Ventilators are stored and ready to be used at ExCel London, during its conversion into the temporary NHS Nightingale Hospital to help tackle the COVID-19 outbreak, in London, U.K., March 31, 2020, photo by Stefan Rousseau/Reuters

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(The RAND Blog)

The COVID-19 Crisis Has Sparked Innovation and Offers Lessons We Must Not Forget

Ventilators at ExCel London, during its conversion into the temporary NHS Nightingale Hospital to help tackle the COVID-19 outbreak, in London, U.K., March 31, 2020

Photo by Stefan Rousseau/Reuters

by Sonja Marjanovic

April 1, 2020

COVID-19 has shocked the world and caught most countries unprepared, forcing them to improvise how best to protect the health of their populations. Among all the potential consequences now being faced, the health risks are undoubtedly the most alarming. The wider social and economic consequences are also starting to hit home, but have yet to fully unravel. However, amid all the confusion and the fear, the power of individuals, organisations, and communities to think differently and to innovate shows what can be achieved when people are united by common, clear priorities and necessity.

Earlier this year, RAND Europe published the results of many years of research focused on innovation in the healthcare system. We flagged that a lack of funding is not the only (and perhaps not even the biggest) barrier to medicines, medical devices, diagnostics, and innovative methods reaching those in need, on time and at scale. Our recommendations considered how to build innovation skills and train the healthcare workforce and entrepreneurs, and how to strengthen leadership, incentives, and accountabilities to help the adoption of innovation in the NHS.

Our research also outlined actions to support better coordinated collaboration between different research and innovation initiatives, funders, and policymaking bodies, and steps to ensure that patients and the public can effectively contribute to progress and benefit from it. Our assumption was that many of the recommendations we put forth will take months at best, and years more likely, to be put into practice—because the translation of research and innovation into practice generally takes a lot of time to unfold.

But if there is one thing that the response to COVID-19 is demonstrating, it is that when there is a critical mass of will and clear priorities, innovation can quickly reach the front line—to save lives and protect the health and well-being of healthcare workers, patients, and the public. People can be trained up, skilled, and re-skilled at pace. Political will and clear lines of accountability can shift courses of national action rapidly, in response to a rapidly evolving evidence base.

When there is a critical mass of will and clear priorities, innovation can quickly reach the front line.

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Innovation is coming together in the most inspiring of ways. Researchers are working closely with policymakers and those at the NHS front line to roll out innovations that would in other circumstances take years to bring to patients. Digitally-enabled consultations (e.g., video consultations, online consultations) are now becoming routine practice for dealing with patients overnight in both acute and primary care in the NHS (wherever possible). And guidance on how to do them well has been produced in response to the degree of need and urgency that COVID-19 presents. The best available evidence on issues such as diagnosing breathlessness is being translated into testing regimes in a matter of hours and days (PDF).

This fast pace of translation comes with its own risks and trade-offs, for example, data security risks or perpetuating inequalities in access to care for those who are not digitally connected. But all those involved are working hard to learn quickly about how to leverage the power of digital communications, while managing the risks and ensuring practices have individual consent behind them.

The research community is also turning around studies and publishing evidence at an unprecedented pace. For example, Oxford University has established a COVID-19 Evidence Service which publishes regular reports on questions that NHS staff at the front line and policymakers urgently need answers to.

Industry actions are reminiscent of what happened in response to the emergence of HIV, when large pharma companies donated compounds for testing to accelerate antiretroviral research and development. Compounds are being donated, tested, and entering trials quickly. For example, the UK has just begun a trial of a combination of compounds used to treat HIV (i.e. iopinavir and ritonavir) and a steroid used to reduce inflammation (dexamethasone) to assess their effectiveness for treating COVID-19.

Interdisciplinary and cross-sector collaboration and innovation are coming out in full force—and making an enormous difference at great speed to save the lives of those most badly affected. For example, Formula One is working with government and health authorities to boost the supply of much needed ventilators to the NHS and is repurposing some of its manufacturing capacity to achieve this. And the British army is working with the NHS to ensure that personal protective equipment supply chains are rapidly improved to address the shortages of getting much needed protective gear to health workers. Supermarket chains are innovating to curb the 'dark side' of individual behaviour as a result of stockpiling by many shoppers. Major risks to continued supply may still exist, but innovation in supply chain management is happening by the day.

Perhaps most inspiring of all is the social innovation I am witnessing in my own city, which provides one story among countless others. While it started with WhatsApp groups in small localities like mine, the NHS has now extended volunteering nationally. Our hearts have been warmed by stories of individuals helping the most vulnerable and needy to provide basic supplies and offering friendly conversations to combat loneliness due to social isolation, particularly among those who lack the technology to connect. Educational aids abound to keep our children engaged in learning and entertained. The spirit of community is shining through as much as possible, with a good dose of humour to make the days a bit brighter.

The critical links to make all of this happen appear to be a very clear sense of priority and strong awareness of interdependence. It would be naïve to think that every issue facing society will in the future be met with the same collective effort and urgency as is the case with COVID-19 at the moment. However, as a result of the crisis being faced now, people will hopefully all become more united by the pursuit of collective well-being. Innovating—individually and collectively—could change the future. And hopefully the changes in attitudes, mindsets, and energies that are uniting people now will persist once this emergency is over.

If people can come together around COVID-19, and all developments are showing that they can, then perhaps they can be equally innovative in tackling many of the more silent 'COVIDs' of the time—i.e., the less immediately impactful but equally urgent and important challenges associated with aging and frailty, mental health, cancer, comorbidities, and health inequalities as just some examples. Along the way, lessons are being learned.


Sonja Marjanovic leads health innovation and healthcare improvement research at RAND Europe.

Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.