Reforming the innovation system to deliver affordable medicines: a conceptual framework of pharmaceutical innovation as a complex adaptive system (forest) and theory of change
Background The current mainstream pharmaceutical innovation system (PIS) is driven by the market-based logic of charging the highest prices societies will bear. Outcomes include unaffordable medicines, restricted access and pressure on health budgets. How can the innovation system change to deliver...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Taylor & Francis Group
2025-12-01
|
| Series: | Journal of Pharmaceutical Policy and Practice |
| Subjects: | |
| Online Access: | https://www.tandfonline.com/doi/10.1080/20523211.2024.2436899 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832593476205674496 |
|---|---|
| author | Suerie Moon Adrian Alonso Ruiz Marcela C. F. Vieira Kaitlin E. Large Iulia Slovenski |
| author_facet | Suerie Moon Adrian Alonso Ruiz Marcela C. F. Vieira Kaitlin E. Large Iulia Slovenski |
| author_sort | Suerie Moon |
| collection | DOAJ |
| description | Background The current mainstream pharmaceutical innovation system (PIS) is driven by the market-based logic of charging the highest prices societies will bear. Outcomes include unaffordable medicines, restricted access and pressure on health budgets. How can the innovation system change to deliver fairly-priced medicines?Methods We inductively developed a novel conceptual framework of the PIS as a complex adaptive system (CAS) analogous to a forest. We constructed a database of 140 pharmaceutical innovation initiatives that sought to address global public interest objectives such as fair pricing or missing innovation. We found a critical mass of initiatives clustered around four areas: pandemic preparedness, neglected diseases, rare diseases and antibiotics, which we conceptualised as niches within the ecosystem. We reviewed the literature on how each niche had emerged and evolved, conducted interviews, and organised workshops with experts on each niche. Finally, we identified from the literature an initial list of ‘levers’ of change in the PIS, supplemented them with additional levers found in each niche, then compared across niches.Results We found that actors created niches in the broader system by purposefully problematising an issue, then pulling on one or more of three levers: mobilising new resources, changing the roles of or creating new actors, and/or changing societal norms or legal rules. A wide range of actors – including governments, funders, R&D practitioners, or civil society groups – could pull these levers, and the order in which they were pulled was not fixed, consistent with a CAS.Conclusions Parts of the vast pharmaceutical innovation system have changed to deliver more affordable medicines by design. Such change has occurred largely within specialised niches, responding to evolving societal norms about the purpose of pharmaceutical innovation. Actors can achieve larger-scale change by further expanding and/or solidifying these niches through changes to resources, actor roles, norms and rules. |
| format | Article |
| id | doaj-art-71bbd596ca9646c4839a8ec6668340b3 |
| institution | Kabale University |
| issn | 2052-3211 |
| language | English |
| publishDate | 2025-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Journal of Pharmaceutical Policy and Practice |
| spelling | doaj-art-71bbd596ca9646c4839a8ec6668340b32025-01-20T14:44:54ZengTaylor & Francis GroupJournal of Pharmaceutical Policy and Practice2052-32112025-12-0118110.1080/20523211.2024.2436899Reforming the innovation system to deliver affordable medicines: a conceptual framework of pharmaceutical innovation as a complex adaptive system (forest) and theory of changeSuerie Moon0Adrian Alonso Ruiz1Marcela C. F. Vieira2Kaitlin E. Large3Iulia Slovenski4Department of International Relations and Political Science, Graduate Institute of International and Development Studies, Geneva, SwitzerlandGlobal Health Centre, Graduate Institute of International and Development Studies, Geneva, SwitzerlandGlobal Health Centre, Graduate Institute of International and Development Studies, Geneva, SwitzerlandGlobal Health Centre, Graduate Institute of International and Development Studies, Geneva, SwitzerlandGlobal Health Centre, Graduate Institute of International and Development Studies, Geneva, SwitzerlandBackground The current mainstream pharmaceutical innovation system (PIS) is driven by the market-based logic of charging the highest prices societies will bear. Outcomes include unaffordable medicines, restricted access and pressure on health budgets. How can the