Paper long abstract:

Epidemiological consciousness profoundly shapes the way one lives through a pandemic. Pandemics make modellers of us all. Different ideas about one’s vulnerability to a pathogen and how it is spread within different spaces and by different types of body affect how one experiences transitions into and out of lockdown, how one behaves during a pandemic, and how one evaluates the behaviours of others. Divergent epidemiological consciousnesses can generate household conflict and lead friendships to drift apart. Conversely, alignments in epidemiological consciousness can underpin new forms of solidarity. While other factors (such as legal consciousness, or conceptions of the public good) are also important, documenting and accounting for emergent forms of epidemiological consciousness is central to understanding sociality, moral experience, and political subjectivity during a pandemic.

This paper demonstrates the constitutive importance of epidemiological consciousness by drawing on survey and interview work with New Zealanders during the Covid-19 pandemic, supplemented with comparative findings from the UK. We show epidemiological consciousness regarding Covid-19 to be shaped by several longstanding factors, including personal and familial medical histories, historic memoires of disease-related traumas, cultural and political ideas about health, and unconscious biases regarding ‘polluting’ bodies arising from structural racism. It also results from disparate policy responses: the centrality of ‘social bubbles’ to New Zealand’s Covid-19 strategy led New Zealand respondents to view exclusive social contact as safer than socially distanced outdoor encounters. In the UK, which prioritised a less limited shutdown of ‘the economy’, scientific advisers (and our respondents) suggested the opposite.

Much as divergent epidemiological consciousnesses have shaped our respondents’ practices and judgements, they have also shaped our own. We therefore conclude by exploring how reflexivity regarding anthropologists’ own epidemiological consciousnesses can best be incorporated into ‘critical medical anthropology’ when living through a pandemic.

Other co-authors: Pounamu Jade Aikman, Megan Laws, Michael Roguski

Paper long abstract:

In recent years the concept of epidemic ‘preparedness’ has gained prominence in global health discourse as concern about (re)emerging diseases with pandemic potential has grown. The resultant sets of mechanisms and institutions oriented towards reducing risk have been analysed as forms of ‘anticipatory imagination’ (Lakoff 2017). As SARS-CoV-2 has emerged as the ‘Disease X’ of the WHO list of priority pathogens, so the unfolding of the pandemic has thrown a political spotlight on ‘preparedness’ and called into question the value of standardised approaches and linear phases of preparedness, response and recovery.

We will draw on findings from a current Wellcome grant on pandemic preparedness to reflect on the shifting and contextual nature of practices aimed at controlling disease outbreaks. This research aims to fill a gap in understandings of the connections and/or disconnections between discourses of preparedness in global fora and local concepts of and responses to outbreaks and misfortune. Fieldwork in two rural villages that have encountered Ebola in Sierra Leone and Uganda respectively, has focused on people’s responses to uncertainty in the form of ongoing threats to health and life in order to explore what views and practices on preparing might exist. Fieldwork has revealed the evolution of understandings of COVID-19, tracking how public health measures and messaging have been received and experienced and the social responses and relations that are mobilised to protect both health and livelihoods. In the national contexts, past experiences of outbreaks and international interventions as well as political agendas have shaped planning and implementation of measures. We argue that ethnographic insights are critical for a more nuanced understanding of the immediate effects and broader repercussions of epidemics and that debates about preparedness and response should consider such perspectives ‘from below’ in order to interrogate who is being prepared for what, and by whom.

Co-authors: Daniel Osinde, Moses Baluku, Esther Mokuwa, Foday Komara, Khoudia Sow

Paper long abstract:

This paper examines how the international response to the 2014-2016 Ebola outbreak helped to prepare Sierra Leone’s health system for COVID-19. It draws on anthropological research on post-Ebola vaccine trials and laboratory strengthening programmes to explore health-worker experiences of epidemic response and preparedness efforts. These on-the-ground experiences and perspectives are under-recognised in evaluative exercises, but are critical to understanding which features of emergency response carry forward as sustainable infrastructures of preparedness.

Analysis will centre on the hopes and expectations that technology-centred preparedness interventions foster for frontline workers in under-resourced health systems, the hidden efforts of building robust preparedness infrastructures, and the contribution of anthropological approaches to understanding preparedness as a social process. In describing the additional labour, informal networks, personal losses and social risks undertaken by laboratory and vaccine trial workers in order for protocols and practicality to meet, we reveal the social performance of preparedness. That is, the contextual engineering that make systems work through personal connections and sacrifice.

The paper expands concepts of preparedness to include its personal and relational aspects, exploring the knowledge and value systems produced in epidemics. From this perspective, the Ebola response and aftermath helped prepare Sierra Leone for COVID-19 by developing capacity at individual and institutional levels, and blueprinting physical and social infrastructures for cultivating laboratory, vaccine development and clinical research systems. Yet failing to build the social experiences of response work into preparedness programmes risks erasing important knowledge of how these temporary assemblages are stabilised and sustained. COVID-19 has confirmed that the rhetoric of resilience is insufficient to capture the extent and expectation of sacrifice placed on staff. Responding to this pandemic requires investing in the long-term safety, security, and support of people undertaking the work prescribed by protocols, as well as that of making protocols work.

Co-author: James Rogers, Rashid Ansumana (School of Community Health Sciences of the Njala University) and Mahmood Bangura (College of Medicine and Health Sciences, University of Sierra Leone).