Permissionless Innovation and Wuhan Pandemic

Borrowing from Charles Dickens, the world might be technologically speaking living in the best of the times yet the Wuhan virus is making it a period of the worst of the times. It is around five months since the virus first made its appearance in China and three months since China announced the same to the rest of the word. Yet despite a lot of talk and promise, the elusive vaccine or cure remains a mirage. Common men and women alike wonder given the resources at disposal, the reasons for the lack of development of cure or vaccine. Surely, with the scientific background, depth, talent, resources, computing technologies, artificial intelligence among many other tools, the scientists and researchers are not able to make headway into a solution for the crisis. The only solution at the moment seems to be social distancing, in other words a shut down across the world till such time the virus reproduction ratio touches close to zero. The economic costs of the same are rising and the amplifying effect will make it worse in the weeks to come across the countries. The poor will not doubt are likely to be hit the most irrespective of the geography they live in.

The answer to the puzzle perhaps lie in the process and regulation of innovation across the world. Edward Jenner when he understood the utility of cowpox in reducing the incidence of small pox, variolated few teenagers with cowpox with success. This was a more of trial and error experiment or an experiment resting on intuition than any modern research principles. Out of this experience emerged the vaccine for small pox with some good help from the learning curve accumulated in those times. Similarly, the vaccine for plague developed by Haffkine was tested on prisoners in Bombay. The cholera vaccine developed around 1890s was first tested by Haffkine on himself. Such trials are virtually unthinkable today. Most pandemics found a solution in vaccines or cures through an experiment of trial and error.

The current process of treatment too seems to rest in some ways on this. There is growing clamour backed by research from France of the need to use hydroxychloroqunine in combination with azithromycin. The former is safe long used drug for malaria and seems to have found a enthusiastic votary in President Trump. Yet in many US states, the treatment is on hold for multiple reasons. There is some study going on serological treatments for the pandemic especially in New York US. While initial results seem to be favorable, there apparently exists no movement for mass adoption of the same. Researchers in Australia and Germany seem to be testing on BCG- a vaccine used against tuberculosis and leprosy- to treat the Wuhan virus yet they do not seem to move out of trial stage. There are many doctors including in India using a cocktail of anti HIV drugs against the pandemic but no universal adoption so far. An anti-parasitic drug seems to have been effective in in vitrio trials in Australia but seem long way off in patient trials. The vaccines are being tested in early trials in US and other places yet the most optimistic estimates suggest more than a year before they become available. Bill Gates is building a facility to manufacture vaccines whenever they are approved but no vaccine seems to be in sight. Some accounts have suggested the trial of five leading vaccines on volunteers through trial and error basis and the most promising be adopted as an alleviative measure. Yet, given the context the government approval is hardly likely to come anytime soon.

The answer perhaps lie as suggested above in the innovation structure. Innovation proceeds either on precautionary principle or permissionless principle. Adam Thierer discusses the significance of the permissionless innovation in his book available here. To Thierer, the innovation when made to pass the test of no-harm principle actually results in the motion of diminishing returns thus reducing the societal welfare. To him innovation minus regulation would drive the innovators towards new products and processes thus generating benefits and increasing societal welfare.  His contention rests on allowing innovation to occur till such time it is proved that it generates harm to the society than good. The cost benefit analysis must be assumed to be skewed in favour of benefits unless otherwise proved. The burden of proof must be on those seeking to declare it harmful than the innovators engaged in the process of new product development.

Thierer argues the central fault line in the innovation debate that emerges more prominently in the current discussions on cure and vaccine for Wuhan virus lies in the permission question. In his words, the approach to the question of the need of new innovators necessitated to seek the permission of public officials before development and deployment of their innovation determines the state of the society in handling the problem at hand. The precautionary principle states the blanket ban on innovation till such time the developers prove it is not harmful to individuals, specific entities, cultural norms and other laws and regulations. The permissionless approach permits innovation and experimentation by default. Jenner, Haffkine among many others represented the tradition of permissionless innovation in medicine. It is possible that they took advantage of certain societal conditions and norms that enabled them to test their offerings. It is possible given the society laid less value to life of certain people than others was the prime reason for their experimentation. Haffkine did suffer failure in experimentation and had his career nearly ruined by the same. Any researcher today is hardly likely to take any steps that imperils human lives and thus his career and reputation.

Yet troubling times require out of box solutions. Borrowing from Thierer, a precautionary model guiding public policy through a fear of worst case scenario might actually prove self-fulfilling. There is bound to be loss of life either way and there would have to be worked out the cost benefit trade-offs with serious time constraints. Again, borrowing from Thierer’s argument, wisdom of experience lies through a path of mistakes yet given the amount of computing technologies we possess, artificial intelligence, deep learning, data mining among many other tools can help minimize the failure rate. In attempting the ethical approaches as legal directives, the prospect of shrinking human freedom increases. Permissionless innovation is by rule bottom up, organic and thus better prospect for solution to complex problems. In the world of complexities, a top down approach might not necessarily work.

As a broad sweep, it is increasingly clear and for good reasons to an extent, precautionary principle trumps permissionless innovation in medicine. However the serious time constraint compels adoption of the permissionless approach. There must be freedom for doctors to experiment with various combinations as long as they have been proved safe in the past experiences albeit for different diseases. Further, certain stages in vaccine trial might be expedited subject to minimum safety norms being met thus increasing the pace for the development of preventive medicine. Data and evidence from many countries indicate the overarching control of drug administrators on production of medical goods including simple masks that hinder in the battle against the virus from Wuhan. The extent of deregulation and accommodation to a large degree of permissionless innovation serve as answers to the socio-eco-medical dimension of the Wuhan pandemic.