The pharmaceutical commons: conceptual clarifications, a practice example, and a research agenda

Abstract Recent technological developments in the pharmaceutical sector have fuelled rapid price increases of advanced therapies, but they have also triggered renewed efforts around developing alternative modes of organizing pharmaceutical research and deployment. Examples include patient- and clinician-driven innovation, hospital-based manufacturing, and drug repurposing. While these developments offer a seam of fresh scholarship in the sociology of pharmaceuticals, they are accompanied by an increase in conceptual blurriness. We bring clarity and a consistent conceptual vocabulary to one crucial dynamic: the pharmaceutical commons. We draw together the landscape of current pharmaceutical commoning activities and some of the very fertile current commons scholarship. On this basis, we propose nine characteristics of pharmaceutical commons across three overarching aspects: (1) Property: open, mutualized, based on conditional sharing; (2) Governance: legitimized, based on bounded membership, and with a needs-driven agenda; and (3) Practices: people-led, fair in distributing (financial) risks and benefits, and accountable. In distilling scholarship and current experiments, illustrated by an empirical account of a pharmaceutical commons, we formulate a research agenda to spark a joint-up conversation on this vital topic.