System Change is the Real Treatment for COVID-19

by Chris McGivern & SF Team, 8 July 2020

It is difficult to discuss silver linings amid a pandemic that has led to over half a million people losing their lives, hundreds of millions losing their jobs, and the global economy placed on a life-support machine. But in the wake of such devastation, it is important to highlight the opportunity and necessity for significant change. While scientists, academics and manufacturers work to create treatments, equipment and protective gear, we should also place the systems they work in under the microscope.

Simply put, these systems have failed us. The global supply chain struggles to balance significant shocks to both supply and demand, the effects of which will last for long into the foreseeable future. We’ve seen the procurement process turned into a grizzly competition, with states and countries bidding against each other for PPE only to have their orders cancelled when the US Government buys everything.

Elsewhere, governments are guilty of wasting valuable resources and time by awarding ventilator and PPE contracts to headline-grabbing engineering companies and ‘old boys’ networks. And while Big Pharma makes soothing noises with promises to open up their research and help deliver affordable and accessible treatments, companies are quickly reverting to type. Testing is still restrictively expensive for low-income countries, and the latest treatments are arriving on the market with eye-watering price tags. Without significant change, it is unlikely the eventual cure – if we see one – will be any different.

We believe open science, open medicine and an open-knowledge society are part of the solution and must be part of the change. Despite efforts by the incumbents of power for a return to ‘normal’, it is striking how much more open the world suddenly became in the face of a global threat. It is essential to celebrate and build upon that momentum, but also for the West to recognise the problems manifesting in the world right now are life as normal in poorer nations.

Shuttleworth Fellow Jenny Molloy is building tools and systems for an open, sustainable bioeconomy and increased participation and innovation by companies, individuals and communities in under-resourced areas. Researchers in Africa, South America and economically similar regions across the world struggle to access the expensive reagents needed to make scientific breakthroughs. Part of the issue is affordability, but distributional problems also play a significant role. It’s only now that we see similar troubles occurring in the West.

The vast majority of labs use testing systems built by only a few companies, all of whom require chemical reagents to be housed in branded, proprietary cartridges. These are simple, plastic devices. Anyone could make them given the opportunity, but their patented design prohibits it. The proprietary nature of testing cartridges also stunts progress, offers no clinical benefit and causes significant access issues. As global demand went into overdrive, pressure on the few licensed companies making cartridges increased significantly. Supply could not keep up.

This highlights the need for an alternative. We must do better. Jenny’s work to create open systems and tools will be critical if we are to overcome similar challenges in the future, and ensure scientists have access to the basics, enabling them to work for the greater good in their communities and the broader world.

Jenny is also working with a group of scientists, lawyers and entrepreneurs on the Open Covid Pledge. This programme encourages intellectual property owners to offer their pandemic research, designs, and knowledge to others – free of charge – to act faster and minimise the impact of COVID-19. The pledge grants community groups, businesses, technologists, and individuals access to academic and design papers to build their own versions of limited equipment and devices, without fear of breaking intellectual-property laws.

Other fellows are joining in with the relief effort to significant effect. Tarek Loubani is continuing his drive to give the world low-cost, high-quality, life-saving medical equipment by adding 3D-printing face shields for medical workers to his impressive catalogue of work. He is also working with researchers and private companies to create non-invasive ventilation masks. Luka Mustafa is working with Slovenian companies and Fab Labs on designing and producing a variety of PPE including masks and visors. Both projects contribute documentation to the world, ensuring other Fab Labs – there are almost 2,000 on the planet – and private citizens can replicate the high-quality designs for their local communities and adapt them to meet local regulatory requirements.

With regards to treatments and vaccines, it is possible – perhaps likely – that a large, global pharmaceutical company will come up with the eventual vaccine for COVID-19. What remains to be seen is how much they will charge for it. When under the spotlight Big Pharma sometimes blinks, as evidenced by the lowering of extortionate prices of antiretroviral drugs after the enormous public outcry during the African AIDS plight in the early 2000s. And in this current crisis, even companies like Pfizer – usually a fierce champion of proprietary medicine – are committing to sharing their tools, learnings and data on an open-source platform with the global scientific community.

But this is atypical. And despite assurances to the contrary, it seems pharmaceutical companies are already staking a monopolistic claim for high prices on treatments and cures that have already been heavily funded by states. Achal Prabhala’s fellowship work in access to medicine provides a worrying prediction of how this might play out without any intervention. While governments might say all the right things, each is looking after its own in terms of ordering future stock, and there is little mention of access conditions written into contracts with private companies. The reality is that when companies hoard knowledge, advancement is stunted. That translates to the loss of life.

In our ideal, open world, intellectual property standards would be designed to maximise innovation and scientific progress rather than profits. Open pharmaceutical practices would enable faster innovation. Any vaccine developed would be available and affordable to all, not just the wealthiest on the planet. Current open models for this already exist – the 50-year old flu vaccine, for example, is a successful example of ongoing open collaboration and shared knowledge between 110 countries. The COVID-19 Technology Access Pool could do the same for the global response to the pandemic. But unless we apply pressure, we are more likely to see further monopolies and shareholder appeasement rather than the widespread saving of lives.

In broader terms, vast improvements to access to medicine would already be in place, and affordable treatments for other diseases would be available everywhere. The knock-on effect would be fewer people in the hospitals of developing countries suffering from illnesses that are virtually nonexistent in the Global North. This would free capacity to deal with the aftermath of a pandemic in parts of the world where healthcare facilities are already extraordinarily stretched.

Finally, we should also recognise the impacts of tying all of this together. In an open world there is more knowledge transfer between governments, medical professionals, regulators and makers. With greater scope for interoperability comes greater opportunity for real innovation. Spare parts and replacements for critical medical equipment are created by anyone with capability in times of a crisis, without fear of legal reprisal. A larger, open hardware community is more capable of innovating at speed – one new ventilator prototype was designed and constructed within a week – as they build on all knowledge that has come before. The societal impacts are also hugely relevant, as the world recovers from a significant blow to business, employment and lifestyle. Amid a pandemic – or any other crisis of the future – openness can stimulate productivity, boost wellbeing, and break down the systemic power structures preventing speedier progress.