A failure in solidarity: Ethical challenges in the development and implementation of new tuberculosis technologies

Prominent tuberculosis (TB) actors are invoking solidarity to motivate and justify collective action to address TB, including through intensified development and implementation (D&I) of technologies such as drugs and diagnostics. We characterize the ethical challenges associated with D&I of new TB technologies by drawing on stakeholder perspectives from 23 key informant interviews and we articulate the ethical implications of solidarity for TB technology D&I. The fundamental ethical issue facing TB technological D&I is a failure within and beyond the TB community to stand in solidarity with persons with TB in addressing the complex sociopolitical contexts of technological D&I. The failure in solidarity relates to two further ethical challenges raised by respondents: skewed power dynamics that hinder D&I and uncertainties around weighing risks and benefits associated with new technologies. Respondents identified advocacy and participatory research practices as necessary to address such challenges and to motivate sustained collective action to accelerate toward TB elimination. We present the first empirical examination of bioethical accounts of solidarity in public and global health. Our study suggests that solidarity allows us better to understand and address the ethical challenges that arrest the D&I of new TB technologies. Solidarity lends credence to policies and practices that address the relational nature of illness and health through collective action.     

Global health inequalities and the need for solidarity: a view from the Global South

Although the world has experienced remarkable progress in health care since the last half of the 20th century, global health inequalities still persist. In some poor countries life expectancy is between 37‐40 years lower than in rich countries; furthermore, maternal and infant mortality is high and there is lack of access to basic preventive and life‐saving medicines, as well a high prevalence of neglected diseases, HIV/AIDS, tuberculosis, and malaria. Moreover, globalization has made the world more connected than before such that health challenges today are no longer limited within national or regional boundaries, making all persons equally vulnerable. Because of this, diseases in the most affluent countries are closely connected with diseases in the poorest countries. In this paper, we argue that, because of global health inequalities, in a situation of equal vulnerability, there is need for global solidarity not only as a means of reducing health inequalities, but also as a way of putting up a united force against global health challenges. We argue for an African approach to solidarity in which the humanity of a person is not determined by his/her being human or rational capacity, but by his/her capacity to live a virtuous life. According to this view of solidarity, because no one is self‐sufficient, no individual can survive alone. If we are to collectively flourish in a world where no individual, nation or region has all the health resources or protection needed for survival, we must engage in solidarity where we remain compassionate and available to one another at all times.     

Ecological solidarity as a conceptual tool for rethinking ecological and social interdependence in conservation policy for protected areas and their surrounding landscape

Policy for biodiversity conservation must evolve to cope with the increasing human footprint on natural systems. A major issue here is the need for policy for protected areas, which integrates their surrounding landscape and local human populations in the construction of socially grounded measures. To illustrate current conceptual thinking in this direction we present and provide a conceptual basis for a recent initiative in national park policy in France that is based on "ecological solidarity". In the light of other policy ideas and tools that have recently emerged for the co-construction of conservation policy, we argue that this concept provides an imaginative step towards consolidating ecological and social interdependence in biodiversity policy that goes beyond statutory park boundaries.     

Putting flesh to the bone: looking for solidarity in diversity,here and now

In many Western European countries, concern rises that both formal mechanisms of redistribution and informal acts of charity, reciprocity and support are challenged by ethnic and cultural diversity. Against such gloomy perspectives, this paper draws on insights from sociology, geography, pedagogy and political science to argue that four traditional sources of solidarity (interdependence, shared norms and values, struggle and encounter) remain relevant, but require a rethinking of their spatial and temporal framing to capture today's intricate engagements of solidarity. More specifically, we draw on theories from the aforementioned disciplines to claim that our understanding of solidarities grounded in the spatial boundedness of territorial states and the intergenerational continuity of supposedly culturally homogeneous nations should be complemented and enriched with an in-depth knowledge of solidarities developing in an entirely different spatio-temporal register, namely that of the everyday places and practices in which people engage across ethnic and cultural boundaries.     

