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This paper argues for a rethinking of disease preparedness that puts incertitude and the politics of knowledge at the centre. Through examining the experiences of Ebola, Nipah, cholera and COVID-19 across multiple settings, the limitations of current approaches are highlighted. Conventional approaches assume a controllable, predictable future, which is responded to by a range of standard interventions. Such emergency preparedness planning approaches assume risk - where future outcomes can be predicted - and fail to address uncertainty, ambiguity and ignorance - where outcomes or their probabilities are unknown. Through examining the experiences of outbreak planning and response across the four cases, the paper argues for an approach that highlights the politics of knowledge, the constructions of time and space, the requirements for institutions and administrations and the challenges of ethics and justice. Embracing incertitude in disease preparedness responses therefore means making contextual social, political and cultural dimensions central.

This article offers an ethnographic and frame analysis of how Mexican anti-gender campaigners have leveraged Mexico’s twin crises of corruption and security to cast “gender ideology” strategically ...

Highlights • COVID-19, an unprecedented health and development crisis, has exposed major faultlines and fragilities in current systems. • A novel conceptual framework grounded in a decade of research on epidemics and development emphasises a structural-unruly duality in the conditions and processes of emergence, progression and impact. • Mainstream development thinking and practice are part of the problem; post-pandemic futures require radical transformations in science-policy under uncertainty; economies, and citizen-state relations. • Post-COVID-19 development must fully embrace resilience, diversity, care and solidarity, and egalitarian, inclusive knowledge and politics., COVID-19 is proving to be the long awaited ‘big one’: a pandemic capable of bringing societies and economies to their knees. There is an urgent need to examine how COVID-19 – as a health and development crisis - unfolded the way it did it and to consider possibilities for post-pandemic transformations and for rethinking development more broadly. Drawing on over a decade of research on epidemics, we argue that the origins, unfolding and effects of the COVID-19 pandemic require analysis that addresses both structural political-economic conditions alongside far less ordered, ‘unruly’ processes reflecting complexity, uncertainty, contingency and context-specificity. This structural-unruly duality in the conditions and processes of pandemic emergence, progression and impact provides a lens to view three key challenges areas. The first is how scientific advice and evidence are used in policy, when conditions are rigidly ‘locked in’ to established power relations and yet so uncertain. Second is how economies function, with the COVID-19 crisis having revealed the limits of a conventional model of economic growth. The third concerns how new forms of politics can become the basis of reshaped citizen-state relations in confronting a pandemic, such as those around mutual solidarity and care. COVID-19 demonstrates that we face an uncertain future, where anticipation of and resilience to major shocks must become the core problematic of development studies and practice. Where mainstream approaches to development have been top down, rigid and orientated towards narrowly-defined economic goals, post-COVID-19 development must have a radically transformative, egalitarian and inclusive knowledge and politics at its core.

This paper highlights the major challenges and considerations for addressing COVID-19 in informal settlements. It discusses what is known about vulnerabilities and how to support local protective action. There is heightened concern about informal urban settlements because of the combination of population density and inadequate access to water and sanitation, which makes standard advice about social distancing and washing hands implausible. There are further challenges to do with the lack of reliable data and the social, political and economic contexts in each setting that will influence vulnerability and possibilities for action. The potential health impacts of COVID-19 are immense in informal settlements, but if control measures are poorly executed these could also have severe negative impacts. Public health interventions must be balanced with social and economic interventions, especially in relation to the informal economy upon which many poor urban residents depend. Local residents, leaders and community-based groups must be engaged and resourced to develop locally appropriate control strategies, in partnership with local governments and authorities.Historically, informal settlements and their residents have been stigmatized, blamed, and subjected to rules and regulations that are unaffordable or unfeasible to adhere to. Responses to COVID-19 should not repeat these mistakes. Priorities for enabling effective control measures include: collaborating with local residents who have unsurpassed knowledge of relevant spatial and social infrastructures, strengthening coordination with local governments, and investing in improved data for monitoring the response in informal settlements.

International audience

This paper argues for an integrative modelling approach for understanding zoonoses disease dynamics, combining process, pattern and participatory models. Each type of modelling provides important insights, but all are limited. Combining these in a ‘3P’ approach offers the opportunity for a productive conversation between modelling efforts, contributing to a ‘One Health’ agenda. The aim is not to come up with a composite model, but seek synergies between perspectives, encouraging cross-disciplinary interactions. We illustrate our argument with cases from Africa, and in particular from our work on Ebola virus and Lassa fever virus. Combining process-based compartmental models with macroecological data offers a spatial perspective on potential disease impacts. However, without insights from the ground, the ‘black box’ of transmission dynamics, so crucial to model assumptions, may not be fully understood. We show how participatory modelling and ethnographic research of Ebola and Lassa fever can reveal social roles, unsafe practices, mobility and movement and temporal changes in livelihoods. Together with longer-term dynamics of change in societies and ecologies, all can be important in explaining disease transmission, and provide important complementary insights to other modelling efforts. An integrative modelling approach therefore can offer help to improve disease control efforts and public health responses. This article is part of the themed issue ‘One Health for a changing world: zoonoses, ecosystems and human well-being’.

TEN MONTHS AFTER THE FIRST INFECTION, Margaret Chan, Director-General of the World Health Organization, described the Ebola epidemic in West Africa as the ‘most severe acute public health emergency in modern times’. The disaster, she said, represents a ‘crisis for international peace and security’ and threatens the ‘very survival of societies and governments in already very poor countries’. As of October 2014, the disease had killed 4,951 and infected 13,567. It has crippled families, health systems, livelihoods, food supplies and economies in its wake. These numbers are likely to be vastly underestimated. How did it get to this? Why has this outbreak been so much larger than previous ones? The scale of the disaster has been attributed to the weak health systems of affected countries, their lack of resources, the mobility of communities and their inexperience in dealing with Ebola. This answer, however, is woefully de-contextualized and de-politicized. This briefing examines responses to the outbreak and offers a different set of explanations, rooted in the history of the region and the political economy of global health and development. To move past technical discussions of “weak” health systems, this briefing highlights how structural violence has contributed to the epidemic. Structural violence refers to the way institutions and practices inflict

This chapter examines science-policy processes for Lassa fever, a rodent-borne viral haemorrhagic fever (VHF) in West Africa, and explores some unique practicalities and politics of zoonotic disease control. In 2014, the Ebola outbreak in West Africa once again brought zoonotic diseases to the forefront of the international community's attention. The surprise and horror that the Ebola epidemic provoked, including in Sierra Leone, was a reminder of the value of One Health, but also of considerable unmet challenges in realizing it. In securitization debates, biosecurity priorities are often portrayed as being in opposition to those of public health. Public health efforts and investments in biosecurity have improved the management of Lassa fever but not in ways that have translated into sustained and wide-ranging health systems strengthening, or in improved understandings of the interactions between human and animal health needed for effective disease management.

Ebola is the most severe acute public health emergency seen in modern times. Begun in December 2013 in the Republic of Guinea, the West African Ebola epidemic has attracted unprecedented global attention. The Ebola epidemic provides a unique vantage point to inspect the processes that transform a single zoonotic spillover event into a transnational medical humanitarian disaster in some localities but not others. The concept of structural violence, first proposed by Galtung and refined by Farmer in relation to global health, refers to the ways in which institutions inflict avoidable harm to people by barring access to basic human needs, often in ways that normalize these practices to those most affected. Structural violence is manifest and maintained by a set of interlocking institutions that, across different spatial and temporal planes, act as vectors for interrelated patterns of economic, political, judicial and social exclusions and injustices.

International audience