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Preparing Civilians to Travel, Live,
and Work in Space: A Human Research Agenda
Michael Marge1,2
1
CSF/MITRE Workshop Summary Report, Commercial Spaceflight
Federation, Washington, DC, USA.
2
Research Professor, SUNY Upstate Medical University,
Millersville, Maryland, USA.
ABSTRACT
The prospect of thousands—perhaps even millions—of civilians
traveling, living, and working in space in the coming decades
requires a collaborative human research program (HRP) to ensure
their health and safety. After a substantial review of the literature
on the health of civilians in space, it was found that little is known
about the impact of the space environment on health and safety
of civilians, many with underlying health conditions and disabilities. To address this gap, the author and the Commercial
Spaceflight Federation (CSF) decided to conduct a workshop on
developing an HRP to study the impact of the space environment
on the health and safety of average civilians in the commercialization of space. With the cooperation of experts in health research in space, a Workshop Planning Committee was created. The
committee included experts from CSF, the space industry, government, and academia to develop the first ever HRP for civilians
in the commercialization of space. The CSF/MITRE workshop was
conducted on May 11–12, 2021, with *100 participants. Recommendations were made to conduct specific research projects
to understand and prevent/mitigate any adverse impact of the
space environment on average civilians in suborbital space and in
space travel and habitation in low Earth orbit and beyond. The
summary report of the workshop’s recommendations was written,
vetted, and completed for public dissemination in November 2021.
The summary concludes with recommendations for implementation of the HRP for civilians in commercial space.
240 NEW SPACE ª MARY ANN LIEBERT, INC. VOL. 10 NO. 3 2022
Keywords: human research, civilians in space travel,
commercialization of space, protecting civilian health
THE ROLE OF CIVILIANS IN THE
COMMERCIALIZATION OF SPACE
W
ith increased space exploration activity and as
the science and technology of space have grown
almost exponentially, numerous new recommendations about the advantages of the commercialization of space have been proposed. The literature
now abounds with reports of scientific meetings and opinion articles about the commercialization of space.1–5
As one reviews the potential commercial and research
activities in the coming decades, the role of the civilian in
space travel and habitation becomes tantamount but with
great concern about protecting their health, safety, and comfort. It has been predicted that the civilian will be involved
in space-related medical research, manufacturing, development, and management of housing for orbital and lunar
tourists and workers, transportation systems, mining, communication systems, space-based solar power as clean energy
for Earth, and space-centric educational programs.6,7
NASA has already contracted U.S.-based companies—Blue
Origin, Nanoracks, and Northrop Grumman—to design space
stations that would combine scientific and commercial activities.8,9 Blue Origin and partner Sierra Space will build the
Orbital Reef, a space station that will be used for research,
commercial, and governmental purposes. The Nanoracks
Company also plans to construct a commercial space station
(Starlab) for biology, plant, physical science, and materials
research. Plans for the space station by Northrup Grumman
will be used for commercial purposes with modular construction so that its base may be expanded as required.
DOI: 10.1089/space.2022.0006
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PREPARING CIVILIANS TO TRAVEL, LIVE, AND WORK IN SPACE
The health needs of civilians in the commercialization of
space have not been adequately addressed. This has implications for a new and challenging role for space medicine and
human space research. Space medicine’s focus on the health
and function of career astronauts will expand to the health of
civilians involved in spaceflight, many with underlying health
problems and disabilities.10 To successfully operate the planned range of potential commercial enterprises in space, the
health and fitness of the workforce need to be considered. We
are assuming that this workforce will include people of diverse
races, cultures, and backgrounds.
Dr. Mark Shelhamer observed ‘‘Anytime you send a person
into space, it’s an experiment. To explain why, let’s compare
aviation and spaceflight. In 2019, pre-COVID, airlines carried
4.5 billion passengers on 39 million flights. Commercial aviation is a very, very mature field, both technologically and
biomedically. Things do still go wrong, but they’re extremely
rare because the experience base is huge. Comparatively,
fewer than 600 people have ever flown into space. Spaceflight
is not a mature field at all, so any data you can get is extremely valuable.’’11
Collection of physiological, behavioral, molecular, and
phenotype data will help us generate proper assessment,
screening, and countermeasures for civilians. In support of
this initiative, Dr. Michael Schmidt stated, ‘‘The vascular
health of the average space tourist/worker is likely to be more
akin to the average person on Earth (as opposed to [the] average astronaut). The vascular system is one of those vulnerable systems that we should pay close attention to.’’12 In
addition, the research to protect and mitigate adverse effects
of traveling and working in space needs to examine the activity in which the civilian will be engaged.
WORKSHOP ON CREATING A HUMAN RESEARCH
PROGRAM FOR CIVILIANS IN THE
COMMERCIALIZATION OF SPACE
In September 2020, the need to address the potential biomedical risks that civilians will face in this decade and beyond
as space is commercialized was discussed with National Space
Council (NSpC) staff. This led to an NSpC request for a workshop proposal to explore the issue.
