31 January 2013

Africa: Pandemic Flu Controversies

'Evil' scientists, deadly mutating viruses and terrorist plots are usually the preserve of Hollywood blockbusters. But when it comes to pandemic influenza, this is the stuff of both cinematic plots and real life.

Last week (23 January) one group of scientists condemned another group for continuing controversial research into the H5N1 bird flu virus, fearing the risk of leaks from the lab or the research getting in to the wrong hands outweighs potential public health benefits.

While Hollywood films like Outbreak and Contagion graphically remind us of the fear and panic a pandemic outbreak holds for the human psyche, most flu experts agree it is not so much a question of if, but rather when, a new pandemic will arrive. With past approaches to pandemic threats proving controversial in the extreme, we have been exploring lessons learnt through a workshop and newly published paper.

Pandemic preparedness policy over the past decade has proven to be anything but straightforward. Rather than calmly putting the necessary plans into place, governments have often had to be dragged to the planning table, with only the threat of an imminent H5N1 pandemic in 2005/6 kick-starting efforts in earnest.

However, efforts to improve pandemic preparedness have been steeped in controversy, engulfing everything from the models for predicting how severe a future pandemic is likely to be (will it be on the scale of the Spanish Flu of 1918?), to the naming and classification of pandemics (should we call it 'swine' flu? Phase 5, Phase 6?) Even the task of shoring up medical defences has not escaped controversy - such as the open data access saga surrounding Tamiflu, or concerns about the rare, but significantly elevated, risk of side-effects of some pandemic vaccines.

Internationally we have witnessed long diplomatic disputes about the sharing of H5N1 virus samples, prompted by concerns about inequitable access to medicines and other intellectual property issues. Even the carrying out of basic virology research on H5N1 viruses by highly trained scientists has provoked international furore.

Exploring controversies to inform future approaches

We have been trying to develop a better understanding of why controversies have emerged around pandemic flu, in order to inform future approaches. Building on research over recent years, the IDS-based STEPS Centre and the Centre for Global Health Policy (CGHP) at the University of Sussex recently hosted a workshop to explore these controversies in depth. More than fifty international experts from the worlds of science, policy, the media and academic publishing - with both social and natural science expertise - explored the multiple facets of these pandemic flu controversies over two days.

We learned from all of these controversies that preparing for flu is simply not just about flu; it is just as much - if not more so - about the interventions that we need to implement in order to manage a pandemic. A North-South politics is particularly evident, as health concerns in the North appear to trump livelihood imperatives in the South. Equally, there is a global-local politics, as responses geared to international health and economic interests meet the often very different priorities of people in local settings.

We also learned that controversies are great opportunities to unearth the contested, contingent, and fractious nature of knowledge that shapes our ongoing quest to protect human lives - irrespective of which side of the controversies we come down on. Social science perspectives are therefore a critical complement to natural science-based understandings. Plus we learnt how some of these controversies could also be diminished and perhaps even avoided in future.

In his new STEPS Centre Working Paper, To Pandemic or Not? Reconfiguring Global Responses to Influenza Paul Forster examines the political economy of knowledge in responses to the H1N1 (swine flu) pandemic in 2009-10.

He found that narrow, technocratic responses to pandemic influenza are not only at odds with the varied understandings, needs and priorities of different people in different parts of the world, but favour rich, industrialised nations, while preventing other options from emerging, thus limiting response pathways.

Forster argues the world would be better protected by a re-ordering of pandemic preparedness and response efforts around the needs of the world's poorest, most vulnerable, and most exposed people. This would allow the examination of the undue pre-eminence of pharmaceuticals, focus on the pressing need for disease surveillance in animals, and scrutiny of contemporary agricultural practices. It might also refresh the World Health Organization's approach, and encourage a broadening of research efforts.

Preparing for an influenza pandemic means preparing for surprises and being ready to respond rapidly and flexibly under conditions of uncertainty. If people everywhere are to be engaged, plural and diverse response pathways are required.

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