In CFIA's GoFrugal blog series affiliated researchers reflect on the role of frugality and frugal innovation in times of Corona in different parts of the world. This blog is written by Prof. Saradindu Bhaduri and Prof. Peter Knorringa.
Europe has offered an historically unprecedented degree of stability, prosperity, comfort and reliability to most of its citizens in recent decades. Many of its citizens have grown to take these benefits for granted, even when all this makes Europe a very high cost economic system. Two recent disruptions, the earlier financial crisis and the Covid-19 pandemic are unprecedented in the history of Europe, at least since World War II. The pandemic has caused more than 150,000 deaths so far, with a mortality rate far exceeding countries outside the continent. Potentially, these two events could shake the faith of people in the institutional mechanisms of the continent, developed brick by brick over the last half century. Especially if such disruptions are expected to recur more frequently in the future.
Understanding the European system
Few would disagree that the present European production and innovation system, inter country variations notwithstanding, relies extensively on super-specialization of work and an overwhelming reliance on strongly protocolised ‘hard scientific evidence’. Together, they are supposed to uphold quality and transparency in economic decision making, even at the cost of being expensive and sticky, i.e slow in its ability to adapt to changing circumstances. While specialization and protocols are in themselves indispensable and desirable elements in a modern economy, too much of it creates its own challenges.
In this blog we argue that the excessive institutional reliance on super-specialization and protocol driven scientific evidence in all its decision-making processes can, at least partly, explain why Europe finds it so difficult to predict disruptions and is not able to quickly adapt its institutional machineries in the face of a crisis1. A remedy in our view lies in reducing over-formalization in its decision-making processes, and creating more space for experimentation and judicious improvisation. These steps can help Europe to adapt quicker to future contingencies2.
A discourse which has begun highlighting the importance of such experimentations and judicious improvisations is the one on frugality and frugal innovations. They suggest ways to re-introduce such experimentations and improvisations in innovation processes to reduce ‘over-engineering’ and costs, while maintaining basic functionality and affordability3. A concurrently emerging discourse on frugality in policy making emphasizes the need for improvised decision making based on seasoned, practical, context-specific experience and the importance of ‘experimenting while deciding4.
We argue that the excessive institutional reliance on super-specialization and protocol driven scientific evidence in all its decision-making processes can, at least partly, explain why Europe finds it so difficult to predict disruptions and is not able to quickly adapt its institutional machineries in the face of the crisis.
Does Covid-19 challenge protocolised hard -evidence driven decision-making?
Indeed, the pandemic struck, and struck hard while the system often continued to wait for a ‘formal go ahead’ by ‘hard evidence’ to be gathered by ‘super-specialised’ actors and processes, to take policy decisions on (i) whether to test ‘asymptomatic patients’, (ii) ‘to wear a mask or not’, (iii) is it okay ‘to use hydroxychloroquine’, or (iv) whether ‘to impose a lockdown’. Waiting for ‘hard evidence’ has often been given a priority over also making clever use of readily available ‘soft evidences’ by seasoned practitioners, presumably also not to disturb convenience and comfort of its citizens 5,6,7,8. Moreover, this denial to act upon soft evidences is not specific to the context of the current pandemic, it is rather the routine. Incidentally, later more systematic studies seem to validate the ‘soft evidence’ of wearing masks, and practising social distance9.
Is the system adapting?
Going beyond ‘super-specialised actors?’
While Europe initially responded slowly to the COVID 19, we do now observe quite a few deviations from the routine reliance on ‘super-specialisation’ and formal protocols surrounding innovation, production, and validation. Such improvisations are particularly visible in products and services related to public health deliveries, arguably to ensure their timely and affordable access at the time of the pandemic. Examples include the open source development of a ventilator, where also so-called lay persons can contribute and participate. Similarly, many informal organizations have sprung up across the continent to produce open source medical equipment and protection gears for patients and healthcare workers10. These organisations are not taking the routine protocolized path of regulatory approval. Instead, in order to ensure timely affordable access, they are relying on the viewpoints of physicians, and clinical administrators on ‘whether it works’ in the ‘actual’ environment of their use11.
Going beyond ‘protocolised’ hard evidence?
A sizeable section of physicians and clinical researchers of repute have vouched for including hydroxychloroquine (HCQ) in the treatment protocol of Covid -19, based, once again, only on soft evidences of clinical acumen, ‘prudent observations’ and targeted non randomised, small sample, clinical studies12, 13, 14. While the opposition to rely on such soft evidences may be rational, the issue remains that we need fast decisions and therapies to deal with the pandemic, and ‘hard evidence’ of randomised controlled trials does not come fast, nor do they come cheap. Indeed, even after three months into the pandemic, we are yet to have any conclusive ‘hard evidence’ of its (non-) efficacy, especially for early stage treatment or as a prophylactic15. Rather, the evidence of low rates of mortality in places and countries using this therapy have triggered a diverse set of responses from scientists, politicians and regulatory authorities16,17. A section of them have outrightly rejected it due to non-availability of ‘gold standard’ evidence from randomised controlled clinical trials (RCT). Other responses have ranged from agreeing to conduct more elaborate studies (RCT or otherwise), to continue with the therapy based on ‘prudent clinical acumen’. Two studies showing its ineffectiveness based on ‘big data’ have been retracted from reputed journals. Indeed, an emerging view in this context invites us to explore “doing, while learning”, by integrating the urge of clinical practitioners to use untested therapies, while designing, if necessary, full-fledged protocolized clinical trials to evaluate efficacy of the therapy better18. These propositions challenge the sharp division of super-specialisations between clinical research and clinical practice: “clinical practice and clinical research are addressed by separate institutions, procedures, and funding”19. The crisis has underlined the necessity to adapt this structure.
