This special issue of Anthropology in Action presents a collection of articles that reflect on and analyse the role of social science in epidemic response. The COVID-19 pandemic has exposed deep social and economic inequalities within and across countries which produce unequal COVID-19 outcomes. Researchers have long noted the connections between socio-economic inequalities and infections, and there is growing recognition that epidemics are also social and political events (Bardosh et al. 2020). Anthropological and other social science research has contributed to epidemic response, through attention to cultural and politico-economic context, reframing community ‘resistance’, bolstering community engagement in preparedness and response, and informing response activities, including risk communication (Abramowitz 2017; Bardosh et al. 2020). Despite this, much of the work has been ad hoc and not systematically integrated into the systems of epidemic response, with the exception of the Centres d'Analyses des Sciences Sociales (CASS) in the Democratic Republic of Congo (DRC). This special issue is timely, in that it builds on foundational work in social science and epidemic response, draws on tensions and experience from recent epidemics including COVID-19 and Ebola, and charts a way forward at both a theoretical and a practical level.
Key Challenges/Questions in Operationalising Social Science
The challenge of operationalising social science includes the need to wrestle with significant tensions. This includes the well-recognised tension between ‘critical’ and ‘applied’ approaches, which has been long debated within anthropology (Scheper-Hughes 1995). How can we as anthropologists use our skills to support urgent epidemic response which may require working within, and thus perpetuating, and even legitimising, unequal systems, structures and power dynamics while also retaining a critical distance and independence that enables the speaking of truth to power and the reimagining and building of more equitable systems? In this issue, Luisa Enria and Shelley Lees reflect on new opportunities to foreground ‘the social’ in responses to health emergencies but also to the debate on the nature of anthropological engagement. Simone Carter and Izzy Scott Moncrieff, who both work at CASS, and Pierre Z. Akilimali, Dieudonné Kazadi Mwamba and Karen A. Grépin show us how social science can be rapidly mobilised to answer key questions of social difference.
This tension played out in the West African Ebola epidemic, in which anthropologists were playing a series of roles that would sometimes create friction: giving voice to communities, critiquing the response and urging countries of the Global North to take responsibility, working within the response as cultural mediators (and sometimes firefighters), and influencing policy (advocating social mobilisation and adaptation of activities to local priorities) while at the same time aiming to produce and convey research with academic rigour (Lees et al. 2020). Tensions emerged from the (dis)advantages of being ‘outsiders’ and being ‘credible advisors’ to policymakers while also retaining the expertise of ‘the local, to avoid being caught in the processes of depoliticization typical of humanitarian interventions’ (Martineau et al. 2017). In this issue, Alex Tasker and Lucy Irvine discuss their role working as Embedded Scientists (ES) in the British COVID-19 response and how their fluid identities and roles were actually a powerful tool to advocate for the greater inclusion of social science in policy. Gideon Lasco provides us with deep reflection on anthropologists as participant-observers of epidemic response. Nevertheless, anthropologists still (and should still) struggle with the questions of legitimacy of speaking on behalf of others and question whether their engagement in epidemic response leads to other voices being silenced (Abramowitz 2017). Sylvain Landry Faye (2015) has called for a ‘symmetrical anthropology’, in which the proximity and distance to the context and the response is balanced. Alternatively, there can be also different anthropologists situated in different spaces – within the response, the affected communities, remotely – whilst at the same time engaging in dialogue.
The incorporation of social science into epidemic response requires institutional and epistemological integration at a systems level. At an institutional level, progress has been made in terms of recruiting social scientists into humanitarian and government agencies, who can provide social science intelligence into everyday humanitarian activities. In parallel to this requirement, there is the need for spaces (or data centres) at the field, the national and the global levels in which social science data is produced, compiled and shared without losing the nuances of local context (Bardosh et al. 2020). This ‘data’ would need to be contextually rich (rather than standardised and homogenised) and gathered with specifically operational purpose. In turn, there need to be institutional mechanisms within the architecture of the response to be able to make sure of this data (Bardosh et al. 2020). This may involve rethinking the institutional spaces where social science is located. Social science within response is largely relegated to what is called ‘risk communication and community engagement’ (RCCE) pillars or clusters, with little opportunity to influence other aspects of response such as treatment or logistics. Rethinking institutional mechanisms within the coordination of the epidemic response is needed in order to avoid this siloing of social science knowledge (e.g. sitting in a cross-cutting pillar or at a higher level within the national government response task force), as Ripoll and colleagues will show. Each country's specific context may yield a different institutional make-up.
