Biotechnology has undergone rapid and multifaceted innovation over the past twenty years since the human genome was decoded. Drug discovery and medicine are already being transformed because the practitioners of the life sciences have discovered how to modify the moving parts of cells like they program software. A prime example was the development of mRNA vaccines to combat COVID-19, which were effectively designed over a long weekend and were in production several months later. Compare this cadence to the decade it typically took researchers to develop a vaccine previously, thereby saving 10 million lives from the pandemic’s ravages. The world stands on the threshold of more such fundamental biotech breakthroughs.
A more complex aspect of the biotech revolution is that scientists will soon be able to gestate human embryos in artificial wombs outside of the female body, in so-called ectogenesis machines, or EGMs. Autocracies with rapidly declining populations will find this technology intriguing—as might women in democracies hoping to avoid the trials and tribulations of pregnancy and childbirth. Merge this EGM technology with those promising “designer babies,” enhanced physical and mental attributes and characteristics (more IQ, more height), and all of this perhaps coupled with AI and human-embedded SCs, and the potential permutations of new life experiences unlocked by biotechnology really begin to intrigue the imagination. And then there are the truly dark sides of the new biotechnology, such as military scientists being able to produce a bioweapon virus with greater ease, at lesser cost, and in record time. Biotechnology is insinuating itself onto the Cold War 2.0 agenda.
Humans have been practicing biotechnology innovation since ancient times. When pastoralists in Mesopotamia, Egypt, or the Indus Valley bred a horse with a donkey to produce a mule, they were consciously bringing two sets of chromosomes together to produce a third species. Of course they didn’t yet know—and farmers for thousands of years would not know—that that was what they were doing in terms of the cell biology, but at the level of “output” they certainly knew what they wanted to achieve, and they were not surprised at their success. Equally, when a farmer in Europe or Asia crossbred one plant with another, perhaps by forming a graft between them, they knew exactly why they were doing what they did, and they anticipated the resulting plant or cereal. But again, like the horse/donkey/mule breeders, they didn’t understand how what they did actually worked inside the plant at the cellular and molecular level. In effect, the technique came well before the science. Thus it was that the medieval brewer of beer knew she needed to add yeast to her brew to make it ferment, but she knew nothing of how the bacteria in the yeast actually worked its magic. And so it was even in the inorganic world of ancient metallurgy. The blacksmith of ancient Greece understood that mixing some tin with copper would give him bronze, but he didn’t—and couldn’t yet—grasp how chemical bonds worked to fuse different minerals together into new alloys. He knew, though, that bronze was a superior metal to work with, and much stronger for making swords than copper alone.
It hadn’t been until fairly recently that the science for pursuits like metallurgy, and even later for biology, caught up to explain the raw innovation. For chemistry, it wasn’t until the late 1800s, while for biology it has only been the last eighty years. The big (huge) breakthrough in biology dates from 1953, when Watson and Crick discovered DNA, the code of all life. The next milestone was the decoding of the human genome in December 1999, an effort that took thirteen years of painstaking work. And finally, to complete the trifecta of biological accelerations, was the invention of CRISPR-Cas9, a procedure that allows scientists to actually splice and edit genes, mainly to remove a defective one, thereby saving that person the suffering of having to live with a specific genetically caused handicap. For example, a person with sickle cell anemia can have their beta-globin gene removed, after which their symptoms of pain and exhaustion stop almost immediately.1
Biotech products and procedures have had a significant impact on agriculture worldwide. In the early to mid-1970s two books caused widespread fear for the future of the earth: Limits to Growth2 and The Population Bomb.3 The upshot of each was that the globe’s population was rising quickly, and there was no way collective food production could keep growing in order to feed all these people. The books predicted that the inevitable result would be starvation on a massive, never-before-seen scale. This forecast of unprecedented human suffering deeply worried people in the poor as well as rich countries of the world.
