GII 2019: Creating healthy lives – the future of medical innovation

By Catherine Jewell, Publications Division, WIPO

The 2019 edition of the Global Innovation Index (GII), launched in New Delhi, India, in July, reveals the latest global ranking of countries on their innovation performance. Now in its 12^th edition, the GII supports policymakers’ understanding of how to foster and measure innovative activity, which is a key driver of social and economic development. GII 2019 also explores the future of medical innovation. Sacha Wunsch-Vincent, a senior economist at WIPO and one of the co-editors of the GII 2019, discusses some of the report’s key findings.

What do GII 2019’s rankings reveal?

Switzerland topped this year’s GII rankings, followed by Sweden, the USA, Netherlands and the UK. China is now a firmly established world innovation leader and continues to improve its ranking. India too, maintains its top place in the Central and Asian region with top rankings in productivity growth and ICT-related services. The Republic of Korea also edged ever closer to the top ten GII countries, becoming the world leader in overall economy-wide investments and research and performing well in most R&D-related indicators. The Philippines and Viet Nam also improved in most indicators and achieved top ranks for high-technology imports and exports. For the seventh consecutive year, the innovation performance of more economies in Sub-Saharan Africa than in any other region outperformed their level of economic development.

Infographics

Infographic: Top five innovation economies globally, by region and by income group

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Infographic: Global leaders in different dimensions of the GII 2019

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How has the global innovation landscape evolved over the past 12 months?

GII 2019 reveals that the global economy is losing momentum and that investment and productivity growth are sluggish. Global foreign direct investment has fallen. And public R&D expenditure in some high-income countries that drive technological advances is very slow. Such spending is central to funding basic and other forward-looking research. Protectionism is also on the rise. These uncertainties are slowing forward-looking investment in innovation and putting global innovation networks and the diffusion of innovation at risk.

Innovation remains concentrated in a few wealthier economies and significant knowledge gaps persist between developed and developing economies. However, the good news is that today all economies are prioritizing innovation to promote their social and economic development goals and are actively seeking to improve their innovation performance. In general, innovation is flourishing globally.

How is modern-day innovation policy changing?

A few years ago, innovation and innovation policies were still the reserve of high-income economies. Today, developed and developing economies – including those with an abundance of natural resources – have placed innovation firmly on their agenda to boost economic and social development. Economies at all development levels now ask questions about how to instill the curiosity of science and entrepreneurship in children and students, how to make public research more relevant to business, how to foster business innovation, and how to make intellectual property work for local innovation.

There is also a better understanding that innovation is taking place in all realms of the economy, including sectors traditionally classified as low-tech. As previous GII editions have shown, countries are well-advised to see the potential for innovation in all economic sectors, including agriculture, food, energy, and tourism. This entails dispelling the myth that innovation is solely concerned with science-driven, high-tech outputs.

Consequently, modern-day innovation policy reveals a number of important trends.

First, innovation policy is invoked not only in relation to economic objectives related to growth and technological change, but also to cope with modern societal challenges, such as food security, environment, energy transitions, and health. Second, on the organizational front, innovation policies have moved from the reserve of a single ministry or policy agency – usually the Science Ministry – to cross-ministerial task forces or various ministries, often with the attention of high-level policymakers, such as the Prime Minister’s office. Third, data-based evidence and innovation metrics such as the GII are increasingly at the center of crafting, deploying, and evaluating innovation policies.

Why the focus on medical innovation?

Over the last century, improvements in healthcare have, on average, resulted in a doubling of life expectancy in all economies, helping to expand the global workforce, drive economic growth and improve the quality of life of many. However, many people still lack access to quality healthcare. Medical innovation (both technical and non-technical) is central to delivering high quality and affordable healthcare for all, a priority shared by all governments. The health sector is one of the most important investors in innovation, second only to the information technology (IT) sector. Health R&D represents a significant proportion of annual private and public R&D expenditures in all countries and, by 2020, global health expenditures are expected to rise to around USD 9 trillion.

Are there any notable patenting trends in the healthcare sector?

Medical innovation is thriving. GII 2019 reveals that medical technology is now one of the top five fastest growing technology fields (the four others are IT-related). Patenting rates are also high in fields such as pharmaceuticals and biotechnology. 

Actual levels of medical innovation, however, are likely to be much higher than patenting statistics suggest because a lot of health-related R&D and patenting is happening in fields like electrical and mechanical engineering, instruments, chemistry and information and communications technologies (ICTs), including artificial intelligence (AI). Many IT-led innovations are enabling process and organizational innovations within the sector and generating operational efficiencies, reducing health care costs and producing better health outcomes.

So, does the sector have a bright future?

Yes. There is a lot of optimism about upcoming health innovations, and their possible impact, which is impressive. Innovations at many different levels are making it possible for more and more people to enjoy better healthcare and improved health.

While most R&D-intensive health firms remain concentrated in Europe and the USA, GII 2019 shows that larger emerging economies, like China and India, and smaller ones, like Indonesia, Mexico, Nigeria, South Africa and Viet Nam, are progressively making their mark on the global health landscape.

