Gene therapies' uneven delivery: How systemic inequities in precision medicine deepen health disparities and who benefits from the 'revolution'

Indigenous healing systems prioritize holistic, community-centered approaches that address root causes of disease rather than targeting individual genes or cells. These traditions often use natural delivery mechanisms—like medicinal plants with specific affinities for organs or systems—that have been refined over generations. However, these systems are systematically devalued in favor of high-tech solutions, reinforcing colonial hierarchies of knowledge. The exclusion of indigenous perspectives in gene therapy discourse reflects a broader pattern of epistemicide, where traditional knowledge is erased in favor of Western biomedical dominance.

The history of medical innovation is riddled with examples of breakthroughs that were weaponized against marginalized groups, from the Tuskegee syphilis experiments to the forced sterilizations of Black and Indigenous women. Gene therapy has parallels in eugenics movements, where genetic manipulation was used to justify racial hierarchies and justify exclusionary healthcare policies. The current focus on 'precision' medicine echoes past eras where technological fixes were prioritized over systemic change, such as the mid-20th century push for vaccines without addressing sanitation or poverty.

In African traditional medicine, healers use complex formulations of plants and minerals to target specific organs or systems, often with fewer side effects than synthetic drugs. Traditional Chinese Medicine employs meridian theory to guide the delivery of treatments to precise locations in the body, a concept that predates Western notions of 'precision' by millennia. Ayurveda's use of 'rasayana' therapies—herbal compounds designed to rejuvenate specific tissues—offers a model for targeted delivery that is both sustainable and culturally grounded. These systems demonstrate that 'precision' does not require genetic manipulation, but rather a deep understanding of the body's interconnected systems.

Gene therapy delivery systems face significant scientific challenges, including immune responses to viral vectors, off-target effects, and the difficulty of targeting specific cell types without harming others. The scientific community is divided on the long-term safety of CRISPR-based therapies, with concerns about unintended genetic mutations and ecological impacts of gene-edited organisms. However, the focus on technical hurdles often overshadows the social and ethical dimensions of these technologies, such as who controls access to them and how they are deployed.

Artistic and spiritual traditions often frame healing as a process of reconnection—whether to the divine, the community, or the natural world—rather than a mechanical intervention. Indigenous and Afro-diasporic spiritual practices, such as Candomblé or Native American sweat lodges, use ritual and intention to 'deliver' healing energy to the body, challenging the Western biomedical model of intervention. These traditions highlight the role of the healer as a facilitator of balance, rather than a technician applying a treatment. The spiritual dimension of healing is often dismissed in mainstream narratives, which prioritize measurable outcomes over holistic well-being.

If gene therapies become widely accessible, they could exacerbate global health inequities, with wealthy nations and elites benefiting first while marginalized communities are left behind. Scenario modeling suggests that without systemic reforms, these therapies may become another tool for corporate control over health, with patents and high costs limiting access. Alternative futures could include community-owned biotech cooperatives that democratize access to gene therapies, or the integration of traditional and modern systems to create more equitable healthcare models. The long-term implications depend on whether these technologies are deployed within extractive or regenerative frameworks.

Marginalized communities—including Black, Indigenous, disabled, and low-income populations—are often excluded from clinical trials for gene therapies, leading to a lack of data on how these treatments affect them. Historical and ongoing medical racism means these groups are more likely to be subjected to experimental treatments without consent, as seen in cases like Henrietta Lacks. The focus on 'hard-to-target organs' ignores the fact that many marginalized populations lack access to basic healthcare, let alone cutting-edge therapies. Their voices are systematically excluded from shaping the narrative around gene therapy, reinforcing cycles of exclusion.