OPINION

published: 12 January 2021

doi: 10.3389/fsoc.2020.613548

Who Gets Cured? COVID-19 and

Developing a Critical Medical
Sociology and Anthropology of Cure
Maria Berghs*

Allied Health Sciences, De Montfort University, Leicester, United Kingdom

Keywords: COVID-19, cure, sociology, anthropology, vaccine

INTRODUCTION
In this opinion piece, I argue that a sociology and anthropology of cure is accelerated by various
features of the scientific and social responses to the COVID-19 pandemic. I illustrate how the
pandemic has made the general public rethink popular notions of “cure,” foregrounded ethical
dilemmas and inequalities in who has access to “cures” and also revealed deep uncertainties
correlated to a future where there is no such thing as cure anymore. Such developments in
the pandemic response illustrate the need for a critical interdisciplinary agenda to interrogate
the social, ethical, cultural, economic, political and technological innovations of cures nationally
and internationally.
The race for a vaccine for the SARS-CoV-2 virus that causes COVID-19 illustrated the
urgency to find a cure during a pandemic but also deep anxieties, as the general public realizes
they have to leave behind absolutes of “cure” and deal with uncertainties of who now gets
cured? In medical sociological and anthropological literature, absolutes of cure have long been
Edited by:
criticized in research, amongst others, focusing on changing ideas of: inequalities in who becomes
Paul Russell Ward, incurable or curable, for example, during the HIV/AIDS epidemic (Schoepf, 2001; Nguyen, 2010),
Flinders University, Australia inclusion in clinical trials (Petryna, 2009), or due to genomic advancements (Inhorn and Wentzell,
Reviewed by: 2012); environmental, lifestyle and embodied (epigenetic) risks which have reconceptualised
Hannah Bradby, understandings of nature and nurture (Kavanagh and Broom, 1998; Lock, 2013; Gale et al., 2016),
Uppsala University, Sweden as “situated biologies” mean rethinking notion of bounded bodies in favor of how biology is affected
*Correspondence: by environment (Niewöhner and Lock, 2018); expectations and hopes of new biotechnologies and
Maria Berghs artificial intelligence that bring to the fore the way in which scientific advancements can politically
Maria.Berghs@dmu.ac.uk shape subjectivities, temporality, emotions and care (Brown and Michael, 2003; Brown, 2005; van
der Niet and Bleakley, 2020); “promissory futures” of biomedical and scientific innovations, such as
Specialty section: in the field of regenerative medicine, become correlated to neoliberal policy-making and economic
This article was submitted to investments (Brown et al., 2006; Selin, 2008; Morrison, 2012); novelty, for instance in epigenetics,
Medical Sociology,
becomes socially constructed (Pickersgill, 2020); clinical forecasting is relationally imbedded and
a section of the journal
negotiated in clinical practices (Timmermans and Stivers, 2018); and dealing with uncertainty of
Frontiers in Sociology
conditions with no cure, where instead experiments become perilous options for patients (Fox,
Received: 02 October 2020
2020). The above is just a sliver of the breadth and depth of knowledge built on a continuum of
Accepted: 11 December 2020
cures, but the very notion itself of “a cure” and how the concept is changing, is never explicitly
Published: 12 January 2021
questioned as such.
Citation:
Yet, as illustrated, just as comprehension of COVID-19 is marked by social understandings
Berghs M (2021) Who Gets Cured?
COVID-19 and Developing a Critical
of inequalities in infection, environment, prevention and intervention (Lupton and Willis,
Medical Sociology and Anthropology 2020; Trout and Kleinman, 2020), knowledge of cure is socially and culturally informed
of Cure. Front. Sociol. 5:613548. too. Public health pandemic responses to COVID-19 have focused on scaling up disease
doi: 10.3389/fsoc.2020.613548 prevention and control efforts, public health information, laboratory systems and development of

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Berghs COVID-19 and A Sociology and Anthropology of Cure