So, is there a new pattern emerging?
Many of the presently successful experiments can be defined as frugal innovations: they are affordable, retain basic functionalities, and are developed through extensive polycentric interactions, involving super-specialised experts as well as seasoned lay-practitioners. Similarly, in line with the arguments of the frugality discourse in policymaking, decisions are being made by localised, practical experiences of people in the field, focusing more on ‘what works’ rather than ‘what ought to work’, to ensure faster access to protective gears, medical equipment as well as medicine therapies. Arguably, such a process of decision making gives priority to arriving at ‘good enough’ faster decisions, rather than waiting for a zero-error solution. Of course, we need to be careful here, most of these experiments show that results are contextual, local in their scope and feasibility, and difficult to scale up.
Still, an exclusive reliance on super-specialisation and protocols would hold forte only in an environment where lives and livelihoods are stable, prosperous, comfortable, and reliable. But, now that the illusion of a zero risk and fully controllable society is fading, we propose a more nuanced future orientation, that creates space for experimentation and improvisation based on localised knowledges. Recent EU efforts to pay more attention to citizen science and frugal innovation, for example in a Horizon 2020 call, are promising stepping stones in this direction, i.e. to develop rigorous science that is also built upon the bottom-up knowledge, practices and creativity of EU citizens. This will help make the society more resilient to future contingencies.
Subscribe to our blog series and stay involved with us for upcoming reflections on the role of frugality and frugal innovation in times of covid-19 in different parts of the world.
#1: Innovation during the crisis: How COVID-19 could boost frugal health technologies
#2: Frugal Innovation during the COVID-19 crisis: Examples from East Africa
#3: Gender and ICTs in fragile refugee settings: from local coordination to vital protection and support during the Covid-19 pandemic
#4: COVID-19: Should Europe embrace frugality?
1. See for an elaborated account of Europe’s early response to COVID -19 'Coronavirus Europe failed the test', Politico. Last accessed on 1 June 2020.
2. See 'Better luck next time? How the EU can move faster when disaster strikes', Sciencebusiness
Last accessed on 10 June 2020.
3. Knorringa, P., Peša, I., Leliveld, A. et al. Frugal Innovation and Development: Aides or Adversaries?. Eur J Dev Res 28, 143–153 (2016). https://doi.org/10.1057/ejdr.2016.3 . Last accessed on 1 June 2020.
4. Patil, K., Bhaduri, S. ‘Zero-error’ versus ‘good-enough’: towards a ‘frugality’ narrative for defence procurement policy. Mind Soc 19, 43–59 (2020). https://doi.org/10.1007/s11299-020-00223-7 Last accessed on 1 June 2020.
5. 'Italy, Pandemic’s New Epicenter, Has Lessons for the World', New York TImes, especially the section on local experiments. Last accessed on 1 June 2020.
6. 'Report on face masks' effectiveness for Covid-19 divides scientists', The Guardian Last accessed on 6 June 2020.
7. 'In one Italian town, we showed mass testing could eradicate the coronavirus', The Guardian Last accessed on 6 June 2020.
8. 'Up to 30% of coronavirus cases asymptomatic', DW Last accessed on 6 June 2020.
9. 'Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis' Last accessed on 6 June 2020.
10. Digital Response to COVID-19. Last accessed on 3 June 2020.
11. 'Open-Source Medical Hardware: What You Should Know and What You Can Do', Creative Commons
12. 'Hydroxychloroquine for COVID-19: What's the Evidence?', Medscape Last accessed on 1 June 2020.
13. 'Hydroxychloroquine prophylaxis for high-risk COVID-19 contacts in India: a prudent approach, The Lancet'. Last accessed on 1 June 2020.
14. See 'He Was a Science Star. Then He Promoted a Questionable Cure for Covid-19', The New York Times. Last accessed on 1 June 2020.
15. 'Preventive use of HCQ in frontline healthcare workers: ICMR study', The Indian Express. Last accessed on 10 June 2020.
16. 'A Look at COVID Mortality in Paris, Marseille, New York and Montreal', Covexit.com
Last accessed on 10 June 2020.
17. 'Coronavirus: How Turkey took control of Covid-19 emergency,' BBC. Last accessed on 10 June 2020.
18. 'Chloroquine and hydroxychloroquine in covid-19', the BMJ. Last accessed on 1 June 2020.
19. 'Optimizing the Trade-off Between Learning and Doing in a Pandemic', JAMA network. Last accessed on 1 June 2020.