Ebola: How can we integrate science, policy and politics?
Two meetings, two worlds?
I am writing this from Montreux, Switzerland where the World Health Organization’s (WHO) Science Committee is meeting to discuss Ebola research priorities. The aim is to define an agenda around which scientists, international organisations and funders, with WHO facilitation, might align. The immediate context is the pressing need to ‘get to zero’ in an epidemic that is still spawning new cases and outbreaks – how can research inform the bumpy road of epidemic control still ahead? Beyond this are questions about how science can inform preparedness for future Ebola outbreaks. It’s a challenging task, and a privilege to be amongst around 40 top medical, epidemiological, public health, pharmaceutical development and humanitarian experts debating it.
Looking around the room, there are some glaring absences - I am the only social scientist, and only three amongst us are nationals of Sierra Leone, Guinea or Liberia. These absences reflect the politics of committee composition and to a lesser extent the absence of some key members in the field. But they mean that despite the strong emphases of our WHO convenors on the value of anthropology and community engagement, these perspectives inevitably remain rather marginal.
At the same time, in Brussels the European Commission is hosting a high-level conference of politicians and donors aimed at garnering financial commitments to end the Ebola crisis and re-build health systems (pdf). By all accounts, the roles of science and research – and funding for it – are absent from their agenda.
But are these two worlds – of Ebola science and politics - really so separate – and should they be? And how do they connect with the world of field practice in Ebola-stricken West Africa? I am struck both by the disconnect between the formal agendas of these meetings – and by the implicit politics of science that this hides. Our IDS initiative ‘Ebola: lessons for development’, launched last week, provides a salutary reminder of why these silences matter.
The politics of Ebola science
Here in Montreux we are hearing and discussing a plethora of science priorities. Many focus on the development of therapies, vaccines and diagnostics, showcasing a current mass of investment, private and public. The political economy of this shift from a pre-crisis situation of Ebola neglect is well discussed in a recent IDS briefing. Yet especially at this point in the epidemic, questions arise about the balance between such scientific efforts and those focused on clinical, public health and social questions – and about the ethics and politics of imposing trials on local populations likely to gain no direct benefit from them. There is relative silence about these broad politics of priority-setting.
Nevertheless, we are also discussing other research needs – from those linked to genomics and biomarkers; clinical case identification and management, epidemiology and modelling; public health and intervention research, and community dynamics and engagement.
However, with some of the key viewpoints missing from the conversation, a large challenge remains, given emerging consensus that some of the most pressing research gaps demand new forms of interdisciplinarity and integration. Thus for instance we need to ask not just biotechnological questions about how effective vaccines can be developed, but also social ones about the ethics and organisation of their trials and public health ones about how they will be used. We need to integrate epidemiology, public health and social science to understand how the epidemic actually turned around, and the relative roles of outside interventions and community learning in this. For the future, we need to integrate virology, ecology, veterinary and social science to understand how and why the zoonotic spillover event that triggered this Ebola outbreak occurred, and assess future risks.
Crucially, we need to integrate community priorities and perceptions – of Ebola, of outbreak dynamics, and of interventions – with those of scientists and planners. As anthropologist Cheikh Niang phoned in from Guinea, villagers have had enough of the ‘telling and selling’ of external messages that has dominated the outbreak response. Is it time for new modes of science that start by listening to their concerns and ideas, and co-design studies from there, drawing on participatory approaches to integrate women’s and men’s own understandings and questions into research that also involves health specialists?
Exploring such issues will need unusual collaborations amongst people, disciplines and approaches that have traditionally worked separately. If today’s meeting is anything to go by, there is tentative willingness – but the challenges of making interdisciplinarity real amidst silos and hierarchies of incentives, institutions and practices are real. Does the Ebola crisis offer an opportunity to reframe paradigms and practices in health-related science?
Science, ethics and governance
The politics of science deeply implicate questions of research ethics and governance. These are more firmly on our agenda, with lively debates turning on the need to strengthen robust national research ethics processes; national capacities to set scientific priorities as well as to conduct research, and appropriate local-national-international partnerships. The crucial roles of emerging networks and oranisations – of traditional healers and Ebola survivors, for instance – in research are also gaining attention.
As data accumulates – biological and social, quantitative and qualitative – the politics of sharing and access are becoming more acute. Tensions are already emerging between national governments, foreign institutions, and private companies around ownership of data and samples, as global aspirations around open access conflict with incentives for privatising intellectual property. The questions at stake touch on legal, ethical and privacy issues, as well as profit and power, while differences across countries present challenges of harmonisation. These are recurring, intractable issues in health-related science, and the Ebola crisis is unlikely to offer simple solutions. Yet previous global outbreaks have brought step-changes – with the SARS outbreak strengthening the International Health Regulations, and the 2009 pandemic flu controversy stimulating new approaches to virus sharing, rights and access. Might the Ebola crisis offer a similar opportunity for major shift in perception and practice, towards approaches that protect the intellectual property that drives innovation, but also facilitates open data sharing when required as a global public good?
Pressing research needs
Meanwhile, amidst the emerging geo-politics of the Brussels meeting, as Sierra Leone, Guinea and Liberia lobby bilateral and multilateral donors for funds to rebuild national health systems and capacities, there is silence on the research that could help inform this.
This is a glaring gap. As our briefings highlight, the Ebola crisis highlights the need not just to re-build health systems, but to build differently: for greater resilience, response capacity, and community integration. The challenges go beyond health per se, to encompass wider issues of governance and trust, state-citizen relations, and development paths. There are opportunities for innovative approaches that link public and private providers; harness digital technology opportunities, and connect human, animal and environmental health in ‘one health’ approaches. All this needs research, though of a particular sort – focused on systems and governance, and co-constructed with partners and change agents in the ‘engaged excellence’ approach that we emphasise at IDS.
Might the Ebola crisis open up new demand and opportunities for this kind of science – to build resilience and respond to future epidemics? And next time around – for unfortunately there is bound to be a next time – might we hope to see scientists and politicians meeting together, rather than at opposite ends of Europe, and for their debates to connect centrally with realities on the ground?