private and public partnerships to develop diagnostics, therapies, open up the door to legal, ethical, and social issues, such as
antiretrovirals and vaccines. Furthermore, critical social discrimination of those without vaccinations (Phelan, 2020).
commentaries have been noted in terms of ethics of access Further complicating notions of immunity and long-term
to: care; life-saving equipment like ventilators; therapies (e.g., cure, is that COVID-19 also has “impairment effects” (Thomas,
remdesivir); vaccines; as well as debunking the idea of recovery 2007) in creation of impairments (e.g., organs), affects senses
and immunity. (e.g., smell) and emotions (e.g., post-traumatic stress disorder)
Presently, with hopeful vaccines on the horizon (Horton, with physical and psycho-social long-term rehabilitative needs
2020), a “critical bioethics of cure” is developing, informed by (Halpin et al., 2020; Mandal et al., 2020). As such, Greenhalgh
differing ethical norms and values in society, associated to who et al. (2020) have noted the emergence of patients who have
gets access to vaccines and how they will be allocated (see, survived COVID-19 but whose clinical and mental health
Emanuel et al., 2020). For example, in the United Kingdom (UK), recovery is slow and long, noting that these patients are termed
the disability community has warned of overt discrimination in “long haulers.” New “biosocial” categories (Rabinow, 1996; Rose,
lack of ethical inclusion in pandemic preparedness and response 2009) of patients are thus emerging around social identities of
(Armitage and Nellums, 2020), “ableism” (Campbell, 2009) of uncertain survivorship from COVID-19, as we discover more
foregrounding of able body in withholding, triage or rationing of about how COVID-19 affects people (Kingstone et al., 2020;
care as cure, as well as warning of “social” deaths in our disablist Ladds et al., 2020; Miyake and Martin, 2020; Philip et al., 2020).
language use, and real deaths in revoking of rights in health While a sociology of diagnosis (Nettleton, 2006; Jutel, 2009)
and social care policies (Abrams and Abbott, 2020; Tidball et al., can be helpful to comprehend patient needs for a medical
2020). diagnosis, people with long COVID-19 struggle with the physical
Disability studies researchers, while long critical of the medical and mental health uncertainties of recovery and realization
model and curative imperative (Clare, 2017), are pointing to that there may only be a partial survivorship or indeterminate
an unethical “curation” or “social sorting” (Grover and Piggott, forms of cure (see Ladds et al., 2020). Similarly, there is no
2010) in how the able body now gets protection against certain prognosis or forecasting that can be made about the
an infection, access to critical care, therapies and vaccines future of how recovery from COVID-19 survivorship will unfold
(Scully, 2020), according to a new curative “imperative of alongside other conditions, and this influences treatment options
health” (Lupton, 1995) or distributed “logic” of cure (Mol, and experiences of primary care (Kingstone et al., 2020). The
2008). The logic of cure describes how an “imperative of cure” current medical emphasis is still on comprehension of the
becomes normalized in our social and cultural lives and is embodiment of curative processes and examining prognosis,
increasingly commodified but not distributed equally nor a treatment and responses to therapies, rehabilitation, mental
choice. Neoliberalism and promises of late modernity have been health support and how survivor experiences can become linked
incorporated in such a logic of cure, in terms of a “biopolitics to prevention efforts.
of cure” in how patients, doctors, researchers, pharmaceutical Attending to risks of COVID-19 and mitigating those through
companies and financial investors create momentum around policies such as lockdowns, means the indirect effects of who
specific infectious diseases, genetic disorders, chronic or does not get access to diagnosis, therapies and curative promises
neurological conditions and now in its acceleration for the in the NHS and whose health and impairment is ignored, has
general population during the COVID-19 pandemic. been neglected in research. As have the social realities of the
thousands of people who have been told to shield because they
are severely clinically vulnerable. We do not yet understand
the psychological and social impacts on this population group
RETHINKING CURE of long-term shielding and messages of “vulnerability” directed
toward them. They and their loved ones have had to deal with the
COVID-19 elicits a variety of human immune responses (e.g., idea that survivorship from COVID-19 may not be a possibility
acute, chronic, mild, and also uncertain recovery) that we do for them, as well as having heightened levels of risk to negotiate.
not yet understand, in both people who are seemingly healthy What has been the physical and psychological impact of such
or have pre-existing conditions. We know that that certain heightened risk work of staying well? There will also be people
sections of the population (e.g., linked to structural inequalities, within this group that will survive COVID-19 but we don’t know
ill-health, co-morbidities, age, disabilities and biology) are at if there is a continuum of mild, moderate and severe short or
greater risk from COVID-19 (Bentley, 2020). People who have long-term effects, nor if there are more curative possibilities that
COVID-19 can also be asymptomatic carriers (see Gandhi et al., will be created in the future?
2020), as well as possibly get reinfected after recovery, further
complicating our ideas of symptoms and signs, as well as
clinical and social understandings of how the virus spreads. PROMISSORY OR UNEQUAL FUTURES?
While patients recover, it does not seem as if immunity is
always long-term or sustained, calling into question ideas like Promising candidate vaccines and research initiatives have raised
giving survivors “immunity passports” (Andersson et al., 2020). local and global public hopes and expectations of promissory
Similarly, “vaccine certificates,” “identification cards” or “vaccine futures (Brown et al., 2006) of living COVID-19 free and
passports,” which while clinically and practically useful, could returning to a normal life. However, these hopes have been

