Introduction
A quarter of the way through the 21st Century, the world is facing a series of serious and interconnected global challenges and uncertainties as climate and environmental change, geo-political upheaval and polarisation, and conflict intersect with intensifying inequalities, technological disruptions, major upheaval in international assistance, and the erosion of commitments to multilateralism. Pandemics – their causes, consequences, and impacts – are widely recognised as an inextricable part of these dynamics. Almost three years on from the formal end of the COVID-19 public health emergency that rocked the world, the legacies of the disease and its responses remain in persistent health, educational, and social challenges – especially for those already vulnerable and marginalised – and in shifted patterns of life, work, and citizen-state relations. Diverse as they are, these enduring effects point to the long tail that a pandemic can have. This long tail also points to the future, as national and global authorities in a spirit of ‘never again’ shore up the sciences, policies, and agreements intended to avert future epidemic threats. As historians of science remind us, this has happened after every major pandemic throughout the centuries; the focus and texture of today’s pandemic preparedness efforts may be shaped by contemporary political–economic and technological conditions, constraints, and opportunities, but the overall narrative genre whereby a pandemic disaster leads to reckoning and lesson-learning and a commitment to do better for future threats is a deeply embedded and recurring one. Concurrently, experts convening to strengthen preparedness warn of an increased frequency of pandemic threats (Global Preparedness Monitoring Board, 2024) and increased vulnerability of the world to them, linked to factors such as marked inequalities (Global Council on Inequality, AIDS and Pandemics, 2025). Since COVID-19, a new Public Health Emergency of International Concern has twice been declared for mpox, while avian influenza strain H5N1 also generates ongoing concern.
Today’s narratives of pandemic preparedness are dominated by certain voices and perspectives. These include, in particular, those linked to international agencies and the global networks of science, policy, and private actors that work with them, as seen, for instance, in recent debates in relation to adoption of a global Pandemic Agreement. They also include the voices of academics who have provided analysis of the handling of COVID-19, and how this reflects politics and political economy, nationally, and globally (e.g. Baldwin et al., Reference Baldwin, Weder di Mauro, Baldwin and Weder di Mauro2020; Blundell et al., Reference Blundell, Costa Dias, Joyce and Xu2020). However, some voices and perspectives are far less heard or visible, even silent or obscured. These include perspectives from the African sub-continent, in all their diversity. Thus, the views of African global health leaders on power dynamics in global epidemic governance are rarely given attention (Adams, Reference Adams2024). Marginalised, too, are perspectives that emerge not from looking at pandemics ‘from above’, but on living them ‘from below’ – an ordering that is in no sense pejorative or implying a hierarchy, but rather one that appreciates and validates the lived experiences of people and communities in everyday settings. What can be learned about pandemic preparedness from greater attention to these? And how might such attention require us to reconfigure science, policy, and practice – as part of a broader shifting of power in pandemics?
These are the questions that motivate and are explored through the papers in this special issue. All present perspectives, experiences, and reflections from African settings, drawing on research co-designed and conducted in close engagement with local communities or in dialogue with African scientists and public health actors. They approach biosocial questions from the concerns of the disciplinary fields of social, medical, and political anthropology, of engaged interdisciplinary social science, and, crucially, of embedded, ‘grassroots’ fieldwork by researchers who have grown up with the communities they are studying. The team bringing these complementary areas of expertise came together for a collaborative programme on ‘Pandemic preparedness: local and global concepts and practices in tackling disease threats in Africa’ supported by a collaborative award from the Wellcome Trust during 2018–2023. Researchers were based at or contracted through six organisations in Africa and Europe: Njala University, Sierra Leone; Gulu University, Uganda; Centre Régional de Recherche et de Formation à la Prise en Charge Clinique de Fann, SenegaI; Institut de Recherche pour le Développement, France; London School of Hygiene and Tropical Medicine (LSHTM), UK, and the Institute of Development Studies, University of Sussex, UK. Consortium-wide meetings – both in-person workshops and monthly online team updates – were important in co-designing, conducting, and communicating the research, as well as building and sustaining the inclusive partnerships and relationships of trust – sharing knowledge, ideas, practices, and dilemmas – so essential to it.
