In the early 1990s, a secret HIV vaccine research project was carried out in the Central African Republic. The project didn’t yield results and was hidden for many years.

Today it sheds light on debates over clinical trials, access to treatment and, more broadly, a specific form of exploitation rarely discussed: biomedical extractivism.

I tell this story in my recently published book, Opération Bangui. Promesses vaccinales en Afrique postcoloniale (The Bangui Operation: Vaccine Promises in Postcolonial Africa). As a sociologist and pharmacist, and a lecturer in the Faculty of Pharmacy at the Université de Montréal, my research interests focus on issues related to pharmaceutical policies. Specifically, I examine biomedical research, access to medicines and pharmaceutical practices by focusing on the ambiguities inherent in pharmaceutical policies and global health systems.

Research hidden in Central Africa

HIV spread rapidly in the Central African Republic in the 1980s. It was present in the city’s hospitals and among groups like sex workers and military personnel, who were more exposed to HIV due to their working conditions, isolation and the power dynamics that increased the risk of sexual transmission.

The number of military personnel in the country also increased significantly in the early 1980s; they were being recruited with French support to consolidate the ruling regime.

This provided researchers at the Pasteur Institute in Bangui, the country’s capital, with privileged access to the population for their research.

The institute, founded shortly after the country became independent, redefined post-colonial links by participating in the Central African public health mission alongside the Ministry of Health while remaining scientifically and administratively under the supervision of the Pasteur Institute in Paris, which was structurally supported by French government funding.

In late 1989, a call for tenders aimed at securing significant international funding prompted French researchers to propose establishing a secret research project.

The project sought to identify viruses affecting Central African soldiers, track infection rates and test prospective vaccines thought to be close to development. The secrecy surrounding it enabled all parties to move forward without drawing attention — whether from scientific competitors in the case of the French researchers, or from international media scrutiny in the case of the local political leadership.

This effectively contributed to the exclusion of local doctors and researchers, who, as a result, were either left in the dark or unable to participate in research involving their own population.

Given the high infection rates within the military population, the idea of turning soldiers into research subjects provided both a scientific advantage for demonstrating the efficacy of a potential vaccine and a strategic one: it represented considerable cost savings. The cost of carrying out clinical trials in the Global North in the 1990s was in the tens of millions of dollars.

The production arm of the Pasteur Institute in Paris, which operates through the pharmaceutical company Pasteur-Mérieux Sérums et Vaccins, was the industrial infrastructure that stood to benefit from this research. As potential vaccines were on their way, the only thing missing was a testing ground — conveniently provided by Central African soldiers.

The raw material for the research

And that was how members of the Presidential Guard and the Central African Armed Forces were gradually included in the research, starting in 1990. Blood samples were taken once or twice a year. Soldiers are ideal research subjects, easily located in their barracks, and more than 11,000 samples were taken from some 3,000 soldiers in all.

But the soldiers weren’t merely objects of research, disciplined and observed; they were also political subjects, something the research itself tended to overlook or render invisible.

This became evident from 1993 during an initial mutiny following the non-payment of wages, and then more dramatically in 1996 and 1997 when soldiers from the Presidential Guard clashed with loyalist forces. The French authorities who had contributed to the recruitment and training of these two rival units partially quelled the unrest by deploying military troops. But the post-colonial situation that initially enabled the HIV research was also the very factor that led to its end.

The Bangui research was forced to stop and was subsequently transferred to other countries. Research questions were relocated to other sites within the international network of Pasteur Institutes. Yet while research in Bangui came to a halt, the research infrastructure (data, samples, research ideas, etc.) was preserved.

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When does research become extractive?

Adding to the secrecy that shrouded the Bangui operation from its inception, there is a great deal of unease within the scientific community when it comes to discussing the topic today. The main parties behind the research have been evasive.

But the history of this secret initiative highlights a particular form of exploitation in research: biomedical extractivism — the extraction of blood and biological data in order to produce scientific knowledge, which can then be exploited for industrial and commercial purposes.

