Policy Innovations Digital Magazine (2006-2016): Innovations: The Innovations Journal Story

Nov 1, 2006

An English country doctor named Edward Jenner discovered in 1796 that inoculation of humans with cowpox conferred immunity to smallpox. To describe the process Jenner coined the term “vaccination,” derived from vacca, the Latin word for cow. When the British Royal Society assented to publish Jenner’s findings in 1798, the work was greeted more with derision than with acclaim. Few believed that fluid from a diseased animal could confer benefits to human beings. The doubters were mistaken. Vaccination became a widespread practice. In 1966, the World Health Organization (WHO) launched an effort to eradicate smallpox on a global scale. By 1980, almost two centuries after Jenner’s discovery, there was no longer a single case of smallpox anywhere in the world.

By what process did the invention of the vaccine ultimately lead to the global eradication of a dreaded disease? Jenner’s work obviously was only the beginning of a long story. The eradication effort required leadership and long-term vision, detailed planning, flexible organization, ingenuity, and hard work on the part of many people. Initially employing a child’s toy construction kit, scientists at the Lister Institute in London developed a method of freeze-drying the vaccine, aiding in storage and transport. Benjamin Rubin of Wyeth Laboratories collaborated with Gus Chakros of the Reading Textile Machine Company to design the bifurcated needle, aiding in administration of the vaccine.

To address problems faced in the practice of large-scale vaccination, fieldworkers involved in the WHO eradication effort developed novel approaches, including smallpox recognition cards, watch guards, reward programs, rumor registers, and containment books. Managers and supervisors encouraged experimentation by field workers, and facilitated communication among them. Discovering the process of vaccination required insight and ingenuity; ending smallpox required a series of innovations. Other cases exist in which technology and novel forms of organization have been employed to address public challenges on a global scale. Yet while problems with major implications for social welfare may be the first to get attention, those with relatively easy answers usually are the first to be solved. In part for this reason, the magnitude of present challenges exceeds that of past successes.

In an era in which the secrets of the genetic code have been unraveled and fundamental processes of life are being newly understood, people everywhere still face a future marred by the stark realities of global climate change, the proliferation of weapons of mass destruction, and the spread of infectious disease. And while the beneficial impacts of technological change have been dramatic, they have not been broadly shared. The majority of people in the world continue to live in persistently poor places, where the local environment is deteriorating and sickness is a daily fact of life.

Existing institutions and incentive structures may or may not be adequate to address these challenges. If the past is any guide, continued progress in addressing public challenges will require continued innovations—the efforts of individuals, groups, and communities who creatively employ new organizational forms, and in many cases new technology, to effect discontinuous change.

Innovations journal is about such innovations and the changes that they bring about. It is less about what needs to be done, and more about what people are doing. Our purpose is to capitalize on the fundamental nature of innovations. Innovations can be copied and possibly scaled up. Innovations open up new possibilities and create the ground for yet more innovations. By drawing attention to innovations in the public interest, we intend to encourage critical thinking about them, and to spur their proliferation.

Why innovations?

Academic journals addressing public challenges typically are structured to address the general characteristics of problems rather than particulars of solutions. The problems in turn are separated by academic field of inquiry: for example, environment, development, health, and energy. However, as illustrated by the smallpox eradication effort, solutions often draw from multiple disciplines and modes of expertise. The conventional approach is successful in motivating communities of scholars to advance the frontiers of understanding within disciplinary boundaries—a key component of long-term advances in the social as well as the natural sciences.

The system is less successful in providing guidance to those seeking near-term options for action leading to lasting solutions. Important insights with potentially broad application are often lost simply for lack of a common space where they can be found. By focusing on the particulars of practice, Innovations is intended to complement existing journals, providing a common space that cuts across academic disciplines, bridges theory and practice, and links human action with global impact.

The journal emphasizes the reciprocal interaction between technology and society. We are particularly interested in the actions of innovators who employ technology to change relationships and thus transform governance. Here, “governance” refers to the institutions, processes, and traditions that determine how power is exercised, how citizens are given a voice, and how decisions are made on issues of public concern. “Technology” refers to things and processes derived from science and put to practical use. We consider the inspiration and impacts of innovations across multiple scales of analysis, both spatially (local, regional, and global) and temporally (short-term, medium-term, and long-term).

Jean Lanjouw was the first person we invited to author a contribution to Innovations. We sought her participation because we admired the singular manner in which she was able to maintain the highest technical standards in her scholarship at the same time that she demonstrated a deep and unwavering commitment to addressing issues of profound societal importance.

Lanjouw made important contributions in a variety of areas. Her series of studies on patent litigation and on the value of patents were widely-read and influential. Lanjouw also made significant contributions in economic development. She studied the role of land titles in urban squatter communities in Guayaquil, Ecuador, and emphasized their interaction with informal property rights. Her development of statistical tools that combined census and detailed survey data so as to view poverty and inequality at the village or neighborhood level, received much attention from academics and development practitioners. But her most influential work focused on empirically understanding the relationship between policies regarding intellectual property rights and economic development.

Debates about intellectual property rights are almost always heated. This is particularly true with regard to policies that relate to the impact of patents on access to critical medicines in the developing world. Yet there has been relatively little empirical research into patent policy and its implications. Lanjouw threw herself into this arena and came up with original and daring policy prescriptions.

The article of Lanjouw’s that appears in our inaugural issue was first published as a Brookings working paper in 2001. Shortly before its release, the Wall Street Journal reported that, Yale University economist Jenny Lanjouw’s plan—in which pharmaceutical companies would surrender patent rights for any new AIDS drugs in poor countries but enforce them in rich ones—is creating a stir at the World Bank and United Nations agencies. Executives at Merck & Co., the drug giant, are reviewing it, and the Treasury Department held a seminar on it last week… While the proposal… is far from being implemented, it is attracting attention from policy makers eager to find a way to address the AIDS epidemic, particularly in sub-Saharan Africa.

For four years, Lanjouw devoted substantial time to meeting with government officials and business leaders in settings as varied as corporate board rooms, the National Institutes of Health, and the World Economic Forum. Yet despite initial interest (and tireless engagement by Lanjouw), there was little movement. In June 2005, four years after the publication of Lanjouw’s Brookings paper, the Washington Post’s Sebastian Mallaby sought to redirect attention to Lanjouw’s proposal: There’s an appetite to spend taxpayers’ money on buying existing vaccines and on a ‘pull mechanism’ for new ones.

But there’s a third challenge in this medical battlefield: How to make drugs that have been invented for rich countries available in the poor world… Jean Lanjouw advanced a solution to [this] problem [in 2001]. The idea would cost nothing: It merely involves drug companies giving up patent protection for heart pills and similar medicines in the poor world. Since poor countries buy almost none of these medicines anyway, giving up patent rights in those markets doesn’t hurt the drug firms. But it would mean that cheap generic versions of these medicines could be distributed to poor consumers.

Lanjouw’s intention was to update her contribution to the journal, describing her experience in seeking to understand and influence the public policy process on the vital topic of pharmaceutical availability in developing countries. She did not have the opportunity to do so. She died on November 1, 2005, at the age of 43, three months after learning she was ill. We dedicated the inaugural issue of Innovations to her memory.

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