A large outbreak of the Bundibugyo ebolavirus (BDBV) was first identified in the Ituri Province in the Democratic Republic of the Congo (DRC) in May 2026. This marked the DRC’s 17th Ebola outbreak overall and only the third known outbreak of this virus since its identification in Uganda in 2007. There are currently no licensed vaccines or therapeutics for BDBV, though several trials are planned and underway. DRC has been at the centre of major experimental Ebola vaccine, and therapeutic and diagnostic research over the past decade. Experience from the outbreak in North Kivu in 2018–20, the DRC-EB-001 trial of the Janssen two-dose vaccine, and more recent mpox vaccine trials has generated important lessons about rumour, mistrust, participant experience, protocol change, and the inclusion of vulnerable groups. A growing body of social science research shows that social and behavioural science (SBS) and risk communication and community engagement (RCCE) can strengthen trial operations when they are integrated from the beginning. This includes improving design and implementation, reducing the risk of coercion or misunderstanding, supporting local ethical deliberation, and identifying contextual factors that may otherwise undermine feasibility, recruitment, retention, and trust. Against this backdrop, the Multi-Hazard Research Network (MHRN) organised an online roundtable on 18 August 2026. The aim was to consolidate lessons learned from past SBS research in/on Ebola clinical trials and discuss current challenges with clinical trial design and rollout. The discussion brought together SBS researchers, trial implementers, RCCE specialists, and Ebola responders.

The current mpox outbreak has challenged previous understanding of the disease, with human-to-human transmission being a significant mode of transmission, particularly among gay, bisexual, and other men who have sex with men (GBMSM). A knowledge gap exists on MSM’s mpox experiences in Nigeria’s restrictive sociolegal context. This study explored mpox awareness, knowledge, and experiences among MSM in Lagos, Nigeria, through 28 in-depth interviews. We analysed the interview transcripts thematically. Findings showed low awareness and knowledge of mpox among MSM, who prefer seeking healthcare outside public health facilities due to stigma. Intimate contact during sexual intercourse is a likely source of infection among MSM. The Nigerian mpox response does not centre MSM, and centreing them may not be ideal due to potential stigma. MSM seek care through various means, including drugs, herbal remedies, and KP-friendly sexual and reproductive health (SRH) services, but face stressful care-seeking due to limited social support and stigma. The study shows that Nigeria's mpox situation differs from the situation in mpox non-endemic contexts. The homophobic legal and social environment and heterogenous spread require unique disease framing and context-sensitive response. The study concludes that further surveillance is needed to deepen understanding around mpox care seeking among MSM in Nigeria.

Global re-emergence of the zoonotic viral disease, Mpox (Monkeypox) has drawn global attention, leading to its declaration as a Public Health Emergency of International Concern (PHEIC) by World Health Organisation (WHO) in July 2022. Nigeria is a spotlight identified for the viral disease outbreak, with attention drawn on its transmission to non-endemic nations. With the country’s healthcare challenges, care seeking practices particularly amongst low-income urban informal settlement populations are diverse – presenting challenges to both case identification and management during an outbreak. In this study, we examine the social, economic, and behavioural context of Mpox therapeutics. This was an ethnographic study conducted between September 2022 and March 2023, with the purposive selection of urban informal settlements and interlocutors in Oyo, Ogun and Lagos States. We interviewed a total of 28 interlocutors who were either confirmed or suspected cases of Mpox or parents of children who are confirmed or suspected Mpox cases identified by the public health workers. Data were elicited through In-depth interviews and observations technique on the interlocutor’s local knowledge and their lived experiences on the therapeutics of Mpox. Analysis of the transcript was done inductively using thematic analysis process. The study revealed awareness and vague knowledge of Mpox. Furthermore, the behavioural practices on how ailments are understood and managed revealed a commonality in their social actions in terms of local diagnosis and management. Mpox was perceived to be a mild disease, and this had implications on the local characteristics of the PHEIC in the endemic regions. Our paper contributes to a more nuanced understanding of not only the health care access barriers, but the complex geographical, economic, and sociocultural factors that shape how and when people seek care for Mpox within the context of urban informal settlements. This further draws attention to behavioral dispositions to the nomenclature of what is perceived as PHEIC. Thus, the global health and security paradigm should give room to local context, expertise, and global politics in shaping epidemic responses.

