The case of pandemic prevention is one of many examples to show that holistic perspectives in disaster prevention and related fields have gained prominence in recent years.
Since the 1990s, health experts have anticipated that we would be hit by an influenza pandemic in the not-too-distant future (cf. Caduff 2015; Lakoff 2008; Weir, Mykhalovskiy 2010). While we may have thought of pandemic primarily in terms of Covid-19 over the past two years, influenza pandemics have long represented the paradigmatic case of pandemic preparedness planning. I will use this paradigmatic case to trace how the understanding of pandemics in the global field of pandemic prevention has changed over the past 30 years and how this has affected the question of what expertise is relevant to pandemic prevention. I show that due to a newly established disaster perspective on infectious diseases, a holistic form of world observation has prevailed that promises to include diverse expertise. In doing so, I also demonstrate inconsistencies in the semantics and reality of expert advice by considering the application of this holistic pandemic perspective to the Covid-19 pandemic emergency. Specifically, I show that the discursive expansion of expertise was not readily realized in the case of Covid-19. While in the last two years there has been a public debate about how society should deal with expert opinions, in this paper I focus on the example of pandemic influenza and how expertise becomes available for society in the first place. I show that while it may be desirable to include a broad range of expertise to deal with disruptive events such as pandemics, it is not so easy to actually bring these diverse views to bear in a crisis situation.
The rise pandemic fear
To understand the fear of a future pandemic influenza, one has to consider the increasing concern about emerging infectious diseases (EID) since the late 1980s. On the one hand, this concern was fed by the discovery of new infectious diseases such as HIV/AIDS, Ebola, or BSE starting in the 1980s. On the other hand, this fear is also the consequence of the realization that “old” pathogens such as tuberculosis were diagnosed more frequently again and proved difficult to combat. Since health authorities assumed from the middle of the 20th century that infectious diseases were a problem of the past (and of developing countries), this development came as a shock.
As Lorna Weir and Eric Mykhalovskyi point out, the rise of the concept of EIDs cannot be attributed solely to increasing infectious diseases. Rather, this concept is also characterized by a new way of observing the world: The perspective of EID reconceptualizes infectious diseases and emphasizes their adaptability and changeability. The world of infectious diseases can thus no longer be captured by a list of distinct and stable entities (Weir, Mykhalovskyi 2010, p. 31-40). This change can be interpreted with Klaus P. Japp as a shift from a risk perspective to a disaster perspective (Japp 2003). While risk communication assumes that one has specific ignorance – in a sense, known unknowns (cf. Mallard, Lakoff 2011, p. 339) – and that one can thus still calculate, disaster communication is based on the assumption that one has unspecific ignorance and is dealing with unknown unknowns. Risks can be identified and probabilities of occurrence can be weighed against damage levels. By adopting a disaster perspective, on the other hand, one assumes unidentifiable causal processes and inconceivable damages in the future. It is precisely this perspective that underlies the EID concept. According to Japp, the reaction to such observations of unspecific ignorance in disaster communication leads to categorical avoidance behavior (Japp 2003, p. 88). Interestingly, the adoption of a disaster perspective in the global field of pandemic prevention did not lead to such an emphasis on avoidance behavior but rather to an attitude of heightened vigilance (cf. Chateauraynaud, Torny 1999). This can be understood as an attempt to normalize catastrophes, but it cannot be equated with risk communication (which, according to Japp, reckons with specific non-knowledge).
The emergence of a holistic perspective on infectious disease
While a global surveillance network for (seasonal) influenza has been established since as early as 1947, the World Health Organisation (WHO), as the central organization of the global health field, did not publish the first influenza pandemic plan until 1997 – after the EID perspective had gained prominence among health experts and in the same year that human cases of A/H5N1 infection were first observed in Hong Kong.
The first WHO pandemic plan of 1999 was still strongly characterized by a medical-microbiological perspective and envisaged mainly the production and distribution of vaccines and antiviral drugs in the event of a pandemic. The plan referred to a relatively narrow group of experts, based predominantly on microbiological and epidemiological expertise from WHO, the WHO Collaborating Centres for Reference and Research on Influenza, the National Influenza Centres, and representatives of vaccine-manufacturing pharmaceutical companies (cf. WHO 1999, p. 55-65). The problem of pandemic influenza was strongly considered to be one of circulating viruses and infected human bodies. Consequently, the solution to the problem was to prevent or at least mitigate the spread of viruses between human bodies.
