14 _____________________________________ Human and Planetary Health

Covid-19 and a New Frontier for Social Innovation

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Sara J. Singer, Sevda Memet, Suruchi Kothari, and Gordon Bloom

The Covid-19 pandemic presented the world with an unparalleled set of problems, a more detailed account of which is provided by Steve Davis in chapter 13 of this volume. Here, we reiterate that the consequences of this pandemic have been devastating, socially and economically, but have also presented important opportunities for social innovation to address the urgency and scale of the fast-moving crisis. In 2020 alone, over ninety-three million people were infected worldwide, resulting in over two million deaths.1 Beyond the human tragedy produced by this virus, the pandemic has both short-term and longer-term ramifications. Several countries went into “lockdown,” transforming personal lives overnight, and many businesses closed, while others faced vast disruptions to services, supply chains, operations, and cash flow.2 Layoffs and stock market volatility ensued, and we entered the most extensive global recession since the Great Depression.3

The magnitude of the disruption wrought by the pandemic surpassed the capabilities and capacity of governments to address this challenge alone, giving rise to collaborations—by necessity and design—with actors from the private and nonprofit sectors.4 Notwithstanding the initial governmental response, large gaps remained, exacerbated by leadership failures, including failures to address immediate needs related to treating the disease and stemming its spread. Furthermore, there were gaps in medium- and longer-term needs related not only to the disease itself but also to a vast array of consequences of the pandemic, including economic and social repercussions. The multitude and unprecedented scale of needs increased demand for the social economy and catalyzed a tremendous response.5 Social entrepreneurs and innovators from the nonprofit and for-profit sectors, including a constellation of nontraditional actors, stepped in at the start of the crisis to fill unaddressed and unresolved gaps.

BIOGRAPHIES

SARA J. SINGER is professor of medicine at the Stanford School of Medicine and professor of organizational behavior (by courtesy) at the Stanford Graduate School of Business. At Stanford, she leads the Health Leadership, Innovation, and Organization Labs, is associate director of the Clinical Excellence Research Center, and is a faculty affiliate of Stanford Health Policy (previously the Center for Health Policy/Center for Primary Care and Outcomes Research), the Freeman Spogli Institute for International Studies, the Center for Innovation in Global Health, the Woods Institute for the Environment, and the Stanford Medicine Center for Improvement.

SEVDA MEMET, MD, pursued a joint master’s degree in business administration and public policy at the Stanford Graduate School of Business as a Knight-Hennessy Scholar. Prior to Stanford, she worked as a medical doctor in hematology-oncology and rare diseases in the Romanian public health-care system.

SURUCHI KOTHARI, MD, is a primary care physician who completed her residency training at Imperial College, London, in the United Kingdom. At Touch Surgery, she created the Virtual Residency Program and later, at OssoVR, the Osso Training Network, democratizing access to surgical training by leveraging digital and virtual-reality technologies. These solutions have been adopted in over two hundred US residency programs. Kothari is currently chief of staff to the CEO at Agilon Health.

GORDON BLOOM founded the Social Entrepreneurship Collaboratory (SE Labs) at Stanford, Harvard, and Princeton. At Stanford, he is director of the Social Entrepreneurship and Innovation Lab (SE Lab) - Human & Planetary Health; faculty fellow at the Center for Innovation in Global Health and lecturer in the School of Medicine, Division of Primary Care and Population Health, in the Department of Medicine; and affiliate at Stanford Health Policy (previously Center for Health Policy/Center for Primary Care and Outcomes Research) and the Freeman Spogli Institute for International Studies.

EXECUTIVE SUMMARY

The Covid-19 pandemic has challenged traditional definitions of social entrepreneurship and innovation. In this chapter, we highlight the interconnected problems the pandemic entails, how social innovators from traditional and nontraditional backgrounds responded, and implications for a new frontier for social innovation. Covid-19 raised awareness of interconnections between human and planetary health and the ongoing need to sustain balance between them. To fully address needs created by the pandemic and prevent the next one, social innovation must come from many actors working in concert to address social, economic, and environmental factors for immediate and longer-term challenges of human and planetary health.

The global pandemic raises questions about several assumptions underpinning traditional definitions of social entrepreneurship and innovation, including the necessity for social innovators to have only prosocial motivations and access to functioning markets in order to solve social problems.6 Covid-19 spurred evolution in the source and form of social innovation, engaging large numbers of nontraditional as well as traditional entrepreneurs, often repurposing resources in markets that had become unstable or had ceased to function. As a global crisis, the Covid-19 pandemic required more than ever that social innovators “think globally while acting locally” by customizing strategies and solutions for local conditions. The global need for coordination and communication frequently required that social innovators initiate new arrangements while also serving as connections for cross-sector solutions. The multifaceted and complex challenges brought on by this crisis have led to a transformation of the role of social entrepreneurs.

This chapter reviews the impact of Covid-19, highlighting the interconnected problems it entails, how social innovators responded to them, and the implications for a new frontier for social innovation. We contend that the Covid-19 pandemic created needs and revealed gaps that spurred innovation. Social innovators assessed comparative advantage and self-authorized bold and rapid action, despite risks. Success factors included their inherent agility and ability to implement solutions. The large-scale response required individual initiatives by traditional and nontraditional actors as well as networked, cross-sector collaborative solutions, where governments and the private and social sectors came together to address unprecedented needs. This pandemic also raised awareness of the interconnections between human and planetary health (that is, how our planet’s environmental ecosystem and its disruption impact human health), the delicate balance that exists between human and planetary well-being, and the ongoing need to maintain this balance sustainably.7 The interconnected nature of the disruption created by the pandemic invites a new frontier for social innovation and collective action. To fully address needs created by the pandemic and prevent the next one, social innovation must come from many actors—a collective “collaboratory” of nonprofit, for-profit, solo, and networked individuals, organizations, and governments—working consciously and unconsciously in concert to address social, economic, and environmental factors as the context for addressing immediate and longer-term challenges of human and planetary health.

Covid-19: A Perfect Storm

An assessment of the causes and consequences of the global pandemic provides insight for rethinking social innovation in this new context. A broader perspective allows us to understand Covid-19 as a globally widespread infectious disease resulting from a perfect storm created and propelled by social, economic, and environmental factors. Viewed in this way, the pandemic demonstrates the importance of the interconnections between human and planetary factors. These connections are apparent in the origin of the pandemic and its repercussions.