The central questions informing the research – and indeed this special issue – were oriented around meanings and practices of epidemic preparedness, asking ‘who is being prepared for what, and by whom?’ And, ‘what can the world learn from people living with multiple health-related uncertainties in African settings?’ The research was initially conceived in the wake of the major Ebola epidemic in West Africa 2013–2016, and the places we chose for our focal field studies – rural communities and national settings in Sierra Leone and Uganda – all had experience of Ebola, either as part of this epidemic or during other outbreaks. Senegal offered both a comparative national site and an important locus to study African regional perspectives, given the number of agencies and meetings there. Local, national, and regional research was complemented by interviews, meeting ethnographies, and digital analysis tracking global concepts and practices, with attention throughout on the ways these travelled and were negotiated across sites and ‘levels’. The ways in which Ebola experiences have shaped subsequent ways of preparing for and responding to epidemics remained a persistent theme, addressed explicitly in several of the papers in this special issue. However, with the onset of the COVID-19 pandemic from early 2020, the programme became, centrally, a tracking of COVID-19 responses and experiences, and how these layered upon earlier encounters with outbreaks – of Ebola as well as other diseases, and the associated threats to lives and livelihoods – to shape how preparedness was envisaged. That several team members were already living with rural communities in our study sites when COVID-19 began provided an in-depth opportunity to participate in and understand localised, lived experiences of a major global pandemic.
From local to global and back again – the papers in this special issue
The collection of papers in this special issue is comprised of contributions authored by team members, either individually or as part of smaller sub-teams. These papers have built upon and complemented other project publications over the course of the research grant. Thus, with respect to the local-level research in rural communities in Sierra Leone, a contribution by Kamara (Reference Kamara2025) reflects upon the value of ethnographic research in exploring understandings of and responses to infectious disease outbreaks, based on his experience of doing fieldwork in a rural village as part of the project. He explains how his observations of responses to COVID-19 revealed differences from villagers’ earlier experience of Ebola, with difficulties related to movement restrictions and market closures a significant local concern. He points to the longstanding value placed on forms of mutuality, a theme picked up by Nyakoi (Reference Nyakoi2025) in a second piece, reflecting upon her documentation of the lived experience of COVID-19, particularly for women seeking nutrition for their infants in the context of food insecurity. Richards et al. (Reference Richards, Kamara, Mokuwa and Nyakoi2024) continue the theme of comparing social responses to two salient infectious disease outbreaks (Ebola and COVID-19) in two sites in rural Sierra Leone. They provide an account from the Ebola epidemic of 2014 of a Chief instituting bye-laws to restrict movement and mandate quarantine, detailing how these responses drew upon an understanding of public health infection control measures as well as knowledge of social institutions. They argue that experiences of the perceived success of these measures reinforced a sense amongst people that following rules to prevent transmission was effective in disease control, alongside rapid testing. By comparison, the authors document reflections on the COVID-19 experience in these sites, a situation where symptoms were non-specific and mortality low. People in these rural areas did not see proof of the effectiveness of measures such as mask-wearing when the disease or serious effects were apparently not evident. Furthermore, local people suffered from the secondary impacts of public health directives such as market closures. The analysis foregrounds the role of institutional contexts and historical experiences of outbreaks in different localities in shaping social responses to disease and points to the importance of understanding the logics and place of institutions in epidemic preparedness, both formal authorities such as chiefs but also informal institutions such as initiation societies.
Mokuwa (Reference Mokuwa2023) extends the analysis of social responses to public health measures to examine responses to COVID-19 vaccine campaigns in this context. The paper foregrounds an historical perspective on the institutionalisation of vaccines in the region to analyse initial scepticism about vaccines for COVID-19 related to unfamiliarity with vaccination for adults, and for a disease which was not perceived of as serious, as Ebola had been.