The intersection of anthropology and global health encompasses the range of beliefs and practices around health that unfold in diverse social and economic settings imbued with meaning, history, and politics spanning local communities up to international agencies. Anthropological attention to ways these domains overlap constitutes a significant contribution of anthropology to global health practice. This chapter applies an anthropological lens to contemporary concerns of localising and decolonising global health, and how the colonial roots of global health hinder these efforts, with a focus on the sub-Saharan Africa region. It reviews what localisation means and whether and how it relates to 'decolonising' global health. It discusses the need to move beyond rhetoric to build sustainable, structural, and systems-wide change in global health, and the role anthropology may play in this effort. The main contention is that, in its current form, localisation does not contribute to decolonising global health in a systemic and meaningful way. Shifting resources and power to a country is important, but it ultimately misses the central point: global and 'local' processes interact, and, therefore, it is not possible to divorce the local from the global or vice versa. To 'do global health', then, requires new ways of uncovering, undoing, and rebuilding a 'new' global health.

Global health leaders often dismiss politics as antithetical to the aims of public health, but Luisa Enria and colleagues argue that political analysis can offer new ways to build trust in vaccination in the context of growing online misinformation

Le Hub pour l’Afrique de l’Ouest de la SSHAP réunit des universitaires, des intervenants humanitaires et des professionnels de la santé publique qui travaillent principalement au Nigeria, au Sénégal et en Sierra Leone afin d’examiner les questions sociopolitiques et historiques liées aux crises, avec l’intention de renforcer les programmes nationaux et humanitaires visant à atteindre les groupes vulnérables. Dans ce rapport, nous cherchons à résumer les facteurs contextuels liés aux urgences sanitaires et les ripostes aux urgences sanitaires dans la région de l’Afrique de l’Ouest (appelés « cycles d’urgences sanitaires »). En nous appuyant sur des exemples du Nigeria, du Sénégal et de la Sierra Leone, nous examinons les corrélations entre les flambées épidémiques et les contextes socioculturels, économiques et politiques, et nous abordons les questions relatives à la gouvernance de la riposte et à la capacité locale au sein des systèmes de santé nationaux. Nous démontrons la manière dont différentes urgences sont interconnectées et liées aux facteurs de stress à long terme au sein de la région, en plaidant pour une approche moins cloisonnée de la riposte. Tout en reconnaissant l’ampleur de l’hétérogénéité au sein de la région, nous nous appuyons sur des éléments communs thématiques qui traitent de questions régionales plus générales. Nous concluons en présentant des priorités en matière de sciences sociales pour répondre aux crises.

The SSHAP West Africa Hub brings together academics, humanitarian responders and public health practitioners primarily working in Nigeria, Senegal and Sierra Leone to explore socio-political and historical issues shaping crises, with the intention of enhancing national and humanitarian programmes seeking to reach vulnerable groups. In this landscape paper, we aim to summarise the contextual factors that shape health emergencies and responses to health emergencies in the West Africa region (termed ‘health emergency cycles’). Drawing on examples from Nigeria, Senegal and Sierra Leone, we explore the interrelationship of disease outbreaks with socio-cultural, economic and political contexts, and we address issues of response governance and local capacity within national health systems. We demonstrate how different emergencies are interconnected and related to long-term stressors in the region, arguing for a less siloed approach to response. Whilst we recognise the vast heterogeneity in the region, we draw on thematic commonalities that speak to wider regional issues. We conclude with some social science priorities for responding to crises.

