The sterile human and the biomedical disease model

Macroscope written by Sebastiaan Crul
October 7, 2020

Viruses and bacteria don’t have the best of reputations. They’re dangerous pathogens and in the past century, they’ve mostly been known as the culprits in virus pandemics and well-known infectious diseases. This image is characteristic of the biomedical disease model, according to which intruders threaten our health. The biomedical disease model has led to great progress but is also subject to much criticism. In the past decades, there has been growing interest in alternative disease models with a new outlook on what it means to be a healthy human being.

Our observations

  • Microbiologists are gaining insight into the complex relationships between us and micro-organisms. From these studies on the microbiome, a more positive image of micro-organisms is emerging than the one common to the dominant biomedical disease model. More and more studies highlight the useful or even crucial aspects to our health of viruses, bacteria and fungi. Consequentially, researchers and medical professionals are calling for a better distinction between the normal, good elements of the microbiome and those that are detrimental to us humans.
  • Scientists are also beginning to view nutrition in a different light. Besides a merely mechanical perspective on food, we’re becoming susceptible to a communicative and informative outlook. Dominant in our view on food are metaphors in which food represents nothing more than energy: food as fuel to keep the engine of our bodies running. In an informational perspective on nutrition, food is seen more as a conversation, and is attributed, besides energizing properties, autonomy and communicative skills. For instance, the genes our food contains can regulate our own genes.
  • In psychiatry in the ‘80s, a strong conviction became prevalent that mental disorders could be captured in a biomedical model as brain diseases. The progress that had been made in the neurosciences had created the expectation that, in the near future, it would be possible to classify all disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as brain disease with a clear cause. Because of disappointing results, after the turn of the century this neuro-centrism was widely criticized, paving the way for alternative disease models that ascribe more importance to psychosocial factors.

Connecting the dots

Of course, that bacteria can be beneficial to our health isn’t new information in medical science. And yet, the history of medicine in the 20th century can be read as mostly a battle against bacteria, which began with the germ theory of disease and the discovery of penicillin. The germ theory of disease was partly responsible for the dominance of a biomedical disease model in modern medicine.
According to this model, there is a straightforward relationship between cause and condition and a clear course of disease, clearly summarized in Koch’s postulates. This functionalist disease model encompasses a mechanical perception of the body. Disease is naturalistically understood as the dysfunction of organs and therapy is focused on recovery and restoring the affected functions. Health then simply comprises the absence of disease; the machine functioning as it should.

Historically, the dominance of the biomedical and functionalist disease model has led to great progress. Sterilization techniques were developed, as were medicine and therapies to effectively debilitate invaders, we learned to disinfect and keep our environment “clean”. Our current life expectancy would have been unthinkable without the biomedical disease model. This “sterile human” has a resistance to infectious diseases and a general level of health unparalleled in human history.
Despite these successes, the biomedical and functionalist disease model has been under fire for decades. Critics argue that the model is too unilateral and unable to explain a plethora of illnesses and phenomena. Auto-immune diseases, for instance, are difficult to classify within the model, hormone diseases are more likely to be the result of disrupted homeostasis and we underestimate the role of our emotional life in the course of physical disease.

Moreover, the dominant biomedical and functionalist disease model still seamlessly fits an anthropocentric worldview, in which the human as a ruling subject is cut off from his environment and is especially attuned to the menacing side of external nature, a nature which can be used for human gain if we so desire. This view of humanity has long been under fire too. New insights from (among others) modern biology, integral medicine, psychiatry and ecology are difficult to reconcile with the dualism of anthropocentrism.
In the past decades, these sciences have shed new light on what it means to be human. A different worldview is emerging in which the world is no longer seen as a large mechanical clock, but as an organic whole in which continual mutual interaction and transference of information take place on different levels of existence. “Subjects” then are not cut off from the world, but only are or become something or someone in relation to others and the environment.

