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Double standards in healthcare innovations: the case of mosquito net mesh for hernia repair
  1. Mark Skopec1,
  2. Alessandra Grillo2,
  3. Alvena Kureshi2,
  4. Yasser Bhatti3,
  5. Matthew Harris1
  1. 1 Department of Primary Care and Public Health, Imperial College London, London, UK
  2. 2 Department of Orthopaedic and Musculoskeletal Science, University College London, London, UK
  3. 3 School of Business and Management, Queen Mary University of London, London, UK
  1. Correspondence to Dr Matthew Harris, Department of Primary Care and Public Health, Imperial College London, London SW7 2BU, UK; m.harris{at}


With over two decades of evidence available including from randomised clinical trials, we explore whether the use of low-cost mosquito net mesh for inguinal hernia repair, common practice only in low-income and middle-income countries, represents a double standard in surgical care. We explore the clinical evidence, biomechanical properties and sterilisation requirements for mosquito net mesh for hernia repair and discuss the rationale for its use routinely in all settings, including in high-income settings. Considering that mosquito net mesh is as effective and safe as commercial mesh, and also with features that more closely resemble normal abdominal wall tissue, there is a strong case for its use in all settings, not just low-income and middle-income countries. In the healthcare sector specifically, either innovations should be acceptable for all contexts, or none at all. If such a double standard exists and worse, persists, it raises serious questions about the ethics of promoting healthcare innovations in some but not all contexts in terms of risks to health outcomes, equitable access, and barriers to learning.

  • biomedical engineering
  • delivery of health care
  • ethics
  • general surgery

Data availability statement

All data relevant to the study are included in the article.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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Data availability statement

All data relevant to the study are included in the article.

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  • Contributors All authors: original concept and design of the study; revision of manuscript and preparation of final draft. MS and MH: first draft and review of literature. AG and AK: analysis of biomechanical data. YB: review and additional of important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

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