Op-Ed: Human Health Research, the Key to the Commercial Space Revolution

If one word can summarize the past five years of human spaceflight, it’s “commercialization.” The early 2020s have been defined by a dramatic shift in the way we think about space exploration, particularly as NASA moves beyond LEO to procure new capabilities for its groundbreaking Artemis program. In this time, a core tenet of NASA’s policy for the future has emerged: to enable an independent commercial economy in space, where recurring services drive continuous innovation and development. In this world, NASA is but one customer in a thriving space environment.

However, while many use cases have been proposed to support the space economy, only one combines a real, urgent need with the ability for immediate implementation: research into human health and performance in space. With commercial providers already turning their eyes towards this field, human research will drive early demand for people in orbit and accelerate our ambitions towards the Moon and beyond. The remainder of this decade will be formative for the space industry, and companies must seize upon the opportunity to cement themselves as key players in the years to come.

Commercial Promise

Springboarding off early successes like Commercial Orbital Transportation Services in the 2010s, commercialization is now the name of the game for NASA. The triumph of Commercial Crew heralded a new age for the agency, ending the United States’ domestic crewed launch gap at a fraction of the traditional cost. Since then, with the model proven, many major NASA projects now aim to leverage commercial capabilities, including Commercial Low Earth Orbit (LEO) Destinations (CLDs), Commercial Lunar Payload Services (CLPS), and commercial space suits under xEVAS.

But procuring cheaper and more diverse systems is not the only aim of commercialization. NASA has frequently stated its desire to stimulate the development of a commercial economy in space, where the agency is but one customer for myriad available services. In particular, Commercial Crew and CLDs are expressly intended to serve other players in LEO. However, it’s never been especially clear what these players would be doing.

Space tourism looms large in the public eye; Blue Origin and Virgin Galactic have a dozen commercial suborbital flights between them, but this doesn’t serve an especially large market. Orbital tourism purely for “sightseeing” has yet to meaningfully materialize (and don’t worry, we’ll come back to that qualifier).

Microgravity manufacturing is another avenue; earlier this year, Varda successfully landed its first W-1 manufacturing satellite after months of regulatory troubles. Products such as pharmaceuticals and fiber optics see benefits from being made in microgravity, and these could one day be imported en masse from LEO. The trick will be to find a niche with consistent and sufficient demand, and to scale production beyond the demonstration phase.

Even the CLPS program has delivered a few eccentric commercial payloads to the lunar surface. Still, besides the mere fact of their existence, the economic productivity of these items is effectively nonexistent.

So, there are plenty of potentially promising avenues for a company to create value in space. In a few decades’ time, any one of these might form the backbone of the new economy – or something totally unforeseen might take that prize instead. Still, in the near term, an economy cannot stand on promises of future breakthroughs, or simply hope for new customers to materialize out of the darkness. If a commercial space environment is to develop in earnest, it needs to ground itself with a market that can be served right now.

Luckily, the current anchor tenant in space has already sculpted the foothold these companies will need to establish themselves.

A Dire Need

Last month, I had the opportunity to attend NASA’s Human Research Program Investigators’ Workshop, held annually in Galveston, Texas. The event occupied several conference rooms in the Galveston Island Convention Center simultaneously, with multiple parallel sessions running during each block of its four-day schedule. The rooms covered a dizzying array of topics in human research, each hosting a rapid-fire series of presentations from researchers summarizing years of their lives’ work in a handful of minutes. Midday plenaries from such titans as Amit Kshatriya, Deputy Associate Administrator for NASA’s Moon to Mars Program, offered a brief respite from the chaos – and a chance to down a few cups of the event’s complimentary coffee.

The sheer diversity of topics on display was staggering. In one room, analogue missions to Antarctica provided critical insight into crew cohesion; in another, mice adapted to partial gravity in a centrifuge aboard the ISS; in another, deconditioned astronauts struggled through a docking simulation shortly after touchdown; in yet another, bed rest participants developed symptoms resembling the insidious spaceflight associated neuro-ocular syndrome. As I scrambled to keep up with my itinerary, I found a few key takeaways turning over in my mind.