This new worldview lays the groundwork for a different understanding of disease and health, which have received more attention in the past decades. In this transition from the Anthropocene to what we could call “the Microbiocene”, we are given the impression that being healthy demands continual exchanges between humans and their environment. Our kind is not just in danger, we would also benefit from this continuous exchange between us and, for example, the bacteria and viruses in our surroundings. This exchange, however, encompasses far more than we can comprehend and control. In this view of humankind, the ability to self-heal of nature and the ecosystems in which we live, are highly valued and trusted.
Key concepts around this idea of health are balance or homeostasis, self-regulation, adaptation, motivation and adjustment. The phenomenon of being ill also becomes more complicated than in the unilateral biomedical model. Disease arises from an interplay of a number of relationships that are impossible to oversee for us humans, which is why we always overlook some of them.

This new perception of disease and health results in contrasting ideas about medical intervention. Intervention and sterilizing humans and their environment can lead to immediate and quantifiable gains for the sterile human, but in accordance with the new worldview, it can also result in imbalances and vulnerabilities in the long-term. One of those new vulnerabilities has come to light in studies on antibiotics. Medics have been expressing increasingly vehement concerns over the unbridled growth of antibiotics, which is leading to antimicrobial resistance, now globally recognized as a serious problem.

Should medical practitioners then intervene less, as advocated by the anti-vaccination movement? On the one hand, the new worldview appears to implicitly call for more laissez faire and restraint when it comes to medical intervention. Human hubris regarding nature should make way for more modesty. The worldview prevents us from suffering iatrogenesis, harm caused by medical treatment. On the other hand, the common purpose of medicine lies largely in therapy through intervention, interventions have proved extremely successful (e.g. in the treatment of measles and pox), and the possibility of treatment causing harm is not sufficient reason to refrain from intervening.
The question therefore begs nuance: how do we retain what led to progress in the unprecedentedly successful functionalist and biomedical medicine, while also being more attuned to the vulnerabilities and imbalances it may cause?

The embedding of biomedical intervention in a more complete disease model that’s better suited to the complexity of disease and health appears to be the right way forward. The more dynamic and procedural disease models found in psychiatry might be a good starting point. In these models, disease and health are not discrete entities but located on a continuum.
They often do not have a clear-cut beginning or end, and there is often no apparent distinction between cause and effect or pathogen and symptom. In this ecological perspective, when designing a therapy, all manner of biological, psychological and social factors are weighed against each other. From this perspective, the biomedical model generally fixates on only one point or temporary condition in this complex relational field, such as the point when a virus in a human body begins multiplying uncontrollably, thereby damaging the organs. This interventionism of the biomedical model is an indispensable tool of medicine but is thus also viewed from a broader perspective on health.

Implications

  • The current battle against the coronavirus shows the implications of the contrasting disease models and worldviews. The biomedical model is particularly suited to answering the question how to intervene now, how to contain the spread of the virus and develop an effective vaccine. But if we want to answer the question how to maintain a healthy relationship with viruses in the long term, we need a disease model that is more attuned to the broader ecological embedding of humans and the everyday relationship we have to viruses. Both questions will have to be taken into consideration, even if they invite contrasting answers and thus fail to provide governments and medical institutions with a clear direction for policy.

My plant the therapist

Written by Jessica van der Schalk, august 26 2020

What happened?

Among young adults, who often live in small spaces in cities, the popularity of indoor plants has grown strongly in recent years worldwide. Internet search data shows that interest has increased tenfold since 2010. The sales of indoor plants has also increased strongly, especially among millennials. So-called plant influencers on Facebook, Instagram and YouTube are getting more and more followers and offers from major brands in the plant sector. The Covid-19 lockdown has given this interest an extra boost, because people have started to pay more attention to home.

What does this mean?

Several reasons are given for the growing popularity of indoor plants. For example, research shows that the presence of greenery, even if it is only a few plants in the house, can reduce stress. What is more, plants have the ability to lower the carbon dioxide content and remove pollutants such as formaldehyde, trichlorethylene. Finally, it is indicated that plants offer millennials, who often start a family later and live in small houses without a garden, the opportunity to take care of a living being, which gives a sense of homeliness.

What’s next?

The growing popularity of indoor plants among millennials in particular, fits in with a broader trend of healthy eating and activities that reduce stress such as yoga and mindfulness. With the global pandemic, an economic crisis and climate change, the need for things that offer peace of mind in everyday life will persist. This trend is also consistent with the idea that people will never get used to an environment in which little nature is present, such as in cities.

The Korean New Deal will build an ‘untact’ world

What happened?

