One Health

Science, politics and zoonotic disease in Africa

Kevin Bardosh, Kevin Bardosh

• Editorial: Routledge
• Año: 2016
• ISBN:
  9781317334965
• Edición: 1
• Categoría: Economics
• Categoría: Sustainable Development

Zoonotic diseases – pathogens transmitted from animals to people – offer particularly challenging problems for global health institutions and actors, given the complex social-ecological dynamics at play. New forms of risk caused by unprecedented global connectivity and rapid social and environmental change demand new approaches. 'One Health' highlights the need for collaboration across sectors and disciplines to tackle zoonotic diseases. However, there has been little exploration of how social, political and economic contexts influence efforts to 'do' One Health.

This book fills this gap by offering a much needed political economy analysis of zoonosis research and policy. Through ethnographic, qualitative and quantitative data, the book draws together a diverse number of case studies. These include chapters exploring global narratives about One Health operationalization and prevailing institutional bottlenecks; the evolution of research networks over time; and the histories and politics behind conflicting disease control approaches. The themes from these chapters are further contextualized and expanded upon through country-specific case studies – from Kenya, Zambia, Nigeria, Ghana and Sierra Leone – exploring the translation of One Health research and policy into the African context.

This book is a valuable resource for academic researchers, students and policy practitioners in the areas of global health, agriculture and development.

1 Unpacking the Politics of Zoonosis Research and Policy

Kevin Bardosh

DOI: 10.4324/9781315659749-1

Prologue: a tale of two zoonotic disease outbreaks

On 20 August 2014, one of West Africa’s largest slums awoke to a cordon sanitaire. Bordering the Atlantic Ocean, West Point remains a visible symbol of Liberia’s slow post-war recovery: dirty, crowded and lacking government services. Tens-of-thousands of residents were effectively cut off from greater Monrovia, with limited food and other supplies. Days before, residents had driven out dozens of Ebola patients from a local isolation centre, taking blood-stained mattresses and other material with them, which likely spread the virus and precipitated the quarantine.¹ During the next ten days, the maxim ‘Ebola is not real’ was a common sentiment in West Point, and indeed throughout West Africa, as rumours continued to circulate about the ‘true origins’ of the outbreak being a government or foreign conspiracy.²

With previous outbreaks confined to remote villages in Central and East Africa, Ebola had never been found in West Africa before. Being a zoonotic disease, the virus is thought to originate in bats from where it spreads to primates and other animals; albeit many aspects of the science remains poorly understood (Saéz et al., 2015). Before the West African outbreak, the virus had actually killed many more chimpanzees and gorillas than people; Ebola is a major conservation threat to dwindling numbers of primates, together with poaching and habitat loss (Ryan and Walsh, 2011).

But for a time, media coverage of the epidemic in Guinea, Sierra Leone and Liberia – which has killed over 11,000 people – made it seem as though it was going to encircle the globe, and kill millions. In the USA and Europe, fears invariably turned to the ‘what-ifs’ of viral mutation and a more virulent, even airborne, viral hybrid quickly spreading through the modern aviation network (Gire et al., 2014). Sales of protective infection gear spiked and ‘Ebola for dummies’ guides proliferated. When West Point was quarantined, more than 500 cases had been reported in Liberia alone, and the idea that the killer virus was going to establish itself in an urban slum conjured up images of ‘state failure’ to the media and international community.

This concern drove President Ellen Johnson Sirleaf to order the military, police and coastguard to surround West Point. But such a draconian measure, done in the middle of the night and without adequate supplies, was sure to elicit resistance from an already suspicious population. As the privileged family of a local politician was escorted out by armed guards, local residents had had enough, became angry and rioted.³ Like the civil war before, the sense was of a government that was not willing, or able, to look after the interests of its people. Stones were pelted at security forces and residents tried to make an escape. Soldiers responded by beating people and firing live rounds into the crowd, killing a teenager.⁴ By the time the lock-down was called off, criticism of the government had reached new heights, and Ebola continued to spread throughout Monrovia. A belated international response then hit the ground, but it took nearly a year for Liberia to be declared Ebola-free.

