Government-directed R&D promotes openness and collaboration in biotech. Proprietary science blocks research cooperation and tech diffusion

In addition, governments should steer the innovation ecosystem to use collective intelligence and innovation for public-health impact. Scientific and medical innovation thrives and progress is made when knowledge is exchanged openly, building upon shared successes and failures. But proprietary science does not follow that logic: it promotes secretive competition, prioritizes crossing regulatory finishing lines in wealthy countries over wide availability and public-health impact globally, and erects barriers to technological diffusion. While voluntary technology pools can be helpful, they risk being ineffective as long as commercial companies are allowed to retain control over critical technologies and data – even when these were generated with public investment.

The public sector, as a critical investor and participant in developing crucial technologies from vaccines, therapeutics and diagnostics, should govern the drug innovation process more like a market shaper: steering innovation, getting fair prices, ensuring that patents and competition work as intended and safeguarding medicine supply. At a global level, this requires governments to join efforts to impose firm rules regarding intellectual property, pricing and manufacturing. In the case of COVID-19, the process must also be governed in ways that value collaboration and solidarity between countries – not competition – both for R&D and for the availability and distribution of products.

Again, conditionalities are key because they can ensure that public investment is structured less like a handout and more like a market shaper, driven by public objectives. The pricing of the drugs and vaccines should reflect the substantial public contribution to their R&D, based on the real costs of research, development, manufacturing and supply. Beyond statements of principle and generic pledges, there should be concrete stipulations to make crucial vaccines – such as those for COVID-19 – free at the point of use in all health-care systems. As needed, compulsory licensing should be considered to allow countries to make the best use of the available knowledge that emerges from research.

Countries need domestic manufacturing capabilities for producing drugs and vaccines, otherwise there is no guarantee that they will have enough during emergencies as every country prioritizes access for its own population. For this, investments may be needed in a range of assets and technologies. To overcome the technological and financial risks involved, collective, public-interest-driven financing is needed at national and international levels, such as from state and regional development banks, the World Bank and philanthropy. It is also crucial to create collective procurement mechanisms and ensure fair allocation and equitable access worldwide to treatments and vaccines. In any scenario, we must prevent countries from monopolizing the global supply or excluding demand from poorer countries.