Disease Outbreaks: Navigating Uncertainties in Preparedness and Response

Abstract

In recent years, fears about infectious diseases with pandemic potential have led to global initiatives to predict, prepare and respond to outbreaks. Practices that are focused on prediction and control centre on turning uncertainties into ‘risk’, through surveillance, modelling and scenario planning. We argue that, alongside scientific uncertainties, a further source of uncertainty has come into view for science-policy communities: the behaviour of affected populations and the social and political dynamics of disease ‘hotspots’. We contend that this has catalysed an increased recognition of social science perspectives, with new practices emerging, detected in approaches that aim to standardise risk communication and community engagement, or to synthesise social knowledge to make ‘context’ more discretely legible. We suggest that such initiatives can also be viewed as part of a broader suite of technologies to transform uncertainties into calculable risks. In this chapter, we seek to open up a richer dialogue about the different understandings of uncertainty, illustrating the potential contestation between the official response efforts of agencies, and alternative ways of knowing and responding to outbreaks in ‘communities’, grounded in local-level practice. In conclusion, we reflect on the limits in comprehending the ontological dimensions of uncertainty: for people living in these settings, it is not ‘context’ that is salient, but the ongoing flow – or text – of social and ecological life, where everyday uncertainties are constantly faced. We ask if alternative processes might be possible for formulating international planning frameworks, more attentive to views ‘from below’ that could reveal alternative priorities and ways of being-in-the-world.