Originally, Covid-19 was a zoonotic virus, which means it was transmitted from wild animals to humans. Factors enabling animal-to-human transmission of Covid-19 and other zoonotic viruses include a complex interplay of planetary changes: the destruction of animal ecosystems, global warming, and risky human behavior, including illegal wildlife trading.8 These linkages demonstrate that human health is dependent on the health of our ecosystems, the availability of natural resources, and the conservation of biological systems. Diminishing biodiversity through deforestation and urban growth is increasing the risk of disease pandemics like Covid-19, and a loss of biodiversity results in fewer animal species, with those remaining tending to be those that carry pathogens to humans.9 Along with Covid-19, HIV, Ebola, SARS, and rabies, there are other viruses transmitted from animals to humans. The US Centers for Disease Control and Prevention (CDC) estimates three of four emerging infectious diseases in humans have animal origins, and they are becoming increasingly common.10 The active destruction of natural systems over decades, where our societies’ activities and structures have disrupted the fine balance between humans and the natural world, impacts our planet’s health and ultimately affects human health.

The repercussions of Covid-19 have been vast and multifaceted and demonstrate—like no other event in recent history—how these human and planetary challenges are interconnected. Not only has the pandemic challenged health systems globally, but its impact also created an economic crisis, exacerbated health and social inequities, and highlighted strengths and weaknesses in different forms of governance.

The response of health-care systems to Covid-19 has been heroic yet inadequate. Health-care systems worldwide increased their intensive care capacity, established testing sites, and developed Covid-19 units to isolate and care for patients.11 Health delivery organizations sourced personal protective equipment and proactively sought private corporations’ support to develop needed supplies. In the United Kingdom, high-end fashion brand Burberry manufactured medical masks and gowns to supply health-care providers.12 In the United States, health-care systems partnered with Ford, Tesla, and General Motors, among others, to build ventilators.13 Health-care systems vastly accelerated adoption of telehealth, enacting a large-scale shift in practice patterns, with telehealth visits accounting for 50 percent of patients in 2020 compared to 11 percent in 2019.14

However, Covid-19 also thwarted health systems’ ability to care for patients. Hospitals canceled nonemergency, elective procedures.15 Clinics postponed non-Covid-related care and non-Covid vaccinations while focusing on treating Covid-infected patients and preventing the virus’s spread.16 The reallocation of health-care services toward treating patients with Covid-19 disrupted care for patients with chronic diseases such as diabetes, hypertension, and cancer.17 More than 80 percent of mental health patients saw their condition worsen, and 40 percent of US adults reported adverse effects of mental health or substance abuse because of the pandemic.18 Hospitals and health-care systems faced catastrophic financial consequences in the wake of this virus.19

This health-care crisis engendered a far greater economic crisis. The pandemic response and national lockdown resulted in a considerable financial toll, which the International Monetary Fund has described as the worst global downturn since the Great Depression.20 In the United States alone, this large-scale economic disruption, when measured in lost output and health reduction, is estimated to have cost over $16 trillion.21

The economic downturn widened existing inequalities, with disproportionate job losses for women, Blacks and ethnic minorities, and low-income workers.22 The sectors hit worst included manufacturing, travel, transport, and retail.23 Conversely, some sectors, notably Big Tech companies, including Apple, Facebook, Alphabet (Google), and Amazon, experienced substantial gains and an “earnings bonanza” during the Covid era.24 These Big Tech companies not only weathered this storm but also took advantage of new opportunities and rapidly expanded, consolidating their market dominance.25 Many predict that economic recovery will be highly variable, even after mass distribution of vaccines to prevent Covid-19 infection, with the hardest-hit sectors, including many small businesses, expected to require more than five years to recover, if they recover at all.26

People’s vulnerability to Covid-19 also varied greatly based on social factors. Reports on the morbidity and mortality of Covid-19 demonstrated that those most adversely impacted were “racial/ethnic minorities, the elderly, the poor, and people with the lowest educational attainment.”27 Their poor outcomes have been attributed to endemic inequities, including poor housing, crowded and polluted neighborhoods, and inadequate access to affordable and nutritious food, putting a healthy diet out of reach.28 Populations that experience these factors have increased risk of developing asthma, diabetes, hypertension, obesity, and heart disease, all of which increase the risk of severe illness from Covid-19.29 Inequities and inadequacies in access to high-quality health care further exacerbated the impact of Covid-19 on these populations, increasing the likelihood of poor outcomes and even death.

Minority populations were also at increased risk of contracting Covid-19.30 Factors associated with high risk of Covid-19 infection include residing in high-density living conditions in large urban centers. Unequal access to water—over thirty million Americans live in areas where water systems violate safety rules31—and poor sanitation reduced the capacity for some even to wash their hands. These minorities are also more likely to work in service industries that require their physical presence, making physical distancing less feasible.32

The tremendous death toll in the United States has also been attributed to deficiencies in governance. The US government’s response to Covid-19 was considered by many both inconsistent and insufficient.33 The Trump administration failed to acknowledge the threat of this virus, relayed contradictory messages about its risks, and provided unequal assistance across states.34 The absence of clear guidance led to delays and a wide variation in responses by states and counties, which suffered delays in funding and supplies, as well as insufficient testing and tracing.35 Some countries fared better than the United States, mainly because of their centralized leadership, while others owed their success to lessons learned during the SARS epidemic twenty years earlier.36 For pandemic “first-timers,” those who responded rapidly, aggressively, and in a coordinated manner (e.g., New Zealand) proved to be more successful in managing the pandemic.37

Notwithstanding the undisputedly enormous toll of Covid-19, some have suggested that the pandemic may present a “golden opportunity.”38 Global efforts to halt the virus’s spread and the associated decline in economic activity have reduced air and ground travel as well as industrial activity, causing a corresponding fall in air pollution levels and improved water quality.39 Covid-19 could force people to recognize that current forms of human behavior are unsustainable. The pandemic has given us an opportunity to build back better, toward a greener economy, by investing in efforts to reduce deforestation, halt the wildlife trade, increase decarbonization, and improve sustainability. We need to continue building toward a digital future, embracing telecommuting as a new norm and curtailing unnecessary travel. We must also acknowledge the importance of mental health as integral for our own individual well-being and that of our societies and economies.

