domestic Healthcare Financing: Enhance domestic healthcare financing systems for targeted research and innovation to promote sustainable and affordable development and deployment of healthcare technologies.

Promote Equitable Access: Establish sustainable healthcare financing systems that ensure equitable access to healthcare technologies through schemes like Universal Health Coverage (UHC).

Foster Academia-Industry Collaboration: Encourage partnerships between academia and industry to accelerate the development and deployment of healthcare technologies, bridging the gap between research and product development.

Implement Effective Health Technology Assessment (HTA): Establish effective Health Technology Assessment (HTA) mechanisms to evaluate the benefits, barriers, and risks of new healthcare technologies, ensuring safety, effectiveness, and cost-efficiency.

Facilitate North-South Partnerships: Create effective partnerships between the Global North and the Global South to promote equitable development and deployment of healthcare technologies, leveraging knowledge transfers and capacity building to address specific regional needs and contexts.

These recommendations, if adopted by the G20, can contribute significantly to addressing the healthcare challenges faced by the Global South and advancing progress towards the Sustainable Development Goals for health. By fostering international collaboration and responsible research innovation, the G20 can play a pivotal role in shaping a healthier and more equitable future for all.