Nicholas Agar, professor of ethics at the Victoria University of Wellington
Recent advances in gene editing suggest a future in which we can radically upgrade human genomes. We might use tools including CRISPR to rewrite genes that influence traits such as intelligence and lifespan. We should bear in mind when we contemplate this enhanced future that the obvious answers aren’t always the right ones. The human genome isn’t something we should seek to build a wall around, protecting it from all change. But a rush to enhance ourselves may erase aspects of our humanity that proper reflection reveals as valuable. More IQ points aren’t better than fewer in the straightforward way that more money is better than less. We risk oversimplifying what’s involved in enhancement. Proper reflection on what about us we might want to preserve takes time – it should draw on a wide range of perspectives about what it means to be human. It’s difficult to set aside this time for ethical reflection when new technological possibilities seem to be coming thick and fast.

Luke Alphey, visiting professor, Department of Zoology, University of Oxford
Agricultural pest insects, and mosquitoes transmitting diseases, are long-standing problems for which we still have no satisfactory solution, indeed the problems are becoming more pressing. Modern genetics can potentially provide powerful new means for controlling these ancient enemies with greater effectiveness and precision – for example minimal off-target effects on the environment – than currently-used methods. Gene drives are just one aspect of this, but perhaps encapsulate some of the issues. One gene drive system, involving inserting into mosquito cells a large amount of foreign (to the mosquito) DNA in the form of an intracellular bacterium (Wolbachia), has entered field trials in several countries. This specific system has avoided the “genetic” or “GMO” label and regulatory system by adroit marketing and some technicalities and perhaps illustrates what could be done if the field were not caught up in the baggage and polarised politics of the GM crops “debate”. Potential applications of genetic methods in public health and conservation biology, for example, have very little in common with GM crops; lumping them together risks poor debate, poor policy and – in my view – potential delay or loss of huge human and environmental benefits.

Elizabeth Bradley, Professor of Grand Strategy, Head of Branford College, Professor of Public Health and Faculty Director of the Yale Global Health Leadership Institute
The tremendous impact that social, environmental and behavior factors have on our health overall. Recent research has shown that a country’s ratio of health to social service spending is predictive of some key health outcomes, like life expectancy, infant mortality, and maternal mortality. Genetics and health care play a role, but social, environmental, and behavioral factors have far greater impact on the whole health of a population.

Some examples of social service investments include job training, supportive housing, and nutritional support – all of which have traditionally had an underestimated focus of attention. Health and social services should be better integrated toward the achievement of common metrics, like lower rates of smoking, obesity, and depression. More research is needed, to measure the health care cost savings of early childhood education or income support programs, and to identify the most sustainable integrated models. Meaningful change in our world’s health may come less from investing in medical care than in addressing the social determinants of health.

Chelsea Clinton, Vice Chair, Clinton Foundation
Read Clinton’s extended response about the US opioid epidemic.

Jennifer Doudna, Professor of Molecular and Cell Biology and Chemistry at the University of California, Berkeley, co-inventor of CRISPR-Cas9 technology
As a co-inventor of CRISPR-Cas9 gene editing technology, I am delighted to see that this groundbreaking ability to “cut and paste” genes so efficiently is being harnessed as a strategy to create new food, therapeutics, materials and methods for controlling the spread of diease.

A challenge moving forward is how to best engage the public with this fundamental science that really can positively impact human life and the world we live in. I believe that we must continue to discuss and consider the profound societal and ethical impacts of CRISPR technology and ensure that it is not abused.c

Joel Garreau, author, journalist, Professor of Law, Culture and Values, Sandra Day O’Connor College of Law, Arizona State University
The major challenge consuming me is that the wheels are coming off the Enlightenment right now, on our watch, and it’s our own damn fault.

The GRIN technologies – the genetics, robotics, information and nano revolutions – are advancing on a curve. Meanwhile, we humans are trying to process this exponential change with our good old v. 1.0 brains. With precious little help at all from those creating this upheaval.

Folk are not stupid. They can clearly detect the ground moving beneath their feet, and that of their children and jobs and futures. When the ground moves beneath her feet, any sane primate looks for something apparently solid to hold onto. Anybody with apparently simple stories about what’s going on, forcefully told, *will* get attention.

You’ve doubtless seen the data about how the most common job in the vast majority of states is truck driver. So what are we doing? We’re obsoleting these jobs as fast as we can, with a hand wave about how, “Oh, they’ll find better jobs.” While, meanwhile, the rate of suicide and drug addiction and protest voting among the solid middle-aged former middle-class soars. These guys are not stupid. They know they’ve been had. And we’re going to pay for it. And don’t tell me the solution is to have the robots just give them a guaranteed income. Humans require meaning as surely as food.

