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Fast and frugal innovations in response to the COVID-19 pandemic

Necessity has been the mother of invention in the response to the COVID-19 pandemic, triggering many an innovation, often without the luxury of time to test these makeshift solutions to pressing problems. But there is much to be learned from times of crisis for times of plenty.

COVID-19 has required unprecedented responses from all countries. Such has been the speed and severity of the pandemic that few countries have been afforded the luxury of following traditional processes of testing and trialing new technologies, processes and medicines. Countries that have delayed their response to COVID-19 seem to be faring worse. The lack of time and resources available to respond to the crisis, as well as the need for rapid scaling in every context, has led to an explosion of innovative responses.

There have been some extraordinary moves. India and Pakistan are refitting their rolling stock of trains to become hospital wards for patients with COVID-191. China constructed a 1,000-bed hospital in 10 days (ref. 2). Distilleries have pivoted to produce millions of bottles of hand sanitizer3. Nations that uphold free choice, movement and competition have suddenly foregone many fundamental values and privileges. For example, in addition to enacting widespread social-distancing measures, the UK, in a landmark deal, has commissioned all of its private-sector hospitals for use by the National Health Service, at cost, expanding capacity by 8,000 beds4.

These responses bear the hallmarks of so-called ’frugal innovation‘—that is, doing more, with less, for the many, and being creative, innovative and resourceful in the face of institutional voids and resource constraints5. This has been the reality of the experience of many low- and middle-income countries, even before the COVID-19 pandemic, which is why so many frugal innovations emerge from these contexts6,7,8. Frugal innovation has been touted for its merits in serving the needs of the poor or the bottom of the pyramid9, formaking business internationally competitive10 and forachieving sustainable development11.

Frugal innovation in healthcare does not mean low quality but instead means the ability to provide safe healthcare in the best way possible under given circumstances and constraints. Challenging as the current public-health crisis is, frugal innovation provides opportunities to expand access to care and to ensure that the care, although perhaps not perfect (yet), is good enough under the current circumstances. While there is a predominant emphasis on affordability and low cost in frugal innovation, there are many other associated drivers, competencies and dimensions as well12. Of these, we believe three approaches help us to relate the examples we have encountered thus far in responding to the COVID-19 threat: repurposing, reuse and rapid deployment. Although it is not an exhaustive list, Table 1 describes several such frugal innovations in some detail.

Table 1 A selection of notable frugal innovation responses in the COVID-19 pandemic

The accelerated pace of clinical-trial approval around the world, including in the USA and Europe, has shown how traditionally conservative institutions can act rapidly in times of urgency. And given the imperative to scale up protective equipment, ventilators, medicines and potential vaccines to the whole world, underpinning all of these approaches is the need to contain costs toward affordability. Although many may be willing to pay anything for containment or cure of COVID-19, governments worldwide can ensure fairness and equity only if the solutions are affordable to individuals and to society as a whole.

These innovations are not without their challenges. Some have not been field tested, let alone evaluated, in randomized, controlled trials. There are other risks, too, with one person reported to have died from the improper repurposing of a form of chloroquine phosphate for prophylaxis following US President Trump’s advocacy of the drug13. However, in the context of this rapidly evolving pandemic, during which even national lockdowns threatening the economic, social and cultural fabric of society have also not been first evaluated and tested, there is merit in using these frugal solutions, improving on them and sharing the resultant findings so that they can bring benefit and needed care to as many victims of COVID-19 as possible.

The physical barrier to co-creation posed by social distancing has been mitigated partly through the greater use of digital tools. Indeed, where the COVID-19 pandemic has witnessed the most effective innovation has been in the sharing of new knowledge though social media, transcending the traditional boundaries of knowledge production, dissemination and consumption. Such has been the speed with which local, regional and national experiences have been shared, nimbly, rapidly and without borders, that it may have left many wondering whether this will disrupt traditional academic publishing altogether.

There are many underlying lessons. Necessity is the mother of invention, and human beings can be resourceful, particularly in crisis, in coming up with frugal solutions that get the job done. It is sometimes necessary to forego high regulatory standards in order to rapidly address new demands at low cost, and although the imperative for frugal approaches to healthcare provision has been witnessed in developing countries for many years, the value of humble approaches to innovation is now being seen even in the most technologically advanced countries. It remains to be seen whether this global crisis will permanently disrupt how innovation occurs in healthcare. Furthermore, the unconscious biases faced by researchers from low-income countries14,15,16,17,18,19,20 may be mitigated by this improved global knowledge flow, and this may result in improved uptake of innovations from these contexts, so-called ‘reverse innovation’21,22.

After the world finishes dealing with the COVID-19 pandemic, the important lesson for humanity here might be to learn from everyone and for everyone. The pandemic may serve as the greatest leveler of our time and teach us to recognize the fragility in all our healthcare systems. There may be, at least, this one positive outcome.

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Acknowledgements

No funding was received in direct relation to this article. M.H. is supported in part by the NW London National Institute for Health Research (NIHR) Applied Research Collaboration. Imperial College London is grateful for support from the NW London NIHR Applied Research Collaboration and the Imperial NIHR Biomedical Research Centre. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

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M.H. conceived of the article, wrote the first draft, and reviewed all subsequent drafts and the final version; Y.B. wrote the first draft and reviewed all subsequent drafts and the final version; and J.B. and D.S. reviewed all drafts and provided substantial intellectual content.

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Correspondence to Matthew Harris.

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M.H. is a non-executive director of Primary Care International.

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Harris, M., Bhatti, Y., Buckley, J. et al. Fast and frugal innovations in response to the COVID-19 pandemic. Nat Med 26, 814–817 (2020). https://doi.org/10.1038/s41591-020-0889-1

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