When epidemics first emerge, all eyes tend to turn to the epidemiologists, virologists and clinical trials. The humanities and social sciences also have an important role to play, both in studying the phenomenon and providing a response to it. Two of the IRD’s health anthropologists talk about their work in France and in the intertropical regions, within their areas of expertise and those of the Institute.
As the Covid-19 (short for Coronavirus19-related disease) pandemic sweeps through more and more countries around the world, research is being ramped up to accelerate diagnosis, predict the trajectory of the epidemic through modelling, identify specific antiviral treatments, and develop a vaccine. But other researchers, in the humanities and social sciences, are also working together closely on the problem. Such is the case of Marc Egrot and Alice Desclaux, two IRD anthropologists who have been hard at work since the alarm was first raised.
“Epidemics and their related health measures tend to move very fast,” begins Marc Egrot. He is a researcher at the LPED, and his joint research project with Sandrine Musso from the Centre Norbert Elias in Marseille has been selected by REACting (see inset) to benefit from seed funding, i.e. a financial boost to get the study off the ground. “
We initially planned to study the quarantine of French nationals repatriated from Wuhan to Carry-le-Rouet, then Aix-en-Provence, at the end of January.” Given the scale of the epidemic, however, the anthropologist and his team have now proposed to extend their research to the other health measures that were subsequently adopted, in stage 2 then stage 3: “Our focus is identical – documenting and analysing the way the virus transmission limitation measures are being experienced from a social viewpoint.”
For the Carry-le-Rouet site, the scientists proposed to study social life in quarantine for all the social stakeholders involved or affected: French Red Cross volunteers, residents of Carry, emergency services, those in lockdown, etc.
Since the switch to stage 3 and the state of emergency, the team has extended the scope of its research to include the social experience of other public health measures designed to limit transmission of the virusProgramme submitted to the ANR: COMESCOV – Lockdown and health measures seeking to limit the transmission of Covid-19: Social experiences in times of pandemic in France, Italy and the US1. This encompasses the measures to protect paramedical professionals in hospitals and surgeries; interventions by institutional actors or citizens to provide help to vulnerable people in lockdown; the construction of new forms of sociability and new kinds of professional, interpersonal and leisure activities; the social experience of home-schooling and lockdown for children and parents; and the changes in funerals and mortuary care (with the involvement of the JEAI RiF&piC programme). “The health guidelines have changed so fast that many social actors are bewildered,” comments Marc. “So we will also be analysing the way various categories of actors understand and interpret these rapid changes.”
The hastily-formed team includes six researchers in Marseille with expertise in anthropology, history and political science, along with two more anthropology researchers, one in Italy and the other in the USA, who will be working on some of the proposed lines of research.
For data collection, Marc explains that “the proposed programme will use methods adapted to the context, that have already been used in similar situations: telephone interviews, observations of videoconferencing meetings, diaries kept by people in lockdown, including children, the use of social media, or delegated observation.” He also stresses that “the programme is being coordinated with other emergency programmes, such as the CORAF (Coronavirus Africa) programme in West Africa, the one put forward by the Red Cross Foundation focusing on volunteers, and the MG-CORA programmeGeneral practice in the face of an epidemic: the management of the Covid-19 crisis from a front-line perspective led by the SESSTIM unit to streamline efforts in order not to over-research certain topics or certain actors.”
“This is operational research,” indicates Marc, who has committed to meeting the requirements of the call for proposals issued by the French National Research AgencyThe ANR has issued a call for projects on Covid-19, with an accelerated evaluation and selection process. With an initial budget €3 M and targeting four priorities identified by WHO, this “Flash” call aims to provide rapid support for the scientific communities mobilised around Covid-19.1. In other words, the team members have to document and analyse the data as quickly as possible so that their findings can be used to fine-tune the response effort, by signalling problems in the roll-out of measures or the drafting of strategy notes. “Actually, many concepts developed in medical anthropology and the history of epidemics, as well as analyses inherited from the study of other epidemics, for instance Ebola in West Africa, will help us rapidly build our research in this emergency situation,” he emphasises.
To discuss the theoretical framework and compare findings, Marc Egrot knows that he can count on the Network for the Anthropology of Emerging Epidemics (see inset), founded in 2014 in reaction to the Ebola epidemics which cast such a dark shadow over West Africa. This highly responsive network uses WhatsApp groups for its scientists to discuss matters immediately. “Everyone knows people who are willing to share their experiences.”
As the Sars-CoV2 coronavirus epidemic continues to spread, the AVIESAN (French National Alliance for the Life Sciences and Health) is working to accelerate research into both that virus and COVID-19, through the action of the REACTing consortium (REsearch and ACTion targeting emerging infectious diseases) coordinated by Inserm. With the support of France’s Health and Solidarity Ministry and its Higher Education, Research and Innovation Ministry, 20 scientific initiatives have been selected by REACTing’s scientific board. They cover themes as diverse as epidemic modelling, the search for treatments, and prevention.
