Jill Lepore’s recent New Yorker article, “The Disruption Machine,” has sparked a spate of commentary on outlets such as Slate, Forbes, and Salon.com. The hullabaloo has revealed vastly different perspectives on what “innovation,” “innovators,” and “disruption” mean.
What these writers are not talking about is where “disruption” and “innovation” matter most—saving people’s lives.
Disrupting the cycle of entrenched poverty and poor health can tip the world on its axis. And innovation has the ability to drive massive improvements in the health and well-being of children, communities, and countries.
Put together, “disruptive innovation,” a term Clayton M. Christensen brought forth in his book The Innovator’s Dilemma, is more than a winner-takes-all game where one technology replaces another or where a business that does the job faster and cheaper replaces an existing, lucrative one. To me, it’s about game-changing, curve-bending opportunities to drive impact—not necessarily through technologies like Amazon’s Fire Phone, which is now caught up in this debate, but through vision, adaptation, and a die-hard commitment to collaboration.
For example, almost every year, a swathe of Africa endures devastating epidemics of meningitis A. The disease can kill a child in 48 hours. Despite the size and impact of the epidemics, for years no vaccine manufacturer was willing to make a vaccine at an affordable price—per African health ministers, it needed to cost less than $0.50 per dose to be a viable option.
The answer: a new model for vaccine development. In 2001, the World Health Organization partnered with our organization, PATH, to create the model. We brought together dozens of collaborators from the United States, Africa, Europe, and India with expertise in such areas as pharmaceutical development, vaccine manufacturing, and clinical and laboratory work. By working across public and private sectors, the Meningitis Vaccine Project brokered the intellectual capital, political will, and technical know-how needed to create an affordable and effective vaccine.
Both the strategy and the vaccine were revolutionary. Affordability was the central feature of the innovation. The project met the target price by procuring an important technology for free from the US Food and Drug Administration and looking to emerging economies for an affordable manufacturer (the Serum Institute of India, Ltd).
As a result of the cross-sector collaboration and the commitment to affordability, the Meningitis Vaccine Project developed the vaccine in record time and at one-tenth of the $500 million cost usually needed to develop and bring a new vaccine to market. The impact: no cases of meningitis A among the more than 150 million Africans who have been vaccinated since 2010.
The most fruitful innovations in global health and development may occur when organizations take a proven technology or intervention, and adapt it for use in low-resource settings. These adaptive technologies are critical when markets have failed, prices must be kept low to ensure access and utilization, and design needs vary due to differences in culture or infrastructure. For example, PATH helped a manufacturer in China (the China National Biotec Group Co., Ltd.) shepherd an existing vaccine for Japanese encephalitis and get it through international regulatory approval and deliver it to millions of children in Asia, where the debilitating disease is prevalent.
The kind of innovation I’m describing—whether in health care, economic development, or other areas—requires a high level of collaboration rather than competition. It means sticking with good ideas until the end—making sure that we put the mechanisms and support in place to bring them through research, development, and introduction, and to scale them up so that we can reach as many people as possible. It means adapting to geopolitical and technological evolutions, and working across borders and sectors to turn great ideas into transformational changes.
All over the world, people are using new ideas and novel tools to solve age-old health problems. And there is evidence of their massive impact: A study just published in the Lancet found that new vaccines, drugs, diagnostics, devices, and other health innovations led to 4.2 million fewer child deaths in 2013, compared to 1990. The study, led by the Institute for Health Metrics and Evaluation in Seattle, was one of the first to quantify the overall impact of innovation on child health. While other factors such as maternal education and rising incomes are also significant drivers behind the decline, new technologies and methods for delivering health interventions account for the largest share.
So let’s recognize that innovation manifests in many ways, whether we call it disruptive, adaptive, or evolutionary. It has astonishing potential to improve the day-to-day lives of people around the world. Let’s talk about that.