Mpox (formerly known as monkeypox) was declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organization on 23rd July 2022, however cases of the disease have been detected in Nigeria since the 1970s and more recently since it began spreading in more urban areas of the country from 2017 onward. Nigeria has a strong track record of epidemic preparedness and response, spearheaded by the Nigeria Centre for Disease Control. Despite being somewhat separate architectures on paper, epidemic response (in particular, integrated disease surveillance and response) relies on a foundation of primary health care, which is inadequately funded not only in Nigeria, but globally. Situating mpox response within this wider landscape, we draw on ethnographic research from September 2022- March 2023 in southwestern Nigeria on lived experiences of mpox and mpox response, focusing on the perspectives of frontline health workers and community-based suspected or confirmed mpox cases. We aimed to understand how prioritization and resource constraints shape mpox response at a local level, including effects on the everyday work of frontline health workers in public health and clinical care who are left to “make do.” We analyze their experiences interfacing with two intersecting infrastructures, community-based surveillance and primary health care. Health workers’ improvisation and “repair work,” which we detail, enables the surveillance system to function in some capacity. However, health workers must regularly contend with competing priorities and routine care that may be sidelined during an outbreak or epidemic. We argue that this reveals the limitations of a global health security agenda as it materializes at a local level and the need for strengthening primary health care for longer-term sustainability.

On 28 May 2024, the Social Science in Humanitarian Action Platform (SSHAP) organised a roundtable discussion on the mpox (formerly known as monkeypox) outbreak which has been spreading in the Democratic Republic of the Congo (DRC) since early 2023.1 The objective was to appraise the current situation, with a particular focus on social science insights for informing context-sensitive risk communication and community engagement (RCCE) and wider operational responses. The roundtable was structured into two sessions: 1) an overview of the situation in DRC, including the current knowledge of epidemiology and 2) contextual considerations for response. This was followed by an hour-long panel discussion on operational considerations for response. Each session was initiated by a series of catalyst presentations followed by a question-and-answer session (Q&A). Details of the agenda, speakers and discussants can be found below. Despite estimates that less than 10% of suspected cases in DRC are being laboratory screened, the country is currently reporting the highest number of people affected by mpox in sub-Saharan Africa. It is notable that clade 1 of mpox is linked to this outbreak, which results in more severe disease and a higher fatality rate. While early cases of mpox were reported to be in gay, bisexual, and other men who have sex with men (GBMSM), the disease is now being detected more widely in DRC. The majority of those affected are children (up to 70% by some estimates2), which is a cause for concern. The outbreak is occurring on top of an overall high burden of disease and significant challenges to the health system and humanitarian interventions. The apparently heterogeneous picture of mpox across DRC – affecting different geographies and population groups – is shaped in part by social, economic and political factors. For instance, in South Kivu, accounts indicate that transmission via intimate and sexual contact is significant in mining areas, with an estimated one third of cases of disease reported in female sex workers. This raises questions about transactional sex and related stigma in these areas, as well as the implications of cross-border mobility linked to mining livelihoods for the spread of disease. A history of conflict and militia activity has additional implications for humanitarian intervention and is a factor in uptake and implementation of control strategies such as vaccination. Severe limitations in government health facilities in remote areas and a plural landscape of biomedical and non-biomedical providers are additional factors to consider for patterns of care-seeking and the timely provision of biomedical care. The limited reach of formal healthcare, including surveillance, makes it difficult to estimate the extent of cases and control disease spread through conventional epidemiological strategies. There are likely further challenges in accessing less visible populations such as GBMSM, as research in Nigeria has suggested.3,4 These complex contextual realities raise significant questions for mpox response. The roundtable convened a diverse range of expertise to offer perspectives from existing research and knowledge, with an emphasis on social science evidence. This roundtable report presents a synthesised version of the roundtable discussion with additional context as needed.

