Uncertainty in times of medical emergency

Knowledge gaps and structural ignorance during the Brazilian Zika crisis

Bibliographic Data

ID4598310
AuthorsAnn H Kelly (0000-0003-4658-2133, King's College London), Javier Lezaun (0000-0002-5483-3628, University of Oxford, corresponding author), Ilana Löwy (0000-0001-6963-0578, Inserm), Gustavo Correa Matta (0000-0002-5422-2798, Fundação Oswaldo Cruz), Carolina De Oliveira Nogueira (0000-0003-2730-8980, Faculdades Oswaldo Cruz), Elaine Teixeira Rabello (0000-0002-8324-1453, Universidade do Estado do Rio de Janeiro)
Year2020
Volume246
Pages112787
Publication date2020-02-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueSocial Science & Medicine (JOURNAL)
Journal identifiersISSN: 0277-9536 • E-ISSN: 1873-5347
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2020.112787
PMID32004803
OpenAlexW2999912005
LanguageEN
Citations received27
References cited56

Uncertainty was a defining feature of the Brazilian Zika crisis of 2015-2016. The cluster of cases of neonatal microcephaly detected in the country's northeast in the second half of 2015, and the possibility that a new virus transmitted by Aedes mosquitoes was responsible for this new syndrome, created a deep sense of shock and confusion in Brazil and around the world. When in February 2016 the WHO declared a Public Health Emergency of International Concern (PHEIC), it noted that it did so on the basis of what was not known about the virus and its pathogenic potential. To better understand the role that non-knowledge played in the unfolding of the Brazilian Zika crisis we differentiate between three different kinds of uncertainty: global health uncertainty, public health uncertainty, and clinical uncertainty. While these three forms of uncertainty were difficult to disentangle in the early weeks of the crisis, very soon each one began to trace a distinct trajectory. Global health uncertainty centered on the question of the causative link between Zika virus infection and congenital malformations, and was declared resolved by the time the PHEIC was lifted in November 2016. Public health and clinical uncertainty, in contrast, persisted over a longer period of time and did, in some important ways, become entrenched. This taxonomy of uncertainties allows us to explore the systematic nonproduction of knowledge in times of medical emergency, and suggests structural limitations in the framework of "emergency research" that global health institutions have developed to deal with unexpected threats

Confusion · Development economics · Economics · Environmental health · Ignorance · Pathology · Political science · Public health · Zika virus · COVID-19 epidemiological studies · Law · Medicine · Mosquito-borne diseases and control · Psychology · Viral Infections and Outbreaks Research · Virology