Who Gets Cured? COVID-19 and Developing a Critical Medical Sociology and Anthropology of Cure.

Abstract

In this opinion piece, I argue that a sociology and anthropology of cure is accelerated by various features of the scientific and social responses to the COVID-19 pandemic. I illustrate how the pandemic has made the general public rethink popular notions of “cure,” foregrounded ethical dilemmas and inequalities in who has access to “cures” and also revealed deep uncertainties correlated to a future where there is no such thing as cure anymore. Such developments in the pandemic response illustrate the need for a critical interdisciplinary agenda to interrogate the social, ethical, cultural, economic, political and technological innovations of cures nationally and internationally. The race for a vaccine for the SARS-CoV-2 virus that causes COVID-19 illustrated the urgency to find a cure during a pandemic but also deep anxieties, as the general public realizes they have to leave behind absolutes of “cure” and deal with uncertainties of who now gets cured? In medical sociological and anthropological literature, absolutes of cure have long been criticized in research, amongst others, focusing on changing ideas of: inequalities in who becomes incurable or curable, for example, during the HIV/AIDS epidemic (Schoepf, 2001; Nguyen, 2010), inclusion in clinical trials (Petryna, 2009), or due to genomic advancements (Inhorn and Wentzell, 2012); environmental, lifestyle and embodied (epigenetic) risks which have reconceptualised understandings of nature and nurture (Kavanagh and Broom, 1998; Lock, 2013; Gale et al., 2016), as “situated biologies” mean rethinking notion of bounded bodies in favor of how biology is affected by environment (Niewohner and Lock, 2018); expectations and hopes of new biotechnologies and artificial intelligence that bring to the fore the way in which scientific advancements can politically shape subjectivities, temporality, emotions and care (Brown and Michael, 2003; Brown, 2005; van der Niet and Bleakley, 2020); “promissory futures” of biomedical and scientific innovations, such as in the field of regenerative medicine, become correlated to neoliberal policy-making and economic investments (Brown et al., 2006; Selin, 2008; Morrison, 2012); novelty, for instance in epigenetics, becomes socially constructed (Pickersgill, 2020); clinical forecasting is relationally imbedded and negotiated in clinical practices (Timmermans and Stivers, 2018); and dealing with uncertainty of conditions with no cure, where instead experiments become perilous options for patients (Fox, 2020). The above is just a sliver of the breadth and depth of knowledge built on a continuum of cures, but the very notion itself of “a cure” and how the concept is changing, is never explicitly questioned as such. Yet, as illustrated, just as comprehension of COVID-19 is marked by social understandings of inequalities in infection, environment, prevention and intervention (Lupton and Willis, 2020; Trout and Kleinman, 2020), knowledge of cure is socially and culturally informed too. Public health pandemic responses to COVID-19 have focused on scaling up disease prevention and control efforts, public health information, laboratory systems and development of private and public partnerships to develop diagnostics, therapies, antiretrovirals and vaccines. Furthermore, critical social commentaries have been noted in terms of ethics of access to: care; life-saving equipment like ventilators; therapies (e.g., remdesivir); vaccines; as well as debunking the idea of recovery and immunity. Presently, with hopeful vaccines on the horizon (Horton, 2020), a “critical bioethics of cure” is developing, informed by differing ethical norms and values in society, associated to who gets access to vaccines and how they will be allocated (see, Emanuel et al., 2020). For example, in the United Kingdom (UK), the disability community has warned of overt discrimination in lack of ethical inclusion in pandemic preparedness and response (Armitage and Nellums, 2020), “ableism” (Campbell, 2009) of foregrounding of able body in withholding, triage or rationing of care as cure, as well as warning of “social” deaths in our disablist language use, and real deaths in revoking of rights in health and social care policies (Abrams and Abbott, 2020; Tidball et al., 2020). Disability studies researchers, while long critical of the medical model and curative imperative (Clare, 2017), are pointing to an unethical “curation” or “social sorting” (Grover and Piggott, 2010) in how the able body now gets protection against an infection, access to critical care, therapies and vaccines (Scully, 2020), according to a new curative “imperative of health” (Lupton, 1995) or distributed “logic” of cure (Mol, 2008). The logic of cure describes how an “imperative of cure” becomes normalized in our social and cultural lives and is increasingly commodified but not distributed equally nor a choice. Neoliberalism and promises of late modernity have been incorporated in such a logic of cure, in terms of a “biopolitics of cure” in how patients, doctors, researchers, pharmaceutical companies and financial investors create momentum around specific infectious diseases, genetic disorders, chronic or neurological conditions and now in its acceleration for the general population during the COVID-19 pandemic.