During the Ebola epidemics, Alice Desclaux, also a health anthropologist who works in the TransVIHMI unit, was in Africa. She agrees that things are moving really fast. “Barely a month ago, based on direct flights from China, it was thought that Africa would be affected first, particularly South Africa, Kenya, Egypt, etc. But actually, the virus hit Europe first. According to WHO, African countries were only affected later, as the virus was brought in by people who had come from Europe, and Senegal and Nigeria were the first to be hit.”
Alice is still in Dakar and has been analysing preparedness with the Brighton Institute for Development Studies since 2019. Senegal’s experience in managing Ebola has enabled the country to be better prepared in certain respects: “Who should do the testing, who is responsible for handling cases, who will conduct the epidemiological inquiry to identify high- or low-risk contacts, how will people in lockdown be monitored, etc. All that has already been arranged.” However, she remarks, “the trick now is to combine exceptional measures with the ‘ordinary’ ones. And while providing a very exceptional response from a specialised team is already quite a challenge in Africa, it is complicated further when you have to coordinate it with the healthcare system as a whole. Not everyone has been trained or equipped to respond to the kind of scale of action that the coronavirus pandemic requires.”
Above all, Ebola is not Covid-19. What happens in one epidemic sometimes no longer holds true in the next one. One of the tragedies of Ebola was the refusal by the population of Guinea during the early stages of the epidemic to take their sick relatives to the centres where the health authorities wanted to treat them. “It was really difficult to convince people to take their sick to hospital, as it was thought that they would be left to die there,” recalls Alice. As Covid-19 spreads, the opposite recommendations are being made: people who have the disease must stay at home; they should not go to hospital where the risk of transmission is high and services are overloaded, but instead keep in contact with these services so that they can be hospitalised quickly in the event of complications. “The instruction not to go to hospital might be perceived negatively,” worries Alice. “Whatever the decision made, it will be criticised, and confidence in politicians will fall.”
To help the health authorities manage the representations people have of the illness and its causes, of sick people themselves, of prevention and treatment measures, and of the decisions taken by the government, the researcher has now turned her attention to analysing messages relayed online and on social media. “Not long ago, France was accused of having ‘coronised’ Africa, a term coined by a Senegalese newspaper. Later, rumours were going around that ‘heat and black skins withstand the virus better.’” A lot of fake news is circulating in the media and on social networks, and Alice and her team are analysing and studying its provenance, its targets and its social effects.
Most of these messages contain only part of the truth. It is often the use of information out of context that delegitimises it. “Our aim is to analyse this information, which is considered to be fake news since its status is yet to be determined, to decipher it and to see how it might pose a problem in Senegal. We did this for chloroquine, which was being promoted heavily on social media despite its unproven efficacy, leading people in several African countries to buy it on the informal market for medicines where products are often of poor quality, and to self-medicate without any guidance from doctors or pharmacists.”
By deciphering this fake news and clarifying its meaning and social effects through comparative ethnographic studies in various contexts, the researchers can pinpoint areas in which insufficient information is being given to the public, and inform the health authorities accordingly.In France and Senegal, both online and offline, people’s behaviour and social experiences will be analysed and deciphered in order to inform public health policy. This work is one component of the very extensive mobilisation and frontline response from the IRD’s researchers and units since the start of the pandemic.
Network for the Anthropology of Emerging Epidemics: from Ebola to Sars-Cov-2
In September 2014, when the Ebola virus disease epidemic in West Africa spread from Guinea to four other countries (Sierra Leone, Liberia, Nigeria and Senegal), anthropologists working in the region created the SHS-Ebola network (West African Humanities and Social Sciences Network for Ebola). The network was initiated by the team at the Fann Centre for Research and Training in Clinical Management (CRCF) in Dakar. Supported by the IRD and Expertise France, the network contacted researchers in social sciences working, or likely to be working, on research, assessments or consultancy actions around the Ebola epidemic, and then drew up a list of members. In this way, the Network grew throughout 10 West African countries. Its objective was to foster dialogue and share information in order to analyse the social effects of the epidemic, along with regional response measures.
At the end of the Ebola epidemic in West Africa, the network’s coordinators changed its name in order to extend its study scope to other types of epidemic. Its name is now the Network for the Anthropology of Emerging Epidemics.
Upon the outbreak of the Covid-19 epidemic, declared by WHO on 30 January 2020 as a global health emergency, then a pandemic on 11 March, the Network, coordinated by Bernard Taverne, mobilised social sciences researchers in various French-speaking countries, particularly in West Africa. The aim of this mobilisation is to carry out online media monitoring in order to analyse public perceptions, representations and interpretations of official health measures.