In the shadow of tomorrow

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Invisibility in global health: a case for disturbing bioethical frameworks

In recent years, the global health community has been increasingly reporting the problem of ‘invisibility’ as aspects of health and wellbeing that are often overlooked and ignored, and predominantly affects the most marginalized and precarious people. However, it is unclear how to realistically manage global health invisibility and move forward. In this letter, we reflect on several case studies of invisibility experienced by people in Brazil, Malaysia, West Africa and other transnational contexts. Highlighting the complex nature of invisibility and its interconnectedness with social, political and economic issues and trends, we argue that while local and targeted interventions might provide relief and comfort locally, they will not be able to solve the underlying causes of invisibility. Moving forward, we argue that in dealing with an intersectional issue such as invisibility, twenty-first century global health bioethics could pursue a more ‘disturbing’ framework, challenging the narrow comforting solutions and sociomaterial inequalities of the sociopolitical status quo. We highlight that comforting and disturbing bioethical frameworks should not be considered as opposing sides, but as two approaches working in tandem in order to achieve the internationally set global health milestones of providing better health and wellbeing for everyone. In doing so, we call for taking seriously insights from sociology, anthropology, postcolonial studies, history, feminist studies and other styles of critical reasoning that have long been disturbing the grand assumptions about people and their conditions, and, practically, to rediscover the ethos of the WHO Alma Ata Declaration, calling for cooperation and support beyond the narrow market logic that dominates the landscape of contemporary global health

Encountering Semiotic Misdirection in Covid-19 Etiquette Guides

This paper examines Global health misdirection unfolding at the semiotic level of Covid-19 related texts and images produced by the World Health Organisation. I argue that such public health materials, claiming neutrality and universal applicability, become multimodal etiquette guides that presume normal bodies and middle-class social environments. I give specific attention to how Covid-19-related materialities, affordances and emotive actants directly contribute to elite-making, stratification and strategic cultivation of shame and embarrassment with regard to Covid-19 etiquette. By tracing such an example of ‘semiotic misdirection’ in global health, I invite STS and adjacent communities to approach the circulation of public health materials as a semiotic practice that creates novel kinds of oddities and stratifications, and to consider the enactment of seemingly neutral and value-free public health rules as morally-charged etiquette

Precarity, clinical labour and graduation from Ebola clinical research in West Africa

The provision of gifts and payments for healthy volunteer subjects remains an important topic in global health research ethics. This paper provides empirical insights into theoretical debates by documenting participants' perspectives on an Ebola vaccine trial in West Africa. This trial provided hundreds of Africans with regular payments, food packages and certificates for participation. The researchers conducting the trials considered these socioeconomic provisions to be gifts in accordance with contemporary ethical standards and principles. Trial participants viewed them differently, however, approaching trial participation as a means for training and employment in what was from their perspective a new job market: the post-Ebola expansion of research and health care systems. This paper analyses participation in contemporary research by viewing the context-specific histories of trial participants through the lens of prior interventions, specifically participatory reintegration programmes conducted in Anglophone West Africa to overcome civil war crises. In particular, we argue that participation in the Ebola vaccine trial was inadvertently shaped by the design and outcomes of past reintegration programmes. Our results highlight the need to investigate existing socioeconomic landscapes which surround and indeed permeate clinical research as a prerequisite for understanding the participatory motives of vulnerable participants in West Africa and elsewhere

Parallel vaccine discourses in Guinea: ‘grounding’ social listening for a non-hegemonic global health

International audienceMisinformation has been identified as a major threat to public confidence in vaccines, particularly during epidemics. As a response, social listening has become a popular and heuristic public health tool for detecting misinformation and adapting vaccine communication. In this article, we take a critical stance on the normalised approach to social listening which solely relies on the analysis of online discourses. We highlight that the current social listening paradigm inherited a reductionist and utilitarian approach from commercial marketing that struggles to grasp – and even misrepresents – the complexity of health-related perceptions and knowledge. This study draws from online COVID-19 vaccines discourses in Guinea and ethnographic fieldwork among Guinean healthcare workers. While the online social listening showcased a predominance of individual and collective safety concerns, distrust towards African elites and Western actors, fieldwork revealed that healthcare workers’ vaccine perceptions were more nuanced and largely shaped by complex kinship relations spanning across online and offline social landscapes. Furthermore, healthcare workers often displayed frontstage and backstage vaccine discourses, their vaccines related representations and claims could evolve depending on the context of enunciation. We advocate for grounding social listening in global health to avoid disconnection from the public. Failure to accomplish this could result in a detached and hegemonic form of ‘social hearing’, rather than authentic social listening. In light of this, the transdisciplinary methodology exemplified in this paper represents one possible solution