Seven Deadly Sins of Innovation
Forging a new path for international development
With the recent collapse of US funding for global health, the need to find alternative pathways to impact has never been more urgent. The Sustainable Development Goals (SDGs), especially those related to health, are far off track, and countries relying on foreign aid now face an uphill battle. How can we accelerate progress when the resources we’ve long depended on are diminishing?
The answer lies in scaling innovations through health systems to deliver results more efficiently and sustainably. But significant barriers to innovation must be addressed. Drawing on experiences from the World Health Organization (WHO) and Grand Challenges Canada (GCC), I will look at creating and scaling innovations and the “seven deadly sins” that hinder success. Above all, I will highlight why national leadership is critical for sustainable development and how countries can take ownership of scaling efforts.
Research and Innovation
Global health research has seen a renaissance since 1990, when the Commission on Health Research for Development highlighted the 10/90 gap—only 10% of global health research resources were dedicated to developing countries, where 90% of preventable deaths occurred. But while this gap has narrowed, another challenge remains: translating research knowledge into practice.
Knowledge translation—the process of synthesizing, disseminating, and applying research findings to improve health outcomes—is slow. Evidence-based recommendations often take years, if not decades, to yield systemic change.
Innovation — the practical application of new ideas — offers a faster route to impact than knowledge translation. For example, the rapid development and distribution of COVID-19 vaccines, fast-tracked through WHO’s emergency use authorization, demonstrates how quickly innovation can save lives.
Yet not all innovations are “game-changing” products like vaccines. Incremental improvements in service delivery can also yield massive results. In 2011, the Gates Foundation launched their “Reinvent the Toilet” challenge, aiming for a revolutionary solution to global sanitation. Around the same time, Grand Challenges Canada funded over a dozen social enterprises in water and sanitation (for examples see here, here and here). As of now, more lives have likely been saved and improved through GCC’s approach to sanitation, although both approaches are complementary.
To use a baseball metaphor, scoring home runs is not the only way to win the game; scoring enough doubles and triples can also be a winning strategy. Ideally, integrated innovation—combining scientific, social, and business approaches—offers a holistic way to address complex health challenges.
Creating and Scaling Innovation
Creating impactful health innovations requires a pipeline where ideas can be tested, refined, and scaled. Since the launch of Grand Challenges in Global Health by the Gates Foundation in 2003, numerous initiatives have emerged to tackle issues such as non-communicable diseases, mental health, humanitarian interventions, and climate change. These challenges have built communities of innovators focused on real-world impact.
Organizations like Grand Challenges Canada, Science for Africa Foundation, and Villgro Africa play a pivotal role in fostering innovation ecosystems. A crucial focus has been supporting innovators within low- and middle-income countries, shifting power dynamics toward locally driven solutions. While moving innovations from concept to scale is possible, the leap to widespread adoption remains challenging.
This is where institutions like the WHO could be helpful beyond their role in prequalifying health products. In 2018, WHO committed to catalyzing the scaling of health innovations, leveraging its close relationships with governments. In 2022, WHO Director-General Dr. Tedros set a goal of scaling five innovations to reach five million people each within five years. The idea was to build on innovations that had already reached 1 million people and expand them to reach a 100 million.
WHO’s Innovation Hub, featuring initiatives like solar-powered oxygen and mental health innovations such as the Friendship Bench, illustrates the power of scaling proven innovations across multiple countries. Other multilateral organizations, including UNICEF, WFP, UNDP, and the UN itself through its UN 2.0 initiative, have developed their own models for scaling innovations, drawing on their expertise in procurement, logistics, and accelerator programs to support national and global efforts.
Supporting countries to scale innovations will be a key role of these multilateral organizations in the new era of foreign aid that is now upon us.
The Seven Deadly Sins of Innovation
Creating and scaling innovations is essential for sustainable development, but organizations face significant internal and external barriers that prevent them from moving from ideas to impact. These challenges can be understood as the “seven deadly sins” of innovation—common pitfalls that, when left unchecked, hinder progress.
1. The Hubris of Culture: “Innovation is in our DNA”
Many organizations claim innovation is central to their identity, but without concrete strategies and funding, it often remains just a slogan. Innovation requires more than rhetoric—it demands action and resources.
2. The Lust for Research: “Research vs Innovation”
Research is vital, but without a focus on implementing and scaling solutions, it will never lead to meaningful impact. Balancing research and innovation is key.
3. The Envy for Technology: “Innovation is Technology”
Innovation is often equated with flashy technologies, but service delivery and social innovations are just as important. WHO’s focus on scaling technologies like vaccines is critical, but more attention is needed for innovations in health service delivery.
4. The Gluttony of Pilotitis: “Endless Pilots, No Progress”
Innovation without scale is like building a plane but never taking off. While pilots are essential to test ideas, true success comes from scaling what works—otherwise, even the best ideas remain grounded.
5. The Apathy for Impact: “You Can’t Pick Winners”
Innovation is sometimes viewed as unpredictable, but focusing on demand signals and investing in high-potential innovations is crucial. Public procurement processes are key to scaling successful innovations in global health.
6. The Wrath of the Public Sector: “Private Sector Stays Outside the Fence”
Public health organizations often shy away from collaborating with the private sector but doing so can be a missed opportunity. The private sector brings essential resources and scaling expertise.
7. The Sloth of Execution Failure: “Innovation is in Our Plan”
Many organizations develop innovative plans but fail to execute them effectively. Monitoring, accountability, and follow-through are critical for turning plans into impactful outcomes.
Conclusion: Sustainability and National Leadership
At the heart of global health innovation lies one essential element: sustainability. And sustainability is rooted in national leadership. With the recent collapse of US funding for global health, the path forward must shift from dependency on external aid to countries leading their own innovation efforts.
While high-income countries focus on innovation for productivity, prosperity, jobs and self-reliance, international development has often centered on charity. But innovation is the path to prosperity for all countries. By supporting national leadership in scaling innovations, we can create sustainable solutions that address critical health challenges and drive measurable results.
Innovation can help countries forge a new path to development.
Thank you, Peter. It is vital to have national leadership and ownership for the success of aid programmes. A process that facilitates co-creation, alignment to local priorities and ensures win-win partnerships, where each player is accountable for results, should be in place.
I really like the list, Peter, which should be posted in every elevator of every institution of every sector that sees itself as part of the innovation economy (disruptive or otherwise). A highlight for me is the emphasis on service delivery as an under-appreciated innovation opportunity.
Also, where would you put the sin of outmoded governance—the presumption that “regulation is bad because it slows innovation”. You used a baseball analogy. Let’s use an automobile engineering analogy - a “regulator”has the capacity to both slow down and speed up a car, as there is a need for both. Development of nimble, agile anticipatory governance tools are area of policy innovation that may warrant more attention.