Human and Planetary Health: A New Frontier for Social Innovation

The complex set of challenges that caused, and have resulted from, the pandemic demands attention. This perfect storm of interconnected social, economic, and environmental challenges constitutes a human and planetary crisis, and overcoming it will require social innovation at human and planetary scales. Such innovation must address social and economic determinants of health and the natural systems on which human health depends, as well as the immediate, medium-term, and longer-term needs of the human health and medical care systems.

Three brief examples illustrate the potential for social innovation at the frontier of human and planetary health. First, social innovators stemmed the spread of the Nipah virus, which, like Covid-19, originated with animals.40 Highly virulent, Nipah kills up to 70 percent of people it infects. In Bangladesh, it spreads from bats through date palm sap to humans when they drink it. By introducing bamboo skirts that prevent the bats from contacting the sap, innovators eliminated the risk of Nipah transmission. Longer term, resolving the challenge will require preservation of natural habitats, biodiversity, and food resources so that wild animals prefer not to invade human settlements. Second, social innovators identified an opportunity to reduce deforestation by improving human health.41 Investigation of illegal logging in Indonesia’s tropical forests, which adversely impacts biodiversity, global temperatures, and human health, found expenses for desperately needed health care were the driving force. To stem deforestation, innovators formed a health clinic for the local community, offering discounts to people from villages that demonstrated community-wide reductions in logging and accepting as payment barter in the form of tree seedlings, handicrafts, and labor. After ten years of operation, the clinic has treated twenty-eight thousand patients, significantly reducing infectious and noncommunicable diseases, and illegal logging has declined by 70 percent compared to control sites. Third, social innovators are controlling mosquito-borne illnesses while improving economic opportunities for young people in Kenya.42 As plastic and other trash accumulates in low-income urban areas, it becomes a medium for proliferating diseases such as the Dengue and Zika viruses. In Nairobi, a pilot program has created a business incubator to accelerate innovative ideas for sustainability. The first wave of local entrepreneurs and community members is exploring the viability of businesses using plastic trash as planters for flowers or seedlings, to make toys or play structures, and to make building materials for houses, with the aim of decreasing mosquitoes and trash accumulation, and generating income for innovators.

Observed Response to Covid-19: Emergence of a Social Innovation Ecosystem

To understand the potential for social innovation to meet the human and planetary health challenges presented by crises like Covid-19, we examine the actual response to the pandemic. We first take a broad view to understand the cross-sector ecosystem constituting the range of actors contributing social innovations to address the Covid-19 pandemic, how these social innovators emerged, and which challenges they sought to address. We then present examples of three specific types of social innovators in order to identify distinctions and commonalities among them. We then propose a theory of change for social innovation that addresses the Covid-19 pandemic in the context of human and planetary health. Our goal is to develop a better understanding of the model of cross-sector collective action, collaboration, and experimentation—the “collaboratory” of social innovation that has emerged to combat the pandemic and continues to develop. We hope that insights will help stakeholders identify opportunities for supporting development of a strong, sustainable ecosystem for social innovation and change and for ensuring attention not only to immediate human needs but also to longer-term environmental factors that will serve to mitigate and prevent future pandemics and protect the people and planet.

Broad View of Social Innovation in the Context of Covid-19

Our broad perspective highlights that the response to the crisis created by the Covid-19 pandemic was unprecedented in its speed and breadth, involving a multitude of innovators from various backgrounds and sectors. The ecosystem that rapidly emerged to address the challenges of Covid-19 includes social innovators from both traditional and nontraditional backgrounds, small and large players, and existing and new collaborations. We provide a brief overview of (1) traditional social innovators, established nonprofit organizations, and incubator programs; (2) less-traditional sources of social innovation, including large for-profit organizations, government agencies, and “mom and pop” innovators; and (3) collaborative efforts, including new collaborative networks of individuals and organizations and accelerator initiatives.

We recognize that these categories are not necessarily mutually exclusive or comprehensive, given the great complexity that characterized the Covid response. With these categories, we seek only to illustrate the range of social innovators that emerged in response to Covid-19 and the innovations they developed to address the crisis, complementing government’s response and filling in gaps produced by the lack thereof.

Traditional Social Innovators

Traditional social innovators include established nonprofit organizations and incubator programs.

Established Nonprofit Organizations

From the outset of the pandemic, large national and international organizations, as well as smaller, local nonprofits, were engaged in seeking to contribute solutions to the crisis. These organizations were well positioned to respond efficiently and effectively given on-the-ground expertise, experience acting opportunistically to address social needs, flexibility that comes from not being bound by the need to earn a profit, access to networks that help navigate nonmarket forces (policy obstacles), and existing credit among constituents as a trusted source of social solutions.43 Grant-making nonprofits committed additional funds for immediate, short-term relief to help particularly hard-hit families and communities. For example, in April 2020, the Robert Wood Johnson Foundation, the nation’s largest philanthropy dedicated solely to health, provided $50 million in immediate short-term relief to national and community organizations, including $5 million for relief efforts in its home state of New Jersey, hit particularly hard by the virus.44 Others (e.g., United Way, Goodwill Industries, Salvation Army, YMCA) sought additional contributions, expanded services in which they were already engaged, and mounted recovery initiatives to address drastic increases in hunger, housing, and health-care needs.