In the end, however, biotechnology saved the planet’s billions of people (indeed the world’s population grew from 3.6 billion in 1970 to 7.8 billion today). Hundreds of new agricultural innovations were deployed that created more productive plants with much higher yields. This so-called Green Revolution saved India from mass starvation. For a lot of average people, these events and trends in biotechnology were overshadowed by the seemingly flashier, and very novel, computing sciences. Nevertheless, it was indeed the biosciences, applied to agriculture, that saved the world from a gruesome famine scenario.
It was also around this time (in the 1970s) that scientists began to experiment with inserting certain genetic material into other organic substances, in particular bacteria, to form new living organisms. One such researcher was Ananda Chakrabarty, who emigrated to the United States after completing his doctorate in biosciences in India and facilitated the creation of a hybrid bacterium that could break down oil from oil spills. Chakrabarty obtained a patent for his invention in 1980.4
In Cold War 2.0 biotechnology will be pressed into action by both camps for agricultural purposes. In the Russo-Ukrainian War the Russian government has already used foodstuffs as a strategic resource by preventing some exports of Ukraine’s wheat and other cereals, especially to the Global South, where Ukraine had many markets for its cereals prior to the war. As temperatures keep rising around the world, and as the number of significant droughts increase globally, it will be necessary for scientists to innovate new crop varieties that can withstand hotter growing conditions while receiving less water. Ideally, agricultural scientists around the world will pool their knowledge and technological expertise in agri-science and new seed development, but the technological decoupling attendant with Cold War 2.0 might block cross-camp collaboration, thereby raising the incidence of food insecurity in many parts of the world.
The biotechnology innovations mentioned to this point all related to the “outside world,” either animal or plants. By contrast, when the human genome was sequenced, biotech got really up close and personal to people themselves. Interested onlookers were starting to see massive developments impacting not just flora and fauna, but real, live and in the flesh human beings. One early beachhead was in orthopedic surgery, where worn-out knees and hips were starting to be replaced by gleaming metallic substitute parts. A little later, cardiac surgeons slipped valves from pig hearts into poorly performing human hearts. People became somewhat nervous about trans-species transplantation, but fairly quickly these fears were allayed when transplant patients started living long, purposeful lives. Nothing breeds confidence in biotechnology better than success. Debate was largely curtailed by the publication of pictures of heart transplant recipients playing golf not that long after their open-heart surgeries.
Debate could not be forestalled, however, when in vitro fertilization (IVF) came along in the 1980s. Biomedical researchers figured out a way to put a human egg in a petri dish, add a male sperm, watch the two gametes fuse into an embryo, which was then inserted into the mother’s uterus so that the following pregnancy could bring a baby into the world for the previously infertile parents. With IVF, the discussion around biotechnology became really intense really quickly. Not surprisingly, regulatory action followed in order to establish some parameters around this radically new biotech domain, so that physicians could earn the confidence of their patients and prove to the general public they weren’t trying to play God. Today, some forty plus years later, “routine” IVF is well accepted, and about 20 percent of couples in economically advanced democracies make use of one kind of IVF procedure or another to conceive a child.
While today bioscience helps mothers with artificial insemination, at the other end of the gestation process, leading medical centers now can keep extremely premature babies alive that were born as early as the 23rd week of pregnancy. (A normal pregnancy usually lasts about forty weeks.) A few years ago, a research group in a Philadelphia children’s hospital invented a uterine sac that could keep lamb embryos alive, essentially by getting the lambs nutrients and removing waste material much as a placenta and amniotic sac would in a natural lamb mother.5 The lead physician of this experiment said explicitly this technology wasn’t intended to replace a mother’s uterus, but rather was simply a device to assist a very premature fetus, to give it further time to gestate before it had to be born.6
Nevertheless, this device could be a prototype of what may be called an “ectogenesis machine” for humans. An EGM could be coupled with IVF, and a few other recent breakthroughs, including a device that re-creates an entire female reproductive system,7 and another that allows for making human embryos without zygotes from humans,8 to permit the human conception, gestation, and birth process to be done outside any human female body. The EGM could one day facilitate the gestation of a human embryo without a mother’s uterus.