Still in Sierra Leone, Martineau et al. (Reference Martineau, Wilkinson and Sao Babawo2026) also draw attention to the role of history and specifically past experiences of disease outbreaks in shaping responses and preparedness in the present, building on existing scholarship pointing to the place of memory in shaping future preparedness policy and practice (e.g. Le Marcis, Reference le Marcis, Roulleau-Berger, Li, Kim and Yasawa2023). Comparative consideration of national level responses to the 2013–16 Ebola outbreak in Sierra Leone and responses to the threat of COVID-19 in 2020 illustrates the direct influence of Ebola: in framings of COVID-19; the institution of control measures; expectations of hazard pay for health care workers; and the institutionalisation of diagnostic and data practices. They argue that both tacit, embodied knowledge and more formal, codified knowledge come to be drawn upon by different actors, reinforcing the link between epidemic pasts and epidemic presents that shapes political mobilisation. Such an understanding extends far beyond the technical orientation of standard ‘lessons learned’ reports that follow outbreaks.
Moving to the context of Uganda, Laing et al. (Reference Laing, Mylan and Parker2024) present quantitative analysis aimed at assessing the impact of the national-level COVID-19 public health and social measures instituted in the country. Reflecting on the low rates of COVID-19-related mortality officially recorded during the second and third outbreaks, they suggest that stringent national lockdown measures had little or no impact on transmission and that dominant narratives of ‘success’ need to be reconsidered. In related publications from the project team focused on the Uganda COVID-19 experience, analysis of local-level responses draws attention to the lack of local experience of the disease and to scepticism regarding the severity, indicating strong parallels with the Sierra Leone fieldwork (Baluku et al., Reference Baluku, Akello, Parker and Grant2020). Akello (Reference Akello, Manderson and Burke2025) also highlights the way in which people’s experiences led them to question the need for strict public health measures and for an extensive national vaccination campaign. Some policy-makers saw the state vaccination campaign in Uganda as unnecessary effort and expense, oriented towards satisfying international agendas and sustaining related funding flows, rather than responding to local epidemiological realities.
Other team members have drawn attention to the ongoing securitisation of global health security and the way in which this helped to create a political space for the Ugandan government to militarise the response to COVID-19 (Parker et al., Reference Parker, Baluku, Ozunga, Okello, Kermudu, Akello, MacGregor, Leach and Allen2022; Allen and Parker, Reference Allen and Parker2024). In the borderland districts of Kasese and Pakwach, militarised enforcement measures enabled unaccountable modes of public authority to be entrenched, whilst also accentuating, rather than diminishing, insecurity on the ground. Livelihoods were rendered ever more precarious in these districts and, inevitably perhaps, people came together to bypass or resist state regulations in mutually supportive ways.
The Ugandan mandatory COVID-19 vaccination programme took place against this highly securitised and militarised background. With a focus on public authority dynamics, Parker et al. (Reference Parker, Akello, Okello, Kermundu, MacGregor, Ozunga, Leach and Allen2025) demonstrated that violently enforcing the rollout of COVID-19 vaccines increased coverage in some socio-political circumstances – notably parts of rural Dei, northwestern Uganda. However, coverage was low in other socio-political circumstances – notably peri-urban Gulu, northern Uganda. Overall, violent enforcement created fear and mistrust and further entrenched unaccountable modes of governance across field sites, with evidence emerging that such an approach was weakening previously established vaccine compliance procedures.
From a West African regional perspective, analysis of the low uptake of COVID-19 vaccines in Senegal, a country praised for the effectiveness of pandemic response, is the subject of the paper by Desclaux et al. (Reference Desclaux, Sow and Sams2024). The authors trace how several factors such as uncertainty about vaccine supplies; uncertainty regarding side effects; a lack of clarity regarding the vaccination strategies as communicated by health services; and a lack of clarity amongst the population about the purpose of vaccination and the actual risks related to the disease, all contributed to the low uptake. Such uncertainties, which were not taken into account in the process of preparedness, also reflected systemic factors and the effects of global and regional power dynamics as these manifested at national level.