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Berghs COVID-19 and A Sociology and Anthropology of Cure

tempered by clinicians, academics, scientists, and philanthropists setting curative agendas for equity, the realities of pandemic
involved in pandemic efforts noting the need for more long- preparedness mean that transnational partnerships can be
term research about effectiveness of vaccines (Horton, 2020). quashed for national interests. This points to the need to
For example, while the Pfizer/BioNTech, Sinovac and Moderna interrogate how “cure” functions and for which political and
mRNA candidate vaccines appear to offer initial effectiveness, economic interests. Philanthropic organizations have also paid
results have yet to be published scientifically and appraised less attention to the possible ramifications of the narrow
by national regulatory bodies (Horton, 2020), although the development for cures without correlated investments in care
UK has approved the Pfizer vaccine. Similarly, while the and social equity. By way of illustration, what is the point of
Oxford/AstraZeneca candidate vaccine has also reported high developing a cure for a neglected tropical disease, if you can still
rates of efficacy, dose errors meant more testing was needed. In get seriously ill because the basics of healthcare are neglected
addition, UK’s Royal Society The DELVE Initiative (2020) have (Berghs et al., 2020). Are there barriers in ethically interrogating
warned difficult medical, political, ethical, economic, cultural, or calling into account such inequalities in curative development?
gendered and social questions remain about vaccinations, such As such, this points to the importance of questioning definitions
as equitable allocation and their long-term effectiveness. of cures, trajectories of their development and by whom curative
The UK’s policy responses have been steeped in self-interested agendas get set during pandemics.
nationalism, for instance, by not engaging in European public-
private partnerships or research platforms and insisting on
British development of UK vaccine (Sharpe et al., 2020). Likewise, A RESEARCH AGENDA?
the UK’s public health arguments and pandemic responses
often emphasize individual civic responsibilities for the common To critically interrogate who gets cured, I argue that a new
good (e.g., to get tested or vaccinated) rather than broader interdisciplinary research agenda is needed that builds on
structural arguments about “affordability, resource allocations the theoretical tools that we have, to develop a medical
and accountability” that the government is responsible for sociology and anthropology of cure. Kavanagh and Broom
(Forman and Kohler, 2020). Very little policy attention has (1998) emphasized that if you wanted to understand intersection
also been paid to the need to rebuild trust nationally and between environmental and embodied risks, it was important to
internationally in government and health services, for instance, work together with people at “risk” to formulate new languages
due to impact of COVID-19 on ethnic minority communities for changed norms and values, as well as approaches to novel
and health care professionals, who are also most affected by environmental and socially embodied understandings. Similarly,
health inequalities, structural racism and history of medical a bioethics of cure could be an empirical-ethical theory that
mistreatment (Bentley, 2020). Surveys have reported that those could develop from the experiential knowledge of patients with
most affected by COVID-19, are more likely to report fears and COVID-19 undergoing diagnosis, therapies and experiencing
less likely to want to be the first ones allocated to participate in differing forms of cure (Caron-Flinterman et al., 2005) or
vaccination efforts (see Thorneloe et al., 2020). This also raises undertaking differing forms of “curative labor” (Cooper and
further questions about accessibility of vaccines, if there will be Waldby, 2014). Yet, we are all currently socially and culturally
multiple offers of vaccinations and if people can choose if they engaging with diverse materialities of cure in various settings.
want to be vaccinated or not, and with which vaccine? What There is an emotional and physical “curative labor” involved
types of choices will people have? Will those be constrained by in gaining expertise on immunity or using techonologies to
nationalism? This remains to be seen as the Pfizer vaccination stay “well,” keeping others healthy and negotiating curative risks
begins and the UK heralds itself as being the first in the world to of COVID-19 that we are all involved with. There are also
begin a mass vaccination campaign to protect against COVID-19. people who will be identified as having more potentialities or
While taking part in scientific research and trials for vaccines probabilities to be cured and others that refuse cure. Likewise,
has undoubtly opened new transnational ideas of curative many people are living in fear, shielding or bereaved and
citizenship (Rose, 2009), in the sense of acting for the common dealing with loss of curative hope and inequalities of cures.
global good to find a cure, access to vaccines seems bound to In a sociological sense, we have all gone through a biological
citizenship and not to ideas of social justice, racial equity or disruption (Bury, 1982) and are dealing with the reality of “no
biological or social needs. This is reinforced by therapeutic and cure” which has profoundly altered our worlds.
vaccine hoarding that certain nations in the Global North have Hacking (2006) stated that people would socially organize
been engaging in. For example, Trump trying to gain exclusive around new types of genetic risks, but I argue that new forms
access to a vaccine for the United States by buying up stocks of identity are emerging, not only in terms of pandemic risks
for national interests (see Dyer, 2020), rather than fulfilling the and cures but concerning novel immunotherapeutic and curative
potential and promises of collaborative academic and private- risks of anti-microbial resistance, potentials and dashed hopes
public partnerships for global equity, solidarity and rights to which are unsettling epistemologies and ontologies of how we
health (Forman and Kohler, 2020). understand biology, identity, embodiment and environment.
It’s important to interrogate how this could have happened? We have the tools to socially frame this new world together
While philanthropic organizations such as the Bill and Melinda with the people most affected, not only for the next pandemic
Gates Foundation and the Wellcome Trust have been involved but also with respect to novel developments in cure. We have
in setting up collaborative research platforms for cures and to engage in interdisciplinary work with epidemiology, public

