Thierry Crouzet

Le coronavirus met en évidence le clivage privé-public

Automatic translation from French

Following my explanation of why we still lack medical masks , an intellectual property expert made me a double objection.

I summarize my reasoning: the disruption in the supply of hydro-alcoholic solutions has never been total because they are free of rights unlike medical standard masks which are proprietary and produced only by the private sector.

Objection 1: complexity

Making masks would be much more complex than hydro-alcoholic solutions. My expert made this demonstration to me by describing to me a process of manufacturing masks requiring specialized machines.

To manufacture their gels, manufacturers use high-speed micro-millimeter or ultra-millimeter filtration membranes to remove impurities, but also contaminating spores, which guarantees the quality of the products. Likewise, they mix several alcohols (ethilic, isopropilic, etc.) and antiseptics such as chlorhexidine digluconate as well as various emollients. These formulations require high precision laboratories, especially when it comes to manufacturing tens of thousands of vials per day. It’s also very complex.

The whole genius of Didier, and in this case especially of William Griffiths, was to imagine a simplified formulation at the same time as ultra-efficient, after dozens and dozens of tries. For example, William had the idea of ​​introducing hydrogen peroxide to kill spores, which makes high-tech membranes useless and therefore a lot of machinery. Everything was done so that, after two days of training, a pharmacist could start production from commonly available products : alcohol, glycerol, hydrogen peroxide. Simplicity is not a coincidence but it has been sought after.

An open source mask should obey the same rules: be simple to manufacture while offering a very good level of protection. It will certainly not be as efficient as masks requiring complex machinery, but it will remain very satisfactory, especially for general public use.

The same goes for hydro-alcoholic formulations. In hospitals, even at HUG in Geneva, we do not use WHO formulations, but more sophisticated products which kill a wider spectrum of pathogens, faster, more durably while better protecting the skin of caregivers.

The first objection does not hold. An open source mask concept must integrate into its design the simplicity of manufacturing and the possible decentralization of production, even if it means using today's general public tools like 3D printers.

Hydro-alcoholic formulations have been designed for poor countries, for crisis situations. We need a mask model that meets the same criteria, but also models of a gown, overcoat, gloves and other essential medical equipment. Rather than storing them by the billions, we need to be able to produce them everywhere when demand suddenly increases.

Objection 2: patents

My expert reminds me that patents have a limited duration, often 20 years. So whether Didier gave the formulations or not would not change anything.

A little chronological reminder. WHO published the formulations in 2009. Since then, thanks to this publication, around sixty poor countries have made hydro-alcoholic solutions and caregivers have saved millions of lives, and now it is the world that manufactures these solutions, without seek the advice of a beneficiary.

If Didier Pittet hadn't done anything, we would still be using industrial products which, even if they had fallen into the public domain, would be too complex to manufacture in often precarious laboratories. We would be out of stock, dependent on a distant supplier relocated to China.

How would we get out of it right now? Where would the solutions from pharmacies or perfumers come from? What would we do? We would be searching patent archives to dig up an outdated formulation, the effectiveness of which we wouldn't even know? We would simply be in the panadic as we are with the masks of which certain models are no longer patented. But do these now patent-free patents change anything for us right now? You can see that not.

An open product is not just a patent, it is a whole philosophy, with the sharing of abundant documentation, know-how, feedback, scientific validation, implementation in the field.

It is an open process. WHO hydro-alcoholic formulations have not evolved since 2009, but nothing prevents it and poor countries will not have to wait twenty years to have this innovation. For example, the hand washing protocol, an integral part of the donation, is evolving towards the method the fingertips first , which was shown in 2017 to be more effective than the one initially proposed. All of this is continuously evolving, without constantly implying new patents that would push the expiration of the public domain.

Fingertip first
Fingertip first

Take the computer analogy: Windows and macOS are constantly evolving. They never fell into the public domain. Who would want an operating system from twenty years ago, which would be frozen in the past?

Sterillium, the first hydro-alcoholic gel marketed in 1965, is still on the market, but it is another product. Manufacturers are smart enough to regularly bring in innovations to keep their products one step ahead of patents filed twenty years earlier.

A patented product that evolves, and any advanced product must evolve, never falls into the public domain, unless it is knowingly poured into it.

By giving the formulations and the protocols that accompany them, Didier made sure that all humans are equal vis-à-vis this innovation regardless of its developments, regardless of their resources, here and now.

AFNOR offers an open source mask plan. That's fine, it's going in the right direction, we will have a solution for the next crisis, but the work remains immense to be sure that it is a good solution, or even the best possible solution in the state of our knowledge and technologies.

The hydro-alcoholic formulations were tested for fifteen years before being released, before their efficacy and safety were demonstrated. Open source is not just a sketch, you have to do the work to the end, and even further than an industrialist, because you always have to think about feasibility in all conditions.

None of this accompanies any patent that has fallen into the public model: risk that it is technologically outdated, risk that it is too complicated, risk that it is not sufficiently effective ...

This is also the efficiency of an open source solution. It sets a minimum standard. Before Didier began his hand hygiene campaign, the products available on the market were of poor quality. The manufacturers have improved because the open source product was already a very very good product. The same thing happens with Windows and macOS against Linux.

The second objection is no more valid than the first. The question of the superiority of free over the privator is beyond doubt with regard to the toolkit of the essentials of humanity. The Covid-19 pandemic shows us that the private sector is failing in times of crisis. We cannot trust him at these times.

Will we learn the lesson? I don't know, I can only hope so. Will we have a free vaccine, we can dream it. WHO invites to create a common resource without using the word common good, but we are not far away. It would be a sign that we are changing times. The other measures will be nothing but trifles, only plasters on wooden legs.