LAUSR

The topic of epistemic injustice in global health ethics is complex, important and vast. While presenting as nuanced and complete a picture of the challenge as we possibly could, we were acutely aware of our positionality and how it gave us a certain viewpoint that would need to be expanded by others with different positions and experiences. We were, therefore, delighted to receive the collected commentaries by Atuire, Abimbola, FrimpongMansoh, Nyamnjoh and Ewuoso, Tangwa, Ambrogi et al. We would like to thank these authors for furthering our account by raising questions, pointing out gaps or complementing our analysis. The points raised by these authors— and many points that will undoubtedly be raised by others in future—should be critically engaged with as we collectively define and work towards a more epistemically just global health ethics. Specifically, two points stand out. First, FrimpongMansoh accurately diagnoses our ambiguity about being drawn into debates about relativism in bioethics. We drew on Atuire’s previous work on pluriversality; FrimpongMansoh proposes an intercultural ethics framework. While intercultural dialogues are commonly suggested as a process for determining what a pluriversal world looks like, what is not clear to us is whether and where the attempt to develop an authoritative, yet intercultural and global, ethics framework fits in a pluriversal world. As we understand it, the proposal for pluriversality rests on the idea that many worlds exist at once, which involves keeping all ideas (concepts, knowledges and ways of being) as they are. Yet in a more intercultural tradition, as in FrimpongMansoh’s proposal, the suggestion seems to be for ideas to be translated and blended to generate a new constellation of knowledge. Developing these ideas further, and interrogating their conceptual limitations and challenges, is integral to the work we proposed. However, efforts to address structural epistemic injustices need not rely on the resolution of this particular issue; many of the issues we outlined in our paper can be resolved even without addressing the important conceptual question FrimpongMansoh raises. Second, Nyamnjoh and Ewuoso remind us that any attempt at defining what it looks like to think and be from the South is a normative and political act in itself. They also warn us of the dangers of elite capture of the epistemic justice project. Tangwa, furthermore, reminds us that the academic freedom necessary to be critical in the way we were in our paper is a privilege that requires employment and security conditions that are more often guaranteed in the global North. Taken together, these commentaries raise deep questions about who defines what epistemic justice should look like in global health ethics and what roles different actors should play to get us there. For instance, what should the role of ethicists from different epistemic and geographic locations, be in attempts to define and reduce epistemic injustice in the field? Abimbola suggests that people from the South need to be able to ‘imagine themselves in the centre’; both Abimbola and Atuire suggest that what is required for epistemic justice is the ability of people and platforms in the South to address their own issues and concerns, in ways that bear some resonance with arguments for reparations for the damages inflicted by colonialism. While neither Atuire nor Abimbola uses that term, perhaps it would be useful to consider attempts at increasing epistemic justice in terms of repair or reparation. These reparations should enable scholars from the global South to create their own worlds, rather than helping them better fit into spaces created by the global North. One appealing recent contribution in this regard comes from Olúfẹ́mi Táíwò who presents reparations in the light of the active pursuit of justice, rather than simply doing the work of repair. One avenue of scholarly work could apply such thinking to global health ethics. Specifically, Abimbola refers to the importance of global South platforms for knowledge exchange, cultivation and curation; is it possible to think about the development of such platforms (that reach a critical mass) in terms of reparations as opposed to charity or philanthropy? And how would that change the way in which the many existing forms of exchange and collaboration already taking place in global health ethics, are shaped and executed? Finally, Ambrogi et al say ‘it’s time for all involved ... to embrace the notion of epistemic injustice’. The rich contributions by the various commentaries have clearly demonstrated that the work of achieving greater epistemic justice in global health bioethics, is work that involves the activism, scholarship and contributions of people around the world, and that work is only just beginning.