The COVID-19 pandemic has had a significant impact on how field-based research is being conducted globally. Given the challenges of undertaking fieldwork during epidemics and the need for mixed methods research to address the social, political, and economic issues related to epidemics, there is a small but growing body of evidence in this area. To contribute to the logistical and ethical considerations for conducting research during a pandemic, we draw on the challenges and lessons learnt from adapting methods for two research studies conducted in 2021 during the COVID-19 pandemic in low- and middle-income country (LMIC) settings: (1) in-person research in Uganda and (2) combined remote and in-person research in South and Southeast Asia. Our case studies focus on data collection and demonstrate the feasibility of conducting mixed methods research, even with many logistical and operational constraints. Social science research is often used to identify the context of specific issues, to provide a needs assessment, or inform longer-term planning; however, these case studies have shown the need to integrate social science research from the start of a health emergency and in a systematic way. Social science research during future health emergencies can also inform public health responses during the emergency. It is also crucial to collect social science data after health emergencies to inform future pandemic preparedness. Finally, researchers need to continue research on other public health issues that are ongoing even during a public health emergency.

Research on youth well-being is often driven by adult researcher voices, while youth experiences are neglected. Youth participatory action research (YPAR) is a distinct and powerful approach to capture youth experiences unique to particular social settings and leverage these voices to produce action and change through research. YPAR can be used to challenge oppression, mitigate the researcher-participant hierarchy, and build a social justice-oriented methodology, particularly when it uses a critical and intersectionality lens, rooted in a wider understanding of racial oppression. This methodology paper analyzes our Youth Lens methodology, which uses Critical YPAR to explore African American youth perceptions of how the neighborhood environment shapes health and well-being in Cleveland, Ohio. We describe, in detail, our methodology which was used to examine the history of redlining and systemic racism in the city and how it has driven present-day health and socioeconomic disparities. Further, we reflect in this paper not only on the methodology, but on our own role in the research. We end with implications for collaborative research with youth.

The cost of the Covid-19 pandemic remains unknown. Lives directly lost to the disease continue to mount, while related health, livelihood and wellbeing impacts are still being felt, and the wider ramifications across society, politics and the economy are yet to fully materialise. What is known about these costs though, is that they have been unequally distributed both within and between countries. Preparedness plans proved inadequate in many settings – especially when it came to protecting those most vulnerable, including those marginalised by geography, poverty, or exclusion along the lines of religion, ethnicity or gender. The top-down, surge-style, biomedically dominated and technologically driven preparedness approach that has dominated global health thinking and which was propelled into action with Covid-19 was found wanting not only on the grounds of effectiveness, but also of social justice. This presents both a challenge and an opportunity for a convergence of the preparedness and development agendas. Drawing on a growing body of social science evidence, this report contends that securing health in the face of today’s uncertain disease threats in often unpredictable settings means making social, economic and political priorities as core to the preparedness agenda as biological and technological ones. We present here a framework for a vision of pandemic preparedness for the real world – one that accepts that context is paramount, embraces inclusivity and justice, shifts power centres and rejects simplistic, one-size-fits-all solutions.

