Cultural, Anthropological, Social and Economic Considerations During a Disease Outbreak

The recent EVD outbreak in West Africa has brought to the forefront the importance of cultural, anthropological and social issues in the prevention and control of deadly epidemic diseases. While a lot of attention and resources were channelled towards upgrading the local health infrastructure and strengthening the individual pillars of the health system (leadership and governance, financing, health workforce, medical products, vaccines and technologies, information and service delivery), relatively little attention and resources have been devoted to understanding the role of cultural, anthropological and social issues in the prevention and control of the epidemic at the beginning of the outbreak. The development of drugs and vaccines, for instance, is crucial towards curbing infectious diseases in Africa. Yet, this only constitutes a fraction of what needs to be done. Social, cultural, ethical and economic dynamics play significant roles in determining how effective these drugs and vaccines would be in the long run.

We cannot underestimate the role of the socio-cultural context in worsening/aggravating the spread of deadly infectious diseases at an epidemic scale. For health systems to be responsive, they must be built around the needs and expectations, as well as the socio-cultural outlook of the communities and patients they serve. This was arguably not the case in the early days of the EVD outbreak. Public health interventions aimed at curbing the spread of the disease did not adequately engage and involve affected local communities, thereby undermining infection prevention and control efforts. While the prevailing weak health systems in the affected countries were ill-prepared to manage the epidemic, ‘lack of trust in the authorities, probable virus infection during the preparation of “bushmeat” for human consumption, traditional funerary practices, and relatively free flow of goods and people between regions and across international borders also constituted important factors that facilitated the spread of the disease and hindered infection prevention and control efforts (Phua 2015)[1]. Moreover, a recent review of the challenges to the control of the EVD epidemic in West Africa reported eight main challenges of which five were linked to cultural, anthropological and social issues (Guadu and Tekle, 2015)[2]. As such, any effective strategy to manage a similar outbreak must integrate and incorporate these issues.

Going forward there is a lot to learn from anthropologists, sociologists and other social scientists to better engage communities in the event of a similar epidemic, and how health systems can better be responsive to the needs of the communities they serve and in rebuilding lost trust. If any key lesson was learned during the recent West EVD outbreak, it is the strong need for community engagement and involvement in any prevention and control programme. For the effectiveness of a health system in responding to the needs of communities depends on appropriate engagement and involvement.

Considering the above, the upcoming 3rd EID in Africa conference in Accra, Ghana, has considered it crucial to include a faculty devoted to Cultural, Ethical, Anthropological, Social and Economic issues. This faculty would broadly address varying issues around these broad areas as they bear on emergence, spread, control and prevention of future epidemics in Africa. It will ensure that the GET Consortium adopts a more comprehensive strategy towards addressing EIDs and Biosecurity in Africa.

Article Submitted by the Global Emerging Pathogens Treatment Consortium: Faculty on Cultural, Anthropological, Social and Economic Issues (CASE)

[1] Phua. Meeting the Challenge of Ebola Virus Disease in a Holistic Manner by Taking into Account Socioeconomic and Cultural Factors: The Experience of West Africa. Infectious Diseases: Research and Treatment 2015:8 39–44

[2] Tadesse Guadu and ZenebeTekle. Challenges to Control Ebola in West Africa: A Review. World Applied Sciences Journal 33 (6): 1000-1009, 2015

 

Interview with an African Bioethicist – Godfrey Tangwa

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During the 2014 Ebola epidemic, bioethicists played a critical role in lending a voice to the world’s most vulnerable people by ensuring that ethical standards were upheld amidst chaos on the global public health scene. One of these bioethicists is Dr. Godfrey Tangwa, Professor of Philosophy at the University of Yaounde in Cameroon and Chair of the GET Consortium’s Cultural, Anthropological, and Socio-Economic (CASE) Working Group.

After reading Prof. Godfrey Tangwa’s recent article, Giving voice to African thought in medical research ethics, we reached out to him to learn more about his work, how he became involved with the GET Consortium, and any advice he had for the next generation of African scientists and ethicists. Below is the short interview we had:

Professor Tangwa, what prompted you to join the GET Consortium? From a bioethics standpoint, how does GET differ to other efforts to combat emerging infectious diseases on the African continent?