The most immediately apparent: a wide range of spaceflight health effects haven’t even been discovered, let alone understood or mitigated with countermeasures. Microgravity disrupts the human body in the absolute, from fluid shifts to musculoskeletal unloading to sensorimotor scrambling to immune dysfunction. We are still deep in the exploratory phase of understanding what spaceflight really does to the human body over long periods of time. The more we learn, the more daunting appears the task of keeping crew healthy on longer missions to the Moon and Mars.

The next, which is closely linked to the previous: learning anything about human health in space is supremely challenging. Human-tended experiments come at an incredible premium, and space is, ironically, in short supply. On the International Space Station, every last minute of crew members’ time is precisely budgeted to maximize the data returned to researchers, and even this scarcely satisfies our thirst for information. Despite touted reductions in launch costs, actually getting research payloads into orbit is a suffocating bottleneck in our ability to understand human health in space.

In response to this barrier, a kaleidoscopic variety of analogue environments has arisen to approximate a few aspects of spaceflight at a time: isolation and confinement can be found in remote installations on earth, while head-down tilt tables and negative pressure devices can unnaturally shunt fluids around the body. Researchers are endlessly creative in their efforts to study spaceflight without leaving the ground. From the lucky few whose work made it to orbit, a running joke throughout the conference struck me: everyone wishes for a larger sample size; the textbook n=30 is an unthinkable luxury in space.

Another, more subtle detail caught my attention as the workshop progressed. Research projects like those at the IWS take years to plan and develop, and those that fly are booked far in advance. The lead time on projects is such that many presenters were only able to pitch their problem and describe their methodology, concluding with the news that the experiment was whirling over our heads at that very moment, or slated for delivery to the ISS later in the year. 

As the conference went on, all of these elements seemed to crystallize into a deep unease. A sense of looming dread silently permeated the event, particularly when researchers mentioned their plans for forward work. Between overflowing demand, extreme space limitations, and long lead times, many researchers are beginning to see a wall approaching on the horizon. For projects whose scope extends many years into the future, the ISS is already on borrowed time.

Changing Hands

The International Space Station has served as the premier laboratory in space for over twenty-five years, and until the recent rise of China’s Tiangong Space Station, has been the only permanent installation in space where long-duration microgravity research can be conducted. However, “permanent” is still a relative term, and NASA plans to decommission the aging ISS sometime after 2030. At the end of its useful lifetime, likely less than ten years from now, the station will be deorbited into the atmosphere, meeting its final resting place in a remote corner of the ocean.

The impending loss of our veteran laboratory weighs heavily on the spaceflight industry. The station has defined a generation of crewed space exploration, and the wealth of knowledge and practical benefit it has showered upon people all over the world cannot possibly be overstated. For many, the end of the ISS will be an emotional end to a great adventure. For the human research community, its loss feels more like a trap door, where decades of cutting-edge scientific capability will drop out from under them.

NASA’s plan to preserve the legacy of the ISS, naturally, is a commercial one: Commercial Low Earth Orbit (LEO) Destinations, or CLDs. The program is supporting the development of multiple commercial stations, which will ideally provide services to a variety of customers besides NASA. As commercial providers shoulder more of the cost and development associated with these platforms, the agency hopes to free its own resources towards its ambitions at the Moon and beyond. All of this is fairly textbook rhetoric about the benefits of space commercialization, but the premise, at least, seems sound.

In practice, the execution of the program – its awards, the distribution of funding, the feasibility of its timelines – is more suspect, though I will not be analyzing the state of CLDs here. Suffice it to say, the program is of critical importance to the future of human spaceflight. NASA has suffered long and painful gaps in capability before, and if it hopes to avoid another massive step backwards, an assured transition to CLDs should be of the utmost priority.

NASA has currently partnered with three organizations for CLDs: Axiom Space, which is developing Axiom Station using the ISS as a construction platform, Blue Origin, which has partnered with Sierra Space and others to develop Orbital Reef, and Nanoracks, now part of the Voyager Space consortium developing Starlab.

One of the plenaries at the Investigator’s Workshop in Galveston was a panel on commercialization, hosting representatives from seven commercial companies interested in supporting human health research in space. Four of the speakers represented a CLD provider: Liz Warren of Blue Origin, Tom Marshburn of Sierra Space, Lucie Low of Axiom Space, and Emily Griffin of Zin Technologies, a member of the Voyager Space team.

