Sudeepa Abeysinghe

Framing disease: The avian influenza pandemic in Australia

Abstract Since 2003, avian influenza has recently spread around the world sparking fears of a potential pandemic. As a result of this, a range of explanations and expectations surrounding the phenomenon were generated. Such social representations of disease depict the issue under discussion and frame reactions to the event. This paper explores the social representations surrounding avian influenza in Australia. Methodologically, a textual analysis of media and government documents was conducted in order to uncover the social representations implicit in these accounts. This demonstrated a symbolic framing of avian influenza with reference to the Spanish Influenza pandemic (1918). Analytically, the study draws upon the concepts of social representations from Durkheim and of risk and symbolic risk in the work of Beck. Overall, it is argued that the framing of avian influenza as a risk, mediated through the collective memory of Spanish Influenza, characterised the nature of the social representations surrounding the phenomenon. This resulted in the production of symbolic solutions to the threat.

The avian influenza pandemic: Discourses of risk, contagion and preparation in Australia

This paper examines the construction of avian influenza in Australian media and federal government policy, with a focus placed on discourses of contagion, preparedness and risk. The threat of an infectious disease outbreak, such as avian influenza, on social life is surrounded by a range of collective narratives which attempt to make it explicable. These narratives socially define the disease and provide explanations for its existence. The paper demonstrates that central to these narratives are depictions of the source of the outbreak and suggestions of appropriate responses to the threat. Methodologically, a narrative analysis of print media and government documents was conducted. This showed that conceptually both government and media discourses could be understood in terms of risk, contagion and blame. Furthermore, it was found that narratives linking the risk of avian influenza with globalised interconnectedness and contagion by the developing world underpin discourses of causation and frame the reactions to and preparation for a potential outbreak.

Vaccine Narratives and Public Health: Investigating Criticisms of H1N1 Pandemic Vaccination

Vaccine hesitancy is often understood and explored on the level of individual decision-making. However, questions surrounding the risk and efficacy of vaccination are evident in wider public discourse; social narratives of vaccination inform and impact on the individual level. This paper takes a narrative analysis approach from the sociology of health to examine data drawn from a wider study on global public health responses to the H1N1 pandemic. The paper concentrates upon criticisms to mass vaccination as recounted within the Council of Europe’s debate of the handling of H1N1. It shows that three narratives were particularly dominant: problematizing the use of vaccination as a public health response; criticising the efficacy of the vaccines; and, questioning the safety of the strategy. This debate presents an important case study in understanding the way in which vaccines are problematized within the public discourse.

Ebola at the borders: newspaper representations and the politics of border control

Abstract As well as a site of politics and public health action, the outbreak of Ebola in West Africa has been a focus of media representations. This paper examines print media narratives around border control in relation to Ebola in the UK, the USA and Australia from the start of the epidemic to May 2015. It shows that Ebola became mobilised as a frame through which domestic politics could be discussed. The disease was transformed from a problem for West Africa to a problem for the West. The context of West Africa and affected populations was homogenised and hidden. The focus of reporting centred upon domestic political actions and more local sources of threat.

When the spread of disease becomes a global event: The classification of pandemics

The classification of novel disease events is central to public health action surrounding them. Drawing upon the sociology of scientific classification, this article examines the role and contestation of the World Health Organization’s Pandemic Alert Phases, as applied to the spread of 2009/10 H1N1 Influenza. The analysis of World Health Organization texts, including policy documents, public statements and epidemiological documents, has been utilized to examine the Organization’s actions and public narratives around the event of H1N1. Analytically, the functional role of such classificatory schemes and the social construction of scientific classifications are examined. It is argued that in understanding the World Health Organization’s 2009/10 application of the Pandemic Alert Phases, the critical limitation of the functions served by the classificatory scheme led to the breakdown of its construction. This case study highlights the importance of classification for the successful production of scientific ‘facts’, the constructed nature of classificatory systems and the potential for contestation that arises when such classifications do not adequately fulfil their functional roles.

‘Because we all know that vaccines are an extremely effective public health tool’: path dependency, H1N1 and the World Health Organisation

Infectious disease threats are surrounded by scientific uncertainty. As a result, institutional structures can heavily determine the way in which such risks are managed. This is illustrated by the World Health Organisations (WHO) management of the 2009 H1N1 pandemic. Given this, theories of path dependency, derived from the ‘new institutionalism’, are useful in analysing such events. This article examines theories of institutional and discursive path dependency in respect to the case study of the WHOs management of H1N1. It argues that the WHOs emphasis on the use of vaccines as a protective measure constitutes a path dependent reaction, based on the organisations historical achievements with vaccines and its discourse surrounding vaccine use. Furthermore, in contrast to accounts which understand historical and institutional path dependency as exclusive theoretical models, the article argues that institutional and discursive path dependencies were mutually interacting in forming the WHOs response to H1N1. Finally, the article explores the question of institutional change within theories of path dependency. Here, using the case of the WHO, it is shown that the interference of an outside actor, the Council of Europe, caused the WHO to internally evaluate its actions, leading to institutional change.

