Blog7th November 2024
Exploring tomorrow and beyond – our 2024 Horizon Scan
Sophia McCully and Melissa Haynes-Agoro
Based upon insights we gathered through a stakeholder survey, 50 specialist meetings, and extensive desk-based research, our scan attempts to display the topics within a timeframe that signals suggest they could raise ethical implications.
A conscious effort has been made to reduce the number of topics spotlighted in this year’s horizon scan. Taking the list from 72 to 51 involved adding new topics (such as geoengineering and AI in drug discovery), removing others (such as cultured human milk) and identifying commonality among some topics so they could be grouped together (for example diversity in clinical research).
Through curation of our 2024 Horizon Scan, we have identified five cross-cutting themes:
- Health inequalities and equity
- Wellbeing of future generations
- Dual-use technologies and research
- Mission-driven innovation
- Best interests and autonomy
We plan to pen blogs exploring some of these in more depth, but initially, alongside the publication of the 2024 Horizon Scan, we wanted to touch upon them all briefly.
Health inequalities and equity
Inequality and equity are a crucial theme that runs through many topics in our 2024 Horizon Scan. It is evident that disparities in access to healthcare and technologies, as well as a lack of diversity in research, could lead to further exacerbation of health inequalities.
In/fertility provision highlights how limited access to fertility treatments has led to a ‘postcode lottery’ in the UK with those from lower-income families often being impacted the most.
Equitable access to medicines and therapies stresses the importance of global collaborations to prevent high-cost treatments from being accessible only to those in wealthier populations.
Antimicrobial resistance continues to be alarming worldwide, low- and middle-income countries are disproportionately affected by infectious diseases and lack resources for adequate healthcare responses.
The development of new technologies is not enough to address health inequalities. A commitment to making them accessible and relevant to all is also needed. Ethical governance must ensure that all populations share in the benefits of scientific breakthroughs and that risks are not concentrated in vulnerable populations.
Wellbeing of future generations
Many topics on our 2024 Horizon Scan raise intergenerational tensions and prompt concerns about how today’s actions will affect future generations.
Global warming and air and plastic pollution are prime examples, with environmental degradation threatening future health and wellbeing. The very real consequences of climate change will likely be most severe for generations to come. This means it is imperative to develop sustainable solutions today that can encompass the values and views of generations most impacted. Geoengineering has been proposed as a possible mitigation approach, but as with all solutions it is important to consider the trade-offs. In this case, there are concerns about its long-term ecological and ethical implications.
Reproductive research and technologies, such as Ectogestation and In-vitro derived gametes, could expand reproductive choices for future generations. However, developments in this area also invite questions about the social and ethical ramifications of such technologies in relation to the metaphysics of pregnancy, family structures and gender roles.
A balance between the needs of current and future generations requires cautious consideration of how emerging biomedicine, environmental and health technologies are designed, developed and distributed.
Dual-use technologies and research
Many emerging technologies and advances in research have transformative potential for both positive and harmful applications. Innovations in AI, engineering biology, genomics and neurotechnology could all lead to major health improvements, but also carry risks of misuse.
Gene drive technology has the potential to control populations of disease vectors like mosquitos and reduce the spread of life-threatening diseases. However, the long-term ecological consequences of releasing gene-altered organisms into the environment remain largely unknown.
Emerging neurotechnologies such as brain-computer interfaces are being explored as possible treatment options for neurological conditions, but also raise concerns about mental privacy and agency.
Striking a balance in addressing dual-use concerns in the research, healthcare and innovation context is crucial. Anticipatory governance, ethical reflection and meaningful engagement will be key to mitigating risk whilst enabling innovation and potential health advancements.
Mission-driven innovation
Mission-driven innovation is tied closely to how Government priorities can address societal needs. In a UK policy context, missions are centred on five key areas: growth, the NHS, safer streets, clean energy and opportunity. This approach resonated with us because so many of the topics on our 2024 Horizon Scan present opportunities to address long-term challenges and their development could play a significant role in driving systemic change.
For example, sustainability in healthcare and net zero emissions both feed into the NHS’ commitment to achieve net-zero emissions by 2050. This mission will require significant system change, from the existing way supply chains function to clinical practice.
It is of the utmost importance that these missions are guided by ethical consideration, to ensure long-term benefits, equitable outcomes and public trust in science, health, research and innovation.
Best interests and autonomy
Best interests can be understood as making decisions that maximise wellbeing and minimise harm for an individual or group. Often these are circumstances where the person or people in question are unable or face significant difficulty in making their own decisions.
Autonomy and best interests are recurring themes throughout our 2024 Horizon Scan. Preconception screening and egg freezing raise concerns about how much individuals truly understand about the implications of accessing these options.
The advent of AI and genomics and digital twins may challenge traditional understandings of autonomy as predictive models and precision medicine could lead to patients being offered treatments and interventions based on probabilistic data, raising new questions about how much agency they have in their healthcare decision-making.
Applying these five cross-cutting themes to our 2024 Horizon Scan, will help us to navigate the complex landscape of emerging health and biomedicine. Exploring what is on the horizon helps us to consider risks, benefits and solutions, and reflect on next steps for a more ethical, equitable and sustainable future.