In the 2009 Pandemic Plan, the WHO announced a paradigm shift in pandemic planning. The new model was now called the Whole of Society Approach (cf. WHO 2009a, p. 16-18) and was characterized by the idea that not only national and international health authorities should participate in pandemic prevention. Rather, the idea was now that all of society should prepare for an upcoming influenza pandemic: “[A]ll sectors of society should be involved in pandemic preparedness and response” (WHO 2009b, p. 7). This paradigm shift was preceded by an expansion of knowledge considered relevant and a 2005 pandemic plan that now included expertise on child welfare, animal health, food security, and humanitarian disasters (cf. WHO 2005, p. 47-48). For the preparation of the 2009 pandemic plan, this diverse expertise was then further acknowledged by establishing five thematically distinct task forces, such as on “Policy Guidelines and Overarching Documents,” “Communications and Social Mobilization,” “Public Health Interventions,” “Medical Interventions,” and “Non-Health Sector Preparedness” WHO 2009a, p. 56-57. For the development process of the pandemic plan, see ibid, p. 60). The latter task force then also drafted a supplementary document in which the Whole of Society Approach was elaborated in detail WHO 2009b.
Although vaccines, as a means of combating the virus, were of course still seen as having an important function in combating an influenza pandemic, this strategy had a greater focus on other measures taken by various actors. The virological-microbiological perspective was supplemented by a variety of other relevant expert opinions, first as additional valued voices and in a second step in the form of more structured and thematically specified working groups. Remarkably, this WHO Whole of Society Approach is embedded in a perspective held by many organizations in the global field of health policy that precedes the WHO Whole of Society Approach in time. This perspective is referred to as the One World, One Health perspective (sometimes just labeled as One Health) in many documents of international organizations such as the Food and Agriculture Organisation of the United Nations (FAO), the World Organisation for Animal Health (OIE), the World Bank, and also World Health Organization (WHO). Like the Whole of Society perspective, it represents a holistic framing that thinks of health comprehensively and on a global scale: it no longer focuses primarily on people, but argues that the well-being of people, animals (wild and farmed), and the health of a (global) ecosystem must be thought of in their totality and interrelation. Thus, they demand to: “Recognize the essential link between human, domestic animal and wildlife health and the threat disease poses to people, their food supplies and economies, and the biodiversity essential to maintaining the healthy environments and functioning ecosystems we all require” (Manhattan Principles, quoted from: FAO et al. 2008, p. 51-52).
The establishment of a holistic perspective in international public health organizations can be traced to the formulation of the Wildlife Conservation Society’s Manhattan Principles at the 2004 symposium Building Interdisciplinary Bridges to Health in a ‘Globalized World.’ From that point on, the perspectives represented in documents of international organizations shifted: The term One World, One Health was regularly invoked with reference to the Manhattan Principles. The One World, One Health concept thus has a different genealogy than the Whole of Society concept. The former stems from an ecological perspective that can be traced back to the Wildlife Conservation Society and has the function of relating the issues of animal health, world nutrition, and human health. The Whole of Society approach, on the other hand, seems to have been significantly articulated in the context of WHO and describes not only the causal interconnections of society with its global environment, but strongly its internal interconnectedness. Nevertheless, these two concepts converge and complement each other in the pandemic prevention work of WHO and its partner organizations.
The semantic expansion of expertise and constraints on its implementation
Documents published in the global field of pandemic prevention point to the multitude of different actors and expertise that should and must be included in pandemic preparedness. As Hinchcliffe points out, “One World One Health [sic!] is an injunction to join up areas of expertise and practice, which have for too long existed in separate silos” (Hinchcliffe 2015, p. 1). The diversity of perspectives is seen as a challenge, but also as an advantage in preparing for pandemics. It is precisely the multiplicity of perspectives that makes the identification of potentially relevant deviations (especially unusual human or animal illnesses) more likely.
In particular, the Whole of Society approach points to the importance of including a variety of experts from different disciplines for successful pandemic prevention: In addition to virology and epidemiology, relevant expertise for preparing society for an influenza pandemic is now also attributed to anthropology, agronomy, ecology, or economics. For example, a UN and World Bank publication on the “One Health” approach to pandemic response states, “One Health approaches require input from all disciplines in society including animal and human health professionals, anthropologists, agronomists, ecologists, economists, engineers and town planners” (United Nations, World Bank 2010, p. 95, emphasis by author). In addition to medical and technical knowledge, social science expertise is now made relevant by pointing out that input from, for example, anthropology and economics are also relevant.
