Do we benefit from scientific advancement equally?
December 2nd 1921, 14-year-old Leonard Thompson is admitted into the Toronto General Hospital. Emaciated and weighing just 29.5 kilograms, suffering from severe diabetes in a time where treatment could only delay death through fasting on a calorie-restricted diet, his prospects of survival are low. However, in a small laboratory not far from where Thompson lies, a series of small successes have laid the groundwork for a medical breakthrough. In January 1922, Thompson becomes the first person to receive medically administrated insulin, stabilising his blood glucose levels and ultimately sparing him from an untimely death.
So important was the extraction and purification of insulin that, only a few months after their success in treating Leonard Thompson, Frederick Banting and Professor John Macleod were awarded the 1923 Nobel Prize in Medicine for their work and the intellectual property of the extraction process sold to the University of Toronto for only $1 each. The patent application itself stressed that the patent was only necessary to ‘restrict manufacture of insulin to reputable pharmaceutical houses who could guarantee the purity and potency of their products’ and ‘prevent unscrupulous drug manufacturers from making or patenting an impotent or weakened version of this potentially dangerous drug and calling it insulin’. Insulin would also earn Professor Frederick Sanger and Dorothy Hodgkin the 1958 and 1964 Nobel prizes in Chemistry respectively for their work on understanding the molecule, and would go on the be a poster-child for biotechnology as transgenic yeast cultures replaced dogs and cattle as a more ethical and sustainable source.
In his meditation ‘No Man Is An Island’, John Donne likens humanity to a continent which becomes less of itself when even a single clod is washed into the sea. For Donne the funeral bell, which tolls in mourning for a lost life, rings not just for the dead themselves but for the loss in us all. More than a century after Leonard Thompson was saved, insulin remains the source of many preventable funeral bells despite being an easily synthesised and administered compound. The reason is economic and in the United States of America insulin prices more than tripled between 1995 and 2014 such that, although the country only accounted for 15% of the global insulin demand, it generated nearly half of the global pharmaceutical industry’s insulin revenue. As a result of these price hikes, one in four of its citizens with diabetes have no choice but to skimp on, or even skip, lifesaving doses. When individual access to capital remains a deciding factor in who can access even the most basic of medical care, a public good and a product of science, it begs the question: for whom does the bell toll?
In 1970, Dr Norman Borlaug was awarded the Nobel Peace Prize for his work developing high-yielding wheat cultivars. Scientific advancements across all agricultural science disciplines saw The Green Revolution, for which he was the figurehead, produce more food than ever before through unprecedented increases in yields. Although this lead to substantial decreases in world hunger in the latter half of the last century, global hunger is once again rising. In 2019, there were 60 million more undernourished people in the world than in 2014, and not for a lack of produce. In Dr Borlaug’s own words, ‘food is the moral right of all who are born into this world’, yet consumer-level food wastage in the Global North waste amounts to almost as much food as the entire net food production of sub-Saharan Africa. Food wastage is an incredibly complex problem, but when there is greater economic incentive to over-supply rich consumers while the workers who produce this food go hungry, it begs the question: for whom does the bell toll?
The on-going SARS-CoV-2 pandemic, a source of immense loss, has reinforced how interconnected we are as a society and further laid bare the entrenched inequalities. The rapid development of the various vaccines coming onto the market has shown what can be achieved when there is a coordinated global effort. Yet, as countries scramble to be the first in line to secure vaccines for their citizens, countries from the Global North have voted against South Africa and India’s proposal for the World Trade Organisation to suspend SARS-CoV-2-related IP until the pandemic is contained. When the Global North chooses pharmaceutical profits over sharing life-saving knowledge in the midst of a global pandemic, it begs the question: for whom does the bell toll?
These examples are by no means outliers, and form part of a long list of instances where the fruits of scientific progress are enjoyed only by those with sufficient capital. Many science enthusiasts continue to regurgitate the mantra that science is apolitical, but as I have said in many of my other posts this is patently untrue. Until we address the inequalities which not only hinder access to the benefits of science, and determine who is disproportionately represented in the body of scientific understanding, we are perpetuating grave injustices. My hope for a post-pandemic world is that we take a deep reflection on who truly benefits from scientific progress, and take a more committed and coordinated approach to building the global social safety-net necessary for a more cohesive and equitable society. When the bell tolls, it must toll for us all.