Now fast-forward to 10 June 2015, and a different bat-associated zoonotic disease, and another quarantined town, are in the international headlines. But this time it is in South Korea, one of the world’s most technologically developed nations. The small hamlet of Jangdeok, about 150 miles from Seoul, is being quarantined after a single case of Middle East Respiratory Syndrome (MERS) was detected.⁵ With 122 confirmed cases and ten deaths, South Korea was in the midst of an unprecedented MERS outbreak second in size only to Saudi Arabia, where the virus was originally discovered in 2012.⁶

MERS is a corona virus thought to originate in Egyptian tomb bats, and is transmitted to people through physical contact with dromedary camels and the consumption of raw camel milk. In the family of Severe Acute Respiratory Syndrome (SARS) that sparked a global outbreak in 2003, as well as the common cold, MERS also continues to spark pandemic fear, although it is far less deadly than Ebola (Azhar et al., 2014). Most debate is centred on the possibility of sustained human-to-human transmission during the Hajj – the mass gathering of two million Muslim pilgrims in Mecca each year. Repeated health messages to camel owners and keepers to wear protective gear and avoid drinking milk have often gone unheeded.⁷ The scope of animal surveillance has also been lacking – due to, as a World Health Organization (WHO) team leader stated, ‘cultural barriers’ in Saudi Arabia.⁸ And MERS has since been found in Nigerian, Tunisian and Ethiopian camels, raising new scientific questions and global concerns (Reusken et al., 2014).

As the MERS caseload grew in South Korea, commentators emphasized how the virus had ‘traumatized the country’ and the media went into a frenzy.⁹ But compared to Ebola in Liberia, epidemic response went very differently in Jangdeok and South Korea as a whole. MERS had not been on the surveillance radar and had clearly embarrassed the government when the initial ‘index case’ (who travelled from the Arabian Peninsula) visited four major hospitals in nine days, where they spread the virus; but the response effort quickly picked up after initial public criticism. In a matter of days, President Park Geun-hye cancelled a trip to Washington. Antiseptic solution started to be sprayed in the Seoul subway. Hospitals established triage and isolation units. Medical teams monitored thousands of potential contacts. And although inconvenienced (perhaps unnecessarily, as some commentators emphasized), the village of Jangdeok had a cadre of health officials in antiviral protection suits taking temperatures, providing food and making special provisions for the elderly. Unlike in Liberia, the outbreak was over in a matter of weeks.

Introduction

Outbreaks of zoonotic disease, like Ebola in Liberia and MERS in South Korea, are biological, social and political events. They reveal some very complicated and multi-layered interactions between science and politics and our relationship with other species and the environment. That invisible ribonucleic acid (RNA) strains originating in fruit bats and dromedary camels have the capacity to disrupt our established social, economic and political status quo attest to our deep interconnectedness to nature, and yet how unknown and unpredictable much of it remains to us. Such diseases provoke panic and anxiety primarily because their origins and behaviour appear so mysterious and alien. The dramatic consequences of past historic pandemics remain very much alive in our collective memory and concerns. These tend to provoke doomsday scenarios; as Laurie Garrett (1994, p620) said in her book The Coming Plague: ‘[Pathogens] are our predators and they will be victorious if we, Homo sapiens, do not learn how to live in a rational global village that affords the microbes few opportunities.’

The stark contrast between the quarantines in West Point and Jangdeok, and the wider epidemic response systems, reveal a very visible maxim: infectious disease is intimately connected with wider political economies (Dry and Leach, 2010; Scoones, 2010). In this sense, they act as metaphors for social and ecological pathologies (Craddock and Hinchliffe, 2015; Singer, 2015). That many millions of people die each year from infectious diseases that are, for the most part, completely preventable – like HIV/AIDS, malaria, tuberculosis and various neglected tropical diseases and diarrheal illnesses – reminds us of just how divided our ‘global village’ remains.¹⁰ Epidemics reveal hidden social orders where science and politics become hard to separate, and the underlying resilience of social and political systems, as much as biology and disease ecology, come to define the limits and characteristics of contagion (Herring and Swedlund, 2010; Bogich et al., 2012). In this sense, globalization opens up a new Pandora’s box, where inequalities and inequities have come to increase our collective sense of disease risk (Farmer, 2004a). Microbes are, in effect, critics of our modernity (Barrett and Armelagos, 2013).

