In the Journals

The Politics and Anti-Politics of Infectious Diseases Control — A Special Issue of Medical Anthropology

The current issue of Medical Anthropology came out recently, and it is a special issue entitled “The Politics and Anti-Politics of Infectious Diseases Control.” Edited by Ian Harper and Melissa Parker, the special issue contains three articles. As they write in their introduction:

For those of us immersed in health and development work, whether as practitioners or researchers, it has been necessary to try and keep abreast of, and understand, these shifts and their implications. Some have tried to categorize the shifts involved. Lakoff (2010), for example, argues that they revolve around the poles of managing pathogens and the emergence of humanitarian medicine. Others point to the underlying pharmaceutical determinism as increasingly central to interventions (Biehl 2007; Harper 2002; Petryna 2009), in part as a reaction to the shifting patterns of global trade and their associated patent debates in the wake of HIV (McGoey, Reiss, and Wahlberg 2011). However we try to define the forces and discourses at work as these issues unfold around us (and to some extent this can only ever be done in hindsight), we adhere to the view—as a recent volume on critical studies in global health so richly attests (Biehl and Petryna 2013)—that ethnographic research has a vital role to play. It allows for problematizing issues, and provides critical commentary and counternarratives to quick fix theoretical and technical proposals for change.

In this special issue, we explore the implications of these institutional and discursive shifts and provide further ethnographic engagement with infectious disease programs. Building on James Ferguson’s anti-politics thesis (Ferguson 1990) in particular, the articles highlight the politics and anti-politics of infectious disease control. …The authors of all articles analyze the politics and anti-politics of infectious disease control at multiple levels and across scales. Taylor and Harper’s article explores the issues occurring at a country-wide level, between ministries, bilateral agencies, and other aid organizations. Parker and Allen move upstream in their article to highlight the way in which anti-political rhetoric is deployed at an international level for political and strategic reasons. They show how this approach has enabled difficulties arising with vertical programs seeking to control neglected tropical diseases (NTDs), through mass drug administration, to be set to one side. Leach and Tadros, by contrast, reveal how political narratives of infection outbreak in ‘international’ forums are taken up by communities and NGOs, and highlight the implications that this has had in specific social and political milieu.

The article abstracts are below. It is also worth mentioning that Melissa Parker and Tim Allen’s contribution is open access.

The Politics and Anti-Politics of the Global Fund Experiment: Understanding Partnership and Bureaucratic Expansion in Uganda
E. Michelle Taylor and Ian Harper

After a decade of operations, the Global Fund is an institutional form in flux. Forced to cancel its eleventh round of funding due to a shortfall in donor pledges, the Fund is currently in firefighting mode, overhauling its leadership, governance structures, and operations. Drawing on a case study of Uganda, we look at how the original Global Fund vision to be a simple financial instrument has played out at the country level. Even prior to the cancellation of round 11, the proliferation of partners required to sustain the Global Fund to Fight AIDS, Tuberculosis and Malaria experiment led to increasing bureaucratization and an undermining of the Fund’s own intentions to award life-saving grants according to need. Understanding these effects through the ethnographic material presented here may be one way of reflecting on the Fund’s structure and practices as it struggles to reinvent itself in the face of criticism that it has impeded resource distribution.

De-Politicizing Parasites: Reflections on Attempts to Control the Control of Neglected Tropical Diseases
Melissa Parker and Tim Allen

Large amounts of funding are being allocated to the control of neglected tropical diseases. Strategies primarily rely on the mass distribution of drugs to adults and children living in endemic areas. The approach is presented as morally appropriate, technically effective, and context-free. Drawing on research undertaken in East Africa, we discuss ways in which normative ideas about global health programs are used to set aside social and biological evidence. In particular, there is a tendency to ignore local details, including information about actual drug take up. Ferguson’s ‘anti-politics’ thesis is a useful starting point for analyzing why this happens, but is overly deterministic. Anti-politics discourse about healing the suffering poor may shape thinking and help explain cognitive dissonance. However, use of such discourse is also a means of strategically promoting vested interests and securing funding. Whatever the underlying motivations, rhetoric and realities are conflated, with potentially counterproductive consequences.

Epidemics and the Politics of Knowledge: Contested Narratives in Egypt’s H1N1 Response
Melissa Leach and Mariz Tadros

This article explores the politics of knowledge involved in understanding and responding to epidemics in an era of global health governance and biosecurity. It develops and applies an approach focused on how multiple, competing narratives about epidemics are constructed, mobilized and interact, and selectively justify pathways of intervention and response. A detailed ethnographic case study of national and local responses to H1N1 influenza, so-called swine flu, in Egypt reveals how global narratives were reworked by powerful actors in a particular political context, suppressing and delegitimizing the alternative narratives of the Zabaleen (Coptic Christian) people whose lives and livelihoods centered on raising pigs and working with them to control urban waste. The case study illustrates important ways in which geographies and politics of blame around epidemics emerge and are justified, their political contexts and consequences, and how they may feed back to shape the dynamics of disease itself.

In addition, the issue contains an open access, editorial essay by Vincanne Adams, Nancy J. Burke, and Ian Whitmarsh, entitled “Slow Research: Thoughts for a Movement in Global Health” that is provocative not only for those engaging with “global health” but for anyone attempting the ethnographic endeavor today. As they write:

The idea of slow research is borrowed from the “slow food” movement. In academic and activist fields of global health today, we are all being asked to be productive in ways that create a sense of having to do more and to do it faster, to multitask for survival in a global workplace, to always be thinking of the next big thing, to scale up and implement, often even before we have completed our tasks at hand. Our perception of normalcy in relation to the pace and vigor of our work seems governed by entanglements in anticipation, innovation, and speed. These demands are not simply a result of how we conceptualize efficiency or capacity. Rather, they are directly related to problems of funding (capital), globalization (scale), and quality and focus (method). A call for slow research interrogates these demands. Slow research is not about doing less over time, although there is a temporal concern. Slow research is not necessarily opposed to ‘fast’ research, but it is opposed to what might be identified as a new normal. Slow research is a response, addition, and possible alternative to the newest normative trends. It entails working with an ethic or set of values and strategies that valorize different things from the emergent norms. Slow research calls for a deliberate shift in the way we do our work and the ways in which that work and its products are valorized. Much like the experience of slow food, a slow research movement is potentially both salutary and productive. The products and fruits of slow research, we believe, will ultimately be more satisfying and more helpful in the effort to create healthy people (or perhaps even a healthier world).

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