For whom the bell tolls

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.


Overcoming toxic culture at tertiary institutions and the servitude required to combat it

The furore over Professor Gray and the role of academics in the response by the South African government to the novel coronavirus pandemic reminded me that in late 2019 I was asked to speak on the institutionalized culture of discrimination at the University of Pretoria by the UP Head of Department: Political Sciences.  My reflection then as now is in line with the South African Human Rights Commission 2018 ‘Transformation at Public Universities Report’ that the perpetuation of exclusionary academia, be it by language, funding models or lack of sufficient curriculum and  faculty transformation continues to be a challenge. Embedded in the ivory towers of higher education is the missing link to communities that they should serve. The more I mull over academia without a community constituency, the more I realize that it’s symptomatic of a societal failure – to serve.

How many academics have significant work experience outside of consulting, writing and lecturing? How many lecturing on public policy have worked in government or developed an actual public policy besides critiquing it? How many PhDs are successful outside academia and beyond research roles? How many universities insist on practical experience hours, volunteered or compensated, be undertaken to continue academic work? Why are we not asking whether it’s in students and broader public interest to be taught by those out of practice with workplace skills and a holistic education that modernizes quicker than books? When tertiary institutions fail to transform and modernize to an ever adapting world, it does not simply fail as an institution. It fails the graduates, the faculty staff development, the organizations that take on board our graduates and most importantly the communities it’s intended to serve. 

In South Africa, higher education hallways remain by and large a remnant of the colonial and Apartheid institutional constructs, which were not fully dismantled post-democracy. Literally like colonialism it mines knowledge to transport via journals, conferences and secure consultancy work; churns out graduates like a factory mill, not taking into account whether South Africa or Africa actually requires those type of graduates and linked whether the graduates leave with skills that work places require. Academia generates a lot of paper, entrenches silos, talks a lot about how much the system works by championing particular collaborators but at the end of the day, how much has it positively changed the issues it champions? In the crisis of COVID19, South African academics have a meaningful opportunity to practically contribute to a new norm where horizontal governance is a standard because sector trust is strengthened by goodwill partnership. From the side of academics, it will mean a move from lecturing those with practical experience that they often lack, an approach that teaching is a two-way process that promotes active citizenry and where students potential to contribute is developed not unearthed for a lecturer’s research ratings. Such a path is hindered by the 250 academics who signed to support Professor Gray, in essence continuing this practice of the sector not being held to the same scrutiny as most professions by virtue of academic freedom.

To address the challenges, we need to stop making parts of the discussion taboo. Why are our African academics not as prominent in discourse? The look towards the female in the room to take minutes irrespective of her standing. The basically indentured labour of the PhD and post doctorate students to keep the numbers ticking overThe ‘mature’ student, no matter how much work experience, who has no opportunities because everything is 35 under. The individualism that is advocated but not applied when it comes to the tertiary institution you graduate from –irrespective of personal circumstance and effort, we prefer to look at the name of the printer of the degree. 

If we start to honestly reflect on these biases – conscious or unconscious – we can start to understand that there is indeed an individual within the broad strokes of academia and some of them, student and staff are bearing the brunt of academic gatekeeping. Continuous exclusion or being forced to conform to a standard not reflective of local realities can lead to stress, anxiety and major depression. These in turn can manifest in physical burnout, chronic illness leading to regular sick leave or absence to treat the symptom but not the cause. It can lead to poor performance and a defeatism that sees individuals just do the minimum, not realizing full potential. The irony is that it reinforces in those who actively sustain this patriarchal and traditional culture, the notion that the sick are actually just lazy and were not committed or capable from the onset – tokenism if you will. The vicious and toxic cycle of discrimination continues not only by those perpetuating it but by those who prefer to not actionably overcome it for fear of further ostracization. 

The substantially debated science of COVID19 is showing us that there are alternatives in a time where information changes at a faster pace than can be taught or published. Early insight indicates that a changed approach and culture within institutions of higher education is feasible.  One which is more inclusive, where expertise is understood as a fraction of a collective framework, acknowledgement of a team approach being more solution orientated and not mistaking advisory capacity with that of policy or decision making.  Ultimately that science must serve humanity and be flexible to respond to the public good as opposed to the individual interest. 

The in progress momentum for structural change to overcome the grossly inequitable divide that is the South African reality should be seized by Vice-Chancellors to change institutional culture beyond paper and impose it if need be.  Universities like the public service need to urgently incubate a culture of Batho Pele in actionable service delivery. Faculties across the sciences must understand that their curriculum, research, lecturers & student mentoring including supervision must serve the needs of what South Africa requires, not their academic interest. Choice, yes, but when you sit with crippling unemployment, we cannot justify the economics of not aligning choices to community necessity. Now sooner than later, those in this space need to iteratively ask how they are going to serve South Africa as opposed to merely joining a long queue of educated extractors.