The epistemological challenge is a greater one. Is social science considered valid data? Or is it considered something that ‘it is nice to have’ to inform context rather than an essential part of an effective response? (Bedford et al. 2019). Even when social scientists are integrated into response, or at least have the ear of decision-makers within one, their contributions and knowledge are not guaranteed to be valued and acted upon in spaces where biomedical and epidemiological knowledge have traditionally dominated and led. Promoting the validity of social science inputs comes from the leadership of humanitarian agencies and donors who fund social science analytic bodies and from within the accountability and evaluation mechanisms to ensure that social science input translates into changes in activities. There is space for collaboration between disciplines, for example anthropology helping epidemiological models to be more context-adapted in their predictions (Rhodes et al. 2020). Interdisciplinarity (with contributions not only from anthropology but from epidemiology, medical science, history, political science, governance, ethics, artificial intelligence, community feedback and so on) is crucial for an effective epidemic response (Bedford et al. 2019; Roberts 2020).
It is challenging for anthropologists to communicate the value of social scientific knowledge, particularly of qualitative data, and to package it in ways which are timely enough, easily digestible and actionable for responders. Building capacity and skills for social scientists to show the operational aspect of their work and to communicate effectively is required in parallel to building the capacity of epidemic responders from all technical backgrounds to understand the contributions of social science in their respective fields (from contact tracing, case management to WASH engineering and food security).1 In turn, the involvement of epidemic responders in defining the research questions and formulating the recommendations together with social scientists has been highly successful in terms of the recommendations being taken up (Analytics for Operations Working Group 2020). Further, humanitarian practitioners’ perceptions of the timeliness and usefulness of anthropological methods are that they are cumbersome and time-consuming (Abramowitz 2017). However, there is a role for anthropologists to show the availability of Rapid Ethnographic Assessments (Sangaramoorthy and Kroeger 2020) and other rapid methodologies and tools that produce rapid and actionable insights.
Balancing these tensions and navigating these challenges are necessary if anthropologists are to make meaningful contributions to epidemic preparedness and response. Alex Shankland, Danilo Paiva Ramos, Domingos Barreto and Renato Athias do just that, leveraging years of academic–activist partnerships around Indigenous health and rights. Together, they co-create knowledge that is deployed to interrogate the politicisation of COVID-19 response in the Brazilian Amazon.
Introduction to the Articles
The authors of the articles in this special issue engage with contemporary questions in epidemic response. Some of the articles are tried and true: there is no ‘one size fits all’ approach to epidemic preparedness and response. Social sciences can highlight the flaws of a ‘context-blind’ approach and highlight which vulnerable groups (such as women, Indigenous groups, the poorest in society) will be adversely affected and how to address these inequalities. Other articles further the debate on how social science can be taken up to inform and shape epidemic response across all pillars of the response.
Ebola, COVID-19 and other recent pandemics have exposed deep social and economic inequalities within and across countries which shape access to health systems and produce unequal outcomes (Ku and Brantley 2020; UNSDG 2020). Yet, the dominant public health paradigm privileges ‘one size fits all’ approaches to epidemic response that tend to ignore local context and historically rooted inequalities (Abramowitz 2017). Social science is well-placed to inform public health guidance not only on COVID-19, but on other infectious disease outbreaks (Leach 2020).