Incubator Programs

Nonprofit incubators come in different types and sizes. Some focus on particular objectives, whereas others are more generalist. They may support only a few or many initiatives. Like established nonprofit organizations, these incubators and the innovators they support were well positioned to act in response to Covid-19. For example, Ashoka, a pioneer of the social entrepreneurship movement, supporting fellows worldwide, reported actions in more than ninety countries in response to the crisis and in preparation for a postpandemic world.45 Cántaro Azul, a social enterprise working to improve access to water in Mexico’s rural communities, responded to Covid-19 by raising awareness, promoting preventive measures, and delivering soap and gel, which are difficult to obtain in these areas. Maldita and Teyit, nonprofit news organizations in Spain and Turkey, respectively, empowered and mobilized citizens as fact-checkers to combat misinformation about the virus. Cycling without Age, a social enterprise that fosters stronger ties between communities and the elderly through biking activities, switched to offering support through food, medicine, and online interactions to fight against social isolation. In example after example, these change makers found opportunities to leverage existing assets to address local needs and mobilized, while supporting and inspiring each other to do the same. Hopelab is another nonprofit incubator, based in San Francisco, that focuses on improving the lives of young people. Like Ashoka, in response to Covid-19, Hopelab supported its social innovators in pivoting toward Covid-related causes. For example, Grit Digital Health, which uses a smartphone app called Nod to address loneliness and build resilience among college students, was well positioned to update its solution using the science of social connection to address the unique challenges brought about by physical distancing and isolation during the pandemic.46

Less-Traditional Sources of Social Innovation

Among less-traditional sources of social innovation, we recognize large for-profit organizations, government agencies, and “mom and pop” innovators.

Large For-Profit Organizations

The private sector has been an important contributor to the pandemic response, quickly filling in gaps left by the government. Pharmaceutical and biotechnology companies and pharmacy chains have been involved directly in drug and vaccine development as well as testing and vaccine rollout. Beyond these players in the health-care sector, however, have been a number of for-profit companies having core businesses not related to health care but that have nevertheless responded to the crisis by repurposing existing capabilities and resources. For example, manufacturers repurposed production lines to make plastic shields and ventilators. Distilleries and makers of luxury goods repurposed factories to produce disinfectant gel as a sanitizer.47 These for-profit companies often distributed products produced in response to the pandemic below cost or for free. More recently, Microsoft, Starbucks, and Amazon have been among the companies assisting the government with logistics and operations for vaccine dissemination.48 Google also disseminated health information through its search pages.49 By boosting the company’s public image and employee morale, these socially innovative endeavors offered the potential to benefit these for-profit organizations, even if not directly improving their bottom line.

Government Agencies

Governments around the world have struggled to respond quickly and effectively to the virus spread. Yet, some government agencies have promoted innovation in the face of the pandemic, and we recognize these activities as part of the social innovation ecosystem. For example, in the United States, state and local governments partnered with hotel chains to repurpose empty hotel rooms and give people experiencing homelessness or those exposed to or recovering from Covid-19 a place to recuperate and quarantine other than in a hospital.50 The US Department of Health and Human Services and the CDC awarded emergency grants and supplemental funds to support state, tribal, local, and territorial efforts to conduct research into solutions for Covid-19.51 Similarly, the National Institutes of Health offered funding and increased flexibility for new and continuing Covid-19-specific research through competition supplements, administrative supplements, and new awards.

“Mom and Pop” Innovators

By “mom and pop” innovators, we mean individuals and small groups innovating independently to address Covid-19. The number of small, local, independent initiatives was strikingly large, with common efforts including sourcing personal protective equipment, organizing volunteers or raising funds for a variety of causes, and gathering and serving meals for the hungry. In many communities, dozens if not hundreds or thousands of innovators spontaneously arose in response to this pandemic. Homemakers made and delivered homemade masks. Restaurants that were closed during the pandemic instead prepared and distributed food for essential workers. Anger over government’s handling of the pandemic, as well as social unrest and environmental disasters, also galvanized unprecedented levels of community organizing in conjunction with the 2020 election.52 In some cases, people whose daily routines had been disrupted—students who could not return to school, workers who could not return to their jobs, business owners who lost their customers—had time and resources and wanted to contribute in what has felt like an epic event. Others, already at home, saw needs and also wanted to give back.

Collaborative Efforts

Collaborative efforts include accelerator initiatives and new collaborative networks.

Accelerator Initiatives

Institutions accustomed to helping entrepreneurs launch businesses through collaborative accelerator programs turned their attention to Covid-19 and applied their winning models to advance initiatives to create a more resilient and equitable post-Covid-19 world. Leading universities were among those that redirected their resources by supporting Covid-19-oriented accelerator programs and hackathons. Examples include Stanford Rebuild, a global innovation accelerator program offered free to anyone globally, the Massachusetts Institute of Technology Covid-19 Challenge, the University of California at San Francisco Covid-19 Hackathon, and the Johns Hopkins “Thinking Fast in a Time of Crisis” initiative. Silicon Valley’s famous accelerator program, Y Combinator, similarly supported startups focused on Covid-19 through its programs. The Draper Richards Kaplan Foundation, a global venture philanthropy firm supporting early-stage, high-impact social enterprises, also launched in April 2020 a time-limited special initiative to respond to the growing noncoronavirus needs created by the Covid-19 pandemic.53 It explored over a thousand initiatives and funded eight projects inside their portfolio and externally, including initiatives to expand broadband access, distribute healthy food, provide a communication platform for schools and students, manage mental wellness of health-care workers, and several international projects. By supporting groups of independent innovators that work through these programs together, these accelerator initiatives fostered wide-ranging solutions addressing challenges associated with developing and distributing tests and diagnostics, treatments and vaccines, and tools for patients and health-care providers facing Covid-1954 and its consequences.55

New Collaborative Networks

New collaborative networks also formed to connect those with needs to others who could address them. Many initiatives connected those who could donate food to those who needed it. Some initiatives provided surgical and N95 masks (and other personal protective equipment and testing supplies) internationally, sometimes in the millions of pieces.56 Other networks moved badly needed nonhealth-related supplies to those most harmed by the economic impacts of Covid-19.57 Other companies striving to produce medical supplies were connected with organizations that could provide capital to scale production.58 Often arising organically when someone identified a need or recognized they had access to resources that could benefit someone else, these networks connected suppliers locally or globally with hospitals, governments, and other institutions suffering from shortages of supplies.

Three Examples of Social Innovation

A deeper look into selected case examples—first, an established nonprofit organization; second, a large for-profit organization; and third, a new collaborative network—illustrates some of the achievements of social innovators in response to Covid-19 and allows us to explore how specific social innovations emerged. This closer look reveals distinctions and commonalities among cases, furthering our understanding of the emergence of a “collaboratory” of social innovation in response to crisis.