In South Korea, the government announced a “New Deal”, pledging to invest $94.5 billion in the economy in the next 5 years. The Korean New Deal will focus on supporting innovation and improving the environment, including a plan to train 100.000 people in artificial intelligence (referring to a Korean tale of a king who did not heed a warning from a scholar to train 100.000 soldiers, leading Japan to rampage the land) and a plan to build 230.000 energy-saving homes. What is perhaps most interesting, is a concept at the center of the Korean New Deal called “untact”.

What does this mean?

Untact is the idea of a future built around doing things without direct contact with others. Examples include self-service retail and contactless payment. The New Deal will promote “untact industries” (e.g. remote healthcare, virtual offices, e-commerce support for SME’s). The idea of building an ‘untact world’ is driven by much more than the corona virus. The Korean government believes that it will support both the competitiveness of the economy (by becoming a leader in “untacting technologies”) and improve the environment.

What’s next?

When the Korean state has a vision for the future and invests billions of dollars into it, we should pay attention. The Korean ‘developmental state’ has a strong tradition of bringing government agencies and business leaders together to rebuild the economy. Through this model, Korean giants such as Hyundai and Samsung became globally competitive. When it comes to the idea of an untact world, the Korean New Deal teaches us that it extends far beyond the current corona virus, and is rather driven by technological, demographic and environmental change. That is why the idea of untact, despite its obvious drawbacks to the social fabric, could gain ground in other parts of the world.

No science is sacred anymore

What happened?

After testing positive for the coronavirus, the Brazilian president Bolsonaro publicly took a tablet of the malaria drug hydroxychloroquine. This drug, however, has not proved effective against COVID-19 and its use against it is not approved anywhere in the world. This move, alongside President Trump’s embrace of the drug, illustrates how politicized research into this drug has become and how a next step has been taken towards the politicization of science as we know it.

What does this mean?

From now on, we should be mindful of the fact that any study may be called into question and that this will be increasingly based on the intentions and underlying interests of the researcher. Sometimes, we are right to doubt; we know, for example, that funding, even in medicine research, can influence research findings (i.e. funding bias). However, we seem to be taking it a step further, which is diminishing our shared knowledge base. As a consequence, in the future attempts to combat fake news (and the broader infocalypse) could become even more futile than they are now.

What’s next?

And yet, it’s understandable that health insurers want to bond more with consumers and to have a more proactive role in the health of their customers. To a health insurer, more data on patients and treatments equals more possibilities to organize care more efficiently and cost-effectively for society. That’s why insurers are seeking alliances to improve their customer retention through cooperation. Big tech companies are crucial in appealing to the homo ludens and promoting a vital lifestyle. Better adjustment to the services and ecosystem of big tech, as for example Vitality health is adjusted to Apple Watches, appears to be a strategic route. To generate trust and security around health data, insurers are more focused on cooperation within the healthcare domain. Digital companies such as CareVoice or apps such as Stresscoach and MS Sherpa could fulfill an important role for the insurer, but caution remains warranted regarding their revenue model and the responsible use of health data.

What view of humankind should a health insurer have?

What happened?

Technology-driven insurer Lemonade is off to an excellent start on the stock market. Lemonade is sometimes referred to as the insurer of millennials and presents the textbook example of technological disruption; with a frictionless user experience, direct imbursement thanks to A.I. applications and a playful image, it emphatically seeks to align itself with younger generations’ motivations. This way, it’s building strong customer retention, which is often lacking in the established insurers. According to investors and consultants, the health insurance sector is next in line for disruption by these “insurtechs”. However, matters are more complicated in healthcare and digital innovation could lead to more problems and resistance here that could make customer retention more difficult.

What does this mean?

Tech disruptors often embody a new view of humankind, with different motivations. With its strong emphasis on a cheerful and playful interface, Lemonade is also turning against the image of man as homo economicus and focusing more on the homo ludens; the playing human. This strategy of appealing to younger target groups is, however, a risky one for a health insurer; it’s prone to being labeled as risk profiling geared towards young people with low health risks, which is illegal in many countries. After all, it undermines the solidarity of the entire care system. Furthermore, there’s a taboo against the use of health data and an insurer is only allowed to a limited extent to use it for personalizing services.