Who would use an EGM? In a Cold War 2.0 context, one important candidate would be a major autocratic government whose country’s population is in deep and irreversible decline, and where immigration is not acceptable to the either the government or the mass of the citizenry. Two autocracies meet this double criteria: Russia and China. Both countries are experiencing significant population decline, and over the past few years it wasn’t simply the COVID-19 pandemic. The single biggest driver of population decline in Russia and China is that female fertility rates have plummeted in both countries (and in thirty-eight other countries around the world) to well below the replacement rate of 2.1 children per mother over her lifetime. In Russia the figure for 2022 was 1.8, and in China for the same year it fell to an even lower 1.2. Russia has been losing population since 1993, dropping from 148 million in that year to 144 in 2022. It is projected by the United Nations to fall to 112 million by 2100. China’s population fell for the first time only in 2022. Once a country’s population begins to fall due to a declining fertility rate, the decline can accelerate itself just by the law of big numbers. The Shanghai Academy of Sciences forecasts that China’s population, currently at 1.4 billion, will fall to 732 million by 2100.9
Population declines such as these predicted for Russia and China will invariably be unacceptable to the autocratic leaders of these countries. While there will be some positive outcomes as a result, such as less pressure on the housing market, it will also cause a fall in economic growth, which will likely cause massive social unrest. In both countries the survival of the political regime would be at serious risk. Moreover, there would be far fewer military-age young men and women to populate the ranks of the armed forces, making it yet harder to suppress any domestic uprising.
Both countries have tried to forestall dropping female fertility rates by instituting various social programs encouraging larger families and offering a number of financial incentives for mothers to have and raise children. None of these inducements have worked. This result is consistent with smaller countries, including a number in the democracies. (South Korea’s fertility rate in 2022 hit 0.8 percent, the lowest in the world.) Might the two autocratic regimes turn to the EGM for a technological solution to reverse a drastic decline in population?
The EGM could be integrated into Russian or Chinese society fairly readily. Both countries have long-standing, well-established orphanage systems for babies, toddlers, and small children who have lost their parents. These could be expanded to accommodate an exponential rise in EGM children. Then, if insufficient prospective foster parents came forward to take in EGM children by the age of three to five, then the state could expand its school system to include boarding schools in modest but functional quarters for EGM children.
Such an EGM program will of course be highly controversial. This is why they will initially be rolled out in autocracies, where public opinion generally does not have the impact it can have in a democracy. The last similar system of child-making and child-rearing “for the good of the nation” was tried in another autocracy, namely Nazi Germany in the 1930s,10 although this program did not make use of an artificial uterus, and it was done on a rather modest scale.
Once a program of EGM child-making reaches the point where the technology has been fine-tuned and is working well, it is not inconceivable that certain groups in the democracies might find the device a useful mechanism for avoiding human gestation. Certain religious groups, for example, that feel their numbers dwindling might resort to such an EGM program. Or a woman, or a couple, who would like to have children but feel their work or other commitments (including care for elderly parents) are such that they wish to avoid a nine-month pregnancy, as well as the risk and pain of childbirth,11 might be quite interested in making use of an EGM program.12
Such interest in the democracies for EGM might be further heightened if, in addition to the procedure as outlined above, some or all of the following sub-procedures were available with it: limited sex selection of the child, which would entail, for a second child, being able to choose a gender different from the first child (so that a couple wanting two children could have a boy and a girl—but no other sex selection would be permitted); genetic screening for medical problems; and limited genetic enhancement, such that the EGM child’s genes are optimized for general intelligence, empathy, and emotional strength. A technology that may permit a tentative form of human trait enhancement (i.e., IQ, height) is already on the market in the US.13
Such procedures permitted by bioengineering will initially be very controversial, and they likely will only be permitted (if permitted at all) after lengthy and detailed discussion and debate within civil society and the governmental bodies of the country, and likely only after significant legal challenges up to and including the highest courts of the land. This was the general trajectory of debate for IVF, and nothing less is expected in the case of EGM. Presumably, though, debate will be more muted, if permitted at all, in the autocracies; rather, the autocratic leadership of the country will decide the matter on its own. In all likelihood, then, EGM will be another fault line between the democracies and the autocracies, as there will likely be two versions of the technology and, more important, different cultures in the laws, norms, and ethics surrounding its use, in a world separated by Cold War 2.0.
