Global health, accelerated: Rapid diagnostics and the fragile solidarities of ‘emergency R&D’

Abstract

A new paradigm of emergency R&D has transformed global health. Beginning with the 2014–2016 Ebola virus disease epidemic in West Africa, experimental product development has been propelled to the frontlines of outbreak response, radically compressing timelines and unsettling regulatory standards, biosecurity strategies and humanitarian protocols. This paper examines these emerging epistemic practices and ethical norms as they played out in the creation of rapid diagnostic tests for Ebola, Zika and COVID-19. In each of these viral public health crises, new platforms for quick detection have been the principal load-bearing pillar of outbreak response, and the effort to speed up their development illuminates the fragile set of accommodations between public health needs and commercial interests that obtain under conditions of emergency. The World Health Organization’s role in stimulating and coordinating the development of these tools provides our analytical through-line, and reveals, we argue, the limitations of an accelerationist model of global health innovation organized around the concept of ‘market failure’. The evolution of this paradigm of ‘emergency R&D’ into a permanent feature of pandemic preparedness will further narrow our imagination of how global health goods should be construed and provided.