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Global health reciprocal innovation: ethical, legal and regulatory considerations
  1. Annette Rid1,
  2. Bernardo Aguilera2,
  3. Chikosa Banda3,
  4. Rao Divi4,
  5. Matthew Harris5,
  6. Amanda Kim6,
  7. Miguel Ossandon7,
  8. John Zervos8,
  9. Virginia Rowthorn9
  1. 1Department of Bioethics, The Clinical Center & Department of International Science Policy, Planning and Evaluation, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
  2. 2Faculty of Medicine and Science, Universidad San Sebastián, Santiago, Chile
  3. 3School of Law, University of Malawi, Zomba, Malawi
  4. 4Methods and Technologies Branch, Epidemiology and Genomics Research Program, National Cancer Institute, Bethesda, Maryland, USA
  5. 5Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
  6. 6School of Nursing, University of Maryland Baltimore, Baltimore, Maryland, USA
  7. 7Cancer Diagnosis Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland, USA
  8. 8The Global Health Initiative, Henry Ford Health, Detroit, Michigan, USA
  9. 9Graduate School, Umiversity of Maryland Baltimore, Baltimore, Maryland, USA
  1. Correspondence to Annette Rid; annette.rid{at}


Global health reciprocal innovation (GHRI) is a recent and more formalised approach to conducting research that recognises and develops innovations (eg, medicines, devices, methodologies) from low- and middle-income countries (LMICs). At present, studies using GHRI most commonly adapt innovations from LMICs for use in high-income countries (HICs), although some develop innovations in LMICs and HICs. In this paper, we propose that GHRI implicitly makes two ethical commitments: (1) to promote health innovations from LMICs, especially in HICs, and (2) to conduct studies on health innovations from LMICs in equitable partnerships between investigators in LMICs and HICs. We argue that these commitments take a significant step towards a more equal global health research enterprise while helping to ensure that populations and investigators in LMICs receive equitable benefits from studies using GHRI. However, studies using GHRI can raise potential ethical concerns and face legal and regulatory barriers. We propose ethical, legal and regulatory considerations to help address these concerns and barriers. We hope our recommendations will allow GHRI to move the global health research enterprise forward into an era where all people are treated equally as knowers and learners, while populations in both LMICs and HICs benefit equitably from studies using GHRI.

  • Global Health
  • Health policy
  • Public Health
  • Health services research

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  • Handling editor Helen J Surana

  • X @bedobardo, @drmattjharris

  • Contributors AR, BA, RD and VR conceived the idea for the paper and wrote the first draft. CB, MH, AK, MO and JZ revised the paper critically for important intellectual content. All authors approved the final version and agreed to be accountable for all aspects of the work.

  • Funding AR is supported in part by the Clinical Center Department of Bioethics, which is in the Intramural Program of the National Institutes of Health (Grant/Award #: N/A). MH is supported in part by the National Institute for Health and Care Research Applied Research Collaboration Northwest London (Grant/Award #: N/A).

  • Disclaimer The views expressed here are those of the authors and do not necessarily reflect the policies of the National Institutes of Health or the US Department of Health and Human Services. The views expressed in this publication are not necessarily those of the National Institute for Health Research or the Department of Health and Social Care.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.