The network of global corporate control

The structure of the control network of transnational corporations affects global market competition and financial stability. So far, only small national samples were studied and there was no appropriate methodology to assess control globally. We present the first investigation of the architecture of the international ownership network, along with the computation of the control held by each global player. We find that transnational corporations form a giant bow-tie structure and that a large portion of control flows to a small tightly-knit core of financial institutions. This core can be seen as an economic "super-entity" that raises new important issues both for researchers and policy makers.     

WHAT IS THE GOOD OF HEALTH CARE?

This paper sets out to discuss what precisely is meant by 'benefit" when we talk of the requirement that the health care system concern itself with health gain or with maximizing beneficial health care. In particular I argue that in discharging the duty to do what is most beneficial we need to choose between rival conceptions of what is meant by beneficial. One is the patient's conception of benefit and the second is the provider's or funder's conception of benefit. I argue that it is the patient's conception of benefit which is paramount and that if this is followed it commits us to a conception of patient care which must be blind to prognosis in so far as prognosis is thought to bear upon issues of prioritisation or resource allocation.     

Legal challenges posed by the use of antimicrobials in food animal production

This review article provides a general analysis of the legal challenges presented by antimicrobial use in food animal production and the emerging public health responses to such use. The article stresses the importance of national and international law to the public health strategies and the interdependence between national and international law. The article argues that antimicrobial use in food animal production poses a challenge to the development of global health jurisprudence.     

Occult return,divine grace,and saabui: practising transnational kinship in postsocialist Guinea

In the Republic of Guinea, where transnational migration has become a critical path to prestige among young urbanites, migrant success abroad is intimately connected to the cultivation of kin ties at home. For performing artists, who were the darlings of Guinea's Socialist Revolution (1958‐84), the experience of migration is uniquely linked to the fall of the socialist state and to the precarity of urban life in contemporary Africa. This article describes how Guinean artists manage distance and uncertainty through three practices: occult aggression, grace‐seeking, and patronage (saabui), which together illustrate the contours and limitations of kinship's efficacy in transnational space. By exploring transnational kinship as an intersubjective and productive practice that can extend beyond obligation or solidarity and into the realm of magic, this article proposes new ways of conceptualizing what it means for migrants to maintain significant connections across national borders.     

Methodological interculturalism: breaking down epistemological barriers around diversity management

As part of the post-multicultural era, transnationalism, super-diversity, cosmopolitanism and solidarity develop a sense of awareness to live in a complex society. This requests us to identify the epistemological barriers preventing us to produce new knowledge, since there is a raising consciousness that these new frameworks cannot be addressed with old policy maps. All share the need to go beyond methodological nationalism, and one of its by-products: multiculturalism. Methodological interculturalism is a promising epistemological lens through which to cluster this new diversity geography. It is a direct answer to the key question, what happens when the unit of analysis from which we argue about “how to live together” is diversity itself rather than a supposed us/we/unity/ majority/state/nation lens. The outcome is the recognition that super-diversity and transnationalism is a fact that we need to incorporate into our public culture, together with new normative claims of justice related to cosmopolitanism and solidarity.     

Conceiving relatedness: non-substantial relations among the Kamea of Papua New Guinea

This article considers the implications of imagining kinship as a non-embodied relation. In recent years, it has become commonplace to argue that relatedness is a gradually acquired state that can be built over time and by non-sexual means. In this view, relationships of consanguinity are not given at birth but are created through purposeful acts of feeding and caring. Here, I address a question that has been less commonly asked by anthropologists: need kinship always be imagined as entailing an embodied connection? Is there a way of thinking about cross-generational relationships that does not ground them in bodily connectedness, or, at the very least, one that imagines contexts in which they are not embodied as a substantial link between people? Drawing upon data collected among Kamea of Papua New Guinea, I describe a world in which the parent-child tie is conceptualized as one that is inherently non-embodied.     