The aim of the workshop was to bring together leading experts
in space medicine and space research to assist in establishing
a practical, prudent, and sustainable framework for a human
research program (HRP) for civilians in space. The proposal was
favorably considered by the NSpC and directed to the Commercial Spaceflight Federation (CSF) for implementation.
The workshop was conducted on May 11–12, 2021, with the
participation of *100 colleagues representing the key leaders
in space medicine and space research. This special report is a
summary of the workshop and the recommendation to create
and implement an HRP for civilians in spaceflight.
For civilians who will engage in business and industry
in space, the workshop participants recommended that we
review what is known about the biomedical risks to these
civilians in suborbital, low Earth orbit (LEO), and deep space
travel to identify the gaps in knowledge and develop a meaningful human research agenda. The authors conducted such a
review of the literature and conferred with astronauts, space
researchers, and space medicine specialists.
Because of the notable differences between the health and
fitness of NASA’s astronauts and civilians who will become
involved in space commercialization, much of the data about
the physiological and psychological responses of career
astronauts were not found useful. It was noted that although
some hazards to human health, safety, and comfort have
been identified— microgravity, radiation, acceleration, and
distance from Earth anxiety—physiological risks and uncertainties for civilians remain with no standardized medical
criteria for selection.
Based on the limited data, it was decided that a robust HRP
for spaceflight participants be initiated.
STUDIES TO IDENTIFY BIOMEDICAL RISKS
TO CIVILIANS WHO WILL PARTICIPATE
IN THE COMMERCIALIZATION OF SPACE
Space medical experts know that orbital and cislunar and
long duration space travel have significant adverse effects on
the human body. These effects include physiological changes
at the tissue and molecular levels. Although NASA’s twin
study represented only an N of 2, it has provided us with an
insight into the omics of spaceflight and points to the possibility of unanticipated changes in human health.13
Antuñano et al. discuss the challenges of suborbital and
orbital commercial human spaceflights, the recommended
medical standards and management of medical risks, and the
informed consent process applicable to the launch, flight, and
landing. They state, ‘‘Space flights are associated with a number of physiological and psychological changes that may
cause and/or aggravate certain medical conditions during
flight, and could adversely impact an individual’s health and
safety.’’14 They continue that the spaceflight environment is
far more hazardous than the operational risks encountered
during commercial aviation flights. ‘‘Such increased risk factors include: acceleration, barometric pressure, microgravity,
ionizing radiation, nonionizing radiation, noise, vibration,
temperature and humidity, breathable air and ventilation, as
well as behavioral issues.’’
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MARGE
They suggest that the space medical specialist identify and
mitigate significant pre-existing diseases, illnesses, injuries,
infections, treatments (pharmacological, surgical, prosthetic,
or other), or other physiological or pathological or psychiatric
conditions among commercial space vehicle occupants (flight
crews and passengers).14 They conclude with the recommendation that commercial spaceflight participants, crew, and
passengers, will have to be carefully evaluated before allowing them to participate in suborbital and orbital spaceflights.
Similar recommendations were made by Schroeder et al.15
The Association of Spaceflight Professionals’ Life Sciences
Working Group reviewed U.S. medical guidelines for commercial spaceflight participants. The review examines available data and publications, and makes recommendations
going forward with respect to pre- and in-flight mitigation
of medical risk, covering medical screening and evaluation,
in-flight medical capabilities, training recommendations, and
opportunities for refining the guidelines as more data become
available. Using relevant search terms to identify publications
of interest, these researchers conducted a search of Google and
Pub Med to obtain their data.
AREAS OF UNCERTAINTY
The review of the current state of knowledge about civilian
health in space resulted in identifying the essential research
topics to meet the goal of protecting the health and safety of
civilians in space. These include:
.
The need for research on the impact of space travel on a
representative large population of civilians, including
women, people of color, people with a variety of chronic
health conditions, and those with disabilities. To date, almost all data refer to fit professional astronauts and several
studies of civilians subjected to the stresses of centrifuge
tests simulating the acceleration profiles (+Gx and +Gz)
that are expected to occur on suborbital spaceflights.16–18
Table 1. Human Research Project Recommendations for Civilians in Suborbital Spaceflight
Needs for Human Research
Description of Human Research Projects
Assess functional capability of civilians
Develop a functional abilities test for individuals with disabilities that is reliable and proven valid to determine functional
to sustain impact of spaceflight
ability to handle space travel.
