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Accepted Paper:

Architectures of preparedness: hope and hidden infrastructures of vaccine development and laboratory strengthening in Sierra Leone  
Luisa Enria (LSHTM) Ann Kelly (King's College London) Eva Vernooij (Utrecht University) Shelley Lees (London School of Hygiene and Tropical Medicine) Alice Street (University of Edinburgh) Shona Lee (Royal College of Surgeons in Ireland)

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).

Panel P01
On being prepared
  Session 1 Thursday 27 August, 2020, -