What’s next?

And yet, it’s understandable that health insurers want to bond more with consumers and to have a more proactive role in the health of their customers. To a health insurer, more data on patients and treatments equals more possibilities to organize care more efficiently and cost-effectively for society. That’s why insurers are seeking alliances to improve their customer retention through cooperation. Big tech companies are crucial in appealing to the homo ludens and promoting a vital lifestyle. Better adjustment to the services and ecosystem of big tech, as for example Vitality health is adjusted to Apple Watches, appears to be a strategic route. To generate trust and security around health data, insurers are more focused on cooperation within the healthcare domain. Digital companies such as CareVoice or apps such as Stresscoach and MS Sherpa could fulfill an important role for the insurer, but caution remains warranted regarding their revenue model and the responsible use of health data.

Will COVID change young people’s quiet image?

What happened?

The average age of people who become infected with the coronavirus is dropping.  It’s increasingly becoming a disease for young people too, for whom it seems to be becoming more difficult to follow the prevention measures against the spread of the virus. Due to the lack of possibilities for young people to come together in, for example, bars or at festivals, there’s an increasing number of illegal parties being organized, in the U.S. and the U.K., for instance, marked as “superspread events”. Because of these events, contagious attendees, who make up 10% of the total number of infected people, are responsible for 80% of the spread of the virus. In addition, a lot of drugs are used, there are connections with the criminal circuit in organizing these events, serious acts of violence are committed and a huge mess is left behind.

What does this mean?

Younger generations, and Gen-Z in particular, has often been characterized as a generation that, in contrast to the standard view of “today’s youth”, is responsible and virtuous. For example, this generation supposedly prefers to stay at home, use less drugs, have sex later in life and be more environmentally conscious than previous generations. Moreover, in the past years, younger generations have levelled substantial allegations at older generations. Climate change, care and pensions becoming unaffordable or the distressed housing market are all attributed to older generations’ lifestyles, particularly that of the baby boomers. Now that younger generations also appear to be getting their hands dirty by needlessly complicating the way out of this global health crisis, this dynamic might change. Because it’s precisely on these issues that a longer duration of the crisis would have a negative impact.

What’s next?

As we wrote before, young people are hit hard by the coronavirus where work, social activities and future prospects are concerned. And although they’ve begun many constructive initiatives to improve those prospects, this recent development could tarnish their reputation. There have been multiple articles in, among other news outlets, The Guardian, in which young people are characterized as “selfish idiots” who might go down in history as the generation that knowingly aggravated the crisis. Since the behaviors that young people now exhibit are not much different from the behaviors that earlier generations have exhibited at a young age (partying, using drugs, cluttering), this generation may be judged harder on their behaviors than previous generations.

Cell factories

Will our use of microbes enable a bio-based future? It is increasingly possible to use and tweak living organisms to produce food, fuel, drugs and materials. Here, we explore cell factories, or engineered microorganisms, to illustrate the ontological and ethical challenges that we will face in light of the rising numbers of hybrids created by advances in biotechnology.

Our observations

  • Cell factories are single-celled microorganisms, or microbes, whose metabolism is synthetically optimized to produce more energy or different substances. In other words, microbes are viewed as production facilities that are engineered with biotechnology to produce for human usage. Examples include chemicals, food ingredients, biofuels, drugs, detergents, paper and textiles. Whereas modern industries manufacture products on the basis of fossil fuels, these cell factories are the building blocks of a bio-based industry.
  • The advances in biotechnology to engineer microbes and create cell factories are in full speed. The question is whether and when these cell factories will be able to produce at industrial scale and economics, so as to accelerate a bio-based industry.
  • One of the major promises of cell factories is the production of food ingredients, such as lab-grown protein (meat, fish, milk, eggs), lauric acid (to replace palm oil), carbohydrates (to replace flour). In the report ‘Rethinking Food and Agriculture 2020-2030’, the authors argue that microorganisms programmed to produce food, or cellular agriculture, are about to disrupt agriculture as we know it for the next ten years. The reason they believe this is that they have calculated that proteins produced in cellular agriculture will be five times cheaper than existing animal proteins by 2030 and ten times cheaper by 2035. Furthermore, these proteins, they believe, will also be more nutritious and healthier.
  • The driver behind this is the rapid advance of precision fermentation. Fermentation farms, the vessels that facilitate the production of these programmed microorganisms, are production systems that are potentially more energy- and resource-efficient, more stable and sustainable than industrial animal agriculture. Industrial animal agriculture as a matter of fact has reached its limits in terms of scale and efficiency, while the worldwide demand for protein is only rising. This technological development will make the plant- versus meat-based diets distinction irrelevant, as food will neither come from animals nor plants, but from unicellular life.
  • Among the parties working in this field, Solar Foods, whose first commercial factory will be running this year, is an example. But Big Food and chemical giants are also heavily investing (e.g. Dupont) in this area.
  • In the past, advances in biotechnology have often raised fears over unforeseeable risks: are we creating little Frankenstein monsters when engineering cells, living organisms that we won’t be able to fully control? We cannot entirely oversee the consequences of industrial biotechnology using cells as factories.

