There is a quote I keep returning to. While I don’t entirely agree with it, it nevertheless captures the gulf between our inherited social values and the technological possibilities of the 21st century: “We are as Gods, we might as well get good at it.”
Written by editor Stewart Brand to explain the purpose of his magazine the Whole Earth Catalog when it first published in 1968, some have argued the phrase articulates a misguided technological utopianism. I disagree. The sentiment of human perfectibility – and its tragedy – is commonplace in the literature that has shaped our culture, from the biblical Fall to Pope’s Essay on Man and Shakespeare’s Hamlet. In keeping with this, Brand’s words strike me as simply a suggestion we might do better than accepting the inevitable. The quote also assumed a new meaning recently, when Brand acknowledged at a 2018 event that he had overstated the influence of hacker culture in his early work and had failed to grasp the role of the state in driving innovation.
As tempting as pessimism presently is, and with good reason, one can be sceptical of the human condition while acknowledging our capacity for cooperation, and the remarkable breakthroughs this continues to generate. Human beings have existed for approximately 200,000 years, only engaging in agriculture for the last 12,000. Since then we’ve created writing, mathematics, cities and, more recently, antibiotics, the jet engine and global communication. While from the perspective of most other species we represent an extinction-level event – an asteroid collision with legs – even that bleak assessment conveys something inarguable: humans have unprecedented agency to transform the environment around them, which brings us back to Brand’s pithy formulation.
In Fully Automated Luxury Communism my argument was a simple one: the core tenets of our economic system are increasingly at odds with the productive capabilities it is giving rise to – a situation which will only intensify further. Key technologies I isolated there, among others, included synthetic biology and genomics, with progress in each reflecting continued falls in the cost of computational power, and by extension information. Moore’s Law, while slowing down for years and subject to no little hyperbole for more than a generation, is behind things as varied as ever-cheaper gene sequencing and the cameras in re-useable first-stage rockets. This is no longer a point of speculative interest, with these very trends making possible the creation of a vaccine for Covid-19 in a matter of weeks rather than years. “Information wants to be free”, attributed to free software guru Richard Stallman, is another phrase often derided for its techno-utopianism. While that may not be wholly accurate – it is certainly getting cheaper. As this increasingly applies in biotechnology, the consequences will be extraordinary.
Healthcare becomes an information good.
By 5 January few had heard of Covid-19. Chinese authorities were yet to confirm its capacity for human-to-human transmission while Britain remained weeks away from recording its first case. Yet the pathogen’s entire genome had already been sequenced by Chinese scientists and was made globally accessible as early as 11 January. The ability to perform such a task at such speed, mapping the entire genetic profile of a virus and making it globally available, was impossible just a few decades ago, with it only being 25 years since the first-ever organism was sequenced. Even more remarkable is that within just two days on 13 January – a week before the first confirmed case in the United States – what the world now knows as the Moderna vaccine was designed. Concurrently a team at Oxford University, led by Sarah Gilbert, produced its own response – the basis for the imminent AstraZeneca vaccine. As David Wallace-Wells has written, we had the vaccine the whole time, and while politics may often have been ineffective in addressing the pandemic, elite science has exceeded all expectations.
While perhaps counter-intuitive, technology isn’t transformative when it first appears but rather when it becomes mundane. People didn’t talk of Facebook influencing elections in 2008, when it was a niche product whose popularity was limited to millennials, but after 2016 – when it enjoyed widespread adoption and was part of everyday life. With this year’s pandemic, something similar appears to have happened with genomics, a field which has enjoyed sweeping progress in the last twenty years of which we’re only now feeling the impact. Until Covid-19, the fastest turnaround for a new vaccine had been four years for mumps in 1967, and even that borrowed heavily from previous research. The principal reason a number of Covid-19 vaccines were created with unprecedented speed is because the dividend of improvements in computational power continues to feed through to healthcare, something which increasingly resembles an information good. This is why improvements can go from impressive to unthinkable in such a short span of time.
The extent to which improvements in medicine may soon reflect exponential progress in digital technologies is best explained through the sequencing of a single human genome. What today can be performed in a matter of hours was initiated for the first time in 1990, and was only completed in 2003 (although even then it wasn’t technically complete) at a cost of several billion dollars. By 2014 that figure had fallen to $1000 and today the same process costs almost half that, although earlier this year China’s BGI claimed it could sequence a human genome for $100 – a figure America’s Illumina had previously touted but has so far failed to achieve. The cheaper the technology, the wider the applications and it’s not implausible that, a decade from now, sequencing the human genome, which is of course infinitely more complex than that of a pathogen, could cost $10 or less. Sequencing Covid-19, something impossible when I was born, can now be achieved by any lab or individual with access to a piece of equipment which starts at around $1000.
This is analogous to the by-now hackneyed comparisons of modern consumer computers and the machines used on the Apollo missions – a comparison which, incidentally, is way off: the recently released Playstation 5 is 10 times as powerful as the world’s fastest computer in 1996. In any case, such a trend is increasingly obvious, only the difference with biotechnology is that rather than better graphics or creating more immersive gameplay, these exponential improvements permit entirely new possibilities in healthcare.