Partners in Health (PIH) is a well-known and highly regarded social justice organization that views providing high-quality health care globally to those who need it as a moral imperative.59 Their work since 1987 in tackling—in collaboration with local public health and government entities—global pandemics, including HIV, Ebola, tuberculosis, and cholera, positioned PIH to innovate quickly in response to Covid-19. During the pandemic, it established a US Public Health Accompaniment Unit to bring its global knowledge to US states and community partners.60 By leveraging its previous experience, PIH rapidly trained an expansive network of contact tracers, case investigators, and care coordinators to help stem the spread of the coronavirus. In partnership with the Commonwealth of Massachusetts, PIH deployed the first large-scale contact-tracing initiative in the United States, the Covid-19 Community Tracing Collaborative (CTC). Its teams provided health education, test results, and access to support services, and initiated follow-up with contacts of individuals who had become infected. Owing to its early success, the CTC program was adopted widely, including in North Carolina, Illinois, Ohio, and the city of Newark, New Jersey, and its network continues to grow. Additionally, PIH leveraged its global network, including seventeen thousand health workers, two hundred public health facilities, and logistics, laboratory, and supply chain systems in eleven countries, to roll out comprehensive preventive responses to Covid-19.61 It also led operational research with academic partners such as Harvard Medical School to accelerate data availability and inform evidence-based responses, using global data sets to locate disease hot spots (syndromic surveillance), understand herd immunity (serosurveillance), and identify risk factors leading to severe disease in lower- and middle-income countries (LMICs).62 Partners in Health drew from its experience in LMICs and applied lessons to the United States while also deepening its efforts in LIMCs and disseminating to them key knowledge. Through these efforts, which they were well positioned and mission driven to undertake, PIH filled gaps, deployed interventions at scale, and contributed to reducing the spread of the virus.

General Motors (GM), the largest US automaker, was one private sector company that forsook the pure pursuit of profit in response to this global crisis. Like a nontrivial number of other for-profit companies, GM pivoted amid the pandemic to create “solutions benefiting public good.”63 It stepped up to manufacture ventilators to meet an urgent need for lifesaving equipment by establishing a cross-industry partnership with Ventec Life Systems, a medical technology company specializing in portable ventilators, which was also supported by the Trump administration’s invocation of the Defense Production Act on March 27, 2020.64 General Motors provided the resources and purchasing power of a large corporate entity, expertise in “high-scale” manufacturing, and, according to an attendee of an initial face-to-face meeting on March 20, 2020, the “intensity and the intention to make a huge dent in this problem.”65 The company converted an entire manufacturing plant in Indiana to commit it to the task. Obstacles included workers who had never built ventilators before, suppliers that had never built the needed components, and parts that were in short supply. Yet, working with its much smaller medtech and system testing partners and its suppliers, GM redesigned where needed, learned from failures, and persisted to deliver thirty thousand ventilators by September 2020.66 This achievement can be attributed to their intention, especially that of progressive CEO Mary Barra, the first female CEO of a major automaker, to respond to an urgent social need and to challenge GM to innovate and to adopt a more agile mindset. This pandemic-facilitated social innovation has also found parallel expression in a much broader corporate strategy for environmental sustainability and economic survival. Two elements include (1) a GM product partnership resulting in the joint development with SAIC Motor, a Chinese state-owned automotive company, of a Mini EV car selling for less than $5,000 with a battery range of over a hundred miles, successfully launched in 2020,67 and (2) the announcement in January 2021 that GM would end the sale of all gasoline and diesel-powered passenger cars and sport utility vehicles by 2035 in order to embrace a future of all electric cars.68

New Global Government-Business-Nonprofit Collaboration to Develop Covid-19 Vaccines

The race to develop effective Covid-19 vaccines is an extreme example of new, global, cross-sector, networked collaboration. On April 13, 2020, the World Health Organization published the “Public Statement for Collaboration on COVID-19 Vaccine Development,” stating, “We are scientists, physicians, funders and manufacturers who have come together as part of an international collaboration, coordinated by the World Health Organization (WHO), to help speed the availability of a vaccine against COVID-19,” with signatories from around the globe.69

Global cooperation to develop a vaccine has taken many forms. Scientists worldwide created extensive open networks, sharing knowledge to advance Covid-19 vaccine development. In January 2020, a Chinese scientist quickly made the viral genome sequence of SARS-COV2 available to other experts around the world for vaccine engineering.70 The University of Oxford used animal-testing results shared by the National Institutes of Health’s Rocky Mountain Laboratory in Montana to develop its vaccine.71 Collaborations emerged among research centers, university laboratories, hospitals, and vaccine manufacturers in different parts of the world. As a result of cross-sector partnerships, investigators launched more than four hundred clinical trials.72 Within a year, sixty-eight vaccines were in clinical trials in humans, twenty in the final stages of testing, and more than ninety in preclinical investigation in animals.73 These global knowledge-sharing efforts and cross-sector partnerships, often benefiting from significant government financial and regulatory support, combined with unprecedented urgency to combat the pandemic. The US Food and Drug Administration (FDA), the European Medicines Agency, and governments around the world have given vaccines emergency approval. As a result, Moderna took forty-two days from getting access to the viral genome to develop an mRNA vaccine and less than one year to receive emergency approval from the FDA. Previously, the fastest time to develop a vaccine was four years, for the mumps.74 The nonprofit nongovernment sector, including the Bill & Melinda Gates Foundation, Clinton Health Access Initiative, Oxford and many university partners, Partners in Health, and others, has provided financing, advocacy, and distribution mechanisms.75 Global health mechanisms are being put in place to address equitable vaccine distribution; examples include the COVAX-ACT (access to Covid-19 tools) accelerator; Gavi, the vaccine alliance; and the Coalition for Epidemic Preparedness Innovations (CEPI).76 There is international commitment to make the Covid-19 vaccine a global public good.77