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Berghs COVID-19 and A Sociology and Anthropology of Cure

health, science and technology studies, economics, disability curative interventions, such as gene editing or stem cell
studies, psychology, politics, ethics, law and so on, to understand donations? How do they understand their curative trajectory
the impact of the search, development, potentials and realities and identity post-cure? Does a biopolitics of cure develop?;
of agendas for accelerated searches for cures and their impacts. (6) Chart what future impact a growing field of cures would
We need to locate “cure” in pandemic preparedness but have on health and social care services for patients where
also wider scientific debates and biomedical and technological treatments are not an option, as well as disability activism
developments. What could “cure” now mean? and advocacy. How does cure become linked to time and
notions of “normality”? Does a focus on cure lead to ableism
in society and increase the imperative of health? Does this
A NEW SOCIOLOGY AND increase curative stigma?;
ANTHROPOLOGY OF CURE SHOULD: (7) Understand the norms and values of scientific involvement
in diagnosis, therapies and vaccines for cures and if those
(1) Investigate how conceptions of cure politically change are reflected by professionals working in development and
during pandemic responses and as a part of national and financing of cures. Does a research scientist view their work
international agendas of technological innovation. Why does as “curing”? Is that the same as the people who finance the
methodological nationalism but also the harsh policing cures or big philanthropic organizations?;
of national borders, for instance, happen during acerated (8) Learn what impacts cures have when viewed alongside
curative searches?; existing inequalities that affect patients in local and global
(2) Critically examine and question the local and global contexts. Are there unintended impacts of cure? What
inequalities in who gains access to care as cure and the role does artificial intelligence have in development of
(bio) ethical, social, financial, political, cultural and historical cures for patients or identification of patients who might
decisions that underpin such access. For example, who is need cures? How is accessibility to both testing for need
going to gain first access to a vaccine globally and what of cure and cure itself ensured ethically, in for example,
are the underpinnings of such policy decisions? What is personalized medicine?;
curative nationalism?; (9) Investigate how information in a local perspective on cure
(3) Understand the expectations, emotions, expertise and connects to broader transnational and transgenerational
embodied experiences of what it means to undergo cure as debates to explore the ethical, economic, political, legal and
patient, make sense of limitations of cure and/or lack of historical implications of cures and searches for vaccines. Are
cure. For instance, how does it feel to survive COVID-19 and new developments for cures connected to previous histories
realize that recovery may only be partial? What psychological and pandemics, for example, Ebola? How do people make
care and social support is needed?; sense of those pasts in the present? Why don’t we interrogate
(4) Frame the local realities of cure against broader transnational a logic of cure the same way we do care?
activism and global debates linked to research for cures
by focusing on how biological data is interpreted through AUTHOR CONTRIBUTIONS
kinship, gender, ethnicity and disability. What does it mean
to be part of an accelerated search for a cure, such as a The author confirms being the sole contributor of this work and
patient in a vaccine trial, and how do people understand their has approved it for publication.
involvement and how their biological data will be used?;
(5) Map what needs exist for patients and their families, ACKNOWLEDGMENTS
with respect to understanding new scientific developments
linked to diagnostics, therapies, vaccines and cures. What Thank-you to Professor Simon Dyson and Professor Nicky
information is needed by families who undergo latest Hudson for encouraging me to think about cure more broadly.

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Frontiers in Sociology | www.frontiersin.org 5 January 2021 | Volume 5 | Article 613548