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Anne Pollock, Synthesizing Hope: Matter, Knowledge and Place in South African Drug Discovery (Chicago, IL and London: University of Chicago Press, 2019), pp. 191, £18.33, paperback, ISBN: 978-0226629186.

Published online by Cambridge University Press:  28 October 2020

Mandisa Mbali*
Department of Historical Studies University of Cape Town
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Book Review
© The Author(s), 2020. Published by Cambridge University Press

A dominant narrative in global health studies is that while scientific knowledge production chiefly occurs in the global North, Africa is mainly a repository of clinical trials subjects and raw materials. What are we, then, to make of transnational scientific collaborations where the aim is to capacitate the development of in-country drug discovery research expertise and infrastructure to address locally prevalent diseases in the global South?

This is a question posed by Anne Pollock in relation to the example of iThemba pharmaceuticals in South Africa. iThemba (which means hope in isiZulu) was founded in 2009 to engage in drug discovery for HIV, TB and Malaria. While located in South Africa, the company was fundamentally transnational in nature: although its bench scientists and managers were based within South Africa, its Scientific Advisory Board was made up of scientists from the global North. Mitigating the ‘brain drain’ (p. 24) and the notion of finding ‘African solutions to African problems’ (p. 10) were important motivations behind the company’s founding.

It was, however, unsuccessful in its mission and closed down in 2015. Pollock argues that this brief chapter in contemporary pharmaceutical history matters because it shows the challenges inherent to creating and sustaining a small, innovation-orientated drug company, driven by nationalist goals in the global South. The choice of South Africa as a case study is significant because, by African standards, it has established, and highly regarded, scientists and advanced biomedical research infrastructure, in terms of universities, laboratories and research institutes.

Pollock’s analysis is that pharmaceutical knowledge needs to be understood in terms of particular places and times (in this instance, post-apartheid South Africa). She also makes the case that it must be interpreted in relation to the material products that the scientists wished to manufacture. Here she mentions elements such as active pharmaceutical ingredients, formulation and manufacturing.

In terms of the parts of the book, Chapter 1 describes the ways in which the example of iThemba undercuts easy notions of global North/South dichotomies in literature on pharmaceuticals in South Africa. These have often focused on access-to-medicines campaigns, traditional knowledges and bioprospecting and clinical trials. Chapter 2 outlines the history of the site on which iThemba was located: a dynamite factory in Modderfontein, which provided explosives to the mining industry. It, thereby, suggests the ways in which post-apartheid South African science has built on infrastructures created by colonialism and apartheid. Its third chapter outlines how it attracted local and international research investment. The fourth then discusses how the bench scientists at the company aspired to make a meaningful situated contribution to global science ‘at home’.

Finally, Chapters 5 and 6 focus more on the material factors of South African scientific knowledge production: pharmaceuticals are simultaneously both intellectual property and products made through processes. In terms of the latter, the company’s focus on green manufacturing using continuous flow chemistry is presented in terms of the vision of ‘leap-frogging’ (ie. skipping over a stage of technology in a fashion similar to cellphones having been introduced before landlines in many parts of Africa). South African government funding was insufficient to sustain the project. Due to the need to generate additional revenue, much of the scientists’ time became consumed with synthesising molecules for pharmaceutical companies abroad. Their time was not primarily used to advance their own research agendas, based on local health needs.

Despite these realities, Pollock ultimately holds an optimistic view that the scientists who were involved in the company have gone on to be involved in other drug discovery ventures in South Africa. A key figure in the book is Dennis Liotta, an Emory University-based founder of iThemba who played a fundamental role in the development of second generation antiretrovirals. According to Pollock, he argued that ‘if drugs were discovered in developing countries and companies based in those countries owned the IP, the drugs would be affordable and relevant to their needs’ (p. 23).

This assumption could have been further examined: to what extent have global South universities, pharmaceutical companies and research institutes committed to global access licencing agreements? In order to realise the rights to access to health care and to enjoy the fruits of scientific knowledge (the ‘right to science’) they should commit to licencing their patents to generic drug companies willing and able to produce them at an affordable price. A failure to do this could theoretically, and ironically, result in African scientists and investors becoming rich from highly priced African solutions (drugs) unaffordable to poor Africans.

A particular strength of the book is its use of a particular global South example to show the benefits and drawbacks of an effort to enable in-country scientists to develop new drugs appropriate to local needs. It could, however, have offered us a slightly more situated account of how South Africa’s political economy shaped iThemba’s trajectory. For instance, its discussion of Nelson Mandela’s hopes in terms of the development of science and technology in South Africa could have been further situated in the context of his role in the post-apartheid government. While he was, indeed, the head of state during the first ANC-led administration, much of the day-to-day business of running the state was devolved to Deputy President Thabo Mbeki. A potentially fruitful area of research would be which individuals and networks were influential in shaping pharmaceutical-related science and technology policy during this period.

Further, relatively minor, points open to debate include: the idea of Tutu as an ANC figure (there have been several moments of dispute between him and the ANC in the post-apartheid era) (see p. 90); and, the idea that there is reliable access to cheap electricity would need to be qualified since 2007, which marked the beginning of the country’s periodic rolling black-outs (often euphemistically referred to as ‘load-shedding’) (p. 44). These do not, however, detract from the overall importance of the work.

Ultimately, in its problematisation of dominant geographic and sociological understandings of scientific knowledge production, the book makes an important contribution to science and technology studies and critical global health studies.