Abstract

Global ignorance about Africa continues to sustain inappropriate global interventions to resolve public health crises, often with disastrous consequences. To explain why this continues to happen, I marshal two theorems that predict basic statistical properties, called ‘the doctrinal paradox’ and ‘the discursive dilemma’, which underlie scientific consensus formation and evidence-based decision making on a global scale. These mathematical results illuminate the epistemic and material injustices committed by the protocols of medical research conducted at the highest level of global knowledge production in the service of international humanitarian aid for Africans. These social choice theorems reveal that a global scientific consensus projecting claims and proposing policies about Africa’s disease burden is likely to yield a low degree of reliability, in that the probability of its accuracy is less than chance. The solution to this anomaly is to remove from the global scientific agenda the statistically unrealisable demand of satisfying too many multinational corporate and foreign governments’ priorities as equally entitled to benefit from the knowledge produced to improve Africa’s public health sector. Instead, foreign funding targeted to support medical science and policy in Africa should be directed by those specialists in situ who are most familiar with their own national health challenges and potential solutions, rather than relying upon foreign decision makers to interpret Africa’s emergency public health care needs. Keywords Doctrinal paradox, discursive dilemma, scientific consensus, epistemic trust, global health ethics, group agency