The final paper of the special issue (MacGregor et al., Reference MacGregor, Leach, Desclaux, Parker, Grant, Wilkinson, Sams and Sow2025) focuses attention on such power dynamics at regional and global scales in relation to different experiences of COVID-19. In the later stages of the project, we interviewed actors in international and regional public health institutions, asking them to reflect on their understandings of preparedness in the light of the pandemic. Analysis grouped their understandings into different domains, with different priorities and proposed responses. The analysis suggests that the COVID-19 pandemic has strengthened a mainstream view of preparedness as related to ‘readiness’ to respond, linked to the development of technologies such as drug and vaccine platforms. Few respondents commented on the politics that is inherent to preparedness, the exception being a few of the regional West African actors who pointed to persistent power dynamics shaping pandemic funding flows that had limited their capacity to prioritise resource allocation. We identified three aspects of the dominant approach to preparedness that can draw attention away from the important consideration of power and politics, acting as a kind of anti-politics. These are the emphasis on urgency, the privileging of technological solutions, and the assumption that universal approaches and protocols should be prioritised, predisposing to a ‘one size fits all’ way of thinking that reduces the possibilities for decentralisation and contextual adaptation.
Emerging themes
The emerging findings presented in these papers reflect shifting debates as they unfolded over the time period of COVID-19 and the research. Concepts and practices of preparedness also illustrate and speak to a series of cross-cutting themes: Risk and uncertainty – highlighting how people are dealing with a set of intersecting crises; agency and authority – highlighting the importance of diverse public authorities and forms of collectivity, and how national politics intersect with local institutions; and knowledge and information – underlining the importance of diverse forms of knowledge including science, citizen science, and everyday experiential expertise, and that the apparently ‘technical’ is never just technical but also involves social and political framings and assumptions, as the papers on vaccines illustrate particularly strongly.
Diverse experiences, diverse perspectives
The papers are reflective of the plural perspectives and varied experiences that proved salient across the diverse sites and amongst the various actors and communities involved. Indeed, this itself is an important overall message from the collection, which firmly questions the ‘one size fits all’ assumptions so often prevalent in global approaches to pandemic preparedness and response. Instead, a heterogeneous picture emerges, in which diseases and responses unfold in different ways in different contexts, suggesting in turn different ways to envisage future preparedness. For instance, the papers point to different views about whether to prioritise universal adult COVID-19 vaccination, reflecting scepticism in local communities where COVID-19 mortality was less evident, as well as amongst policy-makers such as in Uganda and Senegal, where actors argued for decision-making that could reflect local epidemiological realities rather than global directives and universal goals. This plurality of views cautions against homogenising narratives related to priorities for preparedness and response.
The papers also point to the complexity related to the so-called ‘African paradox’ that has dominated so much debate about COVID-19 on the continent: the paradox that early expectations of high mortality amongst already vulnerable populations and weakly resourced health systems did not unfold as expected. On one hand, the papers question the homogenising of ‘Africa’ in these views, revealing instead great diversity in how COVID-19 was experienced over time and within and between countries, with some pockets and waves of high mortality and others where COVID-19 was experienced as mild, or absent – a ‘disease of the radio’, to quote one of the fieldwork interlocutors in Uganda (Baluku et al., Reference Baluku, Akello, Parker and Grant2020). The papers – while not focused on epidemiology – suggest that multiple interacting factors are likely to be salient in explaining these differences, from demography and age profiles to disease co-morbidity, pre-existing immunities, and living conditions. At the same time, they call into question narratives that the paradox reflected tough control measures in Africa, showing that these too were highly varied and that top-down lockdowns, movement restrictions, market closures, and enforced vaccination were arguably limited in their impact on disease spread in our research sites, though often very damaging to livelihoods and to trust in authorities.