The Lancet Global Health March 2023 Editorial takes a bleak view of some of the most harmful expressions of power and politics that undermine the realisation of global health: coloniality, biomedicalisation, depoliticisation, extractivism, and self-interest.1The Lancet Global HealthPragmatic global health.Lancet Glob Health. 2023; 11: e301Summary Full Text Full Text PDF PubMed Google Scholar These expressions of power are so interwoven into the history and contemporary practice of global health that it has been suggested it might not be possible to achieve a decolonised global health,2Hirsch LA Is it possible to decolonise global health institutions?.Lancet. 2021; 397: 189-190Summary Full Text Full Text PDF PubMed Scopus (36) Google Scholar or that with effective anti-colonial action global health might altogether cease to exist.3Abimbola S Pai M Will global health survive its decolonisation?.Lancet. 2020; 396: 1627-1628Summary Full Text Full Text PDF PubMed Scopus (120) Google Scholar Against this backdrop, the emphasis on pragmatic global health as articulated in the same editorial falls short of the requisite principled positioning and subsequent radical action needed to counteract the forces that compromise the discipline. To problematise pragmatism, two important distinctions should be made in its conceptualisation: pragmatism as an epistemological paradigm, and pragmatism as an approach to change. Pragmatism as an epistemological paradigm has value in its defence of the pluriversality and contextualisation of knowledge. This approach values positioning and theorising on the basis of its practical consequences, which should in turn encourage the localisation and contextualisation of pathways for knowledge production to practice. However, this approach also raises several important questions. Who determines the “usability of evidence in practice”1The Lancet Global HealthPragmatic global health.Lancet Glob Health. 2023; 11: e301Summary Full Text Full Text PDF PubMed Google Scholar and against what criteria? What value do global health policy makers and practitioners ascribe to knowledge that does not appear to have an immediate, practical application? A narrow interpretation of usability has long privileged the pursuit of seemingly simple technical interventions, and remains one of the greatest barriers to concerted engagement with complex systems and the political and economic root causes of ill-health. Bridging the know–do gap necessarily requires radically different ways of both knowing and doing that look beyond evidence-based biomedical paradigms, and closer to what Seye Abimbola4Abimbola S When dignity meets evidence.Lancet. 2023; 401: 340-341Summary Full Text Full Text PDF Google Scholar describes as dignity-based practice. Pragmatism as an approach to political and social change describes a commitment to incrementalism and compromise in pursuit of what is feasible or satisfactory at a given moment. Pragmatists are often perceived as action orientated, and idealists as naive dreamers. On the contrary, idealists clearly also strive for action and change, and visionaries, dreamers, and radical voices should not be dismissed so readily on this basis. Of greater concern is the proximity between the determination of usability and an assessment of what can be realistically and practically achieved under current circumstances. What limitations do we place on our collective imagination when we adopt such an approach? Relatedly, consequentialism as the philosophical foundation of pragmatism broadly neglects questions of motivation, process, and aspiration: what drives us, how do we get to where we want to go, and what world do we ultimately want to inhabit? We argue that a singular focus on either values and good intentions (ie, deontological global health) or anticipated and measured impacts (ie, consequentialist global health) will never suffice. One ethical position should continually unsettle the other. The promotion of pragmatism alone will be the death of global health, if it has not killed it already. Currently, pragmatism in global health is pervasive and unchecked, which enables conservative positioning and reformist, incremental change processes that typically serve to preserve the status quo. This pragmatism enables situations such as those in which influential ethicists call for the roll-out of more harmful treatments in low-income and middle-income countries because such treatments are cheaper than safer alternatives.5Persad GC Emanuel E J The ethics of expanding access to cheaper, less effective treatments.Lancet. 2016; 388: 932-934Summary Full Text Full Text PDF PubMed Scopus (19) Google Scholar A pragmatist might see value in this position, insofar as coverage of some form of treatment increases, and yet no systemic change ultimately occurs: the status quo is effectively maintained and injustice and inequity are further embedded into the architecture of global health. Such positioning represents yet another example of the failure of imagination that has stymied the potential of global health; pragmatists tend to see the world as it currently is, and not as it has the potential to be. Of note, several of the urgently necessary changes raised in The Lancet Global Health Editorial1The Lancet Global HealthPragmatic global health.Lancet Glob Health. 2023; 11: e301Summary Full Text Full Text PDF PubMed Google Scholar (eg, respecting people as agentive; emphasising locally-driven and participatory action; and embracing a pluriversality of approaches, experiences and forms of knowledge) are enablers of epistemological pragmatism, but are shaped foremost by a steadfast commitment to principles and ideals: respect, solidarity, and the pursuit of equity and justice. What this muddling of the pragmatic and the idealistic underscores is that no single approach will allow us to dismantle systems of power that undermine the realisation of global health. Driven by the concerns and priorities of people most affected by the failures of global health, reformists and revolutionaries, and pragmatists and idealists, all have a role in imagining that another world is possible, and pushing together until we get there. We declare no competing interests. JS thanks John Pringle for his insightful reflections during the conceptualisation of this manuscript. Pragmatic global healthGlobal health as a knowledge system remains marred by (neo)colonialism , which instils and maintains worrisome asymmetries of power. Moreover, global health solutions all too often fall foul of over medicalisation : the tendency to focus exclusively on biomedical solutions to control individual risk factors without tackling deep-rooted social determinants of health through political and social actions. The co-existence of colonialism and overmedicalisation has enabled parachute (or helicopter) research and a persistent gap between knowledge and practice, as the real-world usability of the evidence produced is seldom the primary focus in this research paradigm. Full-Text PDF Open Access