Intriguingly, however, the remaining three speakers were not aligned with the CLD program as of writing: Kathleen Karika of Virgin Galactic, Dana Levin of Vast, and Marissa Rosenberg of SpaceX. While these companies are not part of NASA’s primary push for commercial stations, each of them are independently pursuing their own avenues for supporting health research in space. Virgin Galactic has flown several research payloads on suborbital missions aboard its SpaceShipTwo vehicle, Vast is working to develop stations that can provide rotating artificial gravity, and SpaceX has flown experiments to LEO aboard its Crew Dragon spacecraft.

Space stations, it seems, are not the full story; of these latter three companies, only Vast is planning to build one. Although a large, dedicated laboratory is certainly a necessity to preserve our current capabilities, providers like SpaceX and Virgin Galactic have demonstrated that human research need not require a full space station, or even an orbital vehicle. All seven of the panels’ guests described the unique accommodations for human health and performance research that their company provides or plans to provide in the near future, discussing their volume, equipment, and expected mission durations. Even outside the CLD program, commercial research services in space are already taking shape – more so than might be readily apparent.

Seizing Opportunity

The chair of the IWS commercialization panel, Jancy McPhee, provided opening remarks about the future of human research in space. NASA’s vision, she asserted, is striking: that every human who flies to space should have opportunities to participate in human health & performance research. McPhee emphasized that there is already a remarkable precedent of human research in commercial spaceflight, and nearly all crewed missions have included some form of research payload to date.

Although private spaceflight missions are often construed as “tourism,” this is not a wholly accurate assessment. While passengers may wish to spend most of their time at the windows, the presence of research payloads requires crew to take on a more involved responsibility in completing mission tasks. Even the high-profile Inspiration4 mission, which advertised a public competition for seats during the Super Bowl in 2021, carried research payloads, claiming on its website to have maximized the payload mass available for this goal. All told, tourism alone has not been enough to spur development in space.

Reporting for Space Policy Online, Marcia Smith offered similar insights from the FAA’s 26th annual Commercial Space Transportation Conference. NASA has sponsored several private astronaut missions to the ISS; to date, these have been flown entirely by Axiom Space, but recent player Vast has expressed interest in bidding on future flights. NASA’s Angela Hart, manager of the Commercial LEO Program Office, expressed the agency’s surprise that the market for these missions has yet to swing in favor of tourism. Instead, as Marcia noted, companies have thus far sought to perform “meaningful work” in space. Science, not sightseeing, is drawing the commercial sector, and the industry is planning accordingly.

The gears are already in motion. As new capabilities come online in the next few years, they will arrive in an industry that is already desperate for additional research capacity. While NASA seeks to create a smooth transition from the ISS to CLDs and other providers, the reality might look more like an overflow effect, as demand already far exceeds the current supply for crew-tended experiments in orbit. The first platform to provide ISS-like laboratory capability, and to catch the attention of the research community, will find itself inundated with interest.

Multiple companies are now advertising their product as the first commercial space station. Even still, the need for research in space is so vast that it’s hard to imagine any one company monopolizing the field. More than just undergoing a transfer of power, the commercialization of human research in LEO is poised to experience runaway expansion – if providers can harness the rising tide.

A Snowball Effect

It’s clear that there exists both a dire need and an emergent capability for conducting human research in space, beyond the capacity already provided by the ISS. These threads alone make a compelling use case for early commercialization in LEO. However, there is one additional layer here that cements human health and performance as a true “killer app,” with the potential to revolutionize the LEO landscape and grow exponentially in the coming years.

The first half of this point: human research needs people in space. Human-tended experiments exist on the ISS today, but many can still be left to their own devices for long periods of time. Indeed, some commercial destinations are planning for a partially-crewed timeline, where astronaut visits are few and far between. But human health and performance research is different: a person is not a piece of hardware which can be left alone on a payload rack. When humans themselves are the subjects of investigation, the experiment uniquely requires people living in microgravity for extended periods of time, monitoring their health and testing countermeasures.

Where some payloads might operate on small, autonomous platforms, humans require more infrastructure to support them. People in space require crew transportation, extending the role of vehicles like SpaceX’s Crew Dragon and Boeing’s Starliner and increasing the demand for these services. People in space also demand frequent cargo resupply, encouraging the continued use of freighters like Northrop Grumman’s Cygnus and Sierra Space’s Dream Chaser. As multiple destinations come online, the load on each of these vehicles will increase beyond their current status in the ISS program, as will the scope of operations and logistics needed to support these missions.