Other collaborations in the field of vaccine development were government initiated. One example is Operation Warp Speed (OWS), an interagency public and multifirm private partnership initiated by the US government to facilitate and accelerate the development, manufacture, and distribution of vaccines, therapeutics, and diagnostics for Covid-19. To accelerate vaccine development, OWS identified and selected the most promising candidates and offered governmental support and funding.78 To allow trials to “proceed more quickly,” the federal government directly supervised protocols for clinical trials rather than taking a more traditional approach that would leave full control of the process to pharmaceutical companies.79 Partners also pursued steps toward vaccine development simultaneously. On May 15, 2020, OWS announced the selection of fourteen promising candidates from more than a hundred vaccine candidates then in development. They later narrowed these fourteen to the seven most promising candidates. These seven proceeded to early-stage clinical trials followed by large-scale randomized trials for safety and efficacy demonstration. The intention was to deliver 300 million vaccines by January 2021. To achieve this, the government supported development and agreed to pay Johnson & Johnson $1 billion for 100 million doses, Moderna $3.2 billion for 200 million doses, Oxford/AstraZeneca $1.2 billion for 300 million doses, Novavax $1.6 billion for 100 million doses, and Sanofi-GlaxoSmithKline $2 billion for 100 million doses. Additionally, though it did not support Pfizer’s vaccine development, the government agreed to pay the company $1.95 billion for 100 million doses to manufacture and distribute its vaccine once approved by the FDA.80 In total, OWS awarded more than $12 billion in vaccine-related contracts and deployed an overall budget of an estimated $18 billion.81

In addition to extensive levels of cooperation, multiple simultaneous trials, and redundant contracting, another characteristic of vaccine development for Covid-19 was the emergence of multiple vaccine platforms, including traditional recombinant protein, replicating and nonreplicating viral vectors, and nucleic acid DNA and mRNA technologies. Like the vaccines they produced, each of these platforms had benefits and limitations, and no platform could meet the global need for vaccine. Thus, a strategy of pursuing all available technologies was crucial.82 Partnerships like the one between Pfizer and BioNTech, which focused on using the mRNA technology, blossomed based on prior collaboration between the two companies.83

Conclusion: A Framework for Social Innovation in a Crisis and Implications for a New Frontier

The enormous need for services, research, and mobilization of resources as a result of the pandemic, and left unfulfilled through government action alone, spurred unprecedented levels, forms, and the rapid pace of social innovation. The specific case study examples we explored in this chapter resembled the broad array of traditional social innovators, less-traditional sources of social innovation, and collaborative efforts that responded to the needs created by the Covid-19 pandemic. Their breadth demonstrated the ability and willingness of all forms of social innovators to contribute within the context of a crisis. It is uncertain whether engagement of nontraditional social innovators in prosocial activities will continue beyond the pandemic. The future participation of for-profit businesses in particular will likely depend on their recognition of benefits to their public image and employee morale and their experience of cross-sector partnership associated with their contributions to the Covid response. Increased pressure from consumers, investors, regulators, and employees for companies to balance purpose and profit would also enhance the likelihood that for-profit businesses would orient toward future stakeholders rather than just pursuing shareholder value.

FIGURE 14-1

Model of social innovation in a crisis

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As depicted in figure 14-1, these social innovators shared common traits, including that they assessed the needs they could observe; considered their available resources, relationships, and comparative advantage; and self-authorized despite the risks of waste or failure. Additional success factors included having inherent agility and ability to implement and scale. Social innovators, including solo and networked individuals, nonprofit and for-profit organizations, and governments, worked consciously and unconsciously in concert to address immediate and medium-term needs during the pandemic.

Resulting from a perfect storm of social, economic, and environmental factors, the Covid-19 pandemic also laid bare the important interconnections between human and planetary factors. Since the main goal after responding to the pandemic remains preventing another similar event,84 to avail ourselves of the golden opportunity presented by the pandemic, the social innovation ecosystem must urgently embrace and encourage contributions from traditional nonprofit as well as nontraditional individual, corporate, government, and cross-sector collaborative sources of social innovation. Efforts across this ecosystem are required to address the longer-term social, economic, and environmental factors, including social inequalities and planetary health, that will mitigate and prevent future pandemics as well as immediate human needs. Such sustainability efforts will make organizations and nations more resilient.

FOR FURTHER READING

For readers wishing to dive deeper into human and planetary health, we recommend Accountable: The Rise of Citizen Capitalism by Michael O’Leary and Warren Valdmanis (Harper Business, 2020), which provides insights on how the pursuit of sustained financial success and the exercise of social responsibility to employees, consumers, and society are essential for our future. Jeff Tollefson’s “Why Deforestation and Extinctions Make Pandemics More Likely” (Nature, 2020) provides insights into the nexus between the loss of biodiversity and emerging diseases. Lissy Romanow’s “Grassroots Organizing and Preparing for the Unprecedented” (Stanford Social Innovation Review, 2020) emphasizes how individuals and small groups innovated independently to address the challenges of Covid-19. Finally, “Rediscovering Social Innovation” by James A. Phills Jr., Kriss Deiglmeier, and Dale T. Miller (Stanford Social Innovation Review, 2008) is a seminal article defining social innovation.

Notes

  1. 1. K. K. Rebecca Lai, Jin Wu, Richard Harris, Allison McCann, Derek Watkins, and Jugal K. Patel, “Coronavirus Map: Tracking the Spread of the Outbreak,” New York Times, December 1, 2020, sec. World, https://www.nytimes.com/interactive/2020/world/coronavirus-maps.html.

  2. 2. Stanford University, “Stanford Scholars, Researchers Tackle COVID-19 Crisis,” Stanford News, April 8, 2020, https://news.stanford.edu/2020/04/08/stanford-scholars-researchers-lend-expertise.

  3. 3. McKinsey & Company, “Innovation in a Crisis: Why It Is More Critical than Ever,” n.d., https://www.mckinsey.com/business-functions/strategy-and-corporate-finance/our-insights/innovation-in-a-crisis-why-it-is-more-critical-than-ever.

  4. 4. Selam Gebrekidan and Matt Apuzzo, “Covid Response Was a Global Series of Failures, W.H.O.-Established Panel Says,” New York Times, January 18, 2021, sec. World, https://www.nytimes.com/2021/01/18/world/europe/virus-WHO-report-failures.html.

  5. 5. Organisation for Economic Cooperation and Development (OECD), “Social Economy and the COVID-19 Crisis: Current and Future Roles,” OECD.org, July 30, 2020, http://www.oecd.org/coronavirus/policy-responses/social-economy-and-the-covid-19-crisis-current-and-future-roles-f904b89f/.