Unlike mining extractivism, this doesn’t involve natural resources being extracted from the ground, but from human bodies. It nevertheless operates in a similar manner, characterized by significant imbalances between the places where research is conducted and those where its results are exploited.

The Bangui operation helps illustrate this dynamic. Central African soldiers were classified as a high-risk population, largely because of their elevated infection rates. Through this form of categorization, individuals were effectively naturalized and reduced to objects of scientific inquiry — treated as quasi-natural resources — while their living conditions, social relationships and positions within the military hierarchy were systematically pushed aside.

This logic operated within a post-colonial situation that enabled the appropriation of the research cohort as a resource. Close ties between French and Central African authorities, along with the concentration of scientific and industrial infrastructure in France, allowed northern institutions to maintain control over the data, samples and research agendas.

Finally, researchers were able to capitalize on the knowledge generated by these samples through publications, access to funding, pursuing international research and, potentially, acquiring patents. Yet no provision was made to foster the development of local research capacities or to legally ensure the people who made this research possible would benefit from the medical benefits resulting from it.

From a public health perspective, the Bangui operation was carried out in vain: the rate of new HIV infections remained almost unchanged among military personnel in the Central African Republic between 1988 and 1996, when the researchers left the country. This disconnect between scientific output, local capacity and access to care constitutes the heart of the problem.

Present-day implications

Ultimately, no HIV vaccine was ever tested in Bangui. Even if it had been, it’s doubtful the Central African population would have been given priority access to it. This isn’t unique; it pervades many international biomedical research programs today. While there are numerous calls for public funding for research, few make such investments conditional on providing local populations with guaranteed access to the treatments or vaccines that could result from that research.

To this day, preventive HIV treatments that are tested in Africa but remain inaccessible to the populations concerned, such as lenacapavir, create a situation of economic blackmail involving human lives.

This shows that the question of fair research goes beyond ensuring consent in clinical trials. It also involves how the economic and political uses of discoveries, as well as access to care and prevention, are structured and envisioned from the very beginning of the research process.

The Bangui operation underscores that biomedical research is never neutral, but shaped by social, political and economic relations that determine who benefits from scientific progress. Looking beyond bioethical procedures opens a broader debate on justice and responsibility in the global production and funding of medical knowledge, and in access to the resulting medicines and vaccines.

Pierre-Marie David has received funding from the France's Agence Nationale de Recherche contre le Sida (ANRS) and Quebec's Fonds de Recherche du Québec - Société et Culture (FRQSC).

Due to recent developments in artificial intelligence (AI), it’s now possible to digitally “revive” dead people and interact with them.

These “resurrections” are sometimes voluntary and planned, but other times, they happen without the consent of families or loved ones. Humans have always fantasized about living forever. But what are we to make of this new way of “artificially” prolonging our existence? Is it desirable? What are the main ethical issues raised by the emergence of “griefbots” or “deadbots?”

As an associate professor at the School of Public Health (ESPUM) at the Université de Montréal, I am an ethicist and researcher who specializes in governance, ethics, law, AI and responsible research conduct.

I lead a research project called Artificial Immortality: Ethical, legal and artistic perspectives. As part of this project, I’ve published an article with two students on the ethical considerations of artificial immortality.

Fragile boundaries

Posthumous digital avatars are created from the digital traces left behind by dead people during their lifetime. Social media posts, photos, audio and video recordings are all traces that can be used to feed these avatars. Built through a combination of AI, machine learning and advanced data analysis, these avatars can recreate the physical and psychological likeness, personality and even memories of the deceased.

The result is that users may be left in doubt about whether or not this is the “real” person. This technology is taking root in a world where virtual life has become well established. So interactions with a digital avatar, whether posthumous or not, are becoming almost commonplace. But the advent of posthumous avatars raises significant ethical issues.

