Ahead of the Rio 2016 Olympics, there has been much fear over the Zika virus epidemic currently ongoing in Brazil. High profile sport stars such as basketballer Stephen Curry and cyclist Tejay van Garderen, as well as seven of the world’s best golfers, have quoted the virus as a reason to pull out of the Games.
Here ESRC Celebrating Impact Prize winner Professor Melissa Leach, Director at the Institute of Development Studies (and former Director of the ESRC-funded STEPS Centre), shows how social science can reveal vital socio-cultural dimensions and stories to help responses to epidemics such as the Zika virus.
Zika virus is the latest emerging infectious disease epidemic to hit global headlines. First identified in Uganda in 1947 and transmitted mainly by the Aedes aegyptii mosquito, the virus is now spreading rapidly across Latin America and beyond.
Many cases just have flu-like symptoms, but the virus is also blamed for complications such as Guillain-Barré syndrome and, most significantly, a dramatic upsurge in birth defects, including thousands of cases of microcephaly in Brazil since October 2015.
The Zika story bears many characteristics of what has been termed ‘the global outbreak narrative’. A mysterious microbe emerges ‘out of Africa’ or ‘out of Asia’ and spreads rapidly in an interconnected world to threaten ‘us all’. The outbreak narrative typically concludes with the heroism of an international response, as medics, epidemiologists and humanitarian agencies unite to put science, power and money behind halting the outbreak. We have heard versions of this narrative many times – with H5N1 avian flu, SARS, H1N1 ‘swine flu’, and in 2014-15 with the Ebola crisis in West Africa. The speed with which the World Health Organisation categorised the Zika epidemic as a ‘health emergency of international concern’, mandating inter-governmental response, is surely no coincidence. Blamed for doing this several months too late for Ebola, they understandably do not wish to be caught out again.
But, as our work in the ESRC STEPS Centre on epidemics has shown, global outbreak narratives may dominate but they are always partial. Other stories need to be brought to light, and social scientists can play key roles in finding, researching and revealing their significance. So what other narratives deserve more attention around Zika?
One concerns the dilemmas of policymaking under scientific uncertainty. The Zika epidemic presents many puzzles and mysteries. What are the actual dynamics of transmission, and the roles of mosquito ecologies and human-human, including sexual, routes? To what extent is the virus actually responsible for the upsurge in birth defects – and what other immunological, social or environmental factors might be involved?
The vital science around these and other questions is a work in progress and fraught with ambiguities, raising real questions for how policy and communication should proceed. When the government of El Salvador advised all women in the country not to get pregnant until 2018, was this due precaution, or overreaction? As scientific controversies in many other arenas have shown, openness about uncertainty, and deliberation by scientists, policymakers and publics, is a less risky route than false confidence that may prove unfounded and undermine trust.
A second narrative shows the Zika crisis less as a dramatic new event than an exposure of longstanding system failures and social faultlines. In Brazil, the Aedes mosquito has proliferated amidst deeply inadequate sewage systems, unplanned urban development and poor access to drinking water, making it necessary to store it. Those most affected are the poorest people. As local commentators have emphasised, Zika is unmasking a country characterised by huge inequalities and a fragile public health system. And it is exposing societies whose religious moralities oppress women and undercut reproductive rights.
A third narrative shows the possibility that community-led responses, local knowledge and cultural logics might hold vital keys to understanding and defeating the Zika epidemic.
This was the big story that eventually emerged through the Ebola crisis, assisted by international networks of social scientists such as those we convened in the Ebola Response Anthropology Platform. We do not yet know whether citizen responses might help turn the Zika crisis around – but the detailed engagement and dialogues with local communities that can find out needs to happen.
Effective preparedness and response to emerging epidemics needs good global health governance, effective public health systems, and rapid response capacity. While the value of social science in all of these is increasingly appreciated our contribution must go beyond simply adding the social and cultural to established responses, to reveal and explore the less-told stories too, and to show why they matter.
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This article first appeared in Society Now magazine (issue 24)