Crisis of Confidence: The Politics of Evidence and (Mis)Trust in Epidemic Preparedness

Lead Research Organisation: London Sch of Hygiene and Trop Medicine
Department Name: Public Health and Policy

Abstract

Across the world challenges to of scientific expertise are on the rise. 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. Recent and on-going Ebola outbreaks across Africa similarly highlight the political undertones of resistance to epidemic control measures: rumours and anxieties reflect fragile trust in national authorities and external intervention. 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 this fellowship I will develop a new interdisciplinary research agenda that explores the politics of everyday negotiations over scientific evidence, taking the field of epidemic response and preparedness as a case study. Through training, empirical research and deployment in an outbreak response, I will develop an original analytical framework to explore:
1) What 'cultures of evidence' exist in the ecosystem of epidemic preparedness and response?
2) How are these assumptions and practices enacted in everyday encounters?
3) What political relations, identities and imaginations are made visible through these encounters?

This research agenda responds directly to a growing interest in the global health community for creative, interdisciplinary approaches and opportunities for opening up epidemic preparedness to a variety of different voices. In recent years there has been increased focus on developing interventions that can account for social, cultural and political contexts and local perspectives for effective interventions. This has sparked fruitful collaborations but also made clear that there are significant challenges for integrating and translating different ways of understanding and experiencing the world. Finding solutions and novel approaches for integration and meaningful citizen engagement is urgent but also raises difficult questions about the relationship between trust, the legitimacy of different forms of evidence and political challenges to authority.

To deliver a practice-oriented analytical framework, I will undertake skills development to support a novel interdisciplinary perspective and carry out ethnographic research across the different spaces that make up epidemic preparedness, from global research and policy forums to interactions in the 'field'. I will map out the different actors, perspectives and preparedness activities in-country, observe the tensions and intersections between different forms of knowledge and the political relations and identities that emerge through encounters in the field. I will have a country case study in Sierra Leone through a partnership with the Kambia District Health Management Team.I will then test and refine my framework through outbreak deployment and participation in the design of interventions through a partnership with Anthrologica, a leading organisation delivering social science research in outbreak settings. In the deployment I will focus on developing innovations for collaboration, community engagement and trust-building.

In the longer term, I will develop comparative research on the politics of epidemic preparedness and response, developing insights from other contexts where political contestations have coalesced with mistrust in scientific interventions.

Planned Impact

In this fellowship I will tackle two interrelated global challenges: i) how to engage with the political dimensions of (mis)trust in scientific evidence and interventions and ii) how to encourage meaningful dialogue between different disciplines and knowledge systems for effective collaborative interventions. Through my programme of work I will generate empirical insights to support innovative solutions to address these challenges, with the aim to benefit three categories of beneficiaries: practitioners involved in different aspects of global health programming and outbreak response; public health officials, community leaders and civil society groups in my country case studies; and policy-makers, private sector and charities interested in tackling the political dimensions of mistrust in evidence and interventions. To maximise the impact of my research for the benefit of these communities I will undertake five sets of activities:

1. Co-Production

- In Year 1, I will hold consultative meetings in London, Freetown and Kambia District in Sierra Leone to collaboratively design the key themes, research questions and potential for innovation with researchers, practitioners, civil society and community leaders.
- Throughout the fellowship I will haver regular consultations with my advisory group made up of world-leading researchers and practitioners and my project partner Anthrologica, an organisation at the forefront of efforts to operationalise social science research for disease outbreak responses
- In Year 2 of the fellowship I will be seconded to the Kambia District Health Management team, working alongside the surveillance team. This will provide opportunities for daily collaborations to shape the direction of my research, whilst also supporting the DHMT through knowledge exchanges, capacity building in research methods and analysis, and funding proposal development
- I will deliver regular presentations and informal consultations during my field research with key stakeholders in Freetown and a community advisory board in Kambia
- In year 4 I will build links and opportunities to set up a similar secondment and partnership to plan a further country case study in the next phase of the fellowship

2. Outbreak Deplyoment
- Through my partnership with Anthrologica I will make myself available for deployment as a social scientist in an outbreak response and to support the design and implementation of other related epidemic preparedness interventions
- As a deployed social scientist I will directly support operation activities through action research, briefings and support to other response pillars

3. Learning tools
- Based on empirical research in Sierra Leone and deployment experience I plan to develop interactive learning tools through an online platform

4. Public Engagement
- I will make a short film from my research in Sierra Leone detailing the everyday negotiations of trust and knowledge brokers (e.g. surveillance officers or community activists) in the field
- The film will be shown at four participatory public engagement events in Freetown, Kambia, London and Brussels attended by researchers, practitioners, policy-makers and the public

5. Dissemination
- Dissemination for academic audiences will include journal articles and presentations at conferences
- In Year 4 I will host a two day academic-practitioner conference in Bath
- I will develop policy and practice briefings through Anthrologica based on my research and from any operational deployment
- I will write for a wider audience through blogs and popular publications

Publications

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