With the world having recently experienced a global pandemic with the swift spread of the COVID-19 virus from China to all corners of the world, and having witnessed the immense harm caused to human life and the economy by this virus, it is no surprise that the specter of bioweapons now hangs more heavily over the world than ever before. Moreover, using human-made biological agents in war fighting is not a new phenomenon. Once more, the concept of dual-use technology is very apropos. In 1913, Fritz Haber invented nitrogen-based fertilizer, one of the biotech wonders of the 20th century, as it probably did the most to improve crop yields in the sixty years between its invention and the development of genetically engineered seed and crops of the 1960s—though nitrogen-based fertilizer is still a huge part of large-scale agriculture. It is the same Fritz Haber, though, who also helped develop chlorine gas as a hideous military weapon. It is estimated that chlorine and other gases killed 91,000 soldiers in World War I.
As a result of the human cruelty and devastation caused by this and several other gases in World War I (including mustard and tear gas) the International Committee of the Red Cross lobbied governments strenuously for banning such substances as weapons of war. The Red Cross’s efforts bore fruit, and in 1925 the League of Nations adopted the Geneva Protocol on Poisonous Gases, effectively outlawing the production, distribution, or use of biological weapons. Interestingly, the treaty has no verification or enforcement mechanism; its proponents hoped the stigma of breaching the treaty would be sufficient for states to comply with it. And generally it has been, though there have been some transgressions, including when Syrian president Assad dropped the sarin chemical agent on his own people in Ghouta in 2013. Russian president Putin also breached the treaty when he had two Russian state security agents administer the banned substance Novichok in a park in southern England against a former FSB agent who had defected to the UK. This scandalous attack was reminiscent of the worst such excesses of Cold War 1 perpetrated by Moscow against foreign governments.
These transgressions raise the possibility that especially an autocracy might manufacture a highly lethal virus and use it against an enemy, particularly against a democracy, where proactive defense against such an attack would generally be quite low, if the track records of the democracies vis-à-vis the COVID-19 virus are any indicator. One of the self-limiters on using biological warfare agents in both world wars in the 20th century was that the various gases could easily backfire on the country releasing them; all it took was for the wind direction to change. Today, with a highly contagious and lethal novel virus agent released as a bioweapon, the releasing country would merely have to make an antidote vaccine and administer it to its own troops and citizens. This is a scenario that democracies must take very seriously in Cold War 2.0.
In response to the COVID-19 virus, no fewer than eight biotechnology companies in the democracies quickly came out with an effective vaccine. Competitive displacement was much in evidence. Two of them were designed and developed using novel mRNA technology, and these became the vaccines of choice in the democracies, particularly because one of the other vaccines, made by AstraZeneca (in conjunction with Oxford University), proved to have a slightly higher risk factor for heart complications. Nonetheless, AZ shared its drug trial data openly and promptly, which still helped build confidence in the vaccine. All vaccine makers in the democracies received government financial assistance when they began their search for a vaccine, but these governments did not “pick winners.” They let competitive displacement run its course in an open marketplace.
Contrast this competitive process and the AZ posture on data sharing against the two main vaccine makers in Russia and China. In Russia, the Sputnik V vaccine was rushed out, in order to allow the Kremlin to play global vaccine diplomacy with it, but the manufacturer was never able to provide the World Health Organization (WHO) with the vaccine trial data that is a standard requirement in order to obtain WHO approval of the vaccine. As such, without WHO approval, many countries that would otherwise have ordered the Russian vaccine ended up having to procure a vaccine from another supplier. Moreover, the percentage of Russians vaccinated was very low, at about 20 percent. This is not a level that can offer herd immunity. As a result, the impact of COVID-19 on the Russian people, and its impact on the Russian economy, was far greater than it would have been had Russia accepted doses from the two mRNA vaccines from the United States and Europe. Strike one against autocratic vaccine diplomacy.
