Access to healthcare in the age of CRISPR: an analysis of the right to heritable human genome editing in the context of the tuberculosis epidemic in South Africa.

Abstract

Tuberculosis (TB) is the leading cause of death from infectious diseases in South Africa and a major risk to global health security. Although notable progress has been made towards TB control, its effectiveness has been limited, partly due to acquired resistance during the first-line TB treatment or poor patient adherence to the treatment. Considering that genetic factors play an important role in one’s susceptibility to TB, it is imperative that all aspects of vertices of the TB triad — a susceptible host gene, pathogen, and environment — be considered in formulating treatment. CRISPR-CasX is a revolutionary new approach to genetic modification that promises effective disease treatment and control in humans. This thesis explores the right to heritable human genome editing in South Africa in the specific context of TB treatment. Against this backdrop is the uncertainty of the ambit of the Constitutional commitment to ensure that all South Africans have access to healthcare services such as gene-editing services. As a result, the application of gene-editing technology for TB treatment is contingent on how this the right of access to healthcare services is interpreted. This thesis endeavours to show how the right of access to healthcare should be interpreted as being inclusive of access to geneediting technology. This study hence serves as an appraisal for South Africans on how to demand access to gene-editing services as a legal right in the search for a suitable treatment for TB. The thesis also provides momentum for South African policymaking by providing recommendations for research and the clinical use of CRISPR therapeutics as a medicinal product as the country has no gene-editing-specific policies or statutes.