Identify effective interventions to prevent
a. Develop interventions to prevent and/or treat space motion sickness (SMP).
or mitigate the impact of spaceflight
b. Identify interventions to prevent the psychological effects of spaceflight: fear, anxiety, and stress.
c. Examine the postflight and long-term impact of suborbital flight on the health status of individuals with disabilities,
such as the potential for developing additional health complications (secondary conditions).
d. Study the impact of suborbital space travel on civilians with pre-existing health conditions, not considered disabling,
to include medically stabilized diabetes, stabilized mild–moderate heart conditions, asthma, stabilized kidney and liver
disease, treated migraine headaches, obesity, controlled high blood pressure, controlled seizures, and medically stabilized
mental health conditions (psychoneuroses).
e. Assess the impact of spaceflight on civilians with implanted devices and who take life-sustaining medications.
Study additional priority health concerns
a) Examine g-transitions to determine effects on physiology and performance. G-transitions are a combination of
acceleration forces and microgravity. In addition, address the questions of ‘‘What acceleration forces can civilians endure
without adverse outcomes’’ and ‘‘How to contend with acceleration forces upon launches, during flight, and landing?’’
b) Measure cardiovascular disease (CV) responses, including vestibular-autonomic (sympathetic) stimulation inducing cardiac
dysrhythmias during suborbital spaceflight. In addition, study the impact of spaceflight on blood pressure, pulse, regularity
of heart beat, and heightened risk for thrombosis.
c) Conduct a research project pursued either separately or in concert with item (b) above to study the mechanisms underlying
increased risk for CV changes, such as fluid shifts, during spaceflight, and duration of experience in microgravity. Fluid shifts are
expected to be relatively inconsequential on suborbital flights, but may be more pronounced in flyers with certain medical
conditions (heart failure and cardiac insufficiency) and should be studied.
d) Study the impact of nominal and off-nominal launch/landing loads: potential for intervertebral disk damage; explore preventive
interventions.
e) Explore the effectiveness of new microgravity medical sensors, tools, and procedures (novel biometric sensors, ultrasound for
jugular venous stasis, microgravity wound management, etc.) to assess physiological responses during spaceflight.
242 NEW SPACE 2022
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PREPARING CIVILIANS TO TRAVEL, LIVE, AND WORK IN SPACE
Currently, there is no research evidence in support of a
type of training for suborbital or orbital flight for civilians that will prepare them effectively for the experience,
especially to ensure an appropriate response in case of an
emergency. Stepanek et al. state, ‘‘Participants in longerduration missions, especially persons with pre-existing
health conditions who are critically reliant on a healthy
immune system, may also be subject to the known effects
of the spaceflight environment (thought to be mediated
by radiation and stress responses) on immune function.
Alterations in T-cell function, the skin microbiome, and
bacterial virulence, as well as asymptomatic viral reactivation, have been described.’’10
. The need to understand how factors in the space environment impact the health and capacity of civilians
to fly successfully with differences in age, gender, race
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.
and ethnicity, physical and mental health status, underlying health conditions, immunity, and resilience.
. The need to identify effective measures to prevent adverse outcomes of spaceflight and habitation in civilians,
regardless of distinguishing differences in the physiology and mental characteristics of the individual, and
to identify effective measures to treat adverse outcomes
if they occur during and after spaceflight and habitation.
. The need to create a publicly accessible database that
contains information from peer-reviewed scientifically
based studies about adverse outcomes of space travel and
habitation, effective measures to prevent and mitigate
these outcomes, and promising new areas of research.
Schmidt et al. state the following: ‘‘The cohort of professional astronauts has been uniquely fit and exceptionally well
Table 2. Human Research Recommendations for Civilians for Orbital and Beyond Low Earth Spaceflight and Habitation
Need for Human Research
Description of Human Research Project
Study the significant hazard of microgravity
This proposes a multiyear study of the impact of microgravity on the physiology and psychology of civilians, using
on civilians in orbital and beyond space
analog environments and simulation tests. Physiological factors include major bodily systems: CV, digestive, endocrine,
eyes and ears sensory, immune and hematology, lymphatic, musculoskeletal, nervous, reproductive, respiratory, skin, and
urinary systems. This will require extensive testing of each civilian, including comprehensive molecular profiling of all
civilians so that personalized countermeasures may be developed to address the heightened risks each individual may
face. It is essential to obtain preflight baselines, measures during analog experiences or flights, and postexperience or
postflight measures. This may include various durations of visits to ISS for a cohort of civilians.
Study strategies to protect civilians in orbital
This includes the impact of radiation on the 12 bodily systems. It will require extensive testing of civilians before, during,
flight and beyond from the dangerous effects
and after the analog experience and/or spaceflight. It may also include various durations of visits to ISS for a cohort of
of space-encountered radiation, including solar
civilians.
and galactic cosmic radiation
Address the impact of isolation and confinement Examine the impact of ‘‘Distance from Earth’’ and feelings of isolation and confinement on the psychology and function
on civilians in orbital and beyond space
of individuals with disabilities, using analog environments and simulation tests. This may be a collaborative research
effort in conjunction with ways to reduce anxiety and stress for civilians discussed under the suborbital space flight
recommendations.