Almost the same fate befell China’s premier vaccine company, which was (and continues to be) unable, or unwilling, to provide WHO with the required data from vaccine trials to show the efficacy and safety of the Chinese vaccine, such that, again, the WHO has yet to approve the Chinese vaccine for international use. Moreover, the trials finally undertaken by other countries show that the Chinese vaccine requires a full three doses of vaccination to achieve the same level of protection as is obtained by only two doses of the mRNA vaccines from the democracies. This makes the Chinese vaccine extremely problematic, including in China, where 90 percent of the population have achieved two vaccinations, but only 50 percent have had a third jab. At the same time, however, the dynamics of Cold War 2.0 make it seemingly politically impossible for Beijing (or Russia) to procure mRNA vaccines from the democracies, even though they are clearly superior to the vaccines produced in China and Russia.
The inability of China to respond to COVID-19 with effective vaccines then led the government in Beijing to spend most of 2022 implementing a very harsh zero COVID-19 policy that saw, among other astounding lockdowns, one for Shanghai (China’s commercial capital of 25 million people) that lasted fully two months, and that saw no exceptions. This finally led to serious street protests, which then caused the government to do an about-face and cease lockdowns altogether. This in turn has caused a huge increase in COVID-19 infections in China, but now the government in Beijing is distributing false COVID-19 statistics (in terms of number of hospital admissions and deaths) because it fears embarrassment and, possibly worse, if the truth were told about the government’s mismanagement of the entire affair.
There is much that needs to be improved in democracies relative to preparations for the next pandemic—and there will be another pandemic. Nevertheless, even with their flaws, the democracies handled the COVID-19 pandemic better than the two leading autocracies. This has been an important episode in Cold War 2.0, and not the last act that both camps will play on the stage of global health.
Another fault line between the autocracies and the democracies in Cold War 2.0 regarding biotechnology is China’s development and deployment of a widespread system of genetic sampling and surveillance of its own people. Chapter 4 discussed the massive digital surveillance and control system implemented by the Chinese government over the past twenty years, initially in Xinjiang Province to oppress the Uighur minority, but then rolled out in various forms elsewhere in China. This system, though, is not limited to digital inputs. It includes Chinese authorities regularly taking DNA samples from Chinese citizens for no reason other than to build a huge database of biological data on the entire population. This can then be used for a variety of surveillance and control operations, particularly when linked to other personal data by AI programs.
Police in the democracies also use DNA data, but ostensibly only for law enforcement activities, and then only under the supervision of an independent judiciary. There is no general requirement of average citizens in democracies having to give DNA samples routinely for government tracking purposes. On the other hand, there have been cases in democracies of private suppliers of genetic testing services abusing the samples they have collected from customers, but thankfully these have been prosecuted under laws that protect against such misuse of data collection. The lesson is that in the democracies great care has to be taken to regulate such services, precisely so they do not become private purveyors of genetic malfeasance. In Cold War 2.0 the democracies have to constantly remind themselves how powerful the new biotechnologies are, and why they have to be used and managed very carefully, precisely so that autocratic practices don’t seep into the democracies.