This special issue explores approaches to operationalising social science from past and present epidemics for more just and equitable future epidemic responses and strengthened health systems; discusses hierarchies of knowledge and evidence; and engages with cultural, social and politico-economic forces behind epidemics and response. Our first article, by Santiago Ripoll, Annie Wilkinson, Syed Abbas, Hayley MacGregor, Tabitha Hrynick and Megan Schmidt-Sane, presents a framework for social science in epidemics to enable responders to engage more deeply and systematically with the social, political and economic contexts of emergencies, ensuring they are not context-blind. Two further articles (about Brazil and the DRC, respectively) give specific examples of how vulnerable groups have been adversely affected by ‘one size fits all’ approaches and how social science can mitigate the effects of this problem. This issue also includes two case studies which show the impact of anthropological involvement in the COVID-19 response in the Philippines and in the United Kingdom. The last article in this special issue moves on to look at the historical and improving nature of anthropological involvement in epidemics and how to move to a critically embedded approach.
References
Abramowitz, S. (2017), ‘Epidemics (Especially Ebola)’, Annual Review of Anthropology 46: 421–445, doi:10.1146/annurev-anthro-102116-041616.
Analytics for Operations Working Group (2020), Guidance Brief: How to Maximise the Use of Social Sciences Evidence for Public Health Emergencies in Humanitarian Settings, September, Anthrologica et al., https://reliefweb.int/report/world/guidance-brief-how-maximise-use-social-sciences-evidence-public-health-emergencies.
Bardosh, K. L., D. H. de Vries, S. Abramowitz, A. Thorlie, L. Cremers, J. Kinsman and D. Stellmach (2020), ‘Integrating the Social Sciences in Epidemic Preparedness and Response: A Strategic Framework to Strengthen Capacities and Improve Global Health Security’, Globalization and Health 16, no. 1: 120, doi:10.1186/s12992-020-00652-6.
Bedford, J., J. Farrar, C. Ihekweazu, G. Kang, M. Koopmans and J. Nkengasong (2019), ‘A New Twenty-First Century Science for Effective Epidemic Response’, Nature 575, no. 7781: 130–136, doi:10.1038/s41586-019-1717-y.
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Leach, M. (2020), ‘Echoes of Ebola: Social and Political Warnings for the COVID-19 Response in African Settings’, Somatosphere, 6 March, http://somatosphere.net/forumpost/echoes-of-ebola/.
Lees, S., J. Palmer, F. Procureur and K. Blanchet (2020), ‘Contested Legitimacy for Anthropologists Involved in Medical Humanitarian Action: Experiences from the 2014–2016 West Africa Ebola Epidemic’, Anthropology & Medicine 27, no. 2: 125–143, doi:10.1080/13648470.2020.1742576.
Martineau, F., A. Wilkinson and M. Parker (2017), ‘Epistemologies of Ebola: Reflections on the Experience of the Ebola Response Anthropology Platform’, Anthropological Quarterly 90, no. 2: 475–494, doi:10.1353/anq.2017.0027.
Rhodes, T., K. Lancaster, S. Lees and M. Parker (2020), ‘Modelling the Pandemic: Attuning Models to Their Contexts’, BMJ Global Health 5, no. 6: e002914, doi:10.1136/bmjgh-2020-002914.
Roberts, S. (2020), Incorporating Non-Expert Evidence into Surveillance and Early Detection of Public Health Emergencies (SHAP Case Study Issue 2), April, UNICEF, IDS and Anthrologica, https://opendocs.ids.ac.uk/opendocs/handle/20.500.12413/15229.
Sangaramoorthy, T. and K. A. Kroeger (2020), Rapid Ethnographic Assessments: A Practical Approach and Toolkit for Collaborative Community Research (London: Routledge).
Scheper-Hughes, N. (1995), ‘The Primacy of the Ethical: Propositions for a Militant Anthropology’, Current Anthropology 36, no. 3: 409–440, doi:10.1086/204378.
UNSDG (United Nations Sustainable Development Group) (2020), ‘COVID-19 Pandemic Exposes Global ‘Frailties and Inequalities’, UN News, 14 May, https://unsdg.un.org/latest/stories/covid-19-pandemic-exposes-global-frailties-and-inequalities.
Note
WASH = Water, Sanitation, and Hygiene.