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Structural violence and the biomedical innovation system: what responsibility do universities have in ensuring access to health technologies?
  1. Sarai Keestra1,2
  1. 1Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
  2. 2Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
  1. Correspondence to Sarai Keestra; s.m.keestra{at}

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Summary box

What is already known?

  • When universities engage in inequitable technology transfer practices, by patenting and exclusively licensing biomedical innovations in ways enabling pricing monopoly formation, they contribute to harmful barriers to access to medicines and other health technologies for millions of people.

What are the new findings?

  • Universities are contributing to the violation of the social and economic rights of those unable to access novel health technologies by unquestioningly engaging in a biomedical innovation system that relies on profit-driven commercialisation of knowledge generated with public funding, and this should be considered structural violence.

  • Applying the lens of structural violence can help reframe the responsibilities of universities in the access to medicines debate by: (1) highlighting universities’ position in the structures of the biomedical innovation system, (2) bringing attention to the systematic inequities in knowledge dissemination and how this can result in differential health outcomes when particular groups are denied timely access to health innovations and (3) reconsidering the role of universities’ technology transfer practices in sustaining the unequal structures and power relations inherent to the biomedical innovation system.

What do the new findings imply?

  • Universities can apply equitable technology transfer practices such as non-exclusive, royalty-free licensing of biomedical innovations to promote access to health technologies, ensuring that all members of the global public can enjoy the fruits of scientific progress.

Inequitable technology transfer practices as structural violence

Universities intend to create knowledge that serves the needs of the public, yet this does not always happen in practice. By engaging in inequitable technology transfer practices, such as the exclusive licensing of a novel health technology to a private company or a spin-off, universities enable the downstream formation of pricing monopolies that limit affordable access to health technologies.1 2 The WHO defines health technologies as ‘the application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures and systems developed to solve a health problem and improve quality of lives’. …

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