While there has been a slowdown in pharmaceutical research productivity in recent decades, innovation is flourishing in other increasingly health-related sectors, such as medical technologies, IT and software applications. For example, over the last five years, regulatory agencies have approved a record number of new medical devices – heart valves, digital health technologies and 3D printing devices.

But caution is needed in mapping how quickly medical innovations come about. The complex nature of health innovation ecosystems tends to slow the deployment of health-related innovation. And many obstacles still need to be overcome, not least the persistent gaps in access to quality healthcare in many middle and low-income countries, and the need to make healthcare more affordable everywhere.

How is the health innovation landscape changing?

We are seeing a convergence of digital and biological technologies, which is creating huge opportunities to improve healthcare systems at many levels. GII 2019 underlines the transformative power of IT-led innovation within the sector. Rapid advances in digital technology and AI, in particular, promise to enrich global healthcare and are driving and reshaping its evolution, prompting a shift from the traditional “react and revive” approach, which helps sick people recover, towards a “predict and prevent” approach that helps people stay healthy. Health-related technologies and organizational innovations have the potential to lower health costs and improve overall healthcare efficiency and quality. These new technologies will transform patient-doctor interactions, diagnoses, treatments and how disease prevention is handled. Greater automation of health systems will improve the flow of information among health providers, enabling a better assessment of the impact medical technologies and pharmaceutical inventions have on patients. AI, big data and machine learning also promise to speed up drug discovery and the development of more precise and affordable diagnostic tools and treatments.

Harnessing these benefits, however, will require the development of infrastructure and policies that enable effective integration and management of data across the healthcare ecosystem and efficient and safe data collection management and sharing processes.

Are there opportunities for emerging economies to improve their healthcare systems?

Developing countries face many of the same constraints as developed countries but may have access to opportunities that developed countries lack. New health technology applications in the field of telemedicine, real-time diagnostics tools and establishment of electronic health records in India and China, for example, are indicative of this. These technologies offer developing countries opportunities to leapfrog existing health systems and to embrace alternative operating and financing models and legal frameworks that were not previously available to them. In so doing, there are opportunities to deploy new health solutions more rapidly with immediate impact without the need to scale-up healthcare facilities and professionals proportionately.

Many medical innovations, such as 3D printing or medical diagnostics for malaria, are relevant to developing countries, as are organizational innovations that enable improved health screening, as seen in Egypt, or the use of remote telemedicine applications, as seen in Rwanda. Such innovations offer unique opportunities for emerging markets to scale-up access to affordable, quality healthcare, even for patients in the remotest regions. China and India stand out as notable examples of countries that are actively embracing IT-led innovations in their healthcare systems.

Many so-called “frugal” or “adapted” medical innovations are also having considerable impact in low-resource contexts. For example, clean delivery kits that allow doctors in low-resource contexts to deliver babies more safely.

Why is the diffusion of medical innovations difficult?

Moving medical innovations from the “bench to the bedside” can take decades. Many different actors are involved and the whole process takes place within a policy and regulatory framework shaped by government or regulators to ensure patient safety and access. Legacy healthcare systems typically work in silos and have inefficient and poorly developed systems and standards to exchange medical data, making them operationally inefficient.

Speeding up the diffusion of existing medical innovations to developing countries would make a huge difference. Medical technologies specifically adapted for low-resource settings are also required. Although the reality is that market forces continue to shape pharmaceutical R&D activities, which target diseases that prevail in high-income countries, there are opportunities for developing countries to advance health coverage by investing in improving the functioning of their health systems. The experiences of Egypt and India outlined in GII 2019 offer useful lessons in this regard. 

What medical breakthroughs are on the horizon?

Many exciting medical advances are in view. A better understanding of how individual human cells function promises breakthroughs in the diagnosis and treatment of many autoimmune diseases and cancer. Advances in brain research will improve diagnosis of neurological conditions and enable breakthroughs in treating Alzheimer’s and spinal cord injuries. We can also anticipate better pain management techniques and advances in regenerative medicine (imagine a biological replacement pancreas using a patient’s own cells!). Advances in immunotherapy will offer hope to millions of cancer patients. New, safer and more effective vaccines are on the radar and the promise of gene editing to cure disease will soon begin to bear fruit. Advances in the application and use of data science will foster important new insights to support personalized or precision medicine. Virtual modelling and AI techniques will transform medical research, facilitating medical breakthroughs and innovation. Healthcare delivery will also improve. IT-led innovations, including AI and big data, will help overcome inefficiencies linked with legacy health systems, and will also allow health monitoring in real time, remote tracking of conditions, and data analysis and sharing for earlier, more precise diagnoses and personalized treatments.

New technologies, and their associated costs, will bring new possibilities as well as new risks and uncertainties. Some, such as genetic engineering, will also challenge current ethics and societal values. Others will raise issues of equity and access. New decision-making structures will need to address these issues. Care is also required to ensure these new advances do not exacerbate existing healthcare gaps. The future of medical innovation and its impact on global health will depend crucially on national and global actors creating the policies and institutions to support medical research and innovation.