Background Cross-border movements between districts bordering Uganda and the Democratic Republic of Congo (DRC) are common due to the interdependence between populations on either side, though this increases the risk of the international spread of infectious diseases. Due to the nature of their work, boda boda drivers (motorcycle taxis), taxis and truck drivers continue to cross the border during epidemics. However, perceived risk of contracting and spreading communicable diseases may be influenced by several factors such as the level of education, packaging and perception of health care messages, limited interaction with local socio-cultural dynamics or personal experiences. This study aims to explore differences in movement patterns and risk perceptions as factors for transmission among transport drivers in Ugandan border districts during the 2018–2020 Ebola Virus Disease (EVD) epidemic and the current COVID-19 pandemic. Methods Between May and June 2021, in-depth interviews and focus group discussions were conducted with transport drivers in three Ugandan districts bordering DRC (Kasese, Kisoro and Hoima). Participants were asked about their knowledge and beliefs about EVD and COVID-19, perceived risk during epidemics, reasons for, and travel patterns during the EVD epidemic and COVID- 19 pandemic. A thematic content analysis was applied. Results Participants’ awareness of EVD was higher than that of COVID-19 however, the risk of transmission of Ebola virus was perceived as a remote threat. Measures restricting mobility during the COVID-19 pandemic had a greater impact on transport drivers compared to those implemented during the EVD epidemic, and were perceived as prohibitive rather than protective, largely due to fear of reprisals by security officers. Despite this, drivers were unlikely to be able to comply with the restrictions as they relied on their work as a source of income. Conclusion The vulnerabilities of transport drivers should be considered in the context of epidemics such EVD and COVID-19 in Uganda. Policy makers should address these particularities and assess the impact of public health measures on transport drivers’ mobility and involve them in designing of mobility-relatedpolicies.

The aims of our study were (1) to explore the impact of having an incarcerated parent on youth (ages 10-18) wellbeing; and (2) to identify recommendations from the youth based on their needs which address the challenges of having an incarcerated parent and promote individual and community flourishing. We utilized a Youth Participatory Action Research approach, including semistructured interviews, focus group discussions, storytelling, and photovoice with 20 participants, ages 10-18. Data were analyzed using qualitative content analysis and organized into five thematic categories: (1) youths' perceptions of their communities; (2) incarcerations' impact on families and communities; (3) incarcerations' influence on mental health and flourishing; (4) incarceration as a solution for community safety; and (5) addressing the impact of incarceration on children, families, and communities. Findings provide important implications for practice and policy with children of incarcerated parents and for promoting flourishing individuals and communities.

The pursuit of flourishing, or living a good life, is a common human endeavor with different meanings across individuals and contexts. What is needed is a further exploration of the relationship between flourishing and health, particularly chronic illness, which affects individuals across the life course and is affected by experiences of stress derived from social and structural vulnerability. Drawing on data from the Soweto Syndemics study, including a locally derived stress scale and in-depth interviews, we explore the connections between flourishing and health for those living with multiple chronic illnesses in Soweto, South Africa within a syndemic of communicable and non-communicable disease. Rather than drawing on Western-centric notions of flourishing (which place emphasis on an individual's capabilities or capacities to thrive), we draw on previous ethnographic work on flourishing in Soweto, South Africa, which described how ukuphumelela, or "becoming victorious," as a social or communal affair. This conceptualization reflects local values and priorities for people's lives and the ways in which their lives are deeply intertwined with each other. We contribute to a more robust understanding of flourishing in context, of how chronic illness is experienced, and of how the role of a patient is transcended in spaces where individuals are part of a social or faith community. As people living with chronic illness(es) actively pursue the good life, health care systems must consider these pursuits as valid parts of the human experience that also challenge narrow definitions of health.

