The International Response to Highly Pathogenic Avian Influenza: Science, Policy and Politics

This 57-page document analyses the international response launched against the avian influenza virus, H5N1, by the main technical agencies – the UN World Health Organization (WHO), the UN Food and Agriculture Organization (FAO) and the Office International des Epizooties (OIE). As stated in the introduction: "...This paper asks: what lessons can we learn from this experience, and what does this mean for future efforts to respond to emerging infectious diseases under the One World, One Health initiative?"

It continues: "The paper explores three core narratives that have shaped the response: one focuses on veterinary issues, another on human public health and a third on pandemic preparedness. All have common characteristics, emphasising outbreak control and containment. Missing dimensions are identified, including a lack of attention to underlying disease drivers, issues of poverty and equity and broader questions of access and governance. The paper examines how discourses of security and risk pervade the discussions, affecting how the response has played out. The paper concludes with a discussion of the emerging challenges, including the implications for organisational architectures, professional training and programme implementation."

The document examines, among other issues, how institutions were involved, organised, and placed in a framework for communication and action. "The key question must be: is this evolving institutional and organisational architecture the most effective and efficient – and does it improve resilience, and the ability of the world to respond to new, uncertain, surprise-laden events?"

The document describes the organisational architecture and roles of major organisations in the attempt at a coordinated effort. "This framing, which avoids models of a fixed, permanent organisation, is interesting and strategic. The focus was on facilitation, on ideas, on getting people talking to each other, on building bridges sometimes over huge gulfs – and raising money.... The sense of personal connection and commitment was apparent too."

One of the observations is that interpersonal communication among experts with different perspectives, for example doctors and veterinarians, is key. Another is the "tricky question of what information is made public, what is kept quiet, and how things are presented... Here the ‘outbreak narrative’ and an emergency framing of the response often comes into play, and events (outbreaks, infection cases, mortalities) are emphasised over processes, and the less tangible, less easily recorded dynamics of slow spread or endemism. Finally, there is the response to risk information and early warning alerts. Who believes it? Who wants to believe it?... a ‘missing link’ between early warning information and response has often been found. As, if there is scepticism about the information, fear about the consequences and uncertainty about everything, it is not surprising that some calls are not heeded. This puts pressure on those handling information, constructing maps and presenting statistics to up the ante: fear and danger is always a good spur to action, it is thought. This may help, but it may also undermine – as people either panic or laugh at exaggerated statistics."

The document discusses "knowledge politics", examining uncertainties – or areas of ignorance - having to do with the areas of risk predictability that have no concrete answers. "Yet the framing of...responses has been...around probabilistic risk – and an emphasis on prediction and control – and not a more central admission of uncertainty and ignorance. This, we argue, is problematic, even dangerous." The document questions how this framing of the risk of avian flu comes about and recommends: "A reconfiguring of...expertise and an involvement of alternative knowledges, including that of those directly affected by the disease, could...have a dramatic effect on the framing of the problem and the response, allowing alternative narratives into the picture. This would help to bring to the fore real uncertainties, ambiguities and forms of ignorance, and push policy to respond to these explicitly, rather than wishing such awkward, troublesome dimensions away." "Alternative ways of thinking about surveillance might not have so much focus on reporting disease events and so constructing purported risk measures, but more on understanding of complex ecosystem change and holistic assessments. This may, in the end, result in better responses....In other words, asking who will be affected, where and with what implications for poverty? Such distributional questions associated with different disease responses should be seen as central to any discussion of policy, but tend to get occluded from the analysis by a universal risk framing."