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Autonomy, data protection and privacy

Amid these concerns, particular attention must be paid to respect for autonomy and data privacy, the reshaping of interpersonal and social relationships, and the disruption of human limits. These give rise to a new awareness of vulnerability and ways to transcend it. The creation of posthumous digital avatars has an impact on the autonomy of three categories of people:

• Those who leave digital traces in the public domain, particularly on social media. These are people who are anticipating their death or who have died, and whose digital traces are voluntarily or involuntarily made available to third parties like relatives, employers, etc.

• Those who receive the digital traces of others upon their death. These are family members, loved ones or businesses. One of the questions concerning their autonomy regards control over the avatar of a loved one. For example, can people who receive the digital traces of others then refuse to create a posthumous digital avatar or a virtual memorial site?

• Those who interact with “avatarization” services. These are the people who use or consume the services and products promoted within the virtual afterlife industry. They interact with posthumous digital avatars for a variety of reasons, ranging from curiosity to coping with particularly painful grief. There are concerns these people might develop unhealthy dependencies on these services and products, even as the industry remains unstable and poses the risk of abruptly altering or discontinuing service offerings.

All these people are at risk of losing control over the perpetuated identity of the deceased person, given the multitude of virtual representations.

Public and pathological grief

Furthermore, when an avatar is accessible to a large number of people, grief becomes public. In other words, it can be experienced both intimately and collectively. This new phenomenon alters our relationship with death and grief and redefines the place of the deceased in our lives.

The story of the young Jang Nayeon, who died in 2016 and became the subject of the documentary Meeting You, expresses the unease public mourning can cause. Devastated by her daughter’s untimely death, her mother agreed to the creation of a posthumous digital avatar so that she could see her again and interact with her in virtual reality.

The reunion, streamed live on several web platforms, provoked discomfort among the audience. This is a particularly striking example of the hypervisibility of grief.

On the positive side, posthumous digital avatars can be used under the supervision of a therapist as part of clinical support. It should be noted, however, that only a minority of current uses take place under the supervision of specialists.

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Consequently, many people use this technology on their own and are more vulnerable to addiction or seek to escape the reality of grief. They are at risk of falling into so-called pathological grief. This is complicated or prolonged grief, characterized by its duration and intensity (an inability, after more than a year, to cope with emotional distress, to resume daily activities or to find meaning in life).

Overexposure and silent voyeurism

Virtual spaces where traces of the deceased are preserved, such as Facebook, are sometimes accessed by passive individuals. These are observers who do not necessarily seek to interact, but who are participating in a phenomenon of silent voyeurism.

This passivity is not necessarily malicious, but it becomes part of a dynamic of continuous surveillance and observation that can lead to overexposure and voyeurism. The ethical issue concerns the fact that people’s privacy can become the object of consumption for others, whether out of curiosity, fascination or even planning for the subsequent misuse of data.

The exploitation of data can result in the perpetual visibility of data generated by the deceased on the web, particularly through posthumous digital avatars that interact with families and loved ones. These serve to maintain the illusion of a presence after death.

This illusion reshapes how we relate to death, allowing a loved one to seem artificially present in our lives. More profoundly, it calls into question the limits of human mortality. Namely, beyond biological life, there is now the promise of an artificially eternal life. But is this desirable?

Understanding the main risks and ethical issues raised by artificial immortality is a crucial step in considering how these avatars should be used. We need to keep reflecting on the merits of the rise of these avatars in order to preserve human dignity — whether posthumous or not — and to prevent abuses in a world undergoing profound transformation.

I would like to thank Josianne Barrette-Moran, a PhD candidate in bioethics at the School of Public Health at the University of Montréal, for her technical assistance in producing this article.

Emmanuelle Marceau leads a research project funded by the International Observatory on the Societal Impacts of AI and Digital Technology (Obvia), entitled "Artificial Immortality: Ethical, legal and artistic perspectives." (https://www.obvia.ca/en/research/projects/artificial-immortality-ethical-legal-and-artistic-perspectives)