Table 2 Strategies addressing ‘nanoequity’ risks and challenges in the development and implementation of medical nanotechnologies for global health

Infrastructure

Encourage domestic RDI in medical nanotechnologies in LMICs that can help address their most pressing health needs.

Support strong collaboration and linkages among academia, government and industry.

Strengthen the local nanotechnology industry sector.

Establish development and manufacturing operations in target countries.

Field test medical nanotechnologies to demonstrate their efficacy and safety in local contexts, confirm their environmental and cultural acceptability, evaluate their application by individuals with little or no training, and ensure their compatibility with local policy and regulatory frameworks.

Nanogovernance

Set priorities in LMICs by identifying resources, capabilities, limitations, existing knowledge gaps, potential niche areas, competitive advantages, and opportunities for strategic engagement.

Ensure the commitment of decision-makers in LMICs to secure long-term government support and funding for medical nanotechnologies.

Combine strong national institutions that orchestrate all efforts in nanomedicine with decentralization of nanotechnology RDI.

Nanodiplomacy and international collaboration

Facilitate South–South and North–South multinational collaborations through nanotechnology RDI networks, always including developing countries as fully participating members.

Establish fair trade agreements between HICs and LMICs for the commercialization of medical nanotechnologies.

Convert ‘brain drain’ into ‘brain recirculation’ in LMICs.

Take advantage of highly educated diasporas, the communities of individuals from developing countries living and working in industrialized nations in academia, research or industry.

Prevent LMICs from becoming the dumping ground of nanowaste and potentially toxic nanoproducts from HICs.

Regulatory frameworks and intellectual property

Design regulatory frameworks in LMICs that are efficient, flexible, transparent, adaptable to local contexts and able to keep pace with advances in medical nanotechnologies.

Harmonize design and usage of nanomedical devices among different manufacturers to facilitate use and prevent the risk of confusion or improper application.

Use patent pools, patent clearinghouses and open-source approaches to balance the promotion of nanomedicine RDI in LMICs while still ensuring access and availability of nanomedical products useful for local health needs.

Education and capacity building

Encourage broad, rigorous, interdisciplinary education in nanotechnology at all levels of instruction.

Support and fund capacity building efforts that provide education and training in public health for nanotechnologists, and in nanotechnology and nanomedicine for public health professionals, clinicians and government decision-makers.

Favour medical nanotechnologies that enable task-shifting or task-sharing, the strategic redistribution of tasks among health workforce teams and personnel from highly trained health workers to those with shorter training or fewer qualifications.

Favour ease-of-use over versatility in the design of nanomedical devices targeted to LMICs, minimizing the need for technology-specific training.

Public engagement

Develop clear, consistent, transparent and socially- and culturally sensitive public engagement strategies that encourage ongoing, active and openminded dialogue among the general public in LMICs about the potential benefits, risks and costs of medical nanotechnologies.

Acknowledge the legitimate expectations, fears and concerns of specific populations in LMICs about medical nanotechnologies.

Avoid top-down, manipulative ‘nanomarketing’ campaigns, as well as communication strategies based on irrational fears and misinformation.

Ensure the participation of all relevant stakeholders in mapping the future of medical nanotechnologies in LMICs.