viruses to cure: the difficult development of a counter-intuitive biomedical innovation – anthropo-phages

This project aims to conduct interdisciplinary reflection on the therapeutic use of bacteriophage viruses (or phages) to treat human bacterial infections. Faced with the rise of antibiotic-resistant bacteria, considered by the World Health Organization (WHO) as one of the major public health challenges of the 21st century, phage therapy, developed in France 100 years ago and gradually forgotten in Western Europe and the United States, appears very promising. At a time when we are witnessing today a strong desire on the part of certain actors in the clinical, scientific and economic spheres to see it develop once again, the disappearance of phage therapy from healthcare provision for several decades in the West, and the multiple hostilities it is encountering today, confining it to a practice for compassionate use, should lead us to question such a situation. This project therefore aims to understand the history of the development of this therapy and the challenges it faces today, in order to better anticipate the conditions for its deployment.
This project is based on a strong hypothesis: phage therapy, the use of dynamic biological entities, involves conceptions of health, disease, care, but also relations between humans and environment that are different from those developed in the framework of 20th century biomedicine, which was mainly based on the use of chemical molecules. This specificity of phages crosses all the disciplinary corpus mobilized on health issues, and has repercussions at different levels of the production, evaluation and circulation of biomedical knowledge, constituting as many obstacles or blocking points to be analysed.
The project is organised in four themes, and is based on an interdisciplinary and comparative qualitative analysis. Its objective will thus be to draw up an inventory of phage therapy in Europe, and to deliver case studies mainly in France and Belgium, in order to analyse the interactions between knowledge production, regulation and phage appropriation or commodification logic.
The first theme, devoted to the scientific and medical history of phages, will notably make it possible to develop a conceptual analysis of the concept of precision medicine and what it involves in our conceptions of care, disease, human relations with microbes and the environment. The second theme, by focusing on the production of evidence in the field of Public Health, will analyse the links existing between regulation and the production of scientific knowledge on phages. This reflection will be all the richer as these viruses, due to ongoing regulatory changes, belong to two distinct legal categories (phages as drugs / as ingredients of a magistral preparation), which will make it possible to compare the two situations. The third theme will analyse the appropriation or commodification logic allowed by these different regulations, as well as their consequences on knowledge production. The last theme will be devoted to the uses of phages. The potential of phages makes them valuable elements in human health, but also in animal and environmental health. It will therefore be necessary to question the acceptability of their use, but also the possible social, cultural, political and environmental consequences of the generalisation of their uses. This project thus aims to study a biomedical innovation but also to renew the way we look at our relations with microbes, a sine qua non condition to face the public health challenges of the 21st century.