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The Covid-19 pandemic is more than a health crisis. It has worse outcomes among individuals with co-morbidities, has exposed fault lines in our societies, and amplified existing inequalities. This article draws on emerging evidence from low- and middle-income contexts to highlight how Covid-19 becomes syndemic when it interacts with local vulnerabilities. A syndemic approach provides a frame for understanding how Covid-19 is amplified when clustered with other diseases and how this clustering is facilitated by contextual and social factors that create adverse conditions. Public health responses to Covid-19 have also exacerbated these adverse conditions as many face social and economic crises as a result of some policies. These multiple challenges generate major implications for both the public health response and for broader development action: first, one size does not fit all and we must attend to local vulnerabilities; second, short-term public health response and longer-term development approaches must be integrated for improved intersectoral coordination and synergy. A synergised public health and development response will allow us to better prepare for the next pandemic.

The heterogeneous epidemiological picture for COVID-19 in Africa continues to generate debate. Modelling projections raise speculation about the phases and trends of SARS-CoV-2 outbreaks across the continent and how these differ from outbreaks elsewhere.[1–4][1] Continental efforts drew praise in

By September 2014, it was clear that conventional approaches to containing the spread of Ebola in West Africa were failing. Public health teams were often met with fear, and efforts to treat patients and curtail population movement frequently backfired. Both governments and international agencies recognized that anthropological expertise was essential if locally acceptable, community-based interventions to interrupt transmission were to be designed. The Ebola Response Anthropology Platform was established against this background. Drawing together local and internationally based anthropologists, the Platform provided a coordinated and rapid response to the outbreak in real time. This social thought & commentary piece explores how the Platform developed and interacted with other epistemic communities to produce knowledge and policy over the course of the outbreak. Reflecting on the experiences of working with the UK Department for International Development, the World Health Organization, and other agencies, we ask: what do these experiences reveal about the politics of (expert) knowledge and its influence on the design and implementation of policy? Did differing conceptions of the place of anthropology in humanitarian crises by policymakers and practitioners shape the contributions made by the Ebola Response Anthropology Platform? What are the implications of these experiences for future anthropological engagement with, and research on, humanitarian responses to health crises?

This paper introduces the Thematic Issue on Innovation in Health Systems in Low- and Middle-Income Countries.

The WHO launched a Global Action Plan on antimicrobial resistance (AMR) in 2015. World leaders in the G7, G20 and the UN General Assembly have declared AMR to be a global crisis. World leaders have also adopted universal health coverage (UHC) as a key target under the sustainable development goals. This paper argues that neither initiative is likely to succeed in isolation from the other and that the policy goals should be to both provide access to appropriate antimicrobial treatment and reduce the risk of the emergence and spread of resistance by taking a systems approach. It focuses on outpatient treatment of human infections and identifies a number of interventions that would be needed to achieve these policy goals. It then shows how a strategy for achieving key attributes of a health system for UHC can take into account the need to address AMR as part of a UHC strategy in any country. It concludes with a list of recommended priority actions for integrating initiatives on AMR and UHC.

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.