Institut de recherches sociologiques

Lessons from the A(H1N1) pandemic to the Ebola epidemic

Unraveling lessons learned from the A(H1N1) pandemic to the ongoing Ebola epidemic



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The 2009 A(H1N1) pandemic was the first global health crisis of the century to be monitored under the revised International Health Regulations (2005). Since the early 1990s, the World Health Organization has striven to gain and maintain a leadership role in global health issues, in a context characterized by (re-)emerging risks, bio-security considerations and the multiplication of actors involved in health issues (charities and major foundations). The management of A(H1N1) took place in this complex changing environment of global health policy.

Since 2010, state agencies and international organizations have engaged in vast lessons learned experiences through published evaluation reports, aiming at better understanding the conditions under which the A(H1N1) pandemic was monitored worldwide. Lessons learned experiences are far from simple to conduct, as many organizational cultures are too often characterized by a blame culture when confronted with self-reported failures or dysfunctions. This is why the impetus given by international and national public health organizations, as well as parliamentary bodies in the aftermath of the pandemic, is a critical source of both academic analysis and policy assessment.

Yet in the midst of this research,  a new major crisis  struck: the Ebola epidemic in West Africa. The response this time again, has been severely critized: from doing too much and crying wolf during A(H1N1) to doing too little to fight Ebola, a deadly disease in countries with no health infrastructures. The inadequate belated response and its consequences at every level (on the ground; in the acting institutions and in the public opinion in general) is subject to numerous narratives, influenced by the position of actors in the larger global health system (doctors without borders's expats and volunteers; WHO headquarter's experts; virologists; infectious disease specialists; public health specialists, to name a few...). We decided to include this case in our project to draw a comparison between these two major global health crises  five years apart. Obviously these two crises are not comparable term to term. While the influenza pandemic has unraveled a highly sophisticated display of preparedness and pre-existing strategies,  the Ebola epidemic has had limited action plans, few experts, little data that could be of any use to the response from the onset. We are indeed dealing with a "super-equiped" disease, i.e the flu and an "under-equiped" disease, i.e the Ebola. However we wish to analyse  how both A(H1N1) and Ebola are challenging public health actors and institutions

This comparative project would like to demonstrate how organizational mitigation strategies, risk communication, and cost-benefit analyses are closely intertwined. Planning and developing organizational responses during acute crises need to be articulated with a corresponding risk communication strategy that should not only avoid reporting on the intrinsic difficulties of planning, deciding, and organizing for such events, but also mirror the organization that has been chosen. Similarly it should attempt to propose an economic evaluation of the costs incurred and seek to look for large support in affected communities for these cost allocations. These are not three sequential moments: 1) planning and organizing, 2) communicating and finally 3) paying the bills. These are three closely related segments of a global response that have almost never been addressed in a multidisciplinary framework so far. These issues are the backbone of this project. 

Ongoing fieldwork, initially planned around A(H1N1) response in different countries (Switzerland, the United States, Japan) and in WHO headquarters, will help understanding the controversies raised by these two crises. The project will eventually provide important insights for outbreak management and global health governance.


Related publications

Bourrier, Mathilde, Burton-Jeangros, Claudine, et Bastide, Lois. 2014. « Sous surveillance. Possibilités et limites du régime de la preparedness : le cas de la pandémie A(H1N1) ». Socio-Anthropologie (29): 157-171.

Barrelet, Clara, Bourrier, Mathilde, Burton-Jeangros, Claudine, et Schindler, Mélinee. 2013. « Unresolved issues in risk communication research: the case of the H1N1 pandemic (2009-2011) ». Influenza and Other Respiratory Viruses 7: 114-119.