Kaushik Sunder Rajan, University of Chicago
I was intrigued, sitting in America, to follow South Africa's initial response to the COVID-19 pandemic. It was completely different from the failed American response, on three counts:
- While the American government failed to institute any kind of comprehensive testing and contact tracing regime, the mobilization of South Africa’s public health infrastructure to combat the pandemic, while hardly flawless, was comparatively efficient, initial hiccups, substantial challenges and eventual, serious allegations of corruption notwithstanding. This is not unique. The well-documented successes of New Zealand’s and South Korea’s responses apart, some of the best initial responses did come from smaller countries, often in the European or global South, such as Greece, Slovenia, Senegal, Vietnam and Pakistan.
- While the American responses foregrounded xenophobia and nationalism, most visibly in Donald Trump’s anti-Chinese racism throughout the pandemic, one of the first South African responses involved a visit of their pandemic response team to China, to understand what could be learned from the epidemiology of the outbreak in Wuhan.
- Perhaps most noticeably, while the public discourse surrounding COVID-19 response in the US centered around the heroic figure of healthcare workers, conversations in South Africa immediately turned to the constitutional dimensions of the response. Thus, as Michelle Pentecost has pointed out, the public health dialogue was immediately co-produced with and as a constitutional one. Such a constitutional conversation looks very different from one in America, where the Constitution has primarily been invoked in terms of a “freedom” to not be constrained by shutdowns or requirements to wear masks. In South Africa, constitutional conversations are immediately attached to governmental obligations to ensure that the socio-economic rights enshrined in the South African Constitution’s Bill of Rights (which includes a fundamental right to health) be fulfilled. It also demands governmental transparency and accountability. Thus, one of the first policy responses to COVID-19 in South Africa was the extension of child support grants to women.
I begin my thoughts about a Global Observatory for Genome Editing so far afield, by discussing a public health response in South Africa, for three reasons:
- It used to be the case, even a couple of decades ago, that discussions of emerging technologies centered around the US, Europe and maybe Japan. The rest of the world was deemed largely irrelevant. This is no longer possible. Nor is the rest of the world (including the so-called “Global South”) merely the passive recipient of the largesse of Euro-American innovation. Both public health response and science and technology capacity are increasingly centered, albeit in unequal and highly differentiated ways, in many parts of the world, including those once regarded as global “peripheries.” In countries like India (where I am from) and South Africa (where I currently conduct my research), biomedical research capacity is a fraction of the scale of the United States. Nonetheless, both countries have global centers of research excellence. Of course, emergent Asian powers such as China and Singapore are very much at the cutting-edge of global biomedical research today. A Global Observatory, thus, develops at a time of proliferation of global nodes of scientific and technological capacity.
- Also and correspondingly, these are global nodes of social and political capacity. The condescending idea that science and technology innovation or public health expertise is simply a function of the twin virtues of capitalism and democracy such as instantiated in Europe and America, and the export of technology therefore must go hand-in-hand with the export of Euro-(and especially)American variants of these political and economic value-systems, rings increasingly hollow. It is not that capitalism and democracy do not matter elsewhere; it is that what they mean, how they instantiate, and what their foundational norms and ideals reflect might be quite different, as can be seen in the very different primary instantiations of constitutionalism (anti-mask protests versus universal childcare) one sees in response to COVID-19 in America as opposed to South Africa. Therefore,
- The substance of socio-technical imaginaries in other parts of the world could be quite different than they are in the US. The implicit American understanding of constitutionalism as reflecting an ideal of freedom that resides in individualistic rights grounded in freedom of contract and the inalienability of property, further instantiating an imagination of rights as primarily negative (as a freedom from state intrusion) is very different from a South African ethos of constitutionalism (itself, to be sure, fraught, fragile and intensely contested) that imagines rights and freedom in terms of positive, trans-individual obligations, including and especially of the state to its people. Such an ideal of freedom links all the way back to the 1955 Freedom Charter, and articulates to aspirations for human dignity, anti-racism and socio-economic uplift.
My investment here is in the relationship between deliberative conversations on norm-making around emergent technologies in Euro-American contexts, and the politics of biomedical science and public health in the Global South. How is the former relevant to the latter? What does the former implicitly assume about the latter? How to build global capacity for norm-making that does not merely “harmonize” Southern interests with Euro-American value-systems, and instead incorporates situated perspectives from the South? Perhaps even in ways that allow for mutual learning via some measure of Euro-American humility? Goodness knows, as we have seen from Euro-American (especially Anglo-American) responses to COVID-19, there is a lot to learn, on both the public health and socio-political fronts.
There is, to be sure, increasing attention to the Global South in Northern deliberative bodies, especially concerning matters of technological access and distributive justice. Nonetheless, there is still a tendency to imagine the Global South as simply a place of lack. It is true that the most radical scientific innovations in the arena of emerging technologies such as genome editing are unlikely to emerge from India or South Africa, a function both of relative scientific capacity and of research priorities. Yet what it would it mean to consider the Global South, nonetheless, as a site of innovation, especially of constitutional innovation?
What I am suggesting is that a truly global conversation on norm-setting and regulation of genome editing ultimately serves the function of thickening our collective socio-technical imaginaries through projects of mutual learning. While I have found American technological imaginaries to be effervescent, even boundless, American sociological imaginaries tend to be relatively impoverished, often with catastrophic consequences. Consider just one critical example where this is so. I have found, both through participating in deliberative conversations around emerging technologies and, a decade or so ago, in participating in a collaboration between Indian scientists and the Program in Health, Science and Technology at MIT to build India’s first biomedical translational research institute, that conversations on biomedical capacity building in America always assume the centrality of markets to technological development and dissemination (indeed, one translational researcher at MIT told me in so many words that he could not imagine translational research without a boardroom). In South Africa, in contrast, it seems that no conversation around health can happen without it being a conversation about constitutionalism. What does this difference mean for a conceptualization of the health impacts of emerging technologies? What does it mean for the conceptualizations of the relationship between health and human rights? What does it mean for an understanding of key societal values such as freedom, equality and justice, and indeed for an adequate reconceptualization of biomedical ethics?
My point here is not to idealize a Global Southern understanding of science/society relations relative to an American (or European) one. Rather, it is to point to the impoverishment of a sociological imaginary that is in fact extremely particular, but presumes its universality. To imagine biomedical translational research to be, by definition, mediated by companies and markets for instance, is an abomination for a country such as India, where, as an Indian biologist in the institution-building collaboration mentioned above kept pointing out, 30% of the population is destitute and falls out of the market altogether. The espoused rationale of building emergent technological capacity is constitutively undercut, in such a situation, by the presumption that such capacity can only be mediated by the market, because it prevents the exploration of other kinds of institution-building that might afford more generative means of distribution, access and community engagement in biomedical research and its public health outcomes. Exploring such alternatives might not just be essential to an Indian context; it might be consequential in providing lessons to more imaginatively address some of the grotesque (often racialized) healthcare disparities in the US as well.
As we consider the establishment of norms for genome editing via a Global Observatory, my hope is that we can build capacity for social imagination that is more comparative and less parochial than American socio-technical imaginaries currently tend to be. This goes beyond thinking how the Global South is different from America, which implicitly centers American norms and value-systems, to also ask, in non-exceptionalist terms, how America is different from much of the world. A necessary exercise in provincializing American social, political and economic norms and ideals as we consider how they shape particular trajectories, elisions and silences in debates around the ethics and governance of emergent technologies.