That is how BioNTech alone had already identified 20 vaccine candidates by the end of February, and more recently claimed that a new vaccine for any mutant Covid variant could be created in as little as six weeks. Yet this seemingly miraculous response wasn’t because the technology had changed but rather the financial incentives had. That is why, as one scientist told the Guardian, a decade’s worth of work has been squeezed into the space of a year, with Covid-19 offering a template in how science might respond to other challenges too.
Re-thinking healthcare in an age of genomics.
In the slipstream of the pandemic, with the unprecedented development of multiple vaccines, 2021 may be the year genomics and genome editing moves from the margins to the centre of the public conversation, from the geopolitics of vaccine nationalism to the possibility of applications beyond epidemiology. This will be amplified by a wave of stories which sound like something from the future. One is Britain’s NHS trialling the Galleri blood test, a liquid biopsy able to detect fifty types of cancer. Combining gene sequencing and computational algorithms, it is hoped this new approach will not only prove eventually cheaper but also more effective – permitting the potential detection of cancer at ‘stage zero’, a remarkable prospect given cancer is responsible for around 200,000 deaths a year in the UK.
As I wrote in Fully Automated Luxury Communism the falling cost of gene sequencing will mean that within a few years it could be relatively commonplace for a newborn child to have their entire genome mapped at birth, further reducing child mortality and allowing future generations to enjoy precision healthcare based upon their specific needs. This is one area where Britain has done relatively well, its 100,000 genome project – which ran from 2012 to 2018 – was the world’s largest-ever gene sequencing project.
The deployment of liquid biopsies in the NHS, along with the falling cost of gene sequencing more generally, means the often fretful conversation around healthcare should start to move away from the allocation of scarce resources, a frame which naturally favours those who want reduced public provision, to a re-examination of more general possibilities as medical progress maps on to exponential improvement. For this reason, it may be that vaccines designed in a weekend, and discovering cancers before they are otherwise visible, is just the start.
Breakthroughs in gene therapy.
In any normal year the story of Victoria Gray, a 34-year-old from Mississippi born with sickle cell anaemia, would be remarkable. In late 2019 Gray became the first person with a genetic disorder to be treated in the United States with Crispr-Cas9 – the ultra-low-cost, and still largely experimental, gene-editing technique.
Gray’s doctors are increasingly confident she has been effectively ‘cured’ with analysis from samples of her bone marrow cells six months after receiving treatment, and again six months thereafter, revealing gene-edited cells that have persisted for the entire time, a “promising indication that the approach has permanently altered her DNA and could last a lifetime” according to NPR. Sickle cell anaemia, as with thousands of other conditions, is caused by a single errant nucleotide of DNA, and it is here, with inherited disease, where the possibilities for both CRISPR and mRNA techniques are particularly impressive. Already a large number of labs are working on gene therapies for conditions such as cystic fibrosis and Huntington’s disease. One of the positives of a post-Covid politics is that such research should receive more attention – and funding.
CRISPR, ever-cheaper gene sequencing and mRNA vaccines, could quickly find an abundance of applications in the real world, from producing proteins that stimulate blood vessel growth, which would help with cardiac disease, to reversing a rare genetic condition or, increasingly plausible after this year, providing vaccines against conditions like rabies, Zika virus, cytomegalovirus and influenza. Indeed before Covid-19, the founders of BioNtech, Özlem Türeci and her husband Uğur Şahin, were working on mRNA vaccines to fight cancer.
In the second half of 2021, as the world begins to recover from the pandemic, expect public appetite for these diagnostic tools and treatments to only grow, with a sizeable minority increasingly literate about technologies that, until this year, felt peripheral and abstract. If humanity can create a vaccine for a new pathogen within days of sequencing its entire genetic profile what else can we do? The answer to that question could lead to some interesting conclusions and, for Britain especially – a country where the word ‘innovation’ has been synonymous with making vacuum cleaners or a novel brand of gin – this is especially pressing. One can only hope that future generations will prefer to model the likes of Türeci, Şahin and Sarah Gilbert than Sir Philip Green or Alan Sugar.
The principal lesson from the creation of a panoply of vaccines in response to Covid-19 is that humanity’s capacity for problem-solving is not the issue, rather it is our economic system, and the incentives which order it, which are holding us back. As a species, this means we shouldn’t be seeking different answers, but rather be posing novel questions: what would it take to create a world without inherited disease? Or to decarbonise global energy supplies in less than two decades? Or to create built environments which enable happiness and mental health rather than alienation and anxiety? How might we both extend life expectancy and also have excellent health into old age? How might we have much more leisure time than we presently do?
These may seem silly questions, shaped by a sense of utopian impossibility, but is designing a vaccine within days of sequencing a pathogen’s genome really that different? And if that is possible why shouldn’t the elimination of cancer or inherited disease be next? The hell of the first world war gave rise to widespread adoption of radio and accelerated aviation, while the second world war achieved similar with the jet engine and rocket propulsion – meaning satellite technology followed within decades. It is not unthinkable that in the aftermath of Covid-19 something similar might happen with a raft of new technologies in healthcare. Here, however, the enduring question will remain: who will benefit?
Aaron Bastani is a Novara Media contributing editor and co-founder.