Amar Kelkar, Physician at Dana-Farber Cancer Institute, Assistant Professor of Medicine at Harvard Medical School, shared a post on LinkedIn about a recent article he and his colleagues co-authored, adding:
“Reimagining ‘Good’ in Global Health: A Communitarian Approach to Cell and Gene Therapy
Cell and gene therapies (CGT) offer cures, but they are incredibly resource-intensive.
As we consider how to expand access to these therapies to low- and middle-income countries (LMICs), we have to ask: How do we do so ethically and sustainably?
In our latest analysis for The Lancet Haematology, we argue that standard ethical frameworks used in high-income countries—like Deontology (duty to the individual) or Utilitarianism (greatest good for the greatest number)—often fall short in resource-constrained settings. They can feel externally imposed and fail to capture the local balance between individual and communal interests.
We propose a different path: Communitarian Ethics.
This approach asserts that an individual’s well-being is entwined with the well-being of the community. Instead of rigid rules, it promotes a flexible, context-driven approach where the community defines what is “good.”
Why does this matter for CGTs?
In many LMICs, funding a program like CAR-T is a zero-sum game. The Communitarian framework forces a hard conversation about trade-offs.
Prioritizing high-cost CGTs for a few could divert resources from:
- Maternal/Child health
- Malaria, HIV, and TB treatments
- Clean water and sanitation
An exclusive focus on the ‘individual patient’ can obscure these broader social obligations.
The Process > The Outcome
We propose using community boards (e.g., representing regions in Ghana) to deliberate, assess disease burden, weigh opportunity costs, and vote on prioritization. Legitimacy comes from collective deliberation, not external mandates.
This isn’t just theory. We also discuss logistical pathways to make this possible, including decentralized manufacturing (hub-and-spoke models) and regional regulatory frameworks (e.g., West African Health Organization).
Ultimately, no external entity can dictate the value of CGTs for a community. Reimagining “Good” in Global Health means empowering communities to navigate these ethical tensions themselves.”
Title: A communitarian approach to cell therapy and gene therapy access in low-income and middle-income countries
Authors: Erica Koranteng, Gregory A Abel, Anoa Aidoo, Amar H Kelkar
Read the Full Article on The Lancet Haematology
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