  6. 6. Sophie Bacq and G. T. Lumpkin, “Social Entrepreneurship and COVID-19,” Journal of Management Studies 58, no. 1 (October 17, 2020): 285–288, https://doi.org/10.1111/joms.12641.

  7. 7. C. B. Bhattacharya, “How the Great COVID-19 Reset Can Help Firms Build a More Sustainable Future,” World Economic Forum, May 15, 2020, https://www.weforum.org/agenda/2020/05/the-covid-19-reset-sustainability/.

  8. 8. Inger Andersen and Johan Rockstrom, “COVID-19 Is a Symptom of a Bigger Problem: Our Planet’s Ailing Health,” Time, June 5, 2020, https://time.com/5848681/covid-19-world-environment-day.

  9. 9. Jeff Tollefson, “Why Deforestation and Extinctions Make Pandemics More Likely,” Nature 584, no. 7820 (August 7, 2020): 175–176, https://doi.org/10.1038/d41586-020-02341-1.

  10. 10. Centers for Disease Control and Prevention (CDC), “Zoonotic Diseases,” Centers for Disease Control and Prevention, 2018, https://www.cdc.gov/onehealth/basics/zoonotic-diseases.html.

  11. 11. American Hospital Association, “Hospitals and Health Systems Face Unprecedented Financial Pressures Due to COVID-19,” American Hospital Association, May 5, 2020, https://www.aha.org/guidesreports/2020-05-05-hospitals-and-health-systems-face-unprecedented-financial-pressures-due.

  12. 12. Olivia Petter, “Burberry Given £500,000 to Make PPE Equipment for the NHS,” The Independent, September 4, 2020, https://www.independent.co.uk/life-style/fashion/burberry-ppe-nhs-500-000-nhs-government-a9704571.html.

  13. 13. Kirsten Korosec, “Ford, GM, Tesla Given the ‘Go Ahead’ to Produce Ventilators, Trump Says,” TechCrunch, March 22, 2020, https://techcrunch.com/2020/03/22/ford-gm-tesla-given-the-go-ahead-to-produce-ventilators-trump-says/.

  14. 14. Oleg Bestsennyy, Greg Gilbert, Alex Harris, and Jennifer Rost, “Telehealth: A Post-COVID-19 Reality?,” McKinsey & Company, 2020, https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality.

  15. 15. McKinsey & Company, “Innovation in a Crisis.”

  16. 16. Tollefson, “Why Deforestation and Extinctions Make Pandemics More Likely.”

  17. 17. Yogini V. Chudasama, Clare L. Gillies, Francesco Zaccardi, Briana Coles, Melanie J. Davies, Samuel Seidu, and Kamlesh Khunti, “Impact of COVID-19 on Routine Care for Chronic Diseases: A Global Survey of Views from Healthcare Professionals,” Diabetes & Metabolic Syndrome: Clinical Research & Reviews 14, no. 5 (2020): 965–967, https://doi.org/10.1016/j.dsx.2020.06.042.

  18. 18. Korosec, “Ford, GM, Tesla Given the ‘Go Ahead’ to Produce Ventilators, Trump Says”; Mark É. Czeisler et al., “Mental Health, Substance Use, and Suicidal Ideation during the COVID-19 Pandemic—United States, June 24–30, 2020,” Morbidity and Mortality Weekly Report 69, no. 32 (2020): 1049–1057, https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6932a1-H.pdf.

  19. 19. David Cutler, “How Will COVID-19 Affect the Health Care Economy?,” Journal of the American Medical Association 323, no. 22 (2020): 2237–2238, https://doi.org/10.1001/jama.2020.7308.

  20. 20. Gita Gopinath, “The Great Lockdown: Worst Economic Downturn since the Great Depression,” International Monetary Fund (blog), April 14, 2020, https://blogs.imf.org/2020/04/14/the-great-lockdown-worst-economic-downturn-since-the-great-depression/.

  21. 21. David M. Cutler and Lawrence H. Summers, “The COVID-19 Pandemic and the $16 Trillion Virus,” Journal of the American Medical Association 324, no. 15 (2020): 1495–1496, https://doi.org/10.1001/jama.2020.19759.

  22. 22. Catalyst, “The Detrimental Impact of Covid-19 on Gender and Racial Equality: Quick Take,” Catalyst, December 8, 2020, https://www.catalyst.org/research/covid-effect-gender-racial-equality.

  23. 23. Statista, “Coronavirus Impact Index by Industry 2020,” Statista, January 22, 2021, https://www.statista.com/statistics/1106302/coronavirus-impact-index-by-industry-2020.

  24. 24. McKinsey & Company, “Innovation in a Crisis.”

  25. 25. Richard Waters, “Big Tech Has the Cash to Expand after Crisis,” ft.com, March 19, 2020, https://www.ft.com/content/27fdaf5c-f4ab-4a0f-ba9e-038911b49fe8.

  26. 26. McKinsey & Company, “COVID-19 Recovery in Hardest-Hit Sectors Could Take More than 5 Years,” mckinsey.com, July 29, 2020, https://www.mckinsey.com/featured-insights/coronavirus-leading-through-the-crisis/charting-the-path-to-the-next-normal/covid-19-recovery-in-hardest-hit-sectors-could-take-more-than-5-years.

  27. 27. Ibraheem M. Karaye and Jennifer A. Horney, “The Impact of Social Vulnerability on COVID-19 in the U.S.: An Analysis of Spatially Varying Relationships,” American Journal of Preventive Medicine 59, no. 3 (2020): 317–325, https://doi.org/10.1016/j.amepre.2020.06.006.

  28. 28. Ibid.

  29. 29. Ibid.

  30. 30. Ibid.

  31. 31. Justin Worland, “America’s Clean Water Crisis Goes Far beyond Flint. There’s No Relief in Sight,” Time, February 20, 2020, https://time.com/longform/clean-water-access-united-states.

  32. 32. Karaye and Horney, “The Impact of Social Vulnerability on COVID-19 in the U.S.”

  33. 33. Daniel M. Gerstein, “Assessing the US Government Response to the Coronavirus,” Bulletin of the Atomic Scientists 76, no. 4 (2020): 166–174, https://doi.org/10.1080/00963402.2020.1778356.

