The increasing convergence of neuroscience, engineering, materials science, and emerging technologies, such as artificial intelligence (AI), robotics, extended reality, and so on, has given rise to a novel technology frontier called neurotechnology. Once dismissed as the stuff of fiction, cutting-edge invasive and noninvasive neurotechnology is now becoming the reality of our time. Significantly intertwined with advancements in AI, machine learning, and deep learning, neurotechnology holds tremendous promise for research and practice. From brain imaging devices that have transformed our understanding of brain structures and functions to neuromodulation and neurostimulation devices that improve the quality of life of people with brain disorders, neurotechnology is revolutionizing our perceptions of the brain and nervous system. It is also becoming a booming industry with growing private and public investments in direct-to-consumer neurotechnologies [1]. This is owing to a number of factors, including the increasing prevalence of brain diseases and the increasing integration of innovation into biomedical research and practice.

In the last decade, many countries and regions have recognized the need for a maintained public investment in brain research as a priority. Some of the publicly funded large-scale brain research projects include the US Brain Initiative (US $3 billion), the EU Human Brain Project (€607 million), China Brain Project (US $746 million), Japan BRAIN/MINDS (US $365,163,41), Australian Brain Alliance (US $500 million), Canadian Brain Research Strategy (US $250.3 million), and Korea Brain Initiative (US $1.2 billion) [2]. These projects and the emerging landscape of public and private funding opportunities have created a global ecosystem where countries in Africa and other developing countries in the Global South are being left behind in brain research and innovation. Public funding for neuroscience research and innovation is almost nonexistent in Africa [3]. Neurotechnology research and innovation are practically being developed in select countries in North America, Europe, and Asia. These are tech devices that are currently being introduced in African contexts and to African consumers. However, as it has been identified in other emerging technologies, such as AI, technology is developed with a specific context in mind and reflects the dynamics of that context. The use of the technology beyond the context it was created for raises concerns, including bias and discrimination. This means that the use of neurotechnology devices in Africa holds potential ethical and legal risks to both individuals and society.

As this technology expands, neuroethics and ethics of emerging technology scholars are bringing attention to the critical concerns it raises [4-6]. These concerns are generally not new, but uniquely amplified by the novelty of technology. They include issues around privacy, rights, human identity, autonomy, and safety. Many of these are already part of the ethics of emerging technology discourse, particularly AI ethics. The unique risks this technology raises have led to calls for adequate regulatory oversight. Global discussions in this regard have gained momentum in the last decade with a focus on ensuring responsible and equitable design and deployment of this disruptive technology. Intergovernmental bodies, such as the Organization for Economic Cooperation and Development (OECD), UNESCO (United Nations Educational, Scientific and Cultural Organization), and the Council of Europe, are playing major roles in this regard. Chile has become the first country to implement legal measures that address the risks of neurotechnologies [7]. The Chilean constitution was recently amended to legally protect citizen’s mental privacy and free will.

However, as more and more countries discuss the ethics and governance of neurotechnology, there is an obvious lack of regulatory oversight and a dearth of literature on the consideration of contextual ethical principles in the design and application of neurotechnology in Africa. This scenario parallels the historical developments within the field of AI and Africa. In order to circumvent the replication of past errors, this study aims to delineate and address these pitfalls through an in-depth examination and analysis of lessons to be learned. This paper highlights prospective insights that the domain of neurotechnology ethics and governance in Africa may derive from the extant body of literature on responsible AI. Stakeholders, such as neurotechnology developers, policy makers, and academic researchers, stand to gain valuable perspectives from these insights. The resultant impact is anticipated to contribute significantly to the responsible design and implementation of neurotechnology devices in Africa. This encompasses the establishment of robust policies and regulations, as well as the provision of guidance for academic discourse within this domain. This paper starts by providing a conceptual clarification of neurotechnology. Then it discusses why Africa should care about neurotechnology and what responsible neurotechnology will mean for Africa. Lessons are then drawn from the available literature. It is important to note that African societies are not considered as monolithic. However, Africa is taken as a continent with common sociocultural values and challenges relevant to the ethics and governance of neurotechnology.

The human brain remains the most complex organ in the human body largely due to its intricate structure and its central role in coordinating all functions and activities of the body. There are many factors that contribute to this exceptional complexity, including its adaptability and plasticity, cognitive abilities, neural network, sensory processing capabilities, motor control, homeostasis, consciousness, genetic complexity, metabolic demand, multilayered structure, and infinite variability. According to Jorgenson et al [8], the goal of comprehensively understanding all these factors “remains elusive, although not from a lack of collective drive or intellectual curiosity on the part of researchers. Rather, progress frequently has been limited by the technologies available during any given era.” Neurotechnology has emerged to provide a greater understanding of the brain and offer solutions to previously understudied brain disorders.

