Crisis of Confidence: The Politics of Evidence and (Mis)Trust in Epidemic Preparedness and Response
Dr Luisa Enria
Challenges to scientific expertise are a growing concern across the world. Anti-vaccination movements and resurgent measles outbreaks in the United States and Europe have been linked to seismic political changes such as the rise of nationalist populism. Ebola outbreaks across Africa similarly highlighted the political undertones of resistance to epidemic control measures: rumours and anxieties reflected fragile trust in national authorities and external interventions. The COVID-19 pandemic has only made the political nature of outbreak response more visible across contexts, laying bare the impact of marginalisation on both disease dynamics and confidence in response measures and forcing reckonings in long-standing struggles for social justice. Epidemics become battlegrounds for these disputes, and these contestations create new opportunities for renegotiating the terms of political inclusion. How to engage meaningfully with mistrust and conflicts over different ways of seeing the world, then, is not simply a question for global health practitioners: it is a major test for contemporary democracies. If a ‘global crisis of expertise’ reveals deeper political tensions, we need to understand how this plays out in practice in order to address it. We must pay attention to everyday encounters with and contestations of scientific expertise as sites where trust is negotiated, political authority is challenged and alternatives to the status quo are articulated.
In recent years, efforts to directly address mistrust in epidemic response measures, for example during the 2014-16 West African Ebola outbreak, have sparked fruitful interdisciplinary collaborations and initiatives to open up the epidemic preparedness space to different voices, including social scientists and representatives from affected communities. However, these endeavours have also highlighted the difficulties of bringing together very different ways of knowing the world. In those spaces distinct ‘cultures of evidence’ become visible, as different standards, concepts and assumed hierarchies of knowledge confront each other. This can be seen in interactions between social scientists and epidemiologists involved in designing interventions, as much as in daily encounters between public health officials and traditional healers, or in citizens’ vaccination anxieties. Delineating the terms of engagement, across disciplines and between interventions and their target communities, is urgent but politically fraught.
In this fellowship, I take these two intersecting challenges, (mis)trust and the nature of dialogue between ‘cultures of evidence’, as my starting point. My aim is to explore the politics of negotiations over scientific evidence, taking the field of epidemic response and preparedness as a case study. I will interrogate the ecosystem of knowledge(s) that exist in this field, considering points of intersection at tension between disciplines and worldviews. I will take a multi-sited ethnographic approach, exploring connections and interactions across the different scales (global, national, local) and spaces that make up epidemic preparedness (from academic conferences and policy meetings to the ‘field’ where interventions are delivered and back), I will develop an analytical framework to identify the possibilities, limits and terms of ‘translation’ across epistemic communities and to uncover the politics and mechanisms of mistrust to develop innovative solutions for meaningful public engagement.
To build an interdisciplinary, adaptive analytical framework and to develop it through empirical research;
To trial innovative solutions through collaborations with operational partners involved in the design and implementation of epidemic response and preparedness programming;
To establish a research profile through training, mentorship and dialogue with different communities of practice
In order to explore the everyday politics of encounter between cultures of evidence to build an analytical framework and practical contributions, the research will be led by three questions: i) What cultures of evidence exist in the space(s) of epidemic response and preparedness? ii) How are the assumptions and practices underlying these cultures of evidence enacted and contested in everyday encounters across different spaces? iii) What political relations, identities and imaginations become visible during these encounters? To answer these questions, research activities during my Fellowship will include:
1. Training and Attendance at Meetings, Workshops and Conferences: To start defining ‘cultures of evidence’ I will take part in introductory trainings across different disciplines (e.g., infectious disease epidemiology) and practice-oriented learning packages and attend interdisciplinary workshops, meetings and conferences. These will be identified through mapping global networks of actors working in the field of epidemic preparedness and response. This will allow me to trace the ecosystem of knowledge in these spaces and observe interactions within and across disciplines and fields of practice.
2. Interviews and Document Analysis: I will conduct interviews with researchers and practitioners involved in international outbreak response and preparedness efforts and do a discourse analysis of training materials and grey literature.
3. Country Case Studies & Video-ethnography: I will develop country case studies to refine the analytical framework empirically. In the first phase of the Fellowship the case study will be Sierra Leone. This will include mapping out preparedness and response activities in country, interviews with national-level practitioner and participant observation in everyday encounters ranging from data collection for surveillance, vaccination drives, community engagement and outbreak response planning and implementation. This will be facilitated through a secondment to the Kambia District Health Management Team (DHMT) epidemiological surveillance office. I will complement this with ethnographic observation in community-led activities beyond formal preparedness interventions and a careful contextualisation of findings in political history and political economy analysis. During this ethnographic work, I will focus on a small number of individuals who act as ‘nodes’, or knowledge and trust brokers, and make a short film about their daily encounters as they navigate their work across different perspectives, mediating contestations, disagreements and mistrust. Further case studies will be defined over the course of the Fellowship.
4. Operational Application: I will collaborate with operational partners to support their work in outbreak response and preparedness. This will allow me to test and refine the utility of my analytical framework for generating practical innovations in two areas. Firstly, in identifying avenues for meaningful communication and co-production of interventions across ‘cultures of evidence’. Secondly, in proposing new approaches to building trust, to foreground contextual programming that identifies trust as a political process of negotiating the legitimacy of an intervention.
- Academic articles on key components of my analytical framework
- Policy and practice briefings and learning tools on an interactive online platform
- Bespoke support to operational partners
- A short film exploring everyday negotiations over scientific evidence and interventions in the field
- A dedicated website
- Co-production and public engagement workshops from the start of the fellowship
- Knowledge exchange and training materials for the Kambia District Health Management Team