Preparedness ‘from below’
The papers and the wider research output of the project contribute important insights regarding local level or ‘community-centred’ responses to disease outbreaks, revealing the importance of responses ‘from below’ to epidemics – including Ebola and COVID-19 – and how these in turn provide the basis for ‘preparedness from below’ to future disease threats. At the outset of the project, we proposed the idea of ‘preparedness from below’ as a contribution to the vital task of shifting power in pandemics. We did not propose the concept with a view to speaking from the margins to the centre, or from the bottom to the top in a hierarchical schema. Rather, it was oriented towards encouraging appreciation of the everyday experiences that are central to pandemic preparedness and response and towards facilitating greater connectedness and more equitable dialogue between people in local settings and in national and international organisations that prepare and respond. By choosing to work with people in communities in resource-poor places in African settings that are often the focus of pandemic imaginaries that conjure assumptions around ‘hotspots’, ‘victims’, ‘fragility’ ‘deficit’, and ‘ignorance’, and thus the targets of pandemic interventions ‘from above’, our research has been well placed both to explore, critique and seek to challenge the power relations involved in pandemic preparedness and response.
Across the papers, many experiences, concepts, and practices important to responses and preparedness ‘from below’ emerge. Whilst there was often an underlying substrate of capacities evident, these were limited also by chronic uncertainties and insecurities related to climate, food, a high burden of disease, and structural deficiencies in health systems. The research provided insights to expand the concept, based on findings concerning the varying experiences of COVID-19 and the multiple uncertainties and competing crises that people faced in the fieldsites.
At the outset of the project, the idea of ‘preparedness from below’ was built on earlier work by anthropologists conducting research during and in the aftermath of the West Africa Ebola outbreak (2013–2016) which had made the case that direct experiences are critical to people’s understandings of disease and that these are highly varied. Ebola research suggested that people observed and drew their own conclusions about transmission and risk and mobilised to address perceived threats. These instances have been characterised as a form of ‘citizen science’ (Richards, Reference Richards2016). Other examples that arose from accounts of responses in villages emphasised how people adapted burials to be safer and continued to care for their sick, attempting to balance disease prevention and existing relational obligations and ethics of care (Parker et al., Reference Parker, Hanson, Vandi, Sao Babawo and Allen2019a, Reference Parker, Hanson, Vandi, Babawo and Allen2019b). These kinds of responses relied upon locally available material resources, existing knowledge of the environment and cultural logics, established relationships and trusted networks, and were oriented in different ways to forms of formal and informal authority – all elements that were a part of the fabric of life that predated Ebola and would likely have been mobilised before in instances of other threats to health or life.
Our research on ‘preparedness from below’ in the context of COVID-19 additionally drew attention to the conditions of life that placed limitations on capacities to prepare, in particular the chronic uncertainties and insecurities that people faced in the fieldwork localities. These are related to climate events (e.g. flooding), food insecurity, and a high burden of endemic and epidemic disease. For instance, our fieldsite in Kasese district, Uganda, on the border with Democratic Republic of Congo (DRC) remained under public health surveillance in the early period of COVID-19 due to an Ebola outbreak across the border. Villagers in all our fieldsites were evidently dealing with a mass of everyday and seasonal challenges, often uncertain – in livelihoods, food, trade, other health conditions, local politics, citizen-state relations and more, conditions resonant with Vigh’s notion of the ‘chronicity of crisis’ (Vigh, Reference Vigh2008) and Anderson’s notion of ‘slow emergencies’ (Anderson et al., Reference Anderson, Grove, Rickards and Kearnes2019).
Where people had direct experience of Ebola, there were fears that COVID-19 would be similar. These dissipated over time. In our rural sites, COVID-19 was for much of the earlier part of the pandemic mostly something people heard about (on the radio, social media, government messages), but they reported little experience or knowledge of actual cases. As the papers illustrate, in rural village settings in both Sierra Leone and Uganda, the disease itself did not cause a generalised high mortality. Given competing challenges in their lives, any given new epidemic shock (especially with health effects seen as minor) appeared unlikely to be singled out or prioritised as a ‘disease event’ unless the overall mortality was high. In fact, in two of the fieldsites, devastating floods in the rainy seasons of 2020 drew more attention and concern.