When Akin Abayomi approached me (I have no idea how he got to know me, as I did not know him at the time) upon the outbreak of the Ebola epidemic in West Africa (2014) and informed me of an African-led initiative to respond in a comprehensive manner to the epidemic and any similar future threats, I felt very excited. I have been a careful observer of the disease burden of sub-Saharan Africa, combined with poverty and ignorance, since the outbreak of the HIV/AIDS pandemic in the 1980s and have noted, heart-brokenly, the exploitative attitude, exemplified in sundry engagement and research scandals in Africa, of some agents and agencies of the industrialized developed world. I was involved in the early 1990s with the formation of the Pan-African Bioethics Initiative (PABIN) which, for various reasons, has not lived up to its promise.

The Global Emerging Pathogens Consortium (GET) seemed to me much more hopeful in the clarity of its conception and comprehensiveness, in its focus not only on the ethics but on the science, the research and the governance; above all, in its being an original indigenous African initiative. Abayomi informed me that the initiative needed a strong socio-cultural and anthropological component and invited me to help form the CASE work group. I attempted without success to shift leadership of this component to various individuals I considered much more qualified to do the job than myself but ended by settling to do the best I could within the circumstances. Luckily, I easily found a couple of very qualified and talented young people willing and ready to give the best of themselves working for the working group. I am not aware of any other efforts aimed at combating emerging infectious diseases on the African continent and cannot therefore make a comparison as yet with the GET.

In your article, “Giving voice to African thought in medical research ethics,” you mention that African countries, in general, do not seem to recognize the importance of funding [biomedical] research for development. From both an ethics and economic standpoint, how do these governments reconcile research funding against more immediate health threats?

I do not think that there are many African countries with a clear, well thought-out, healthcare delivery system in which the relative importance of routine healthcare, emergency healthcare and healthcare research and development are carefully rationalized. What is glaringly evident in most countries is that budgetary allocations for healthcare are ridiculously derisory by comparison to other sectors such as military and security or Presidential pomp and pageantry.

In the wake of Emerging Infectious Diseases such as Ebola, antimicrobial “superbugs,” and ongoing epidemics such as HIV/AIDS and TB, how will African countries be able to break out of the vicious cycle of depending on external sources of funding for research as time progresses?

To break out of this vicious cycle, clear political thinking and an attitude of self-reliance are necessary. This should not exclude external sources of funding; only that such funding should not come with hidden or disguised strings attached, especially if such are likely to lead to more dependency.

The compelling theme of cultural relativism pervades your article. You describe African cultures, while incredibly diverse, as collectively characterized by terms such as “eco-bio- communitarian, tolerant, cautious, non-aggressive, non-proselytizing, and inward-looking.” How do African cultures’ aim to compete in a Western-dominated, increasingly globalized world while securing biosecurity from within with this cultural foundation? Is it not an inherent challenge? 

Cultural diversity is a value because every culture, no matter how small or modest, results from an adaptation of a group of human beings to a particular niche of the physical environment and this is an experience that is not repeatable by other cultures. In that respect, all cultures as cultures are equal or of equal value. Reality and the universe are vast and infinite and there is no way any individual of group of individuals can capture the salient points about the universe or reality in a holistic manner. The best we can do is to combine partial and limited perspectives of the different individuals and groups of human beings. There are ineradicable limitations to all human knowledge, collective or individual, and this imposes co-operation, deliberation and sympathetic understanding as the way forward for human beings for a bio-secure and stable globalizing world. Such a vision is more tease-able from the values of, say, African culture than from those of, say, industrialized Western culture. Bioethics can help to bring us towards that path. That is why, although I am a cultural relativist, in the above sense, I am a moral universalist.     

What key message do you think is most important to communicate to the next generation of African scientists and ethicists?

I have a lot of faith in young African scientists and ethicists. My earnest message to them is to take Africa and their Africanity,  their being African and their African cultural background,  more seriously than their elders who, fascinated by Western marvels and technology, have so far been unable to do. It is time for them to relate their knowledge and expertise to their continent and cultural background, to cast off the yoke of colonialism, colonial mentality, colonial doctrines and proselytization. It is their task to attempt modernizing Africa from within.

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Prof. Tangwa speaking at the International Commission on Occupational Health (ICOH).

Thank you, Professor Tangwa! We look forward to hearing you speak at the 3rd African Conference on Emerging Infectious Diseases and Biosecurity, August 16-18th 2017 in Accra, Ghana.