Connecting the dots

Animals and plants play a major role in our society by providing us with food and materials. For a long time, we have held animals to produce meat, milk, eggs, leather and wool, have grown plants to produce grains, vegetables, fruits and fibers. We have become incredibly adept at optimizing these animals and plants, by breeding them in such a way that they comply with our wishes. Indeed, all animals and plants we see at farms today are the result of a long chain of human interventions. The beginning of domesticating these life forms is considered a revolution in the history of humankind. Thousands of years ago, when we started to keep and breed animals and plants to optimize them according to our demands, the way we co-existed with them also drastically influenced our own lives. It meant that humans were able to quit their nomadic, hunter-gatherer lifestyles and settle in places. The agricultural revolution allowed humans to collect more food per unit area and thus the overall population multiplied exponentially.
With the advances in synthetic biology, we might witness what we could call the second domestication of life forms in history. This might again radically alter how we interact with other life forms. This time, however, the focus will not be on visible life forms, such as cows, pigs, sheep, chickens or plants, but on invisible ones: microorganisms, or microbes. Through strides made in the field of synthetic biology and the insights gained in molecular biology, microbes can now be engineered and optimized to fulfill certain tasks, such as producing certain substances. By reading and writing the genome in microbes, or cells, it is now possible to create so-called cell factories. They are a promising way to replace conventional ways of production, as they can be tweaked to produce the specific type of chemicals, food ingredients, biofuels, drugs, detergents, paper, textiles and other materials we need, considering this can be done on a large scale and with a minimum amount of input. Because there are good reasons to believe this will be possible within the next ten years, the question is: will this domestication of microbes change our relation to other life forms?

First of all, it will raise the question how we should view and treat these new life forms. In industrial livestock farming, animals have not exactly been treated as life forms of intrinsic value, raising animal welfare problems. On huge farms, animals often live and die on a production line, in a sense bred to be production units. This industrial handling of living organisms has been questioned for long. It has alienated us from our living world. The current corona pandemic has been labeled a “One Health issue”, which means it is seen as an integral health problem for humans, animals and ecosystems. We are increasingly aware that fixed categories of “human” and “animal” do not always make sense and that we are not an individual species, but that our wellbeing is determined by our relationships with and dependencies on other species. We look more holistically at our living world rather than as existing of separate categories. But if we want to treat other life forms rightfully, where do we draw the line? The claim can be made that microbes have less intrinsic value than macrobes, but since all macrobes are built on microbes (or individual cells), there is no clear line to be drawn. Indeed, the fact that we are more focused on life forms that are visible to us has led us to the macrobist bias in the philosophy of biology. But if we take microbes to have the same value as macrobes, should we grant them microbial rights? Already in 1977, this scenario was explored in a sci-fi story by Joe Patrouch, showing the consequences of full microbial rights, such as a ban on household bleaches as they kill microbes. But today, legislation for microbial life is not sci-fi anymore. The Swiss Federal Ethics Committee on Non-Human Biotechnology has declared that all living beings, including microbes, have minimal value in themselves, implying that all life forms, however small, will have “rights” to some extent.
The fact that we are intentionally interfering in microbial life forms with synthetic biology more often leads us to the second challenge. How do we see these altered life forms or hybrids? These are times when one can find ever-increasing numbers of hybrids that blur the lines between natural and artificial. Cell factories show the characteristics of life forms, such as metabolism, but are artificially engineered. Indeed, cell factories can be seen within a broader category of late modern technology that is increasingly showing signs of autonomy and agency, like AI. These technologies seem to have a “life of their own”. Yet, there is no clear moral framework for these hybrids to come.
The rapid advances in cell factories lay bare the challenges that we’ll have to respond to in the coming years, in order to decide what a bio-based future will look like.