There are several metrics that can be used to measure the relative standings of the autocracies and democracies in biotechnology league tables. The charts below track the ranking of universities with biology expertise, as well as the size (by market capitalization) of public biotech companies. (This latter metric indicates the relative value of each company measured by the aggregate price of its outstanding shares.) Finally, it is worth noting that while Chinese research medical centers (i.e., major medical centers that also carry out leading-edge research) are not ranked relative to their counterparts in the democracies, conclusions can be drawn from the fact that each year some 500,000 rich Chinese travel to medical centers in democracies for major medical procedures.14
Universities with strength in the biosciences and medicine are critical, as these are the launchpads of innovation in the biotechnology domain; they also groom the researchers who start biotech businesses and/or go to work in larger pharmaceutical companies. Here is the ranking of the top 100 universities in terms of their attributes in biosciences and medicine.15
|
Top 20 |
Next 30 |
Next 50 |
Democracies |
|||
United States |
12 |
9 |
9 |
United Kingdom |
5 |
4 |
7 |
Australia |
1 |
3 |
3 |
Canada |
1 |
3 |
2 |
Sweden |
1 |
0 |
3 |
Germany |
0 |
2 |
1 |
Netherlands |
0 |
1 |
5 |
Belgium |
0 |
1 |
1 |
France |
0 |
1 |
1 |
Japan |
0 |
1 |
1 |
South Korea |
0 |
1 |
1 |
Denmark |
0 |
1 |
0 |
Singapore |
0 |
1 |
0 |
Switzerland |
0 |
0 |
3 |
Finland |
0 |
0 |
1 |
Italy |
0 |
0 |
1 |
New Zealand |
0 |
0 |
1 |
Norway |
0 |
0 |
1 |
Spain |
0 |
0 |
1 |
Taiwan |
0 |
0 |
1 |
Autocracies |
|||
China |
0 |
2 |
3 |
Saudi Arabia |
0 |
0 |
1 |
Russia |
0 |
0 |
0 |
Nonaligned |
|||
Brazil |
0 |
0 |
1 |
Democracies |
|
United States |
|
Johnson & Johnson |
$510 B |
Eli Lilly |
$356 |
Merck |
$289 |
AbbVie |
$285 |
Pfizer |
$224 |
Bristol Myers Squibb |
$146 |
Amgen |
$130 |
Gilead Sciences |
$105 |
CVS |
$93 |
Regeneron Pharmaceuticals |
$87 |
Vertex Pharmaceuticals |
$84 |
Zoetis |
$80 |
Moderna |
$54 |
Biogen |
$41 |
Seagen |
$38 |
Europe |
|
Novo Nordisk—Denmark |
$372 |
Roche—Swiss |
$249 |
AstraZeneca—UK |
$231 |
Novartis—Swiss |
$209 |
Sanofi—France |
$139 |
Merck KGaA—Germany |
$75 |
GlaxoSmithKline—UK |
$74 |
Bayer—Germany |
$65 |
Lonza—Swiss |
$45 |
BioNTech—Germany |
$39 |
Japan |
|
Takeda Pharma |
$52 |
Chugai |
$41 |
Mitsubishi |
$35 |
Takeda |
$31 |
Other Democracies |
|
CSL—Australia |
$100 |
Autocracies |
|
China |
|
Jiangsu Hengrui |
$45 |
WuXi AppTec |
$32 |
BeiGene |
$27 |
Russia has no companies in the top fifty pharma companies, and clearly China is in a different league than the democracies, with only four companies in the top fifty, and they are small by market cap. If ranked by sales, two Chinese companies are in the top fifty (Sinopharm and WuXi).
Special mention, though, should be made of BGI Group (formerly Beijing Genomics Institute), a company begun in 1999 in China focused on sequencing the human genome. It has sales of about $250 million annually, and now sells a line of gene-sequencing machines. It pioneered low-cost gene sequencing and offers the service for about $100. In 2020, and again in 2023, the US government put BGI on its sanctions list for providing genetic analysis services involving Uighur citizens in Xinjiang to further their surveillance and repression by Chinese authorities.
BGI competes against the American company Illumina, which has a market cap of $35 billion and annual sales of $4.5 billion. Illumina offers a full human gene-sequencing service for $200. There has been patent litigation between BGI and Illumina over their gene-sequencing machines. In May 2022, a court in Delaware found Illumina willfully infringed two patents of Complete Genomics (a subsidiary of BGI) and awarded damages of $334 million.