As it became evident that experience was not of an acute crisis as expected, people questioned and sometimes resented government-instituted COVID-19 responses (movement restrictions, vaccines) that appeared not to be addressing a genuine problem. National ‘lockdown’ measures were also exacerbating the existing conditions of life that already generated precarity. For instance, in Sierra Leone, market closures led to hunger by restricting the essential food trade that people have long relied on to fill seasonal gaps in their own farm production. In Uganda, Kasese district has a long history of anti-government cross-border militia activity, and government efforts at enforcement of lockdown restrictions led to an increased presence of the Ugandan defence force. A militarisation of lockdown restrictions was also seen to advantage the ruling party through curtailing opposition campaigning in the general election of early 2021. This led people to comment on their experience of ‘corona’ (COVID-19) as the ‘political’ virus.
Through living with and negotiating a multitude of everyday and seasonal uncertainties, villagers have developed many ways to address threats to health, life, and livelihoods. These rely on local and experiential knowledge and sometimes on diverse experts and forms of expertise (e.g. Traditional Birth Attendants, Village Health Workers, elders, those with knowledge of particular health or livelihood issues or experience in negotiating well with the state). Issues (disease, a technology such as vaccination, a livelihood challenge) may be framed in ways and through idioms that do not match those of formal science or government discourses and that reference bodily, social and wider political understandings – as our research on people’s understandings of COVID vaccines showed (in this special issue and also Leach et al., Reference Leach, MacGregor, Akello, Babawo, Baluku, Desclaux, Grant, Kamara, Nyako, Parker, Richards, Mokuwa, Okello and Sams2022). These can be understood as citizen science but also extend beyond it to include a wider range of relevant knowledges and past and present experience, each embedded in their own cultural logics and social relations of knowledge production.
Mutuality and mobilisation
The fieldwork documented diverse forms of mutual support, collective organisation, and mobilisation of public authority, informal and formal. Our findings showed many examples – from women’s networks and groups supporting children’s nutrition and market traders grouping to re-open markets, to support by youth groups, church groups, family institutions, and chieftaincy structures. These were often part of the pre-existing fabric of life, already dealing with all sorts of everyday uncertainties and differential vulnerabilities (taking turns to help each other out as the need arises), and were well-positioned to ‘act up’ amidst the greater needs of an epidemic. Preparedness from below can be understood as built upon such everyday small acts and the norms of reciprocity and social practices that they involve, the constant presence of everyday forms of action and agency that can be stepped-up as the need arises. The array of forms varies from place to place, according to local histories and politics, including factional rivalries. The fieldwork also documented forms of agency in bypassing legal restrictions placed by lockdowns, such as through payments of bribes to police officers in order to travel despite movement restrictions, or to the military in order to cross the DRC border to tend fields, or to health workers to get a vaccination certificate. Some forms of control that emerged were also of more questionable mutual value, such as the vigilante groups who policed movement of people with COVID-19 who were assigned to home-based care in Uganda. Unlike the anthropological findings from the West Africa Ebola outbreak, the agency and mobilisation evident in these localities was largely in response not to COVID-19 the disease but to these other exacerbated political and economic challenges.
Negotiating intersecting precarities
It has been argued that the effects of COVID-19 in many parts of the globe intensified inequalities and surfaced the intersecting nature of crises (e.g. Dowler, Reference Dowler and Dowler2020). Drawing on this idea, we built on ‘preparedness from below’ to propose the concept of ‘intersecting precarities’ which included the effects of epidemic control measures themselves (MacGregor et al., Reference Leach, MacGregor, Akello, Babawo, Baluku, Desclaux, Grant, Kamara, Nyako, Parker, Richards, Mokuwa, Okello and Sams2022). From our findings, we argued that people do not just accept but actively negotiate these intersections as they seek to sustain their lives and livelihoods, including through mutuality and collective action. Having the preexisting capabilities, forms of collective organisation, and experiences in dealing with everyday uncertainties to do so, then becomes key to ‘preparedness from below’. Butler’s concept of precarity (Butler, Reference Butler2004) proved salient as it incorporates consideration of states of insecurity as well as the ways in which political–economic processes create and intensity states of exclusion as they play out in particular localities, capturing the ways in which vulnerabilities were intensified during and in the aftermath of the pandemic. COVID-19 was experienced in the village fieldsites largely as a set of disruptions that added to and exacerbated such everyday livelihood and health-related uncertainties (via restrictions on movement and trade, closures of schools and markets, presence and sometimes violence and predatory activities of military guards, and so forth).
