Institute of Development Studies

STEPS book calls for more long-term thinking in epidemics policy making

5 August 2010 - Sarah Dry

As the dust settles from the international conference AIDS 2010 held in Vienna, a new book published by the STEPS Centre explores epidemics policy making and considers the unintended effects epidemics policies can have on the world's most vulnerable citizens.

Epidemics: Science, Governance and Social Justice, edited by Sarah Dry and Melissa Leach, asks when and where the next serious epidemic will arise and how well will we manage it - questions more pressing than ever given the recent outbreaks of SARS, avian and H1N1 flu', and hemorrhagic fevers. With the help of case studies on these diseases, as well as on obesity, HIV/AIDS and tuberculosis, the book brings much-needed breadth of content and analysis to the critical challenge that epidemics present today.

Published by Earthscan, Epidemics is one of the first in a new STEPS Centre book series. STEPS is an interdisciplinary global research and policy engagement hub that unites development studies with science and technology studies. It is based at the Institute for Development Studies (IDS) and funded by the Economic and Social Research Council (ESRC).

Epidemics shows the unintended consequences of broad-brush and emergency approaches to epidemics policy making, arguing that such emergency-oriented, top-down responses have become dominant in health policy when the perceived risk of a disease event is strongest.

The result is an emphasis on biomedical interventions, such as vaccination and anti-viral medications, and on global surveillance systems for early identification and response. But these policies may not be the best suited for infectious disease outbreaks today.

Understanding disease causes

Epidemics argues for the need to incorporate alternative understandings about the social, biological, environmental and technological causes of disease outbreaks. Such an approach is important: first, because it is more likely to lead to policies that take into account the multiple social, technological and environmental factors at play in an uncertain and complex world; and, second, because it is more likely to result in policies that benefit the poor, the marginal and those already suffering from disease.

When the Egyptian government implemented a nationwide cull on pigs in response to fears about H1N1 (also known as swine flu), it triggered another crisis: the destruction of an informal waste recycling industry. Killing the pigs which had consumed much of Cairo's waste, led to a garbage, and subsequent public health, crisis in the city. The cull also destroyed the livelihoods of the Christian minority who had employed pigs as waste recyclers for generations.

This example, one of many in the book, provides a cautionary tale about the potentially profound but unintended impact that epidemics policies can have on the most vulnerable members of a society.

Planning for the long term

The book acknowledges that it is natural to fear hard-hitting and fast-spreading diseases, and to focus on eliminating or eradicating them in the short term. But it argues that this approach may not work - or even be desirable - for many infectious diseases, including avian flu' and HIV/AIDS. In planning for epidemics, it states, we need to be alert to both long and short-term factors, so that valuable resources and time are not wasted.

We don't know what the next big epidemic will be, or have all the answers to the diseases we currently face. But being aware of uncertainty, incorporating alternative understandings and planning for the long term will help us to respond more effectively and protect those who are most vulnerable.

Sarah Dry is a Research Officer with STEPS

Related Publications

• Dry, S. and Leach, M. (2010) Epidemics: Science, Governance and Social Justice, London: Earthscan