innovation system change to deliver fairly-priced medicines?Methods We inductively developed a novel conceptual framework of the PIS as a complex adaptive system (CAS) analogous to a forest. We constructed a database of 140 pharmaceutical innovation initiatives that sought to address global public interest objectives such as fair pricing or missing innovation. We found a critical mass of initiatives clustered around four areas: pandemic preparedness, neglected diseases, rare diseases and antibiotics, which we conceptualised as niches within the ecosystem. We reviewed the literature on how each niche had emerged and evolved, conducted interviews, and organised workshops with experts on each niche. Finally, we identified from the literature an initial list of ‘levers’ of change in the PIS, supplemented them with additional levers found in each niche, then compared across niches.Results We found that actors created niches in the broader system by purposefully problematising an issue, then pulling on one or more of three levers: mobilising new resources, changing the roles of or creating new actors, and/or changing societal norms or legal rules. A wide range of actors – including governments, funders, R&D practitioners, or civil society groups – could pull these levers, and the order in which they were pulled was not fixed, consistent with a CAS.Conclusions Parts of the vast pharmaceutical innovation system have changed to deliver more affordable medicines by design. Such change has occurred largely within specialised niches, responding to evolving societal norms about the purpose of pharmaceutical innovation. Actors can achieve larger-scale change by further expanding and/or solidifying these niches through changes to resources, actor roles, norms and rules.https://www.tandfonline.com/doi/10.1080/20523211.2024.2436899Pharmaceutical innovation systemmedicinesresearch and development (R&D)fair pricingaffordabilityalternative innovation model |
| spellingShingle | Suerie Moon Adrian Alonso Ruiz Marcela C. F. Vieira Kaitlin E. Large Iulia Slovenski Reforming the innovation system to deliver affordable medicines: a conceptual framework of pharmaceutical innovation as a complex adaptive system (forest) and theory of change Journal of Pharmaceutical Policy and Practice Pharmaceutical innovation system medicines research and development (R&D) fair pricing affordability alternative innovation model |
| title | Reforming the innovation system to deliver affordable medicines: a conceptual framework of pharmaceutical innovation as a complex adaptive system (forest) and theory of change |
| title_full | Reforming the innovation system to deliver affordable medicines: a conceptual framework of pharmaceutical innovation as a complex adaptive system (forest) and theory of change |
| title_fullStr | Reforming the innovation system to deliver affordable medicines: a conceptual framework of pharmaceutical innovation as a complex adaptive system (forest) and theory of change |
| title_full_unstemmed | Reforming the innovation system to deliver affordable medicines: a conceptual framework of pharmaceutical innovation as a complex adaptive system (forest) and theory of change |
| title_short | Reforming the innovation system to deliver affordable medicines: a conceptual framework of pharmaceutical innovation as a complex adaptive system (forest) and theory of change |
| title_sort | reforming the innovation system to deliver affordable medicines a conceptual framework of pharmaceutical innovation as a complex adaptive system forest and theory of change |
| topic | Pharmaceutical innovation system medicines research and development (R&D) fair pricing affordability alternative innovation model |
| url | https://www.tandfonline.com/doi/10.1080/20523211.2024.2436899 |
| work_keys_str_mv | AT sueriemoon reformingtheinnovationsystemtodeliveraffordablemedicinesaconceptualframeworkofpharmaceuticalinnovationasacomplexadaptivesystemforestandtheoryofchange AT adrianalonsoruiz reformingtheinnovationsystemtodeliveraffordablemedicinesaconceptualframeworkofpharmaceuticalinnovationasacomplexadaptivesystemforestandtheoryofchange AT marcelacfvieira reformingtheinnovationsystemtodeliveraffordablemedicinesaconceptualframeworkofpharmaceuticalinnovationasacomplexadaptivesystemforestandtheoryofchange AT kaitlinelarge reformingtheinnovationsystemtodeliveraffordablemedicinesaconceptualframeworkofpharmaceuticalinnovationasacomplexadaptivesystemforestandtheoryofchange AT iuliaslovenski reformingtheinnovationsystemtodeliveraffordablemedicinesaconceptualframeworkofpharmaceuticalinnovationasacomplexadaptivesystemforestandtheoryofchange |