Among the variety of microorganisms that can make us sick and kill us, zoonotic pathogens have a particular tendency to cut across different divides, to fascinate and to generate concern. They offer a unique vantage point to inspect relationships between species, the environment and wider political, economic and socio-cultural forces (Nading, 2013). Historical outbreaks of the Black Plague, the influenza pandemic of 1918/1919 and the ongoing HIV/AIDS pandemic have shown just how significant zoonotic diseases can be. Such examples serve as rhetorical devices to justify the need and importance of investing in biosecurity, strengthening global detection, surveillance and response systems (IOM and NRC, 2009; Elbe, 2010a). But they also reveal the need to engage wider issues of poverty, environmental degradation and economic development in the prevention and control of zoonotic infections, both endemic and emerging (Chivian and Bernstein, 2008; Maudlin et al., 2009; Dakubo, 2010; FAO, 2013a).

As complex problems, zoonotic diseases have led to increased recognition of a need to integrate perspectives and actions from human, animal and ecosystem health (Zinsstag et al., 2015a). This has become known as a ‘One Health’ approach, a concept that was catalysed into the global policy limelight with the avian influenza crisis of the 2000s (Scoones, 2010). One Health has quickly moved from a concept to a global movement, with innumerable publications, projects, initiatives and platforms proliferating across the globe (Gibbs, 2014; Vandersmissen and Welburn, 2014). At its core, One Health stresses the need to work across disciplinary divides through a cross-sectoral, collaborative and integrated approach to zoonotic diseases, as well as other health problems that cut across the human–animal–ecosystem interface. In this sense, One Health is related to a number of parallel movements in public health that promote trans-disciplinarity and systems thinking, such as the EcoHealth movement (Zinsstag, 2012) or the more recent field of ‘planetary health’ (Whitmee et al., 2015). Although the One Health concept is certainly timely and important, many scholars and practitioners have increasingly highlighted the real-world challenges in moving from the rhetoric to concrete policies, research and disease control programmes in different contexts (Scoones, 2010; FAO, 2013b; Bardosh et al., 2014a; Craddock and Hinchliffe, 2015).

This book offers a fresh perspective on these debates by exploring the political economy of zoonosis research and policy. It focuses on Africa, where zoonotic diseases continue to have a disproportionate effect on human wellbeing and health (Grace et al., 2012a), but where the institutional and organizational capacities, structures and policies to address them – across the fields of conservation, public health, agricultural development and veterinary sciences – remain, in many cases, fragmentary and inadequate, intertwined in complex ways with wider questions about governance and poverty alleviation (Leonard, 2000; Keeley and Scoones, 2003; FAO, 2013a; Okello et al., 2014a).

The book unpacks the rhetoric of One Health and situates it in an uncertain, real world. Such an approach demands attention to the interconnectivities between politics, science, ecology and zoonotic pathogens. Hence a central premise is that zoonotic disease research and policy processes are deeply influenced by social, cultural, economic and political contexts. They are produced by specific sets of actors, interests and networks that configure relationships in specific ways (Keeley and Scoones, 2003). These have profound effects on the ways in which global institutions, governments, scientific research and local worlds are related, made known and manifested. By situating these contexts, and the drive for greater One Health collaboration and coordination, in differences of power, knowledge, values and norms, we seek to raise important, if at times uncomfortable, questions about current priorities, approaches and perspectives to zoonotic diseases in Africa. This allows us to challenge some of the current orthodoxies surrounding One Health, and showcase the value of a political economy approach in charting out how current zoonosis policy and practice landscapes can be made more sustainable, resilient and equitable.

Zoonoses: conundrums and connectivities

As a biological category, scientists have sought to catalogue just how many zoonotic diseases exist. Woolhouse and Gowtage-Sequeria (2005) examined 1407 viruses, bacteria, protozoa, fungi and helminth organisms that can be transmitted via air, bodily fluids, food, vegetation and insect vectors, among other routes. They found that 58 per cent were zoonotic. In a parallel study, Jones et al. (2008) mapped emerging disease events between 1940 and 2004, and found that 60 per cent were zoonotic and that most originated from wildlife. As with Ebola and MERS, economists stress the huge economic costs of zoonotic disease epidemics since they affect human health, conservation and the livestock sector. A World Bank study, for example, estimated that six major outbreaks between 1997 and 2009 – Nipah virus, West Nile, SARS, highly pathogenic avian influenza (HPAI), bovine spongiform encephalopathy (BSE), and Rift Valley fever (RVF) – cost the global economy some US$80 billion (World Bank, 2012).

What the science tells us is that the frequency of pathogenic ‘spillover’ events from animals, particularly wildlife, is increasing...