Furthermore, our understanding of spaceflight health effects is limited by barriers to sample composition. While astronaut corps are gradually becoming more reflective of humanity as a whole, there is still a dearth of information on how diverse populations experience spaceflight. The first African-American astronaut to spend a full, six-month expedition aboard the ISS was Victor Glover, who was part of Expeditions 64 and 65 from 2020 to 2021 – barely four years ago. Space exploration is often tied to grand visions of a future in which spaceflight is utterly pedestrian, where hundreds, thousands, or even millions of people may one day live and work beyond Earth. Accomplishing these goals requires a thorough understanding of how all humans are impacted by life outside our home, and expanding the total population of people who have flown to space will only deepen our knowledge.

The second half of this point, the keystone that closes the loop, is this: just as conducting human research needs more people in space, more people in space will require further human research. As our presence beyond Earth grows, humans will begin to encounter new environments besides microgravity, from the partial gravity of the Moon to the rotating artificial gravity envisioned for future stations. Furthermore, large populations will eventually experience bottlenecks in resupply missions for food, clothing, and other consumables. This places an impetus on commercial providers to seek out the same closed-loop solutions that will enable years-long missions to Mars and beyond. All the while, the need for human-in-the-loop testing of new systems will continue to increase.

An interesting case study can be seen in Axiom Space. While Axiom is a relatively new player in the space industry, it is hardly wanting in experience. As previously mentioned, Axiom has flown several private astronaut missions to the ISS, which have directly informed human spaceflight operations for its own upcoming space station. Under NASA’s xEVAS contract, Axiom is also developing space suits for the lunar surface to support the first few Artemis missions. Whereas LEO is a well-understood environment, the Moon is a place where groundbreaking work will be needed to improve on heritage designs. Finally, just a few weeks ago, Axiom was revealed to be part of the Astrolab-led FLEX team developing an unpressurized rover for the Artemis program. Predictably, their focus lies on the astronaut side, developing interfaces and studying human systems integration to ensure the rover is ergonomic for suited astronauts.

Companies like Axiom have an opportunity to “double-dip” in the research sphere. Under the terms of these contracts, NASA has given Axiom and other providers access to its own extensive research on projects like the xEMU, as well as the opportunity to use government-funded test infrastructure. So, while these companies are currently receiving funding to develop services for the space environment, they are also gaining crucial experience working with human systems, which they can then turn around and apply to the rest of their portfolio. The process of developing space stations, moon rovers, space suits, and more will build a commercial knowledge base in bioastronautics, while incentivizing providers to pursue further research services to meet their own needs.

Ultimately, the human element is the single biggest obstacle to long-duration spaceflight in the future. Developing orbital stations for hundreds of people, building villages on the lunar surface, and sending our first emissaries to Mars will require multiple giant leaps in our understanding of human health and performance in space. On our current trajectory, ambitious projects like these will carry commercial partners along for the ride, and companies can secure their place right now by supporting research in this field.

Closing Thoughts

A self-sufficient commercial economy which exports value to Earth is an enticing dream, and an endless stream of ideas have been put forth about the nature of that value. But in the near term, companies don’t need to invent new use cases for a human presence in LEO. The need for additional human research capability in space is already overwhelming our current resources, and the impending retirement of the ISS places an urgent deadline on the launch of new platforms. Commercial companies recognize the importance of this capability, and have already begun to court the research community with a diverse array of new capabilities.

This is not to say that human health & performance research should be pursued at the expense of other promising “killer apps.” Other viable use cases may prove themselves in time, be they tourism, manufacturing, pharmaceuticals, or something else entirely. However, human health research is a real and present need which can be leveraged right now to develop the infrastructure needed to support these promising future pathways. And in the meantime, human health research consistently provides benefits to those of us down on Earth, bolstering the case for this fledgling economy.

Ultimately, the fundamental purpose of space exploration is to expand our knowledge about the universe, and to improve life on Earth as we go. Rather than attempting to chart their own new and unproven course, commercial players in space in the coming years may instead find themselves closely aligned with NASA’s exploration goals, supporting the breakthrough research needed for us to take our next steps into the cosmos.

Edited by Scarlet Dominik