The days when scientists could not [care] about the impact of their work on cultural, values and society are over. If they ever existed, which they didn’t, but that’s water over the dam.

I can’t tell you how many times I’ve talked to guys working on, oh, something like massively increasing the number and power of mitochondria in human cells. And I’m like, you know that if you massively increase the amount of energy creation in cells, you’re talking about changing what it means to be human, right? Are you intentionally trying to create supermen? And the answer every time is “Wow, what a fascinating question, I never thought of that.”

It’s not that these scientists are stupid, obviously. It’s that they’re tunnel-vision. They don’t wake up thinking about how they can change the human race. They wake up thinking about how they’re going to wire the goddamn monkey. That’s just the way these guys are.

Fix it. Get out of your silo. If you can’t figure out the societal and cultural implications of what you’re doing, start seeking out people who might, and start systematically having lunch with them. And then invite the most interesting ones into your lab with the goal of them becoming partners.

One example of this was the scientist who was spending her life finding the biomarkers for a disease for which there was no cure. Mercifully, her lab was among the first to start systematically bringing in partners from entirely outside. One of them asked, “What’s the point of creating despair? Might it be possible for you to find it interesting to search for a biomarker for a disease to which there is a cure?” To which she replied, of course, “Wow, what a fascinating question, I never thought of that.” But once it was pointed out to her, she happily did find another interesting biomarker problem that was culturally useful.

Culture moves slower than does innovation. That’s just what humans are like. Deal with it, or watch the collapse of the Enlightenment as they ever increasingly come at you with torches and pitchforks – and correctly so. Mary Shelley knew her humans.

My wife and I used to raise border collies. Border collies make terrible pets. You can not give an intelligent species nothing to do. If you don’t give them sheep, or something comparably interesting, they will come up with something to occupy their great minds. And you may not like it.

Laurie Garrett, Pulitzer Prize-winning science journalist, senior fellow for global health at the Council on Foreign Relations
1. Greatest frustration: It is deeply annoying and vexing that CRISPR-cas9 and other gene editing techniques are being applied to treatment of rare diseases and a host of pharmacology development, but little investment is directed toward application of state-of-the-art gene editing or metagenomic sequencing and detection for point-of-care diagnostics creation. There are many exciting developments at the lab bench level that could translate into "Star Trek"-like abilities to wade into epidemic hysteria and swiftly identify who is infected, and with what organism. There are even innovations that allow identification on-the-spot of infections with previously unknown microbes, based on conserved genetic regions found in classes of viruses or bacteria. But nobody seems interested in bankrolling such game-changing innovations for production on a mass scale. It's a market failure issue – a where's-the-profits problem. If Ebola broke out somewhere tomorrow we are better off today in that some methods for quickly identifying the virus in blood samples exist, but even now they remain noncommercial, require a laboratory and have no relevance to real-world conditions.

2. In 2009-10 some in the national security community were obsessed with concern about gain-of-function research, mainly on flu viruses. Researchers were deliberately creating forms of H5N1 and H7N9 and H1N1 that could be passed mammal-2-mammal, probably human-to-human. The goal on researchers' parts was to understand what genetic switches had to occur to turn a bird flu into a potentially catastrophic human airborne transmissible pandemic strain. But of course the work was very dangerous – especially if it got into the wrong hands.
That was then, this is now: The technology of gene modification is far more advanced, and application of cutting edge gene excision and incision techniques makes gain-of-function work potentially far easier, and more dangerous. The two governments that were taking the lead on dual-use research of concern issues (UK and US) are both preoccupied now with very different problems and new leadership. And the WHO was the lead global agency – it is facing a major leadership change. So we have no guidance regarding how governments are likely to view these issues.

Tim Jinks, Head of Drug Resistant Infections at Wellcome Trust
Modern medicine depends on doctors having effective drugs to treat infections. But many common infections are becoming more difficult to treat because bacteria are becoming resistant to the drugs available. Drug-resistant infection – or antimicrobial resistance – is a very serious health threat to us all. Already it results in around 700,000 deaths a year globally. Within a generation it could be 10 million; it could mean we can no longer safely carry out not only complex, lifesaving treatments such as chemotherapy and organ transplants but also more routine operations like caesareans and hip replacements. More needs to be done to improve our ability to diagnose, treat and prevent drug resistant infections and to speed up development of new antibiotics to replace those no longer effective in protecting us against deadly infections.