UNESCO defines neurotechnology as a “field of devices and procedures used to access, monitor, investigate, assess, manipulate, or emulate the structure and function of the neural systems of animals or human beings” [9]. It involves the application of engineering principles to the “understanding, engagement, and repair of the human nervous system” [10]. Neurotechnology refers to a set of technologies, rather than a specific technology, that enables direct connection or interface between technical components with the nervous system [4,11]. This interaction with the brain and nervous system raises a variety of ethical and legal risks, necessitating the discussion of the ethics of neurotechnology.

The importance of ethics in neurotechnology is demonstrated in UNESCO’s call for solid governance of neurotechnology design and deployment at the last international conference on the ethics of neurotechnology on the theme “Towards an Ethical Framework in the Protection and Promotion of Human Rights and Fundamental Freedoms” [12]. From noninvasive technologies used to study the brain to wearable or implantable devices, neurotechnology is opening new possibilities to study the nervous system and help diagnose, treat, and prevent brain-related diseases [1,13]. These technologies are currently being developed for diverse uses in clinical and research settings, as well as for everyday life, workplace well-being, and education. In research, the development of neurosensing technologies, such as magnetic resonance imaging (MRI), functional MRI, electroencephalography, magnetoencephalography, positron emission tomography, functional near-infrared spectroscopy, single-photon emission computed tomography, biomarker analysis tools, and invasive intracranial electrodes, has been transformative for studying the brain. These technologies are fundamental for advancing the understanding of the brain because they provide valuable insights into brain function, neurophysiology, and neurological disorders.

Beyond neurosensing, neurotechnology is also being developed for other purposes, including neurostimulation, neuroprostheses, and neurorehabilitation. Neurostimulation technological devices have shown potential in trials to provide therapeutic relief for a number of brain-related disorders, such as epilepsy [14], chronic pain [15], Parkinson disease (Schuepbach et al [16]), obsessive-compulsive disorder [17], depression [18], addiction disorders [19], spinal cord injuries [20], and Tourette syndrome [21]. Neurotechnology encompasses invasive and noninvasive devices that serve as motor [22] or sensory [23] neuroprostheses. These devices work by connecting to or bypassing any damaged neural pathways to restore function or enhance communication in people with stroke [24], spinal cord injuries [25], amyotrophic lateral sclerosis [26], cerebral palsy [27], and traumatic brain injuries [28]. When these technologies are designed to help individuals regain lost functional abilities, improve their quality of life, and promote independence, it is called neurorehabilitation [29]. These include noninvasive brain-machine interfaces for patients with stroke [30] to noninvasive interfaces, such as brain-actuated robotic devices designed to restore the independence of people experiencing severe motor disabilities [31].

Indeed, there is an emerging and thriving neurotechnology industry; an industry that reached a market value of US $11.3 billion in 2021 and is projected to exceed US $24.2 billion in 2027, with an estimated annual growth rate of 14.4% [32]. According to a recent UNESCO report, “the United States emerges as the main place where neurotechnology-related innovations are generated (47% of worldwide IP5 patent applications in neurotechnology), followed by Korea (11%), China (10%), Japan (7%), Germany (7%), and France (5%)” [1]. It is further revealed that out of 1400 identified neurotechnology companies, 50% are based in the United States, 35% in Europe and the United Kingdom, and the rest in Asia [1]. These figures are not surprising, given the level of public funding that brain research and innovation are receiving in the Global North. While investments in neurosensing, neurostimulation, neuroprostheses, and neurorehabilitation are different in size, volume, and level of maturity (neurosensing being the most mature and with the highest investments), there are exponential increases in all aspects of neurotechnology.

Globally, the burden of neurological disorders has increased significantly over the past 2 decades, with a significant increase in mortality (36.7%) and disability (7.4%) rates [33]. There is also evidence from literature to show that there is a large geographical variation in the burden of these disorders [33-37]. There is consistent evidence that there is an increasing prevalence of neurological diseases in Africa, putting huge burdens on public health systems [38-40]. Some of these brain-related diseases include stroke, dementia, Parkinson disease, epilepsy, migraine, medication overuse headache, motor neuron disease, cerebral palsy, brain development disorders, peripheral neuropathy, trauma, alcohol-related brain damage, nervous system complications of HIV/AIDS, brain and nervous system cancers, and multiple sclerosis. It also includes psychiatric disorders and mental health diseases, such as depression, anxiety, schizophrenia, psychosis, bipolar, stress, and other behavioral disorders [41,42]. Many of these are preventable (eg, some developmental disorders and strokes) and others are possibly treatable with novel technologies and therapies.