Develop a preflight training program for civilians Develop an effective preflight training program that best prepares civilians for spaceflight. The preparation is to (1)
that addresses the safety and comfort of the
reduce SMS, (2) reduce anxiety and stress, (3) function successfully in case of emergencies, and (4) become a team
space traveler
member of the spaceflight passengers and crew.
Study issues related to special accommodations
Identify which special accommodations, if any, are required for individuals with disabilities so that spaceflight is
for individuals with disabilities in spaceflight
and habitation
accessible, safe, and comfortable. This project will entail spacecraft design, vehicle operations, emergency procedures,
and other technical factors that may be modified so that the needs of the civilians are addressed.
Determine the effects of acceleration forces,
a. Measure the impact of these factors on civilians in analog environments and experiences. The experience could
vibration, noise, and G transition factors on
civilians during launch and landing
include travel to ISS by a representative group of civilians who are carefully monitored and measured before, during,
and after the spaceflight to ISS.
b. Measure the impact of these factors on individuals with disabilities in analog environments and experiences. This
project could be collaborative with other projects already stated that involve travel to ISS.
ISS, International Space Station.
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trained. The advent of commercial spaceflight will see a wider
range of individuals enter space, who lie on a variegated
continuum of physical fitness, metabolic fitness, disease complexity, drug therapeutics, and genetics. Yet, there are currently little data on individuals of lesser fitness entering
space.’’19 Schmidt and his coresearchers acknowledge that
spaceflight medicine ‘‘has grown in sophistication,’’ but we are
still confronted with serious knowledge gaps. Research efforts
to address the biomedical hazards faced by civilians who
will be involved in space travel and habitation are disparate,
uncoordinated, limited, and not part of a national plan of
action to meet research goals according to a timetable.
HRP FOR CIVILIANS IN THE
COMMERCIALIZATION OF SPACE
The human research projects of highest priority were identified based on review of the relevant literature and the recommendations of the workshop participants.
The identified human research priorities are presented in
2 sections: Suborbital Space, and Orbital and Beyond Low
Earth Orbit Spaceflight and Habitation found in Tables 1
and 2. In addition, a publicly accessible database should be
created to include the results of the research projects and the
biomedical testing that will be applied before, during and after
spaceflight and habitation. All data will be anonymized to
protect the privacy of civilians who participated in the human
research studies.
.commercialspaceflight.org/wp-content/uploads/2021/11/2021Summary-Report-of-the-CSF-MITRE-Workshop-and-HRP-forcivilians.pdf)
ACKNOWLEDGMENTS
The author expresses his sincere appreciation for the contributions of the following who served as scientific advisors
in the editing of the CSF/MITRE Workshop Summary Report
upon which this article is based: Melchor Antunano, MD,
Federal Aviation Administration; Kenneth Davidian, PhD,
Federal Aviation Administration; Tommy Sanford, Commercial Spaceflight Federation; Erika Wagner, PhD, Blue Origin;
Sirisha Bandla, Virgin Galactic; Jaime Mateus, PhD, SpaceX;
Christian Maender, Axiom Space; Christopher Scheibler, MD,
DoD; Victor Schneider, MD, NASA; Leith States, MD, OASH/
HHS; Valerie Gowran PhD, MITRE; Mark Shelhamer, PhD,
Johns Hopkins University School of Medicine; Michael
Schmidt, PhD, Sovaris Space.
AUTHOR DISCLOSURE STATEMENT
No competing financial interests exist.
FUNDING INFORMATION
No funding was received for this article.
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1.
SUMMARY
The proposed HRP for civilians focuses on studies to
make space travel and habitation accessible to all, including
individuals with underlying health conditions and disabilities.
We also identify opportunities to leverage this large diverse
population of flyers to conduct hypothesis-driven research
in the general flying public or specialized research subjects.
In addition, we recommend nonhypothesis-based research to
advance discovery. The results of these biomedical studies
should be anonymized and included in a publicly accessible
database.
Although spaceflight accessibility is a topic of primary
relevance to the space industry, opportunistic research within
this population represents a mixture of aeromedicine, public
health, and technology maturation. Next step is the implementation of the HRP for civilians in space travel and habitation with the cooperation and support of all stakeholders
dedicated to protecting the health and safety of civilians in the
commercialization of space.
Copies of the CSF/MITRE Workshop Summary Report
may be accessed on the CSF website at this link: (www
244 NEW SPACE 2022
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PREPARING CIVILIANS TO TRAVEL, LIVE, AND WORK IN SPACE
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Address correspondence to:
Michael Marge
SUNY Upstate Medical University
c/o 449 Old Orchard Circle
Millersville, MD 21108
USA
E-mail: michael.marge@comcast.net
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