Implications

  • The rapid advance of the commercialization of cell factories will stir up debate on the moral status of smaller life forms and hybrids. This will again create fears about biotechnologies similar to those surrounding genetically modified crops.

  • Cell factories might have important second-order effects on society. First, cell factories would decentralize production facilities, as they can be produced in vessels anywhere. For instance, fermentation farms can be located in or close to towns and cities. And second, cell factories might help to reduce the focus on chemicals we have in our daily practices – fertilizers, synthetic textiles, carbon-intensive materials and substances – and incite the turn to more microbe-based products.

A liberating vaccine

Insofar as there can ever be a definitive end to the corona pandemic, a vaccine will probably play the most substantial role in this. This is not just a matter of whether there will ever be a vaccine and if so, when, but also of who will be the first to develop it and subsequently who will get access to it. It’s highly likely that this will be a lengthy process, with countries partaking in an extreme form of vaccine diplomacy, and the choices they make will reverberate for years, if not decades, to come in international politics.

Our observations

  • Many dozens of candidate vaccines are currently being developed. Testing and approval procedures are being accelerated and carried out simultaneously as much as possible (e.g. operation Warp Speed in the U.S.). A number of vaccines is now being tested on humans and companies are already investing in production capacity in case their vaccine is approved.
  • An eventual vaccine will not immediately be available to the entire world population. Not even now that major pharmaceutical companies and NGOs are investing tens of millions of dollars to prepare for the large-scale production of vaccines that have yet to be tested. Depending on the type of vaccine that is developed, several factors will determine the production speed. This could pertain to specific equipment, the availability of well-trained personnel and, of course, the availability of high-grade raw materials. Even something as seemingly banal as the availability of medical glass in which to package the vaccine, could be crucial to the speed at which production can be increased.
  • Most vaccines will be developed by large pharmaceutical corporations, possibly in cooperation with universities. These corporations are currently promising that they’ll do their part to achieve a fair, global distribution of their vaccines. This is important to their reputation, and revenue, and they want to avoid becoming a pawn on the geopolitical stage (e.g. by becoming nationalized).
  • Meanwhile, governments will involve themselves specifically in the distribution of scarce doses and they will initially take national societal, economic and geopolitical interests into account when doing so. During the swine flu outbreak in 2009, it became clear that a number of rich countries were only concerned with protecting their own populations and were impervious to appeals for international solidarity. The fact that the Chinese Academy of Military Medical Sciences is involved in the development of a highly advanced vaccine highlights once again the geopolitical importance of a corona vaccine.
  • It’s not surprising that countries believe themselves to be co-owners on the vaccines. Be it directly or indirectly, the state is always involved in processes of innovation: as financier, educator, custodian of infrastructures, etc (i.e. “the entrepreneurial state”). This legitimizes the role of the state as divider on a national scale, but also enables it to primarily utilize the technology for its own population (although every vaccine will have partly been facilitated by knowledge from the scientific community). From a moral perspective, one could, however, also argue that any vaccine is always the result of previous efforts from, and data shared by, the international scientific community and no country could ever be the sole owner of the final vaccine.
  • Uit moreel oogpunt zou je echter ook kunnen beargumenteren dat elk vaccine dat ontwikkeld wordt direct of indirect ook gebaseerd is op eerder werk van de internationale wetenschappelijke gemeenschap en dus nooit het exclusieve eigendom van een enkel land kan zijn.
  • At the initiative of the European Commission, an international consortium of mainly European countries – the U.S. did not participate at all – and NGOs, has raised $8 billion dollars for, among other things, global collaboration in the development of a corona vaccine. The WHO is also developing guidelines for an effective and fair distribution of an eventual vaccine.
  • Not everyone is enthusiastic about the advent of a corona vaccine. The anti-vax movement has campaigned against vaccines in general for years and is also up in arms already over a possible corona vaccine. On the other end of the spectrum, there are those advocating to make these vaccines compulsory.