This introduction to the special issue, Exploring Medical Mistrust: From Clinic to Community, provides a conceptual framing of ‘medical mistrust’ from a critical social science lens. This special issue explores and unpacks the complex temporal, social and scalar relationships which are intertwined with contemporary manifestations of mistrust in medicine. We ask what social science and humanities disciplines can offer in relation to wider understandings of the processes driving resistance to and refusal of medical interventions, including but also beyond vaccines. We distil insights derived from diverse spaces of medical encounter, ambivalence and resistance that serve as arenas which generate mistrust. We bring this analysis to deepen an understanding of the frictions and affective relations which exist between vertical and horizontal relations which constitute health systems.

Si l’on s’en tient aux chiffres de la vaccination contre la COVID-19 dans les pays du G7, la campagne apparaît comme un véritable succès tant au niveau global qu’au niveau national. En effet, à ce jour, 79,4 % de la population totale des pays du G7 a reçu une première dose, 72,9 % une seconde, et 45,4 % une dose de rappel (données du 28 avril 2022) 1 En France, c’est 80,6 % de la population totale qui a reçu une première dose, 78,2 % qui a reçu deux doses, et 55,4 % qui a reçu un rappel (données du 28 avril 2022).2 Au Royaume-Uni, 79,3 % de la population totale a reçu une première dose, 74,1 % une seconde, et 58,5 % un rappel.1 Enfin, en Italie, 85,2 % de la population totale a reçu une première dose, 80,4 % a reçu deux doses et 66,5 % a reçu leurs rappels (données du 28 avril 2022). Ces taux de vaccination élevés masquent pourtant des disparités importantes à l’intérieur de chaque pays. Ainsi, à Marseille, deuxième ville de France, moins de 50 % des habitants des quartiers nord de la ville étaient vaccinés à la fin de l’année 2021, alors que plus de 70 % des habitants des quartiers sud l’étaient au même moment.3 Dans le quartier populaire de Ealing, situé au nord-ouest de Londres, 70 % de la population admissible avait reçu une première dose, soit près de 10 % de moins que la moyenne nationale. 4 (Données du 4 avril 2022). Des disparités similaires ont été observées dans d’autres métropoles urbaines des pays du G7. Ce document examine ces disparités au prisme de la notion d’« (in)égalité vaccinale ». En s’appuyant sur des recherches qualitatives menées pendant la campagne de vaccination de la COVID-19 dans les quartiers nord de Marseille, le quartier de Ealing à Londres (Nord-ouest) et dans la région de l'Émilie-Romagne et à Rome, en Italie, il montre comment les autorités locales peuvent agir pour atténuer ces inégalités. Mieux comprendre les inégalités en matière de vaccins fut primordial lors de la pandémie de la COVID-19 en ce sens que les populations sous-vaccinées étaient la plupart du temps des minorités ethniques ou culturelles, vivant dans des zones défavorisées, ou sans-papiers, donc plus susceptibles de contracter la COVID-19, et d’en subir les conséquences les plus dramatiques. 5 6 7 8 Ainsi, à Ealing, quatre mois après la campagne de vaccination, seulement 57,6% des personnes dans le décile de pauvreté le plus bas avaient reçu une dose, contre 81% des personnes dans le décile le plus aisé. 9 En outre, 89,2 % des résidents britanniques blancs de Ealing étaient vaccinés, contre 64 % des Pakistanais et 49,3 % des habitants issus des Caraïbes.9 À Rome, comme c’est le cas dans d’autres métropoles urbaines des pays du G7, nos données révèlent des disparités particulières importantes entre le recours aux vaccins des populations sans papiers et celui des citoyens établis. Les facteurs d’inégalité vaccinale dans ces environnements urbains sont complexes et liés à l’interaction de nombreux phénomènes tels que les inégalités économiques, le racisme structurel, l'inégalité d'accès aux soins de santé, la méfiance envers les professionnels de santé, les représentants de l'État, et plus encore. Les collectivités locales tout comme les professionnels de la santé, les groupes communautaires et les résidents jouent un rôle clé dans la manière dont s’exprime l’(in)égalité vaccinale. Pour autant, peu de leçons ont été systématiquement tirées des efforts menés en matière d’ «engagement vaccinal » au niveau local. Dans ce document, nous proposons d’expliquer comment l’expérience des inégalités structurelles se recoupe avec celle des habitants, et comment ces expériences ont été prises en compte ou au contraire ignorées dans la promotion et l’administration des vaccins contre la COVID-19 par les collectivités locales. Nous adressons également un ensemble de recommandations qui s’appliquent aux programmes de « vaccination de rattrapage » contre la COVID-19 (visant à atteindre les personnes qui n’ont pas encore reçu leur schéma vaccinal complet), mais elles concernent également les programmes de vaccination d'urgence à venir. Ce document repose sur des recherches menées entre octobre et décembre 2021 à Marseille et sur des échanges réguliers avec les autorités du Borough de Ealing initiés dès mai 2021. Il identifie comment les gouvernements locaux, les acteurs de la santé, les groupes communautaires et les résidents jouent un rôle clé dans la production d’(in)égalités vaccinales. Ce document a été élaboré pour la SSHAP par Santiago Ripoll (IDS), Tavitha Hrynick (IDS), Ashley Ouvrier (LaSSA), Megan Schmidt-Sane (IDS), Federico Federici (UCL) et Elizabeth Storer (LSE). Il a été revu par Eloisa Franchi (Université de Pavie) et Ellen Schwartz (Conseil de santé publique de Hackney). La recherche a été financée par la British Academy COVID-19 Recovery : Fonds G7 (COVG7210038). Les recherches ont été menées à l’Institut d’études du développement (IDS), à l’Université de Sussex et au Laboratoire des sciences sociales appliquées (LaSSA). La SSHAP en assume la responsabilité.

