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

Health emergencies are increasingly complex, for example as climate change intensifies the frequency of infectious disease outbreaks. The COVID-19 pandemic made clear that health emergencies are also socially and politically complex phenomena, laying bare the impact of marginalisation and deep political division on disease dynamics and public confidence in disease control measures. In response to this complexity, public health agencies have strengthened their efforts to develop more collaborative approaches that bring together a broader range of sectors and social groups to design epidemic interventions. This includes a commitment to a more diverse evidence base that draws on different disciplines and on mechanisms to engage affected populations and address mistrust. In these processes, different forms of knowledge and expertise come together and can at times be hard to reconcile. These moments are also political because they reveal how mistrust has roots in political histories and dynamics and because they highlight how unequal power and voice is attributed to different form of knowledge.

My FLF launched a programme of research and innovation to 1) identify the possibilities, limits and terms of translation between different forms of knowledge in epidemic response and 2) to uncover the politics and mechanisms of mistrust to help strengthen public engagement with science. Through a case study in Sierra Leone and research in global networks, as well as operational partnerships to support ongoing epidemic response and preparedness efforts, I researched everyday encounters between ways of knowing in the different spaces of epidemic response. I developed a distinctive analytical framework to explain these moments as fundamentally political, showing how epidemics become sites where authority is asserted and challenged, where (mis)trust is negotiated based on specific political histories and dynamics and where new political identities and relations are forged. For the renewal phase, I will build on the work of the first phase to consolidate its theoretical and practical contribution. Firstly, I will expand the conceptual reach of my current analytical framework by conducting research on how health organisations have tried to integrate different forms of evidence and perspectives to respond to health emergencies. I will do this through qualitative research with MSF LuxOR on their experience working across sectors and disciplines, and particularly on including patient and community perspectives in their work. This will form the foundation of a toolkit co-produced with MSF staff to co-produce interventions across disciplines and with affected communities. I will also develop a case study with the newly established Sierra Leone National Public Health Agency to explore how they have tried to institutionalise lessons on collaborating across sectors during the Ebola and COVID-19 response. We will develop a pilot training package on interdisciplinary approaches to epidemic response, with a focus on using qualitative approaches, that will be evaluated and standardised to support other public health agencies.

A second component of research will be to test and refine the wider applicability of the analytical framework by developing a new country case study led by a postdoctoral Research Fellow. This case study will take place in a European country and focus specifically on the experiences of undocumented migrants, including exploring the efforts that have been made to include their experiences in the design of epidemic response and preparedness measures, how migrants themselves navigate and contest these and the kinds of political relations that emerge from these encounters. This case study will apply ethnographic methods, including participatory workshops and collaborative video-ethnography. Outputs will include academic articles, a book, policy briefs, a training package and toolkit for transdisciplinary collaboration.