As preparations ramp up for a new global treaty on pandemics next year, it’s time to ask: Who is being prepared? For what? And by whom? Researchers in the Pandemic Preparedness Project spent three years exploring these fundamental questions and they shared their findings in an event featuring field researchers and expert speakers from Africa, the Americas and Europe.
The ’Shifting Power in Pandemics’ public webinar on connecting and supporting preparedness ‘from below’, heard from local researchers in Sierra Leone and Uganda and featured videos from the field. It also included insights from and discussion with senior representatives from the ministries of health in Sierra Leone and Paraguay, the World Health Organization (WHO), UK Foreign, Commonwealth and Development Office, and Chatham House. It was chaired by the project’s co-Principal Investigators, IDS Director Professor Melissa Leach and IDS Research Fellow Professor Hayley MacGregor.
The event marked the culmination of the Wellcome Trust-funded Pandemic Preparedness project, which began work researching preparedness ‘from below’ in 2019, focusing on different meanings and practices of preparedness. It involved fieldwork at global and regional levels as well as in villages in Sierra Leone and Uganda, and set out to explore what could be learned from people living with multiple health-related uncertainties in African settings.
Since early 2020 the work was significantly informed by the Covid-19 pandemic – affecting fieldwork plans but adding a new dimension to the research. The pandemic catalysed new thinking about the place of local capacities in preparing for and responding to disease threats.
While there is much emphasis currently on improved surveillance and technical advances, such as vaccine platforms for immediate readiness, there is less attention to identifying and understanding preparedness ‘from below’ as complementary to conventional preparedness investments. At the same time, discussions in decolonising global health point to a need to: i) avoid inadvertently entrenching established power hierarchies, and ii) ensure that better connections across scales of response can support inclusive and acceptable actions.
The Shifting Power in Pandemics event set out to further discussion about the kinds of efforts and global-local relations needed to strengthen and build local-level preparedness. We would like to share recordings of the presentations by our researchers and the expert comment from discussants and panellists.
Session one: Learning from and with communities
The first session in the webinar, chaired by Professor Melissa Parker of the London School of Hygiene and Tropical Medicine (LSHTM) and Professor Hayley MacGregor, focused on local-level insights into how people navigate disease outbreaks in the context of often-intersecting acute and chronic challenges and precarious livelihoods, amid multiple uncertainties. In a prepared video package, project field researchers Bob Okello, Moses Baluku, Marion Baby-May Nyakoi, Foday Kamara, Peter Kermundu and Bono Ozunga described their fieldwork.
The session raised important insights about the place of local knowledge, diverse formal and informal public authorities, individual and collective agency, and adaptability. It explored how such insights have implications for approaches to community engagement and understandings of the possibilities and limitations of community resilience.
The discussants for this session included:
- Dr Guillermo Sequera, Head of the National Health Surveillance Directorate of the Ministry of Health of Paraguay, who emphasised that this work is a collective, not individual effort.
- Dr Amone Jackson, Public Health Physician, Uganda, who spoke from the field where he was responding to an ongoing Ebola outbreak in his country. Dr Jackson explained the importance of community involvement in Uganda, including teaching and training people to bring them closer to the responders and working with survivors.
- Dr Alfred Jamiru, National Pillar Lead, Social Mobilization, National COVID-19 Emergency Response Center (NaCOVERC) in Sierra Leone, who described how he was responsible for social mobilisation in his country and explained the need to separate social mobilisation and community engagement.
- Dr João Rangel de Almeida, Technical Officer, WHO, who picked up on the point that epidemics unfold within particular social contexts and can involve difficult choices for people, such as when community livelihoods are compromised by public health measures.
Session 2: Technologies and systems
The second session, chaired by Professor Alice Desclaux, of Institut de Recherche pour le Développement, and Dr Fred Martineau, of LSHTM, focused on technologies and systems, and in particular on the balance between technical, risk-based interventions in response to outbreaks and longer-term initiatives to strengthen health and social protection systems to ensure their agility and build trust. The session explored how technologies such as vaccines, pharmaceutical treatments and diagnostic tools, and the information about their use, are not neutral instruments but have important social dimensions. It considered the question: What might inclusive ‘systems preparedness’ look like in different contexts?
Project researchers Dr Esther Yei Mokuwa, Professor Grace Akello, Dr Khoudia Sow and Dr Lawrence Babawo presented their findings.
The discussants for the second session included:
- Professor Ann H. Kelly, Professor of Anthropology & Global Health, King’s College, London, who spoke about the importance of trust and engagement with communities.
- Dr Thierno Baldé, MD, PhD, Associate Professor at Université de Montréal and Regional COVID-19 Incident Manager, WHO Africa Region Office, who spoke about future challenges and how things could have been done differently.
- Dr Julienne Ngoundoung Anoko, a social anthropologist and focal point social sciences and Risk Communication and Community Engagement Pillar lead at the WHO Regional Office for Africa/EPR/EMP, who spoke of the importance of people trusting and understanding vaccines.
- Dr Cathy Roth, Senior Research Fellow and health adviser from the Health Research Team, FCDO, UK, who spoke about getting community voices to inform preparedness before as well as during epidemic events.
Session 3: Connecting preparedness from below
In the final session, ‘Connecting preparedness from below’, chaired by Melissa Leach and Hayley MacGregor, panellists returned to consider the significance of the current moment for rethinking understandings of preparedness and reflected on what future preparedness would ideally involve. The panel comprised:
- Dr Sylvie Briand, Director, Global Infectious Hazard Preparedness Department, WHO, who began by telling us that it is important to recognise key characteristics of epidemics as this is key to better preparedness..
- Professor Susan Erikson, Professor in Health Sciences, Simon Fraser University, talked about the ‘politics of recognition’ and the need to give greater recognition to ‘the elsewheres’.
- Professor David Heymann, Professor of Infectious Disease Epidemiology, LSHTM, and Distinguished Fellow in the Global Health Programme at Chatham House, explained the need for the right balance at political levels and greater emphasis on listening to multiple voices. He emphasised the need to continue capacity building, including the treaty now being negotiated, ensuring that prevention and preparedness are included in this.
- Dr Chikwe Ihekweazu, Assistant Director General WHO and leader of the WHO Hub for Pandemic and Epidemic Intelligence, discussed the need to work across all different diseases and pathogens and across professions and sectors, explaining the importance of building opportunities for this to happen.
This discussion focused on how global and regional efforts might interconnect more effectively with preparedness ‘from below’, with an emphasis on the kinds of local capacities, global-local relations and mechanisms needed for strengthening inclusive systems of preparedness that are attentive to local realities. The experts commented on how these concerns might contribute to current global conversations about preparedness, each from their particular institutional vantage point.
For further information on the research programme Pandemic Preparedness: Local and Global Concepts and Practices in Tackling Disease Threats in Africa visit the programme web page.
