Synthetic biology in Global Health: lessons from history and anthropology

Abstract

Drawing on Douglas and Stemerding's special issue of Systems and Synthetic Biology that examined synthetic biology in relation to global health, I suggest that synthetic biology (syn bio) work in global health should attend seriously to local contexts and would benefit from historical and anthropological insights. Specifically, I emphasize the importance, in syn bio projects, of: (1) the inclusion of multiple publics from the outset, (2) locating the technological promise of syn bio in broader social projects and contexts, and (3) subjecting syn bio institutions and projects to examination.

Keywords:

• synthetic biology
• global health
• history
• anthropology
• social context
• science publics

The term global health ‘implies consideration of the health needs of the people of the whole planet above the concerns of particular nations’, and is associated with the emergence of important nongovernmental actors (Brown, Cueto, and Fee, 2006, 62). Synthetic biology (syn bio) as a field of research and practice, and those working with syn bio, may constitute such actors. Last year, Douglas and Stemerding convened a special issue of Systems and Synthetic Biology to address select syn bio applications, processes, and governance as they relate to global health. They suggest that ‘syn bio is positioned to address major global health issues through advanced vaccine development, diagnostics, drug synthesis, and the detection and remediation of environmental toxins’ (Douglas and Stemerding 2013, 63).

Syn bio holds potential value for the remediation of various health problems, including designing out cold chain requirements, simplifying certain (e.g. vaccine) administration procedures thus facilitating local capacity and uptake (Vohra and Blakely 2013), rapid production of preventive and therapeutic agents, and environmental monitoring, etc. (Douglas and Stemerding 2013). The authors in the special issue address a number of important considerations including IPR and patent regimes (van den Belt 2013, Hollis 2013). In this short piece, I suggest that we would do well to take some lessons from history and anthropology as we consider the application of syn bio in global health contexts.

By global health contexts, I mean both the local peoples and sites that are most often the targets or recipients of global health interventions (typically in the global ‘South’ and marked by relative underdevelopment and poor health metrics) and the global health partnerships that most often occur between institutions in the global ‘North’ and ‘South’. I use global health contexts to remind us that global health is not a singular thing. ‘You cannot dwell in the global’ (Anderson 2014, 378).

Thus, if syn bio is to be meaningful in global health contexts, I suggest that we pay serious attention to various social issues, three of which I foreground here. Histories of global and international health are riddled with stories of failure. Often institutional goals, priorities, and logics do not align with those of targeted groups. Against a backdrop of attending seriously to local contexts, I suggest that we also give serious attention to the following three related areas:

• (1)Public inclusion: including local and multiple publics in design of research, technologies, and programs at every step.

• (2)Placing the technological potential of syn bio in social contexts: locating the broader social, political, economic, etc. aspects of the health problems to be addressed by syn bio.

• (3)Studying syn bio institutions: assess and analyze the underlying priorities, assumptions, and logics of those practicing and applying syn bio.

• 1.Public Inclusion: Most international health programs have been designed in a top-down manner. The subsequent move to global health initially seemed to include a recognition of the failure of the vertical approach, however many recent programs appear to have resuscitated it. Reardon's account of the failure of the Human Genome Diversity Project (HGDP) shows that considerations of varied public values cannot simply be tacked on to existing project design, but rather must be built-in every step of the way (Reardon 2005).

  Especially in projects of controversial science, Science and Technology Studies (STS) scholars have shown that the early inclusion of multiple publics not only produces better public acceptance of downstream programs and products, but also better science. O'Doherty et al. (2013) offer examples of in-depth public deliberation on controversial scientific projects. Far from the earlier ideal of value-free science, science is shot through with social values and human interests. Thus, Douglas (2009) advocates for value-laden sciences; good science requires the acknowledgement of values. Thompson (2014) shows how good stem cell science comes out of an ongoing and iterative relationship between science and ethics. This is a relationship in which scientists become one of a set of multiple publics. These scholars, and others, show that good science is expressive of social values and that the inclusion of broad publics is necessary for the production of good science as well as the uptake of its outputs.

• 2.Placing technology in context: A ‘magic-bullet’ approach has long been favored in biomedicine with its high-tech focus and cultural logic of eradication. If we take seriously the substantial research that suggests that health problems reflect social problems, and that poverty and inequality strongly shape health vulnerability, then technological approaches that ignore the specific social contexts are unlikely to provide much relief and, in fact, risk to make things worse.

  Many scholars attribute the failure of the 1950s WHO Malaria Eradication Programme (MEP) to an overreliance on technological fixes (e.g. Cueto 2013, Greene et al., 2013). Unfortunate consequences include the development of DDT and artemisinin resistance. Even the successful smallpox eradication campaign has been criticized for its violence and social rupture, which has left, in some areas, resistance to subsequent vaccination efforts (Apffel-Marglin 1990). Syn bio technologies applied in global health contexts are thus more likely to have a positive impact as components of broader socio-political projects, rather than as stand-alone solutions. These might include, for instance, strengthening health infrastructures.

• 3.Studying Syn bio institutions: barriers to technological and medical interventions in developing countries have most often been framed as located in the recipient cultural groups. That is, cultural, social, or psychological attributes in local communities are seen to act as barriers to appropriate uptake. As early as 1976, however, Foster ([1976] 2010) recognized the importance of attending to the cultures of bureaucracies as well; global health institutions and personnel have cultures, too, which may serve as barriers to implementation.

  Even as the designers of the failed HGDP, for instance, saw the project as an anti-racist corrective to the limited scope of the Human Genome Project, those targeted by the project had their own epistemic approaches and political concerns that proved irreconcilable (Reardon 2005). The failed MEP was reshaped in response to institutional, as much as malarial, pressures along the way (Cueto 2013). We must, therefore, critically analyze our own syn bio-related institutions and projects in order to understand the internal underlying logics, assumptions, and interests that underpin syn bio work. This could be accomplished, in part, by incorporating independent social science funding streams within such projects.

In sum, while some working in syn bio and global health explain public resistance to their projects by recourse to a deficit model of public understanding, this is neither an accurate nor productive framing. Often the deficit is located in our own understandings of other public values. By taking seriously local contexts, including diverse publics, using syn bio innovations in tandem with broader social projects, and scrutinizing our own practices and assumptions, we enhance the possibilities for meaningful engagements of syn bio in global health. Finally, by now, most working definitions of global health include a statement about equity. Equity is not only about the distribution of benefits, but also risks. We should exercise extra caution to ensure that those already most vulnerable – for this is precisely what constitutes them as populations in need of intervention – do not bear an undue burden of risk related to synthetic biology.

Notes on contributor

Jennifer Liu is a cultural and medical anthropologist working on social and cultural aspects of emerging biomedical technologies. Much of her work has been in Taiwan and California. She is Assistant Professor of Anthropology at the University of Waterloo where she is also cross-appointed in the School of Public Health and Health Systems. She is a Fellow at the Balsillie Institute of International Affairs.