LEAD ACADEMIC(S)
Tony Sandset, Research Fellow, SHE
Kyung Hye Kim, Associate Researcher, SHE
OTHER PARTICIPANTS
DESCRIPTION
Epidemics and pandemics are an integral part of human life and have affected human society throughout history in myriad ways: medically, economically, culturally and politically. This strand of the OMC focuses on how different epidemics/pandemics have been narrated, the conflicts they have given rise to, and forms of contestations that have emerged in the context of these conflicts. It also attends to the various ways in which different actors have come to approach epidemics/pandemics as ‘objects of epistemic knowledge’.
The corpus is designed to cover a broad set of epidemics/pandemics in order to cater to the research needs of a diverse range of users. These might include, for example, the 1918 Spanish Flu; the malaria eradication efforts from the 1930s to the 2000s; the HIV/AIDS epidemic from 1981 onwards; the Avian Flu; and COVID-19. Corpus compilation efforts, however, will initially focus on a relatively small set of epidemics/pandemics, as detailed below, in order to ensure sufficient coverage to support meaningful analysis.
JUSTIFICATION
The focus on epidemics/pandemics, including the effort to control and ultimately end them, is highly relevant to SHE’s core agenda because epidemics/pandemics are excellent sites for investigating agonistic and competing rationalities and how they clash. It is also in line with SHE’s engagement with the sustainability agenda, given that a core element of SDG 3 is a commitment to ‘end’ HIV, tuberculosis and malaria by 2030. Epidemics and pandemics are moreover a core part of global health efforts and have been so since the founding of the WHO; indeed they precede the founding of the WHO as international collaboration started much earlier on epidemics such as yellow fever, malaria, and tuberculosis.
The topic section on epidemics/pandemics is by its very nature immensely broad and covers large areas both in terms of time and space. Moreover, epidemic/pandemics can be approached from diverse disciplinary angles, which makes their study an inherently multi-disciplinary and open-ended endeavour. In light of this, the process of building the OMC epidemic/pandemic corpus prioritizes specific epidemics/pandemics in its starting phase. Below is a brief rationale for the initial choice of epidemics/pandemics to focus on.
* HIV/AIDS. The OMC already contains a large collection of policy and strategy documents from UNAIDS, representing policy and strategy plans from the turn of the century onwards. The HIV /AIDS epidemic has been one of the most devastating global epidemics in the modern era and continues to constitute a global health challenge in the twenty-first century. The HIV/AIDS epidemic is also a global phenomenon which has demonstrated the extent to which politics and ideology influence the way in which the global health community approaches epidemics. Moreover, the HIV/AIDS epidemic illustrates how social inequality and discrimination can negatively affect the course of an epidemic and the manner in which it develops. Finally, the HIV/AIDS epidemic is a global epidemic that is transmitted predominantly through sexual contact; as such, it contrasts with pandemics such as influenza or epidemics caused by airborne pathogens or vector borne diseases.
* COVID-19 is a truly global pandemic in the twenty-first century. It is an example of a pandemic caused by an airborne pathogen and illustrates, together with its predecessor, the Spanish flu of 1918, the potentially devastating effects of a global flu pandemic. COVID-19 also illustrates how contentious a pandemic can become in terms of access to vaccines; what kind of non-pharmaceutical mitigation actions should be taken and when; how social inequalities affect and drive the pandemic; and how political decision-making influences the development of such a health crisis. Finally, the COVID-19 pandemic also illustrates the ways in which ‘evidence’ is deployed in conflicting debates about the best approach to end a pandemic. These include, for example, debates about ‘anti-vaxxers’, vaccine hesitancy; ‘zero COVID’ policies; and long-COVID and it is after effects.
* Malaria. The OMC epidemic/pandemic corpus also includes sources on the global malaria epidemics that are found across the globe. Malaria is a disease with a long history in global health, and efforts to eradicate it are well documented across many nations throughout the preceding century. Malaria is a vector borne disease which still claims the lives of over 600,000 people globally every year. The history of malaria eradication efforts is particularly interesting because it serves to highlight the entanglements between colonialism, the emergence of ‘tropical medicine’, and the tensions between the global north and the global south. It further evidences the intervention of global non-governmental institutions in global health and their power; examples include the Rockefeller Foundation and the Bill and Melinda Gates Foundation.
* Polio. The global polio eradication programmes represent an interesting and global case for investigating the ways in which international collaboration at the height of the Cold War was able to deliver effective vaccines. Access to historical documents on polio can offer us insight into how and why some eradication efforts are successful, or otherwise. From a contemporary perspective, the success of the polio vaccine also illustrates how eradication might be achieved.
* HPV (Human Papilloma Virus). The case for including HPV might seem less obvious in terms of it being seen as a global epidemic or pandemic. HPV is interesting in that it is a sexually transmitted virus that is associated with different types of cancer that individuals develop later in life. As such, the virus has been called an ‘onco virus’, hinting at its association with cancer rather than with direct viral disease. Moreover, HPV is an infectious disease which has generated a great deal of debate and controversy in relation to its vaccination programme. These debates focus on issues such as who should be vaccinated and when; young girls versus young boys; gay, bisexual, and other men who have sex with men and their access to vaccines; as well as the wider issue of the safety of vaccines. Refracted through this lens, HPV also illustrates how sexual morals become implicated in making decisions about who to prioritize for a vaccination programme, echoing similar moral judgements relating to sex, responsibility and risk that have been evidenced in relation to the HIV epidemic. Finally, the inclusion of the HPV virus on this list of priorities provides synergies with two other topic areas in OMC: reproductive health and adolescent health.