  34. 34. Nicole Huberfeld, Sarah H. Gordon, and David K. Jones, “Federalism Complicates the Response to the COVID-19 Health and Economic Crisis: What Can Be Done?,” Journal of Health Politics, Policy and Law 45, no. 6 (2020): 951–965, https://doi.org/10.1215/03616878-8641493; Gavin Yamey and Clare Wenham, “The U.S. and U.K. Were the Two Best Prepared Nations to Tackle a Pandemic—What Went Wrong?,” Time, July 1, 2020, https://time.com/5861697/us-uk-failed-coronavirus-response; Peter Beaumont and Julian Borger, “WHO Warned of Transmission Risk in January, Despite Trump Claims,” The Guardian, April 9, 2020, sec. World News, https://www.theguardian.com/world/2020/apr/09/who-cited-human-transmission-risk-in-january-despite-trump-claims.

  35. 35. Huberfeld, Gordon, and Jones, “Federalism Complicates the Response to the COVID-19 Health and Economic Crisis.”

  36. 36. Ian Bremmer, “The Best Global Responses to the COVID-19 Pandemic,” Time, June 12, 2020, https://time.com/5851633/best-global-responses-covid-19.

  37. 37. Ibid.

  38. 38. Rachel Kyte, “No Silver Lining to Coronavirus, but a Golden Opportunity,” Climate Change News, May 1, 2020, https://www.climatechangenews.com/2020/05/01/no-silver-lining-golden-opportunity-build-back-better/.

  39. 39. Organisation for Economic Cooperation and Development (OECD), “Making the Green Recovery Work for Jobs, Income and Growth,” OECD.org, October 6, 2020, https://www.oecd.org/coronavirus/policy-responses/making-the-green-recovery-work-for-jobs-income-and-growth-a505f3e7/.

  40. 40. Jonathan H. Epstein et al., “Nipah Virus Dynamics in Bats and Implications for Spillover to Humans,” Proceedings of the National Academy of Sciences 117, no. 46 (2020): 29190–29201, https://doi.org/10.1073/pnas.2000429117.

  41. 41. Isabel J. Jones et al., “Improving Rural Health Care Reduces Illegal Logging and Conserves Carbon in a Tropical Forest,” Proceedings of the National Academy of Sciences 117, no. 45 (2020): 28515–28524, https://doi.org/10.1073/pnas.2009240117.

  42. 42. Angelle Desiree and Amy Krystosik, “Trash to Treasure,” Disease Ecology, Health and the Environment, ecohealthsolutions.stanford.edu, accessed February 1, 2021, https://ecohealthsolutions.stanford.edu/research/trash-treasure.

  43. 43. James Austin, Howard Stevenson, and Jane Wei-Skillern, “Social and Commercial Entrepreneurship: Same, Different, or Both?,” Entrepreneurship Theory and Practice 30, no. 1 (January 2006): 1–22, https://doi.org/10.1111/j.1540-6520.2006.00107.x.

  44. 44. Robert Wood Johnson Foundation, “RWJF Support for Those Facing Greatest Strain under the COVID-19 Pandemic,” Robert Wood Johnson Foundation, April 7, 2020, https://www.rwjf.org/en/library/articles-and-news/2020/04/rwjf-provides-50-million-in-relief-for-people-facing-the-greatest-strain-under-the-covid-19-pandemic.html.

  45. 45. Ashoka and Changemakers, “Changemakers Respond to COVID-19,” Ashoka Insight, March 25, 2020, https://medium.com/change-maker/changemakers-respond-to-covid-19-3ff47494d575.

  46. 46. Julianne Holt-Lunstad, “Why Universities Need to Address Loneliness in COVID Plans,” thriveglobal.com, August 14, 2020, https://thriveglobal.com/stories/why-universities-need-to-address-loneliness-in-covid-plans/?utm_source=Newsletter_Transaction&utm_medium=Thrive&utm_campaign=Published.

  47. 47. Richard Kestenbaum, “LVMH Converting Its Perfume Factories to Make Hand Sanitizer,” Forbes, March 15, 2020, https://www.forbes.com/sites/richardkestenbaum/2020/03/15/lvmh-converting-its-perfume-factories-to-make-hand-sanitizer/?sh=2dc6e8254a9a.

  48. 48. Gillian Friedman and Lauren Hirsch, “Help with Vaccination Push Comes from Unexpected Businesses,” New York Times, January 23, 2021, sec. Business, https://www.nytimes.com/2021/01/23/business/vaccines-microsoft-amazon-starbucks.html?smid=em-share.

  49. 49. Ibid.

  50. 50. California Department of Social Services, “Project Roomkey/Housing and Homelessness COVID Response,” 2021, accessed August 3, 2021, https://www.cdss.ca.gov/inforesources/cdss-programs/housing-programs/project-roomkey.

  51. 51. US Department of the Treasury, “The CARES Act Works for All Americans,” US Department of the Treasury, 2020, https://home.treasury.gov/policy-issues/cares; Centers for Disease Control and Prevention (CDC), “Coronavirus Disease 2019,” Centers for Disease Control and Prevention, 2021, https://www.cdc.gov/media/releases/2021/p0107-covid-19-funding.html.

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  60. 60. Partners in Health, “Mobilizing against COVID-19 and Ensuring a Healthier Future for All,” Partners in Health, 2020, https://www.pih.org/sites/default/files/2020-05/Partners_In_Health_COVID19_Global_Project_Concept_May_2020.pdf.

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  63. 63. Efrat Shadmi et al., “Health Equity and COVID-19: Global Perspectives,” International Journal for Equity in Health 19, no. 1 (2020), https://doi.org/10.1186/s12939-020-01218-z.

  64. 64. Greg Slabodkin, “An Insider’s Look at How GM, Ventec Ramped Up Ventilator Production amid COVID-19,” medtechdive.com, July 13, 2020, https://www.medtechdive.com/news/an-insiders-look-at-how-gm-ventec-ramped-up-ventilator-production-amid-co/581461/.

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  79. 79. US Department of Health and Human Services, “COVID-19 Vaccines.”

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  84. 84. Neal Myrick, “Green Leadership Will Be More in Demand Than Ever after COVID-19,” World Economic Forum, June 15, 2020, https://www.weforum.org/agenda/2020/06/environmental-leadership-will-be-more-in-demand-than-ever-after-covid-19.

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