Anit Mukherjee, policy fellow at the Center for Global Development
Technological innovation is progressing rapidly not only in the digital sphere but also in areas such as health, education, nutrition, food safety and life-saving/enhancing drugs. However, the gains of these new technologies are being captured by a minority of the population both domestically and internationally. While the digital divide has received more attention (and being bridged significantly), inequality is manifesting in other sectors that ultimately affect peoples’ well being. One outcome is human migration which is not only political but also economic and social. The other is the more frequent outbreaks of diseases, epidemics and pandemics such as ebola, MARS and Zika. In a world where there is a sentiment against movement of goods and people, how can developing societies adapt to increasing inequalities and build systems of governance to ensure human security?

Pardis Sabeti, Associate Professor of Organismic and Evolutionary Biology and of Immunology and Infectious Diseases, Harvard University
The recent Ebola and Zika epidemics exposed our global vulnerabilities to deadly microbial threats and highlighted the need for proactive measures in advance of outbreaks and swift action during them. At the same time it shows our ability to prevent, diagnose, and treat deadly infectious diseases through new technologies. It is a time of great potential for devastation or advancement for one of the greatest challenges of our lifetimes.

Robert Sparrow, adjunct professor, Centre for Human Bioethics, Monash University
What does justice require of wealthy Northern states when confronted by mass migration from increasingly impoverished Southern countries as a result of accelerating climate change?

How should we respond, both ethically and emotionally, to the knowledge that we are living through one of history’s fastest periods of extinction and that this catastrophe is the result of humankind’s activities?

As technological developments increasingly drive social change, how can democratic societies empower ordinary people to have a say in the decisions that shape the technological trajectories that will in turn determine what the future looks like?

How can the public have meaningful input into the character of the algorithms that will increasingly determine both the nature of their relationships with other people on social media and their access to various important social goods?

How can we prevent an underwater arms race involving autonomous submersibles over the coming decades?

Should we use “gene drives” to try to eliminate disease vectors in nature?

How can we ensure that questions about meaning and values, and not just calculations of risks and benefits, are addressed in decisions about human genome editing?

Eric Topol, Scripps Transatlantic Science Institute
Our major challenge is related to our new capability of digitizing human beings. That is, via biosensors, DNA sequencing and imaging, we can define each individual’s medical essence. But the problem is that this generates many terabytes of data, which includes real-time streaming of key metrics like blood pressure. Aggregating and processing the data, derived from many sources, with algorithms and artificial intelligence (particularly deep learning) is a daunting task. Once we can do this, we’ll be on our way to a virtual medical coach – your smartphone providing instantaneous feedback on all your health and medical metrics to help prevent you from getting sick.

Mike Turner, Head of Infection and Immunobiology at Wellcome Trust
Infectious disease outbreaks are a growing threat to health and prosperity in our modern world. Vast amounts of international travel, increasing urbanisation and a changing climates means that viruses can cross borders and spread around the globe faster than ever before. Recent outbreaks like Sars, Ebola and Zika have all shown how unprepared the world is to deal with epidemics. To stand any chance of tackling this threat, we need new vaccines, stronger healthcare systems and a better coordinated global response.

At Wellcome, we’re working to address this threat in a variety of ways; we are a founding partner of the Coalition for Epidemics Preparedness Innovations (Cepi) that will develop new vaccine candidates against infections we know could cause a serious epidemic. The WHO also needs to be much better funded and have the mandate to respond swiftly and effectively when diseases do begin to spread. Only by investing, coordinating and working together can we expect to prepare the world for the next inevitable epidemic.

Watch our animation with words by Bill Gates on Cepi’s vaccine plans.

Gavin Yamey, professor of the practice of global health, Duke University Global Health Institute
I believe one of the most urgent global issues that we face in 2017 and beyond, and one that we are woefully ill-prepared for, is the threat of epidemics and pandemics. We have three enormous gaps in the global system of preparedness. First, many countries have weak national systems for detecting and responding to outbreaks. Second, we have too few vaccines, medicines, and diagnostics for emerging infectious diseases with outbreak potential. Third, at the international level, we simply don’t yet have a robust, joined-up approach to providing the essential components of a preparedness and response system – like surge capacity in producing vaccines in a crisis, an inter-connected global surveillance system, or a global reserve corps of emergency responders. Closing these three gaps is one of the most urgent global priorities if we are to avert a potential world catastrophe. For example, if we suffer another flu pandemic similar to the 1918 “Spanish flu,” the World Bank estimates that there could be 71 million deaths and a global recession costing over $3 trillion.

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