The need for systematic reviews of reasons

There are many ethical decisions in the practice of health research and care, and in the creation of policy and guidelines. We argue that those charged with making such decisions need a new genre of review. The new genre is an application of the systematic review, which was developed over decades to inform medical decision-makers about what the totality of studies that investigate links between smoking and cancer, for example, implies about whether smoking causes cancer. We argue that there is a need for similarly inclusive and rigorous reviews of reason-based bioethics, which uses reasoning to address ethical questions. After presenting a brief history of the systematic review, we reject the only existing model for writing a systematic review of reason-based bioethics, which holds that such a review should address an ethical question. We argue that such a systematic review may mislead decision-makers when a literature is incomplete, or when there are mutually incompatible but individually reasonable answers to the ethical question. Furthermore, such a review can be written without identifying all the reasons given when the ethical questions are discussed, their alleged implications for the ethical question, and the attitudes taken to the reasons. The reviews we propose address instead the empirical question of which reasons have been given when addressing a specified ethical question, and present such detailed information on the reasons. We argue that this information is likely to improve decision-making, both directly and indirectly, and also the academic literature. We explain the limitations of our alternative model for systematic reviews.     

An upgraded national biodiversity risk assessment index

The setting of priorities for international conservation assistance is important due to limited available financial resources. A recent study constructed a national biodiversity risk assessment index (NABRAI) in order to prioritise nations for conservation assistance. The present study aimed to upgrade the original index in order to address computational and weighting inconsistencies. The results of the upgraded index corresponded relatively well with those of the original model. We feel this study goes a step further towards strengthening the methodologies for biodiversity risk assessment. However, due to the absence of theoretical constructs for biodiversity risk assessment and the considerable disagreement between the various models of biodiversity risk, we recognise a need for a more sophisticated understanding of national biodiversity risk before these models can be used to identify global conservation priorities with any degree of confidence.     

跨国土地利用及其生态影响

在全球食物价格不断上涨,粮食安全已经威胁到经济安全的环境下,跨国农用地投资成为国际浪潮。跨国农用地投资推动着各国的土地资源向全球化资源转变,对土地的跨国利用成为全球土地资源优化配置的必然。在对跨国土地利用的背景及现状进行阐述的基础上,指出"代理性农业耕作"方式对区域生态环境可能造成的影响。同时,新型农业科技与跨国土地利用的结合,也在推动着农业经济发展的同时,改变着传统的土地利用模式,进而改变着区域生态环境。最后,指出需要对跨国土地利用做出理性分析并建立相关的国际规则,从而维护可持续粮食安全及生态安全。     

Fleshing Out Vulnerability

In the literature on medical ethics, it is generally admitted that vulnerable persons or groups deserve special attention, care or protection. One can define vulnerable persons as those having a greater likelihood of being wronged – that is, of being denied adequate satisfaction of certain legitimate claims. The conjunction of these two points entails what we call the Special Protection Thesis. It asserts that persons with a greater likelihood of being denied adequate satisfaction of their legitimate claims deserve special attention, care or protection. Such a thesis remains vague, however, as long as we do not know what legitimate claims are. This article aims at dispelling this vagueness by exploring what claims we have in relation to health care – thus fleshing out a claim‐based conception of vulnerability. We argue that the Special Protection Thesis must be enriched as follows: If individual or group X has a greater likelihood of being denied adequate satisfaction of some of their legitimate claims to (i) physical integrity, (ii) autonomy, (iii) freedom, (iv) social provision, (v) impartial quality of government, (vi) social bases of self‐respect or (vii) communal belonging, then X deserves special attention, care or protection. With this improved understanding of vulnerability, vulnerability talk in healthcare ethics can escape vagueness and serve as an adequate basis for practice.     