Our research shows the long-term embedded nature of precarities, which may be revealed by acute shocks such as disease outbreaks and control measures, but which are in themselves manifestations of longer term structural violence linked to political economies, histories, and ongoing relations between citizens and state. Precarities (in health, livelihood, economy, and so forth) reflect long-term, structural problems, and inequalities, including failures in the availability of accessible, affordable health care, of navigable roads and accessible markets, of clean water and sanitation systems, and other essential infrastructure and services. Our research shows many examples of how such basic system lacks or dysfunctions undermine both everyday life and epidemic responses – the broken bridge and flooded road; the long distance to a vaccination post, and more. Farmer (Reference Farmer2014) talked of the basic importance of ‘stuff, staff, space, systems’ in relation to health but our research has also revealed a range of multisectoral systems issues and needs – from infrastructure to economy and the requirement for social protection.
A concern with the pandemic’s intensification of preexisting conditions of life also moves us beyond the image of a discrete event and temporality such as an outbreak to address the unfolding of precarities – acute crises compound chronic uncertainties that might be of greater local priority, and a pandemic threatens to introduce yet another endemic challenge that must be lived with and navigated in the present. These challenge a pandemic temporality oriented to a single disease event requiring exceptional prioritisation.
Implications for rethinking preparedness
What are the implications of these research findings for informing more nuanced understandings and indeed for rethinking pandemic preparedness? Certainly, notions of preparedness in terms of preparation for a single time-bound disease shock and the standard WHO sequence (readiness-response and further phases) make little sense in relation to locally lived realities; they should be attuned to these longer-term, overlapping timescales of hazard. Epidemic preparedness and response need to be re-thought as interconnected processes shaped by older and newly generated vulnerabilities and capabilities in navigating uncertainties.
These capabilities can point to forms of local knowledge and expertise that are a vital basis for preparedness from below and need to be better recognised, appreciated, and legitimised. Public health messages (such as around disease or vaccination) need to engage with and build on local knowledge and understanding. This means that bringing them together is not a straightforward task of integration but will require dialogue and triangulation to flesh out a richer picture and seek convergences.
Thus, preparedness must also include building capacities amongst response agencies to pick up on and respond to more diverse experiences ‘from below’, such as of different outbreaks and responses to a wider range of threats. Responses can then be adapted accordingly – for instance through community-engaged surveillance and dialogues that can feed up to national agencies. An approach that encourages dialogue about the disease and local experience can also counteract a more one directional approach to health messaging that can characterise some of the risk communication and community engagement activities of external agencies.
A shift amongst global agencies towards a greater appreciation of ‘community-centred responses’ became evident in the latter part of the pandemic. This also manifested as increased interest in identifying and strengthening community ‘capacities’ for such responses. There is a danger that systems for measuring these are designed to be overly technical and thus miss out on relations, institutions, and forms of knowledge that do not confirm to preconceived notions. Similarly, attempts to measure community ‘resilience’ for such responses need to appreciate also the limitations that exist in terms of material resources and should seek to engage with a range of forms of public authorities who are trusted to act on behalf of local people and to voice their concerns and needs.
Forms of local collective organising, mutuality, and collaboration are a vital basis for preparedness from below and need to be better recognised and appreciated, including less formal and visible forms. This is both to avoid undermining institutions that are playing positive roles and to be aware of more problematic ones. Recognition of diverse forms of public authority also confounds notions of ‘the community’ as homogeneous and bounded, with implications for how ‘community engagement’ is envisaged and organised. And recognition of preparedness as built on everyday small acts, constantly present in the social fabric, is distinct from the idea of community capacities to respond that are somehow exceptional and need to be identified and strengthened. Rather, the everyday and taken-for-granted can become exceptional.
