Introduction
Infectious diseases are responsible for 25% of the annual global deaths (Dry and Leach 2010). Epidemics arising from these diseases are unpredictable, carry uncertain, varying risks, and narratives in different contexts (Scoones 2010). It is important that the scholarly literature represents the diverse and sometimes competing, narratives from all affected particularly the most vulnerable (Dry and Leach 2010). Arguably, national and global responses to epidemics are inherently political. The experts selected for consultation, the evidence used to inform response pathways, and narratives of blame, vulnerability, and responsibility are politically driven, and require analysis.
In this paper, epidemics refer to a spike, above normal, in the prevalence of a specific disease in a specific population (Centre for Disease Control and Prevention 2012). The literal definition of politics is the “activities that relate to influencing the actions and policies of a government or getting and keeping power in a government” (Merriam-Webster 2016). However, in the “politics of epidemics” literature, politics often refers to the extensive and diverse influence of local, national, and international governments and organizations, on the health outcomes of communities during disease outbreaks. For the purposes of this paper, politics will also refer to how scholars talked about epidemics, and whose narratives are reported in the reviewed literature.
Several key themes emerge when examining scholarly narratives about the politics of epidemics namely the socioeconomic distribution of disease, decision-making in research and development, the credibility of evidence that informs response pathways, and attribution of responsibility for causing the outbreak and determining who is responsible for responding. While the literature presents obviously competing narratives that explain disease outbreaks, a close examination of these reveals a high prevalence of certain narratives, which reflect the influence of power and privilege. Hence, some of the literature has called for increased representation of the narratives from the most marginalized populations who bear the brunt of epidemics, in the scholarly literature (Dry and Leach 2010; Nightingale 2010).
Furthermore, the decisions with regard to the type of research, the study population and the research beneficiaries often lack transparency, are also dominated by the most powerful. The case of the swine flu, dubbed the “pandemic that never really was” (Evans 2010; Bonneux and Van Damme 2010), demonstrates the potential consequences of private and uncommunicated decision-making processes in research and development. In the case of the swine flu, allegedly scientists conducting research and advising the World Health Organization on the virus were compensated by drug companies. This may have introduced bias (Evans, 2010, p. 296). By increasing fear of a global pandemic, scientific research funded by pharmaceutical companies justified the stockpiling of anti-viral supplies, thus increasing their vaccine sales (Evans 2010).
Fear mongering has been criticized in the literature, since it has the potential to distort the evidence, which should guide credible decision-making. It is therefore critical to assess the credibility and quality of the evidence that is being used to inform the response to epidemics around the world, particularly in light of the complicated and often problematic relationship between the academic and industry (Bonneux and Van Damme 2010). In determining the credibility of evidence, consideration should be given to the legitimacy and authority of its producer(s).
The literature identifies discourse with regard to the attribution of responsibility; who is to blame for the outbreak and who should response? Some of this literature assigned the blame and responsibility, for the outbreak, to people’s cultures (Dong 2008; Morinet et al. 2016), which oversimplifies complex issues that result from complex processes, such as globalization, climate change, and global economics. This kind of narrative reflects the politics of blame, which typically attributes responsibility for the sources of the outbreak to a cultural minority group and neglects the influence of colonialism and the social determinants of health, including overcrowding, poor sanitation, and poverty that increase these people’s vulnerability (Dry and Leach 2010).
Given these sociopolitical issues that characterize epidemics, a comparative analysis of the narratives on the politics of epidemics is relevant. To date, most of the narratives in the scholarly literature on the politics of epidemics have considered one epidemic in one context (Dong 2008; Morinet et al. 2016; Nyenswah et al. 2014). We hypothesize that the narratives may vary depending on the kind and context of the epidemic.
The overall aim of this review paper is to discuss the scholarly narratives on the politics of disease epidemics by diseases and income level; Ebola in a low-income setting, Zika in a middle-income setting, and SARS in a high-income setting (Table 1). This analysis allowed for the consideration of the role that socioeconomic, geographical, and cultural context might play in the narratives on the attribution of blame and response to disease outbreaks.
Table 1 An overview of the disease outbreaks