Connecting the dots

An effective vaccine could definitively end the corona crisis. Worldwide, many dozens of vaccines are being developed and some are hopeful that the first vaccines will be approved this year. This would, however, be unprecedentedly fast and chances of this happening are slim, if only because vaccines can also have serious side-effects (e.g. dengue fever and SARS). Moreover, there are doubts about the actual degree and duration of the protection a vaccine can offer, and mutations of the coronavirus could lead to an existing vaccine becoming less effective. Nonetheless, even if a vaccine doesn’t get approved until next year, or even later, this would be an enormous victory for modern (multidisciplinary) science and would liberate us from the pandemic that’s disrupting our society.
It’s worthwhile to speculate on the question how this process of liberation will take place. In our collective imaginations, there seems to be a notion of a vaccine being hailed as a liberating army that will abruptly end a drawn-out war. This image ties in with the war rhetoric that has been applied to this crisis with abandon (e.g. we’re at war with an invisible enemy and healthcare professionals are on the frontlines). In reality, the approval of a vaccine will be much more like D-Day; the beginning of the end of the battle, but hardly an immediate cease-fire.
This D-Day will probably only take place in the country of origin of the vaccine and, because of its scarcity, it will initially only reach part of the population there, presumably groups such as healthcare workers and the elderly. From that moment, it will still be months, if not years, before both the entire population has been vaccinated and there is herd immunity. This period will be characterized by debates on who is most in need of the vaccine (e.g. nursing staff), who deserves it the most (e.g. based on lifestyle) and, depending on the local care system, who is willing to pay the most. As in the current phase of containment of the pandemic, the debate will oscillate between the importance of public health (i.e. vulnerable groups first) and that of the economy (e.g. hospitality workers first).

On a global level, the question will then be which other countries will get access to the vaccine. Initially, it’s highly likely that the country that developed it will keep production entirely to itself, something Trump seems to be aiming for, but at a certain point, part of the production will also become available to other, friendly or high-paying, countries. By means of licenses, other countries will also be enabled to start their own production. India and China are currently the biggest producers of medicine, mostly developed in the U.S. or Europe, and will be particularly well-poised to start their own production lines. Furthermore, international hackers also seem to be engaged in attempts to ascertain the required recipe.
Depending on which country will be the first to develop an effective vaccine – China and the U.S. seem to be the frontrunners – there will be an extreme form of vaccine diplomacy. Especially China is likely to deploy a possible vaccine to strengthen ties (i.e. soft power) with other countries around the world and possibly also to gain more direct advantages (e.g. better terms in trade agreements). Building on the comparison with World War II, the distribution of the vaccine could even determine the sphere of influence of global power blocs. After the war, Europe was divided up among the allied powers. This could also happen to countries or regions that, for example, become dependent on an American or Chinese vaccine, which would place these countries under more direct influence from their vaccine donors.
It’s no wonder then, that the WHO and European Union are placing such emphasis on global cooperation in the development of the potential vaccines and are attempting to come to agreements about fair distribution in this early stage.

Implications

  • The availability of a vaccine could mean that the economy can go full steam ahead. If several countries are able to “open” much sooner than others, this will lead to large disparities in wealth, which will also impact power relations between these countries. This could result in vaccine nationalism, but at the same time, countries also have an economic and medical interest in a global or regional “liberation” from the pandemic (e.g. in terms of international value chains).

  • The development and distribution of a corona vaccine will have considerable consequences for both national as well as international societal cohesion and cooperation. The eventual vaccine will probably be used as a vector of soft power and possibly also as a more direct means of power.

  • The distribution of a vaccine will also be a stress test for European unity and solidarity. There are several explicitly European development projects, but it remains to be seen whether a possible vaccine resulting from them would in fact be regarded as such or as a national product, with producing countries vaccinating their own populations first after all.

Foodnationalism

What happened?