Os surtos de cólera têm vindo a aumentar na Região da África Oriental e Austral (AOA) desde Janeiro de 2023, com uma transmissão generalizada e alargada no Malawi e em Moçambique e surtos registados na Tanzânia, na África do Sul, no Zimbabué, no Burundi e na Zâmbia.1 Existe o risco de uma maior propagação causada pelos efeitos do ciclone Freddy, que atingiu Madagáscar, o Malawi e Moçambique em Março de 2023. Continuam a registar-se surtos na Somália, na Etiópia, no Quénia e no Sudão do Sul, onde os países estão a atravessar uma situação de seca após sucessivas estações chuvosas deficitárias.1 O contexto de resposta na AOA é complexo. Isto deve-se à escassez de recursos de saúde pública, incluindo a insuficiência de vacinas orais contra a cólera, e às múltiplas emergências de saúde pública e humanitárias simultâneas, incluindo a reemergência do poliovírus selvagem. O envolvimento da comunidade nas respostas ao surto de cólera é essencial, especialmente enquanto o impacto da COVID-19 ainda se faz presente na região, sobretudo no que tange à confiança na saúde pública e nos esforços de vacinação.2,3 O objectivo do presente guia de orientação é apoiar os Ministérios da Saúde, a UNICEF e outros parceiros de resposta na concepção e implementação de um envolvimento comunitário eficaz, centrado na comunidade e baseado em dados, para a resposta ao surto de cólera. Este guia de orientação foi redigido em abril de 2023 por Megan Schmidt-Sane e Tabitha Hrynick (IDS), com a colaboração de Stellar Murumba (Internews), Ngonidzashe Macdonald Nyambawaro (FICV), Eva Niederberger (Anthrologica), Santiago Ripoll (IDS), Nadine Beckmann (LSHTM), Mariana Palavra (UNICEF) e Rachel James (UNICEF). Este guia de orientação tem por base o trabalho anterior sobre a cólera da Social Science in Humanitarian Action Platform (SSHAP).