Connecting the Dots – a UCT fellowship

by Eyob Balcha Gebremariam 

I’m one of the fellows in the University of Cape Town (UCT) – University of Bristol fellowship program, and I’m sharing the overall orientation of the research I’m doing as part of my fellowship.

In my research, I focus on health-related research and policy-making in Africa. The key entry point is understanding the lived experiences of African academic researchers involved in health-related international research partnerships. The driving question is how do African academic researchers in health sciences navigate the layers of power asymmetries in international research partnerships?

Health science is the single most dominant field of study that dominates the scientific publication outputs of African countries, especially south of the Sahara. The sub-Saharan average for 2017-2019 is 52.7% (Southern Africa – 44.75%; Central & Eastern Africa 55.33%; West Africa 58.13%). Twenty-five sub-Saharan African countries have more than 50% of their scientific publications in health sciences, and 16 countries from the region have more than 60%. For comparison, the percentage for other regions is 36.2% for South Asia, 42% for Latin America and 35.17% for EU28 (including the UK) between 2017 and 2019.

My research aims to go beyond these numbers and understand the dynamics and processes of scientific knowledge production and policy-making in health research through the lived experiences of African researchers. My inquiry is informed by what I call the “Coloniality—Empire” framework, which I constructed based on my readings of decolonial literature. Here is another piece where I applied the framework to answer a different but related question.

To explain how I apply this framework to answer my research question -, I want to share with you two stories (two dots) – that happened in different times and spaces … seemingly separate but inextricably linked, especially if seen through the lens I’m proposing.

Dot no. 1

During the first wave of the COVID-19 pandemic, two French scientists discussed running clinical trials of a potential vaccine in Africa on a live broadcast. The usual uproar of condemnation ensued, and the scientists apologised. Then life went on. Everyone was too busy adjusting to the abnormalities caused by the pandemic.

QUESTION A: why would the scientists pick Africa and Africans as testing grounds for the new vaccine? What are the enabling epistemic, cultural, political and economic factors for such “provocation”?

Dot no. 2

Back in the days of my doctoral training, I remember having a conversation with one senior researcher at my university. He was sharing his experience of speaking with a high-level government official at the health ministry of an Eastern African country. When the researcher asked about priority national health policy areas, the government official responded, “We don’t have a strategy yet. We’re waiting for what Bill Gates will come up with. If he says maternity health is his priority, we‘ll develop our strategy accordingly. If Bill Gates says vaccination or Malaria… we’ll do the same. We shall wait and see.” [ paraphrased, recollected from memory and double-checked]

QUESTION B: What explains the dominance of a philanthrocapitalist in determining a country’s health policy priorities and strategies? Again, what are the enabling factors for this country’s dependence (perhaps more African countries) to rely on the corporate goodwill of a wealthy billionaire to design its health policy?

We can reasonably respond to questions A and B separately. However, in my research within the UCT-UoB fellowship program, I aim to demonstrate that they are closely intertwined. I use the coloniality and the empire framework as my overarching lens in my explanation.

Coloniality & “scientific practices”

When I speak about coloniality in this context, I’m referring to pseudo-science such as “eugenics”, which has been used as a legitimate and objective scientific practice whilst dehumanising non-Whites and especially Black people. When the French medical doctor Jean-Paul Mira wanted to be “provocative” in his conversation with Dr Camille Locht, a research director at the French National Institute of Health, saying, “Should we do this in Africa?” he was not just offering some research techniques. He was categorising Africans as legitimate targets of clinical trials using methods that will not be allowed in France.

Such a double-standard approach is called “ethics dumping.” The EU-sponsored Global Code of Conduct, launched in 2018, explicitly addresses ethics dumping. In this case, ethics dumping is more than a clever way of avoiding hurdles. Instead, it creates hierarchies among human beings based on skin colour and socio-economic status. Hence, racism is the driving factor for what is technical and sanitised terminology, i.e. ethics dumping.

So, in one go, I see all three domains of coloniality checked, i.e. a dehumanising “scientific practice”  (knowledge) that can be envisaged because of the assumed position of power on a deliberately targeted segment of society, “Africans” (being).  The two French medical professionals could not imagine conducting these clinical trials in Africa out of the blue. They are leveraging on the legacies and current manifestations of colonialism that give France (Europe in general) economic, cultural, political and military power over several African countries.

Let’s not forget that African countries and most of the world outside of Global North countries were denied access to COVID-19 vaccines. The epic of the inhuman and unfair nature of such “scientific” practice is that it targets Africans for its clinical trials and denies them fair access to the life-saving vaccines and medicines produced thereafter.

Empire and Philanthrocapitalism

To explain what enables Bill Gates’s extraordinary power on an African country’s health policy, I refer to what Ndlovu-Gatsheni calls “the commercial-non-territorial-military empire.” This empire is an extension of the colonial period, and its power is exercised through global multinational corporations, the World Bank and IMF, WTO, the UN Security Council, the EU, etc. This web of actors, the global elite they represent, and the Global North countries determine the flow, access, control and distribution of financial and material resources worldwide.

One of the lasting legacies of the structural adjustment programs is the decimation of health systems in African countries and the capacity of African states to fund them adequately. With the imposition of market-oriented conditionalities, African governments have become too dependent on aid and donations to fill the inevitable financial and technical gap to finance social policies. The same logic applies to other social and public policy areas such as education, agriculture, infrastructure development etc.

Philanthrocapitalists like Bill Gates have become vital players in filling the gap. Philanthrocapitalism is preserved for ultra-rich individuals and their organisations. The business model is an intricately designed system of running charity/philanthropy with business leaders’ motifs, orientations, acumen, and methods. So, it is a smart way of normalising the market’s power and dominance and socialising neoliberal principles and practices.

The conversation between the researcher and government official about waiting for Bill Gates’s opinion before setting a country’s health policy is hardly an isolated incident. It manifests a deep-seated structural problem in which African elites become too lenient in defining their countries’ path outside the visible and invisible hands of neocolonialism. The structures and institutions of colonisation also remain too agile and more subtle in subverting the radical departure many African leaders envisaged in the early days of independence. That’s why it is always important to learn from the wisdom of Kwame Nkrumah, who warned us against the façade of independence in his articulation of neo-colonialism.

The lived-experiences of African academic researchers

I’m expanding on the above two observations by generating empirical insights about how African academic researchers contribute to scientific research under the shadow of coloniality and empire. Africa’s health research and policy-making ecosystem is a complex site where the manifestations of coloniality and empire are interwoven. After articulating the key thematic elements that dictate the processes of health research and policy-making, my focus is to explore how African academic researchers navigate these processes. As articulated by the Africa Charter, Africa’s scientific knowledge production ecosystem has multiple layers of power imbalances. African researchers are key actors in the ecosystem despite the power asymmetries they encounter. In the second year of my fellowship, I will systematically document and analyse the lived experiences of African academic researchers in health sciences and how they engage with the system entangled with coloniality and empire from their positionalities. I envisage demonstrating that the two dots mentioned above are intricately intertwined and are more than anecdotal incidents but genuine manifestations of the scientific knowledge production ecosystem.

Watch Eyob’s seminar delivered at the University of Cape Town (UCT)