Anthropology and the Politics of Indigeneity

This article is essentially a critical reflection on the transnational concept of Indigeneity, drawing from my long-standing involvement as a scholar-activist with indigenous peoples in Malaysia. With its multiple interpretations, configurations, and local inflections, the concept of Indigeneity has attracted much debate and contestation. It has become a significant political strategy in the counter-hegemonic indigenous social movements against exploitative, oppressive and repressive regimes throughout the world. In some contexts, Indigeneity is complicated by its conflation with racialised identities. While there is an implicit understanding that Indigeneity and marginality are closely linked, this is not always the case for certain claimants of indigenous status. In this article, I address these issues in the context of Malaysia and India, focusing on some of the conundrums and contradictions associated with the transnational concept of Indigeneity. I also reflect on some of my experiences with indigenous peoples in Hawaii and Australia and at international conferences. The article concludes with the viewpoint that anthropology requires continued engagement in a politics of critical solidarity with indigenous peoples, one that focuses on enablement rather than endless deconstruction.     

A decade of suspicion: Islam and Muslims in Denmark after 9/11

In 2011, al-Qaeda leader, Osama Bin Laden, was killed in Pakistan and the US president, Barack Obama, concluded a decade of global ‘war against terror’. In light of this, it seems only sensible to explore what implications the post-9/11 international developments have had on a local basis in specific national contexts. With this in mind, this article focuses on Denmark and discusses how the critical event of 9/11 motivated a security/integration response, including various pre-emptive measures that have cast the Muslim population as the usual suspects. It will discuss how these changes have affected the everyday lives of ordinary Danish Muslims over the last ten years and changed the relationship between majorities and minorities. Finally, it will also examine how and why recent national and international events have created the potential for another shift in majority–minority relations.     

Focus: Vaccines: Achieving Global Vaccine Equity: The Case for an International Pandemic Treaty

This paper presents an ethical argument in support of an international Pandemic Treaty. It argues that an international Pandemic Treaty is the best way to mark progress on global vaccine equity and broader issues of global pandemic preparedness and response which came to light during the coronavirus disease 2019 (COVID-19) pandemic. Section I evaluates principles of multilateral charity, national security, and international diplomacy standardly invoked in debates about global vaccine allocation and argues that these approaches fall short. Section II explicates notions of solidarity, duties to the least well-off, and mutual aid as ethical values more fitting for an era of emerging infectious diseases. Section III relates the discussion to an international Pandemic Treaty and presents legal, pragmatic, and ethical reasons to support it. The paper concludes that in an interconnected world, fair sharing of vaccines between nations is morally mandatory.     

Why am I not disabled? Making state subjects,making statistics in post--Mao China

In this article I examine how and why disability was defined and statistically quantified by China's party-state in the late 1980s. I describe the unfolding of a particular epidemiological undertaking--China's 1987 National Sample Survey of Disabled Persons--as well as the ways the survey was an extension of what Ian Hacking has called modernity's "avalanche of numbers." I argue that, to a large degree, what fueled and shaped the 1987 survey's codification and quantification of disability was how Chinese officials were incited to shape their own identities as they negotiated an array of social, political, and ethical forces, which were at once national and transnational in orientation.     

Rethinking tropical phenology: insights from long‐term monitoring and novel analytical methods

Here, we introduce the Special Section (SS) on long‐term monitoring and new analytical methods in tropical phenology. The SS puts together nine original papers plus a synthesis, bringing significant advances and new insights into our understanding of tropical phenology across Africa and tropical America. The papers address environmental cues, methodological shortcomings, and provide innovative analytical approaches, opening new pathways, perspective and applications of tropical phenology for forest management and environmental monitoring. The SS is a substantial step toward a more comprehensive overview of trends in tropical phenology, as seven of nine studies evaluate >10‐yr data sets applying new methods of analysis such as hierarchical Bayesian models, generalized additive models, and Fourier analysis. We argue that it is essential to maintain ongoing monitoring programs and build a tropical phenology network at least for long‐term (>10 yr) study sites, providing the means for national and international financial support. Cross‐continental comparisons are now a primary goal, as we work toward a global vision of trends and shifts in tropical phenology in the Anthropocene.