The corona crisis has significantly increased the risk of a global food crisis. In the past months, trade restrictions have disrupted the logistics of the global food value chain of 8 trillion dollars and as seasonal workers were banned, parts of harvests have gone to waste. This means that a lot of food never reached the consumer. In wealthy countries, this has resulted in empty shelves and shortages at food banks, but for a large part of the global population, and especially in developing countries, it has caused extreme hikes in food prices and led to acute shortages. The food organization of the UN has warned that, as a consequence of the corona crisis, the number of people with acute hunger in the world will double this year, to over a quarter of a billion people.

What does this mean?

The global food system is an infinitely complex, international network of producers, distributors and consumers. The corona crisis has made painfully clear how fragile large parts of this network are. This has amplified the call to safeguard food at a national level. But similar to vaccine nationalism, food nationalism is not the right solution to the looming food crisis now. In fact, for many countries, it’s a pipe dream. The reality is that a lot of countries depend on each other for their supply of food. Singapore, for example, is 90% dependent on food imports and Iraq, formerly the granary of the Middle East, imports more than 80% of its food. The fact that grain-producing countries such as Russia, the Ukraine, Kazakhstan, Cambodia and Thailand are now pursuing food nationalist policies by restricting grain exports, is leading to alarming developments in countries that depend on their grain supply. But food nationalism isn’t just problematic for food-importing countries now. It also affects countries with revenue models based on exporting food, such as the Netherlands.

What’s next?

In the short term, it’s crucial that the international food market continues to function to prevent shortages. In the long term, however, it would certainly be worthwhile for individual countries to look into solutions in the form of shorter and less vulnerable chains and, wherever possible, more local production. Furthermore, the corona crisis could be a warning for countries not to depend on just-in-time delivery as much and to more seriously consider strategic supplies. The EU supplies are only enough for 43 days (12% of annual consumption, contrary to Russia (18%), India (23%), the U.S. (25%), and China (75%)). Europe could draw up a regional plan (instead of every European country fending for itself). Furthermore, the corona crisis could prompt countries such as the Netherlands, that depend on the supply of large volumes of resources and meat for their food exports, to think about a more sustainable revenue model, less geared towards volume and aimed more at knowledge and sustainable agricultural products.

Inequality kills

What happened?

To fight the spread of the coronavirus, many countries introduced measures such as working from home and home-schooling, social-distancing or even strict quarantining. However, these measures, as simple as they seem, are not feasible for all. While many white-collar workers can indeed work from home, people with jobs that cannot be done remotely (taxi drivers, cleaners) have no choice but to keep working, and thus to keep exposing themselves to the virus. Their type of employment literally puts their health at risk. Moreover, these often low-paid and flexible jobs are more vulnerable to be laid off (for instance in retail and hospitality services) in the corona crisis. Also, parents can only teach their kids when they have the ability to stay at home and well-educated parents have better resources to offer their kids high quality learning. This divide creates a deeper rift between kids of different social classes. Furthermore, low-income households are often cramped in smaller housing, limiting possibilities for social-distancing. In short, in developed countries, one’s socio-economic status defines the chance to effectively protect oneself from the virus and to deal with its consequences in everyday life. (Let alone how it affects the less well-off in developing countries, where even water and soap for handwashing are not a given, considering that just 25% of the world population already does not have access to adequate sanitation.)

What does this mean?

At the same time, inequality may be a multiplier for the coronavirus’s spread. As research on influenza has found that in an epidemic, poverty and inequality can exacerbate rates of transmission and mortality for everyone. As soon as this crisis has raised awareness that inequality is not only posing a health threat to the vulnerable, but it is also creating risks for societies at large, which might give momentum to policies aiming at reducing social vulnerabilities, reducing inequality, welfare policies or at least to healthcare-as-a-public-good initiatives. It might spark more foreign aid and support initiatives from developed to less developed countries.

What’s next?

The coronavirus reveals that high trust in Asian countries leads to strategy that is more effective. Interestingly, one consequence of high trust in government is a different role of technology. To battle the coronavirus, the most interesting innovation has emerged from countries such as China (automatic temperature detection, Alipay Health Code) and South Korea (drive-through testing pods, self-monitoring apps). As technology is rooted in cosmotechnics, the current crisis forces us to look beyond the coronavirus to imagine a different technological future in Asia. We can expect Asian tech companies to benefit, as Asian governments and citizens are more willing to experiment with innovative technological solutions to the coronavirus.