Novelty and scientific uncertainty
The scenario of novel pathogen emergence engenders uncertainty of various kinds. The very notions of the ‘novel’ and ‘emergent’ in scientific understandings reference uncertainties that can in turn seep into popular imaginaries – of viral mutation and flux, and the unexpected and unknown. Scientific uncertainties emerge alongside the pathogens from the moment of first detection, such as those related to the type of agent, the spillover event, the epidemiological features, the clinical manifestations and virulence, and the immunological response. Amongst scientists, uncertainties are talked and written about with the excitement of a detective challenge and form the grist of discussion and interest at gatherings, such as the Research & Design (R & D) ‘Roadmap’ meetings for priority pathogens, convened by WHO.
At these meetings, the stated aim is that public health responses should be formulated on a scientific ‘evidence base’. In reality, the very nature of the ‘novel’ ensures that this base is partial and emergent as well. The assumption of Roadmap exercises is that the gathering of ‘experts’ and the targeted funding of a prioritised scientific endeavour will elucidate the mysteries, leading eventually and inevitably to scientific certainty and a robust scaffolding of ‘evidence’ for actions (WHO 2016). Yet consideration of the case of an ‘old’ novel virus, such as Nipah, suggests that uncertainties persist and indeed new uncertainties are spawned, with constant unexpected elements and viral surprises – for Nipah, in repeated outbreaks over two decades since it was identificatied in Malaysia in 1998 (Chua et al. 2000). Recent scientific articles on Nipah still employ the language of detective work: “[t]he high mortality rate, broad species tropism, multiple plausible modes of transmission, risk of person-person transmission and documented cases of health care workers being affected during outbreaks has left the medical community perplexed…a lot remains to be deciphered about the virus and many efforts to unravel its mysteries are ongoing” (Banerjee et al 2019:1). Unpredictability appears to have been the one certain feature of this ‘emerging-re-emerging’ virus.
Disease preparedness and uncertainty
In response to the outbreaks of epidemic diseases such as Ebola in recent years, global efforts to build the ‘evidence base’ and the social, material and institutional infrastructures for disease preparedness and response have developed apace, with investment in the implementation of tools and frameworks at regional and national levels (WHO 2017). This constitutes an important but particular response to the uncertainty of ‘Disease X’ scenarios, by elaborating technologies and systems for surveillance and control. Drawing on Stirling’s (1999) conceptual framework delineating four dimensions of incertitude, Leach et al. (2010) contend that disease control and preparedness activities aim to respond to uncertainties related to (re)-emerging diseases by reducing these to calculable risks.
In what follows, I will propose that the stringent public health responses that we have seen to COVID-19, in China and beyond, are taking this tendency to an extreme point, with potentially significant consequences. As an anthropologist observing the COVID-19 discussions and the anxieties raised by the rapidity and seriousness of events, I raise some concerns about the limiting ways in which social science ‘evidence’ can be harnessed in epidemic response. I argue that bigger political questions about discourses of preparedness and response need to be thrust into the debate about current and future responses to uncertain and alarming scenarios of novel emergence.
Social science and the uncertainty of ‘social context’
The move to greater incorporation of social science perspectives into health emergency responses in the last few years has been noticeable and has led to inclusion of social scientists into the WHO Roadmap’s ‘expert’ portfolio. The West African Ebola outbreak in 2014 galvanized the engagement of social scientists and the current outbreak in the Democratic Republic of Congo has seen that engagement deepen. Yet, there are also caveats related to engaging as an anthropologist in these endeavours to make ‘social context’ more legible to response agencies, such as through briefings and so forth. Inputs can easily be siloed into ‘community engagement’ or ‘risk communication’, with the nuances lost in the interests of behavioural change activities. Anthropologists working in this space are often acutely aware of these dilemmas. Whilst ‘social context’ has come into focus for practitioners, at times it appears that this is viewed as yet another source of uncertainty to bring under control and manage (MacGregor et al, forthcoming). The DRC Ebola events have demonstrated that such control efforts face limitations in contexts shot through with uncertainty, such as the complex political realities of conflict, distrust and multiple forms of public authority. DRC also illustrates a reality where, alongside a disease drawing global prioritisation, people experience and embody multiple ‘everyday’ uncertainties associated with precarious lives throwing up a range of misfortunes, including those associated with ‘slow’ emergencies (Anderson et al. 2019).