Scientific communities as well as science-based professions are in competitive situations with each other and typically try to emphasize the relevance of their expertise for societal problem areas or even claim exclusive responsibility (for scientific disciplines and movements, see Frickel, Gross 2005; Jacobs 2013, p. 38-39, for professions, see especially Abbott 1988). This competitive relationship can also be observed in disciplines such as virology and epidemiology, which try to make their expertise relevant to the fight against infectious diseases (cf. Oppenheimer 1992). Can we therefore assume that competitive dynamics between the various knowledge carriers are neutralized by the holistic problem definition based on the One Health and Whole of Society approaches through their virtually all-inclusive perspectives? On a semantic level, it can be assumed that this has been relatively successful: with the holistic perspective, the gateway to the territory of pandemic prevention is basically wide open to many fields of knowledge. At the same time, the price of such inclusiveness is great vagueness. For example, in an interview on the One World, One Health perspective, a member of the OIE states:
“For some people [at the meeting], this [One World, One Health] means to investigate the animal-and human interface, while others believed that food security is more important. Still other experts thought that health issues should be more broadly defined. including not only disease prevention but also healthy lifestyles. The final consensus of the meeting was that One World, One Health could mean whatever people want to.”Chien, 2013, p. 220, emphasis by author
This interview passage suggests that we are dealing here with a consensus fiction (cf. Hahn 1983) that works as long as it is primarily a matter of symbolic recognition. Nevertheless, there is a danger that conflicts will arise among these heterogeneous experts when it comes to concrete decisions and the rather vague concepts of One Health and Whole of Society must be applied to a real-life emergency. As Adam Hannah and Erik Baekkeskov observe, “specifying the […] policies and actions that follow from One Health thus has the potential to become intensely contested” (Hannah, Baekkeskov 2020, p. 441). So far, however, it appears that no publicly visible conflicts have erupted in the field of global pandemic influenza prevention in this regard. How can this be explained?
Insight into this question can be gained by comparing the anticipated influenza pandemic and the current Covid 19 pandemic. An obvious explanation can be derived from the temporal structure of the problem: Because the influenza problem is situated in the future (at least for now), specific decisions cannot be made until an emergency occurs. The global field of pandemic prevention with WHO, FAO and OIE at its center thus has a temporal distance of many concrete measures that are particularly prone to conflict. It is instructive to test this explanation against the current Covid-19 pandemic, where the buffer of the future is no longer available. Since, as noted above, pandemic influenza is the paradigmatic case of pandemic prevention, it is only natural to apply the Whole of Society and One Health approaches here as well (e.g. Dubb 2020; Marty, Jones 2020). In this case a variety of disciplinary perspectives have been recognized by key actors. For example, WHO built a publicly available database that captures relevant scientific publications on Covid-19. In addition to epidemiological and microbiological research articles, articles from sociology, theology or economics can also be found here (the database is available at the following link: https://search.bvsalud.org/global-literature-on-novel-coronavirus-2019-ncov/). For a contribution from economics, see, for example, Chowdhury et al. (2021), for a contribution from sociology, see Averett (2021), or for a contribution from theology, see Smejdova (2020). The relevance of various disciplinary perspectives is thus acknowledged. However, it can now be observed that criticism is formulated from veterinary medicine, for example, that – despite the commitment to One World, One Health perspective – it has hardly been taken into account:
“The ‘One Health’ concept is defined by the World Health Organization as ‘an approach to designing and implementing programs, policies, legislation and research in which multiple sectors communicate and work together to achieve better public health outcomes’. It must therefore be asked why, in spite of this much applauded One Health concept, has veterinary expertise been ignored during the current Covid-19 pandemic and, it would seem, is also likely to be left out of any plans for the next (inevitable) pandemic in the future”Mackinnon 2020, p. 277, emphasis by author
The case of the current Covid 19 pandemic thus supports the interpretation that the expansive recognition of expertise works on a symbolic level (for example, by taking disciplinary contributions into account in publication databases) but becomes susceptible to criticism when it comes to including different expertise in concrete decision-making processes. However, for reasons of time and resources, a selection of expertise is still necessary. It may not be surprising that in crisis situations microbiological-laboratory-scientific and human-medical expertise, which has already been anchored in the structures of global pandemic prevention for decades, prevails again, while ecological and veterinary medical expertise, on the other hand, tends to be marginalized.
The case of pandemic prevention is just one of many examples to show that holistic perspectives in disaster prevention and related fields have gained prominence in recent years. For example, the Whole of Society Approach (starting from natural disaster prevention) has expanded to other issues such as dealing with migration, fighting climate change or realizing the sustainable development goals. Moreover, in the field of disaster management, we also find in recent years the rise of an all hazards approach, which also aims at the inclusion of diverse expertise. In many institutions, there is an established understanding that the complexity of the world requires a correspondence in the expertise available and recognized. At the same time, the article demonstrated that, against a backdrop of institutional trajectories and scarcity issues associated with emergencies, it is not easy to actually bring this recognized breadth of expertise to bear. Moreover, the article also reminds us that important negotiations about expertise do not take place in public, but already in specialized boundary organizations (cf. Lidskog 2014). From a social science perspective, this may not be particularly astonishing and is well known. Nevertheless, after the discussion about legitimate and relevant expertise has taken place particularly on the stage of the public sphere in the last two years in the context of Covid-19, it is perhaps worth pointing out that expertise is often (or one might even say: usually) negotiated beyond the broader public sphere.