Silberberg and Katabira [43] believe that the increasing prevalence and burden are the results of factors such as “adverse perinatal conditions, malaria, HIV/AIDS and other causes of encephalitis and meningitis, demographic transitions, increased vehicular traffic, and persistent regional conflicts.” In addition to these, there are other factors that increase the impact of neurological disorders in Africa, such as sociocultural and religious beliefs, stigma and discrimination, lack of quality therapies or treatment, and the absence of organized public sector response [40]. Neurological disorders are often neglected or comprehensively ignored in most African societies [44]. Patients in Africa face challenges related to a lack of health care infrastructure and access to specialized services. Many strongly believe that there is no available treatment or therapy for neurological disorders.

Neurotechnology provides hope to African societies struggling with the burden of neurological disorders. It can help bridge the gap in access to neurological care in many underserved communities. They can help with early diagnosis through advanced neuroimaging and diagnostic tools (eg, portable and low-cost electroencephalography machines). Neurorehabilitation tools, such as virtual reality–based therapies [45,46], functional electrical stimulation [47], and telerehabilitation platforms [48], can provide patients access to rehabilitation services in areas with a lack of resources for therapy. A number of neurostimulation devices may possibly provide effective treatment options for patients with epilepsy, while remote computer-based therapies offer possible relief for a number of brain diseases. There are potentially significant opportunities for neurotechnology to have a positive impact on neurological diagnosis, treatment, and rehabilitation in Africa. However, challenges related to cost and infrastructure remain and will need to be overcome.

In addition to clinical support, neurotechnology can also strengthen research in Africa to better understand the epidemiology of neurological disorders, and factors contributing to their prevalence in Africa, as well as improve the global knowledge of the human brain and nervous system. The introduction of neuroimaging data, generated and processed in Africa, can contribute immensely to the global understanding of the brain and its diseases given the genetic diversity in the continent. It implies that brain diseases plaguing the African population will be better understood, raising the likelihood of developing suitable therapies for them. Neurotechnology can also be applied in marketing and consumer research in Africa, especially in the emerging field of neuromarketing. From product testing, pricing, and value perception to emotion analysis and branding, neurotechnology can help companies understand and influence consumer behavior, preferences, and decision-making. Although far-fetched, this can help African businesses to become more competitive in the global market.

Despite the abovementioned potential benefits of neurotechnology, there are also many good reasons for Africa to prioritize other goals and issues, such as cleaning and sanitation, food security, housing and shelter, education, and access to basic health care. This is a valid argument, and governments need to focus more on these basic needs. However, it is important to note that as a technology, neurotechnology is pervasive, becoming increasingly widespread and influential across various aspects of society. While most of these technologies are being developed outside of Africa, they will be used in Africa. In today’s interconnected world, neurotechnologies can spread rapidly across borders through various channels, such as trade, investment, collaboration, and intellectual property agreements. Therefore, the pervasive and ubiquitous nature of this technology makes it hard to neglect.

Furthermore, as UNESCO [12] has observed, the application of neurotechnology triggers a number of critical ethical and legal considerations, including, but not limited to, autonomy, privacy, mental integrity, human dignity, personal identity, and freedom of thought. Given the African sociocultural context and possibilities of using this technology for enhancement, it also raises fundamental questions related to personhood with profound implications for individuals and societies at large. There are also issues around benefit sharing, digital divide, and accessibility and safety concerns. These concerns are amplified by the fact that current neurotechnological systems are being developed with limited data from Africa without consideration of African sociocultural values and principles. For instance, a brain-computer interface that decodes continuous language from noninvasive recordings would have many useful scientific and practical applications [49], but it raises fundamental questions about the privacy of brain data. In a study that in part relies on an AI transformer model, Tang et al [49] claim to have used functional MRI to produce texts of participants’ imagined thoughts. The implications this has on privacy are novel and immensely significant in the face of an evident lack of governance mechanisms to ensure that these technologies are designed in an ethically responsible, socially acceptable, and legally compliant way. But what should responsible neurotechnology for Africa look like?

