The experimentality of real-world evidence studies: Turning a population into value

In January 2021, Israel signed an agreement with pharmaceutical company Pfizer guaranteeing the speedy delivery of vaccines. In exchange, Israel committed to collecting and analyzing medical statistics about the effectiveness of the vaccines and its side effects, while sharing those results with Pfizer. Fundamental to this collaboration was the collection and analysis of “Real-World Data” (RWD), which refer to routinely collected data relating to patients’ health and the delivery of healthcare originating from a range of sources other than traditional clinical trials. Drawing on policy and epidemiological document analysis as well as semi-structured interviews with Israeli public health officials and policy-makers involved in the management of the COVID-19 pandemic, we unfold the role of digital surveillance systems, public healthcare services and particular state politics characterized by strong executive powers in enabling the Israel-Pfizer collaboration. More broadly, these insights shed light on practices and logics underpinning clinical studies drawing on RWD. Such studies examplify an experimentality by data assetization, whereby RWD are turned into valuable assets, which are made available by healthcare organizations to third parties in exchange for revenue. We discuss the implications of such experimentality, which gambles with citizens’ trust in public institutions, while capitalizing on the vulnerability of such populations, as they become research subjects—most of the time without their awareness or consent. We conclude by highlighting the role of public health ethics in creating conditons favorable for such experimentality.