In terms of SHE’s deployment of the UNESCO framework for education, epidemics and pandemics are important sites for reflecting on systems thinking; normative thinking; critical thinking; and anticipatory thinking. They also provide good teaching material to support agonistic learning and for revealing the complexities of global health – in terms of both system complexity and value complexity.
INDICATIVE SOURCES
(1) HIV/AIDS
* ‘GLOBAL HIV/AIDS RESPONSE. Epidemic update and health sector progress towards universal access’
* ‘2004 report on the global HIV/AIDS epidemic : 4th global report’
* ‘Detained and Denied: The clinical care of immigration detainees living with HIV’
* ‘90-90-90: An ambitious treatment target to help end the AIDS epidemic’
(2) COVID-19
* Covid-19 vaccination: Evidence to inform decision making, Monitoring of vaccine effectiveness, impact and safety, Facilitating vaccine acceptance and uptake, Prioritisation of target groups for vaccination, Vaccination preparedness and stress-test exercises (all excluding EU/Nation specific)
* Efficacy, effectiveness and safety of vaccines against covid-19
* Guidance on quarantine and isolation
* How to protect yourself (>> help us identify what is required at the personal level)
(3) MALARIA
(4) POLIO
* ‘Understanding the reasons for refusal of polio vaccine by families in Quetta Block, Pakistan’ by Samsoor Zarak et al. Eastern Mediterranean Health Journal
* ‘Effectiveness of a new vaccine for outbreak response and the increasingly complicated polio endgame’
* Exploring alternative narratives: the prioritisation of polio in northern Nigeria
* ‘The Global Polio Eradication Initiative—polio eradication cannot be the only goal’
* ‘From smallpox to polio, vaccine rollouts have always had doubters. But they work in the end’
(5) HPV (Human Papilloma Virus)
* Uzbekistan achieves high HPV vaccination coverage against cervical cancer
(6) AVIAN INFLUENZA
* Weekly threats reports on avian influenza viruses
(7) SPANISH FLU
Older documents from The International Sanitary Conferences detailing the birth and formalization of quarantine regulations for various infectious diseases.
(8) ONE HEALTH
Foundational documents of the One Health approach, such as ‘A Comparison of Three Holistic Approaches to Health: One Health, EcoHealth, and Planetary Health’
POTENTIAL MA/MD PROJECTS
The corpus can be used to address one or more of the following questions as the focus of an MA or MD dissertation. SHE will undertake the responsibility to locate a suitable supervisor in each case.
* From a One Health perspective, how is the role of animals narrated in epidemics? This question can be pursued by examining some of the ways in which one health or animals vs humans are conceptualized in the sources covered by the corpus, for example what combinations animal occurs with: animal reservoir is typical of surveillance in the context of the one health approach whereas animal husbandry is more common in discourses on antimicrobial resistance.
More specific questions may include the following: How has the link between humans and animals been conceptualized in malaria and avian flu discourses, for instance? What competing narratives have emerged on the tension between attending to human health on the one hand, and on the other hand, to agricultural and economic productivity in the context of Avian flu.
Answering these questions will serve to reveal the nature of the intersecting systems of human epidemics/pandemics, animals and agricultural production, as well as conflicts inherent in attempting to attend to human health vs attending to animal health.
* From a global health and political science perspective, how have efforts to control epidemics such as malaria been contested and negotiated between the global north and global south? This question can be pursued by searching the corpus for instances of items such as control and elimination in the context of epidemics/pandemics or a specific epidemic such as HIV and examining the collocates they tend to attract. For instance, in these examples from the corpus, you can immediately identify that infection prevention control is a common pattern in the context of WHO discourses, pollution control is more pronounced in UN discourses and on antimicrobial resistance, and case-control(ed) and random(ised) control in the context of evidence-based medicine. Elimination may be directed at a range of phenomena, including virtical elimination, gender disparity and inequality, mother-to-child transmission in the context of UNAIDS’ AIDS/HIV prevention.
More specific questions might include: What role have private actors such as the Rockefeller Foundation played in the drive to eliminate malaria or that Bill and Melinda Gates Foundation played in relation to HIV/AIDS and malaria? What forms of political and epistemic contestation have emerged in the context of global efforts to control the spread of malaria, HIV, measles, yellow fever, etc.?
Answering these questions can reveal important aspects of political and conceptual contestation involving key global health actors as well as the influence of private actors on epidemics/pandemics elimination efforts.
* Epidemic/pandemic control and elimination efforts are often contested through different rationalities and ideologies. This is particularly evident in the case of vaccine hesitancy. How can we trace and map different rationalities as they emerge and clash around vaccine hesitancy in the context of different epidemics and pandemics such as COVID-19, measles or polio?
Addressing this question allows us to map the different narratives that underpin anti-vaccination and vaccine hesitancy and reveal the different political standpoints and types of epistemic thinking that inform them.