Epidemics: Science, Governance, and Social Justice

Epidemics: Science, Governance, and Social Justice

Epidemics: Science, Governance, and Social Justice

Epidemics: Science, Governance, and Social Justice

Synopsis

Recent disease events such as SARS, H1N1 and avian influenza, and haemorrhagic fevers have focussed policy and public concern as never before on epidemics and so-called 'emerging infectious diseases'. Understanding and responding to these often unpredictable events have become major challenges for local, national and international bodies. All too often, responses can become restricted by implicit assumptions about who or what is to blame that may not capture the dynamics and uncertainties at play in the multi-scale interactions of people, animals and microbes. As a result, policies intended to forestall epidemics may fail, and may even further threaten health, livelihoods and human rights.The book takes a unique approach by focusing on how different policy-makers, scientists, and local populations construct alternative narratives-accounts of the causes and appropriate responses to outbreaks- about epidemics at the global, national and local level. The contrast between emergency-oriented, top-down responses to what are perceived as potentially global outbreaks and longer-term approaches to diseases, such as AIDS, which may now be considered endemic, is highlighted. Case studies-on avian influenza, SARS, obesity, H1N1 influenza, HIV/AIDS, tuberculosis, and haemorrhagic fevers-cover a broad historical, geographical and biological range. As this book explores, it is often the most vulnerable members of a population-the poor, the social excluded and the already ill-who are likely to suffer most from epidemic diseases. At the same time, they may be less likely to benefit from responses that may be designed from a global perspective that neglects social, ecological and political conditions on the ground. This book aims to bring the focus back to these marginal populations to reveal the often unintended consequences of current policy responses to epidemics. Important implications emerge - for how epidemics are thought about and represented; for how surveillance and response is designed; and for whose knowledge and perspectives should be included.Published in association with the Economic and Social Research Council (ESRC)

Excerpt

In June 2009, the World Health Organization (WHO) officially declared that the world was experiencing a global pandemic of H1N1 influenza. An initial outbreak of a new virus in Mexico (termed ‘swine’ flu because of its early identification in pigs and mix of pig, avian and human genetic mater ial) had jumped to humans and was now sweeping the world, hastened by travel and rapid transmission on our interconnected and crowded planet. Soon after the emergence of the virus, the WHO had called the outbreak an ‘extreme expression of the need for global solidarity’ (WHO, 2009). Pandemic preparedness plans, put into place in many industrialized countries in response to the earlier threat of H5N1 avian influenza, were mobilized at scale. Yet by July, it was clear that the battle to halt the epidemic had been lost. With thousands of new cases being reported every day and scientists predicting a huge rise as the winter flu season kicked in, some governments, such as the UK and US, switched strategy from containment to damage limitation, through a mix of public hygiene campaigns and the handing out of stockpiled antiviral drugs such as Tamiflu to reported cases.

Swine flu may be the latest epidemic outbreak to be hitting the headlines, but it is, of course, not the first and it will not be the last. Current global health policy is dominated by a preoccupation with infectious diseases and in particular with so called ‘emerging’ or ‘re-emerging’ infectious diseases that threaten to ‘break out’ of established patterns of prevalence or virulence into new areas and new victims (Kickbusch, 2003; Foresight, 2006; Knobler et al, 2006). Such episodes are variously described as outbreaks, epidemics or pandemics depending on their severity, temporal or geographic reach, or their ability to capture our attention (or frighten us). Of the many risks currently facing the international community, the ‘most feared security threat’ is that a highly infectious and virulent form of human influenza will develop, causing a global pandemic potentially worse than the epidemic that killed so many in 1918–1919 (WHO, 2007a, p45). But the complete list of significant global health risks that have the potential to become epidemic is long and includes multidrug-resistant tuberculosis, malaria, newly emerging and highly infectious viral diseases such as Ebola, Marburg and Nipah, and . . .

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