COVID-19: critical issues for social science contributions
The current COVID-19 experience is equally revealing a set of context and uncertainty challenges for response agencies and practitioners. At the WHO Roadmap meeting in February, where COVID-19 was named, the Director General of the WHO, Dr. Tedros Adhanom Ghebreyesus, suggested that the gathering of experts would reassure the world that the efforts of the best scientific minds will uncover the secrets and conquer the virus. Other public-facing scientists have suggested that the health surveillance and preparedness building efforts over recent years are proving their worth, in that these systems enabled the detection of the unexpected in Wuhan in the first place. In his repeated statements calling for global solidarity, Ghebreyesus has also hinted at the geopolitical ramifications of events. It is probable that the frequent use by WHO of a language of ‘solidarity’ is pointing to the importance attached to information sharing, ‘transparency’, and the scientific data required to pursue the holy grail of greater certainty.
Clearly the politics shaping public health and social responses to the disease, and the political re-shaping that is being catalysed by the outbreak, go beyond data sharing. It seems a critical moment for social scientists to delineate these dynamics and the current events more clearly and to draw greater attention to the implications. This outbreak has again revealed the tendency for shoe-horning of social science into significant but narrow operational questions related to how to enable containment, enforce behavioural change and adherence to public health messaging, and counteract ‘misinformation’ in risk communication. It is essential to keep inserting critical questions into the global debate and to push for a more explicit acknowledgement at a higher level of the profoundly political nature of the COVID-19 event. Discourses of disease preparedness and understandings of the ‘ideal’ models of response are being reshaped in real-time by the Chinese experience of COVID-19, with potentially significant implications also for other contexts where the disease is likely to spread. Which voices are currently shaping the narratives of what constitutes a successful response? It seems a crucial time to interrogate also the unintended consequences of extreme curtailment strategies, and to ask the classic questions about the relevance to other settings with different histories of public health, with other disease experiences, with lesser-resourced health systems, and with different forms of public authority and state-citizen relations. Whilst few would deny the very real concerns about mortality and the importance of robust and coordinated public health responses, it seems important also to interrogate further what the nature of those responses should be. Given the high levels of uncertainty and anxiety that have inevitably accompanied the global spread of COVID-19, the danger is that the ‘draconian’ public health containment response becomes the unquestioned default reaction to this uncertainty, and that the difficult issues related to the social and ethical implications and trade-offs will receive inadequate reflection and scrutiny.
 Jeremy Farrar, Wellcome Trust Press Release on novel coronavirus, 18 January 2020.
Anderson, B., Grove, K., Rickards, L. and Kearnes, M. 2019. Slow emergencies: Temporality and the Racialized Biopolitics of Emergency Governance. Progress in Human Geography.
Banerjee, A., Gupta, N., Kodan, P., Mittal, A. et al. 2019. Nipah virus disease: A rare and intractable disease. Intractable & Rare Diseases Research. 8(1): 1-8.
Chua, K., Bellini, W., Rota, P. et al. 2000. Nipah virus: a recently emergent deadly paramyxovirus. Science. 288(5470): 1432-5.
Leach, M., Scoones, I. and Stirling, A. 2010. Governing Epidemics in an Age of Complexity: Narratives, Politics and Pathways to Sustainability. Global Environmental Change. 20.3: 369–377.
MacGregor, H., Ripoll, S., and Leach, M. forthcoming. Disease Outbreaks: navigating uncertainties in preparedness and response. In Scoones, I. and Stirling, A. (eds) The Politics of Uncertainty.
Stirling, A., 1999. On Science and Precaution in the Management of Technological Risk’, Sussex: SPRU [based on contributions from O. Renn, A. Rip, A. Salo]
World Health Organisation. 2016, with subsequent review. R&D Blueprint for action to prevent epidemics.
World Health Organization. 2017. A strategic framework for emergency preparedness.
Hayley MacGregor is a clinically-trained medical anthropologist and co-leads the Health and Nutrition research cluster at the Institute of Development Studies, University of Sussex.
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