Disappearing everyday materials: The displacement of medical resources following disaster in Fukushima, Japan

This study draws upon interviews of medical staff working in the city of Minamisoma, Japan, following the 2011 Triple Disaster. It investigates staff responses to the disruption of material resources as a consequence of the disaster and its management. The disruption of spaces, and the loss of oxygen supplies, food, and medications impacted upon staff experience and the ability of institutions to care for patients. This resulted in a restructuring of spaces and materials as workers made efforts to reconfigure and reestablish healthcare functions. This is one of the few qualitative studies which draws upon the experience and perspectives of health workers in understanding material disruption following disaster. This is particularly important since this case did not involve the breakdown of lifeline infrastructure, but rather, brought to attention the way everyday material objects shape social experience. In highlighting these effects, the paper makes the case for the social scientific investigation of the impact of disasters on healthcare, shedding light on an area of research currently dominated by disaster medicine.

Contesting a Pandemic: The WHO and the Council of Europe

Contemporary risks are often understood as fundamentally uncertain. This uncertain status can be mobilized within political debates surrounding risks. Such a challenge serves to destabilize scientific claims. The World Health Organization’s (WHO) management of the 2009/10 spread of the H1N1 virus became a site of one such contestation. Debate within the Council of Europe particularly served to criticize the action of the WHO. This resulted in a definitional and policy contestation between the two institutions. The WHO accounted for its actions through allusions to (seemingly stable) scientific facts, using epidemiological evidence of influenza and its management based on normal science. In contrast, in criticizing public expenditure and panic, the Council of Europe critics problematized the stability of the science employed by the WHO. This included fundamental aspects of scientific knowledge such as the measurability of morbidity and mortality caused by H1N1 and the effect of vaccination against influenza viruses. This criticism relied upon the ability to destabilize the WHO’s scientific knowledge, a process made possible through understandings of the uncertain nature of the science of risk (post-normal science). The case study illustrates that potential for previous-established and seemingly stable scientific facts to become destabilized and problematized during contestations of risk management.

Globalization and Global Public Health

In providing a social scientific account of the WHO’s reaction to H1N1, the organization’s self-proclaimed role as a coordinator of ‘global health’ is key to explaining its decision-making process. The global health paradigm, which replaced earlier conceptualizations of ‘international health’, was fundamental to the WHO’s management of H1N1. This is both because pandemics are essentially globalized diseases and because the organization strongly subscribes to the new global health perspective. It characterized H1N1 as particularly ‘global’ in nature. This characterization led the WHO to emphasize global cooperation and interdependence in the management of the pandemic. In respect to this global management strategy, it presented its own role as one of coordination and facilitation rather than one of action. In fact, using the lens of the global health paradigm, the WHO characterized the reaction to H1N1 as the responsibility of state governments and not its own. This distancing of responsibility was key to the WHO’s narrative of H1N1. It reflects the institutional attempts to adapt to the new structuring of global health. However, the organization’s positioning was somewhat ambiguous as it was perceived to be a directive body by outside actors (exemplified by the Council of Europe’s narrative), where the WHO’s recommendations were understood as explicit instructions.

Narrating the Nature of H1N1

For a scientific object or idea to be accepted by all actors who engage with it, it first needs to reach stability as an incontestable ‘fact’. In the case of H1N1, the institution responsible for this fact-making was the WHO, since it is accountable for defining and managing global disease threats. Throughout this book I will examine how the WHO failed to effectively mobilize a stable construction of the ‘H1N1 pandemic’, ultimately resulting in the contestation of the concept by prominent global health actors. However, in order to explore the reasons why the H1N1 pandemic proved to be a fragile concept, it is first necessary to illustrate the elements of the WHO’s initial construction. This chapter examines the WHO’s attempt to define the phenomenon of H1N1. It argues that there were several factors of the construction that lent to its fragility as a scientific fact. These include a lack of early consensus on the name, a failure to articulate a robust and coherent origin narrative, and ineffectual comparisons with seasonal influenza and historical pandemics. These inadequacies meant that the concept of H1N1 did not reach definitional ‘closure’ (Callon, 1986; Pinch and Bijker, 1984), rendering it open to contestation.