With respect to the technological emphasis of mainstream visions of preparedness, our research on vaccines (and potentially other technologies envisaged as part of pandemic preparedness) reveals that people’s anxieties about COVID-19 vaccines – both negative worries, but also positive desires for the vaccines – are embedded in often sophisticated understandings and reflections that make sense amidst their social and historical contexts and experiences. It also shows the importance to uptake of accessible health systems and of trust between people and local health providers (something that varied a great deal between our field sites). It highlights the importance of the socio-political contexts through which vaccine technologies enter African settings and the crucial intersections between supply and demand. A new conceptualisation of ‘vaccine preparedness’ must become a central part of pandemic preparedness. This must move beyond existing WHO notions of ‘vaccine readiness’ to address the longer-term structural, social, and political relations in which vaccine delivery and distribution are embedded. And it must move beyond narrow assumptions about vaccine demand or hesitancy and the effects of an ‘infodemic’ and address the real anxieties embedded in bodily, social, and wider political experience (see also Leach et al., Reference Leach, MacGregor, Akello, Babawo, Baluku, Desclaux, Grant, Kamara, Nyako, Parker, Richards, Mokuwa, Okello and Sams2022).
All of this highlights the importance of the complex politics of a place in shaping what is possible in terms of pandemic measures, how they are implemented, and the crucial relations of trust that shape these. ‘Preparedness from below’ highlights how what is there already – in terms of knowledge, forms of agency and authority, and trust relations, and resources – shapes what is possible in the moment. This recasts preparedness not as a state of passive anticipatory waiting (perhaps boosted by practice exercises) but an ongoing set of active processes in negotiating everyday uncertainties. Importantly, preparedness must include anticipation of possible intersecting precarities and creation of the means to avoid them – both through more proportionate, multi-sectoral and locally adapted response strategies, and through support mechanisms such as the availability of social protection. This underscores that preparedness must encompass ‘systems preparedness’ – with respect to both health systems and wider political–economic and infrastructural systems.
Conclusion: the politics of pandemic research
The papers in this collection illustrate what emerges when a diversity of voices and perspectives – including those marginalised or ignored by mainstream pandemic science and policy – are brought to the fore. This points to a broader politics of research, with this collection both arguing for – and representing – the importance of hearing from a diversity of African scientists, social scientists, and communities in a rethinking of research and its applications. The negotiations related to the Pandemic Agreement similarly underscored that reaching agreement on contested political issues requires appreciation of views from Africa and serious consideration of the critiques of the persistence of colonial echoes in the framing and practices of pandemic preparedness and response.
The papers point to the different visions of pandemic preparedness that exist across regions, scales, and actors. Overall, a rethinking of pandemic preparedness will have to pay attention to improving interconnections across these scales and to resourcing mechanisms that enable more equitable partnerships between states and regions. A more explicit consideration of power dynamics and the political nature of pandemic preparedness is critical to enable sustained shifts in established hierarchies. These include hierarchical notions of what is valuable research evidence for informing pandemic preparedness. The kind of research represented here – in-depth anthropological study involving cross-national teams of social scientists, including those from the communities where research is located – has the potential to inform immediate operational questions in pandemic response. Significantly, it can also offer important critiques of received assumptions of mainstream preparedness – reframing key concepts and pointing to the unintended consequences of dominant paradigms, such as ‘health security’ itself. In an era of intersecting crises, it is increasingly important to appreciate different priorities and understandings of crises – what to prioritise, and how best to prepare and respond. With dominant approaches emphasising the urgency to act, anthropological evidence pointing to the implications of different experiences and understandings can easily be side-lined. This is even more likely as resources for global health research decline, and funding is readily diverted to technological innovation. This special issue thus forms part of wider advocacy for the value of anthropology in informing meanings and practices of pandemic preparedness, now more than ever.
Financial support
This research was funded in whole, or in part, by the Wellcome Trust 212536/Z/18/Z. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
Open access
