Gene-edited babies, a virus engineered to spread in humans, and DIY genome editing. Recent events like these highlight an increasingly pressing global issue: there is a large and growing gap between our technical capabilities and the regulations dictating their application. This is a particularly acute problem in the life sciences — increasingly driven by advances in synthetic biology — with unprecedented and rapidly accelerating progress since the start of the 21st century. Policy and regulations are increasingly struggling to keep up, at both the national and international level.
In each of the three examples above, capabilities with potentially enormous consequences for human health had leaped ahead of regulations. There wasn’t enough time for a consensus to emerge on these highly controversial subjects through discussions in the public or scientific sphere.
With science and technology continuing to race ahead, reacting to these events after the fact is no longer adequate. We need to start anticipating and preparing for future advances, enabling us to define a considered and timely response.
Recognizing this need for a more proactive approach, the World Health Organization (WHO) wants to strengthen its foresight capabilities. WHO is now mulling the establishment of a foresight unit whose mandate is to identify scientific and technological trends, and how they will impact global health. The WHO foresight unit will act to promote discussions on the ethical, policy, and regulatory implications of these technologies. Understanding what advances are on the horizon, and their implications, will not only decrease the likelihood that they are misapplied but also help ensure that their potential benefits to human health are realized and equitably distributed.
WHO, Science, and Technology
The World Health Organisation (WHO) was established in 1948 on the principle that all people have the right to the highest possible level of health. In over 70 years of promoting health globally, WHO has championed the vital importance of scientific and technological progress in achieving its mission. It has also played a global role in promoting discussion about how these capabilities should be used and regulated. The current WHO General Plan of Work, recently approved at the 71st World Health Assembly in May, calls for WHO to “be at the forefront of … new scientific fields and the challenges they pose.” It also calls for WHO to “tackle proactively [their] ethical, regulatory, professional and economic implications and to provide independent guidance”.
Producing normative guidance in matters relating to health is a central component of WHO’s mission. WHO recommendations in the life sciences go back over three decades. Since 1983, it has published the Laboratory Biosafety Manual, now in its third edition. In 2006, the organization published the first edition of its Laboratory Biosecurity Guidance. More recently, following Dr. He Jiankui’s claims of having modified the genomes of human embryos, WHO established an expert advisory committee to develop recommendations on governance mechanisms for human genome editing. As the pace of progress accelerates, WHO’s mandate calls for it to continue staying abreast of emerging and future capabilities that have the potential to impact human health.
To that end, WHO wants to establish a foresight unit whose mission will be to identify and analyse future advances in science and technology to understand how these could impact human health. The life sciences demand particular attention, including advances in biotechnology and genomics. However, in the future WHO is also interested in considering the impact of other areas such as artificial intelligence and big data on human health.
Collaboration with external partners is a cornerstone of WHO’s work, and its foresight function will be no exception — they will be engaging with stakeholders around the world to carry out their work. Stakeholders will include researchers across academia and industry, as well as those groups around the world that will be affected by new capabilities.
Foresight is often framed as a defensive process, aiming to anticipate what events and conditions could threaten or impede an organization in the future. However, the process need not be inherently pessimistic. Advances will also be essential to meet the health challenges of the 21st century. Foresight at WHO will help it make the most of technical progress as well as mitigating its drawbacks. Understanding upcoming capabilities will help WHO position itself to incorporate and make the best use of them as it carries out its mission in the future.
By leveraging its global position in human health, WHO will be able to bring together health practitioners from around the world to better understand how upcoming advances will impact their work. Furthermore, WHO has a mandate to ensure the ethical implications of scientific and technological developments are considered. The foresight unit will therefore also draw on the expertise of ethicists and bioethicists. Bringing all these viewpoints together will help drive a global and timely dialogue about the impact of future biotechnical capabilities on human health.
To anticipate our rapidly evolving capabilities will require transparent dialogue that is open to all stakeholders in human health. Responding ahead of time will enable regulators, policymakers and health practitioners around the world to maximize the benefit to human health of new technologies while simultaneously minimizing risks. WHO’s proactive approach aims not only to foresee where science and technology are going but also to shape these developments. In a rapidly changing world, foresight will be essential for achieving the fundamental goal of health for all in an equitable and ethical way.1