Like other emerging technologies, neurotechnology raises crucial ethical and legal challenges. However, there remains a dearth of policy frameworks and regulations to ensure the development of responsible and trustworthy neurotechnology. During the UNESCO conference on ethics of neurotechnology in Paris on July 13, 2023, participants agreed on the need for a comprehensive governance framework to harness the potential of neurotechnology and address the evident risks it presents to societies. Speaking at the conference, the Assistant Director-General for Social and Human Sciences of UNESCO declared that “…we must act now to ensure it is not misused and does not threaten our societies and democracies” [12]. In the absence of national, regional, and international principles, policies, and governance mechanisms for neurotechnology, the OECD adopted a set of recommendations on responsible innovation in neurotechnology in 2019 [50]. This is the first attempt to set an international standard that aims to guide government agencies as well as innovators to address the ethical, legal, and social challenges that neurotechnology raises. Principles encompassed in the OECD recommendation are promoting responsible innovation, prioritizing safety assessment, promoting inclusivity, fostering scientific collaboration, enabling societal deliberation, enabling capacity of oversight and advisory bodies, safeguarding personal brain data and other information, promoting cultures of stewardship and trust across the public and private sector, and anticipating and monitoring potential unintended use or misuse. While this instrument does not constitute an international treaty, it covers critical challenges and opportunities for better innovation practices through responsibility-by-design approaches. Such a governance approach is needed to protect and promote human rights and fundamental freedoms. It is an approach that requires the integration of relevant values and principles that reflects the contexts within which the technology will be applied.

So far, the discussion on ethics and governance of neurotechnology has neglected narratives, values, principles, and contexts in Africa. African datasets that can inform the design of neurotechnological systems are currently missing from available open-access platforms. Potentially, therefore, neurotechnology devices are being designed without relevant data from Africa, and the field of neuroscience and neurotechnology remains largely dominated by countries in the Global North. The question then is can responsible neurotechnology be achieved in Africa without African values, principles, data, and experts? Neurotechnology cannot be designed and developed in and for Africa without Africans, their data, and without considerations of African sociocultural contexts, needs, expectations, values, and principles. The current debate on ethics and governance of neurotechnology has taken a similar turn that AI ethics took. Therefore, as UNESCO moves to develop a global normative instrument and ethical framework similar to UNESCO’s Recommendation on the Ethics of AI, it is important for policy makers, innovators, and civil society groups to consider these lessons from AI ethics.

Neurotechnology and AI share some similarities and differences. It is common knowledge that artificial neural networks draw inspiration from the brain structure and function because they are designed with interconnected nodes that loosely mimic how brain neurons interact [51]. Both AI and neurotechnology also involve some forms of learning and adaptation. Similarly, they both have uses in health care. However, there are differences in implementation, complexity, and function. For instance, AI uses chips and programmed algorithms, and is based on mathematical models, while neurotechnology often interacts directly with biological systems (brains and nervous systems).

Brains use biological neurons with complex chemical interactions, while AI uses silicon chips and programmed algorithms. The implication of these differences and similarities is that both AI and neurotechnology share common aims and challenges, but they also demand distinct approaches, methodologies, and considerations. The convergence of the 2 can potentially lead to breakthroughs in understanding the brain as well as both biological and AI, ultimately providing benefits for society. However, attention must be paid to the risks they raise for which the discourse on ethical considerations of AI is more advanced than in neurotechnology.

In general, neurotechnology can learn valuable lessons from the evolving field of AI ethics and governance to ensure responsible design, development, and deployment. AI ethics debates highlight the need for transparency and explainability in disruptive technological systems to build trust and accountability. Fairness, equity, responsibility, justice, and autonomy are central to AI ethics. These are principles neurotechnology innovators and policy makers need to adopt to ensure that societal needs and contexts are prioritized.

In addition to these, there are also unique lessons for relevant stakeholders designing, developing, and using neurotechnology in and for Africa. These include innovators, neurotechnology industry players, users, and policy makers.

This paper makes an argument that neurotechnology is no longer a future technology; it is here and is now available not only for clinical research and practice but also to consumers. It is revolutionizing our understanding of the brain and its diseases; providing much needed therapies for a wide range of patients are increasingly used in direct-to-consumer products. Some of these technological devices are being designed in and for Africa [92]. However, the rapid advancement of this technology raises serious risks concerning safety, privacy, human rights, digital divide, bias, and discrimination. With evident weak or nonexistent ethical and regulatory institutions capable of ensuring responsible development and use in Africa, individuals and the society at large face serious risks. Without putting Africans and their needs, interests, values, principles, contexts, data, and expectations into consideration in its design and governance, neurotechnology risks discriminating against Africans as well as jeopardizing the privacy and safety of citizens. This is similar to what is happening in the field of AI. Stakeholders, including policy makers, innovators, and users, can learn the above lessons from AI ethics and governance to ensure that proactive actions are instituted to mitigate against the risks neurotechnology presents to Africans. These lessons need to be taken into consideration as public debates and governance mechanisms for neurotechnology are shaped in Africa. Proactivity and collaboration are the key to being responsive to the demands of mitigating the risks this technology poses. Researchers and scientists working in Africa also need to focus on providing evidence-based insights that can inform policy and practice. This includes consistently providing users and citizens in general with the awareness of the benefits and risks of neurotechnology, which is becoming the new and disruptive technology frontier.