The political economy of avian influenza

SE Asia country study workshop

February 2009

Context

Politics of policy – lessons from the international response to HPAI

• Scoping study (end 2007) - PPLPI• Planning meeting (April 2008) – PPLPI/STEPS• International study (January-October 2008) - PPLPI• Country studies (April-December 2008) – DFID/HPAI• Expert meeting (February 2009) – Chatham House/DFID/WB

Leading to reflections on the One World, One Health initiative….. And inputs to the Winnipeg meeting (March 09), Chatham House high-level meeting (tbc 09)

Key questions• What narratives have driven the response – at

international and national levels?• Who have been the main actors and networks, and

what interests do they represent?• How effective have the responses been?• Who wins and who loses – distributional outcomes?• What and who has been left out – alternative framings

and narratives?• How responsive and accountable is the policy

process?• How resilient is the system that has been built – for

HPAI or other emerging diseases?

And what lessons can we draw for the future….?

Actors and networks

Wider themes

• Whose world, whose health? Challenging public goods and security discourses

• Expertise and the professions. Challenging dominant technical and policy framings; drawing in new forms of expertise.

• Organisational architectures. Challenging the post-WW2 international sectoral solutions, in the UN and beyond

Risk, uncertainty and surprise

unproblematic

problematic

unproblematic problematic

knowledge about likelihoods

knowledge about outcomes

RISK

UNCERTAINTY

AMBIGUITY

IGNORANCE

decision rulesaggregative analysisdeliberative processpolitical closure

reductive modelingstochastic reasoningrules of thumbinsurance

evidence-basing agenda-settinghorizon scanningtransdisciplinarity

liability lawharm definitionsindicators / metricsinstitutional remits

powerful pressures to ‘justify’ favoured actions

‘Closing down’ Risk

Implications

• From eradication/control to managing endemism• From emergency/outbreak mode to long term

development• From universal/global public good to questions of

differentiated, distributional/developmental outcomes• From singular technical disciplines and expertise to a

more diverse mix• From Post WW2 sectoral organisational architectures to

more integrated, networked and embedded arrangements

• From top-down vertical accountability and governance arrangements to more bottom-up, responsive, negotiated systems.

Country studies

Country studies……Cambodia, Vietnam, Indonesia, Thailand

• What happens when the international response meets local realities?

• What lessons can be learned from the comparative experiences?

Cambodia Vietnam Indonesia ThailandHumans and livestock

14m people, 16m poultry, 90% backyard

84m people, 245m poultry; backyard 65%

225m people; 600m poultry; c. 40% backyard

62m people, 20% backyard

Economy and aid

Agriculture 34% of GDP; Aid 11% of GDP; tourism critical; no poultry exports

Agriculture 20% of GDP; Aid 7% of investment; rapid economic growth; negligible poultry exports

Agriculture 14% of GDP; aid 1% of GNI; limited export but local industrial interests in poultry sector

Agriculture 10% of GDP; aid minimal

Risks and perceptions

Droughts, floods seen as important. Major coverage of HPAI in media

Selective media coverage; little debate

Earthquakes, tsunamis, ferry disasters….HPAI widely reported in media

SARS, tsunami; Major media coverage of HPAI

Politics, governance and political culture

Strong patronage politics

Party dominance, patronage politics

Decentralised, chaotic, patronage politics

Top down, centralised; extra-governmental, commercial interests

HPAI human deaths

7 52 113 17

HPAI response Public awareness, village animal health workers

Vaccination; culling and compensation

Selective culling, monitoring and surveillance (PDS); some drug/vaccine mfg capacity

Ring culls and compensation; public info campaigns; lab capacity; vaccine and drug mfg capacity

Recurring themes• Standard policy/technical solutions don’t work, context

matters (structure economy of production, but also political contexts)

• Technocratic, expert driven and top down solutions falter in the face of bureaucratic and political complexity, patrimonialism and the ‘envelope culture’ (implementation and delivery are important critical)

• Winners and losers in achieving ‘global public good’ aims – real interests at play, and poor people’s livelihoods often the losers (whose public, whose goods? Whose world, whose health?)

• The global institutional/organisational architecture often jars with local settings, resulting in resentment, blocking and lack of momentum (responsiveness and accountability, not just efficiency and effectiveness)

• Socio-cultural constructions of risk, threat and the role of poultry define perceptions and response (more than behaviour change, but embedded ‘cultural logics’)

One World, One Health?

OWOH – strategic elements• Initiating more preventive action by dealing with the root causes and

drivers of infectious diseases, particularly at the animal–human–ecosystems interface

• Building more robust public and animal health systems that are based on good governance and are compliant with the International Health Regulations (IHR) 2005 (WHO, 2005) and OIE international standards, with a shift from short-term to long-term intervention

• Strengthening the national and international emergency response capabilities to prevent and control disease outbreaks before they develop into regional and international crises

• Better addressing the concerns of the poor by shifting focus from developed to developing economies, from potential to actual disease problems, and to the drivers of a broader range of locally important diseases

• Promoting wide-ranging institutional collaboration across sectors and disciplines

• Conducting strategic research to enable targeted disease control programmes

OWOH - activities• Develop international, regional and national capacity in

surveillance, making use of international standards, tools and monitoring processes

• Ensure adequate international, regional and national capacity in public and animal health—including communication strategies—to prevent, detect and respond to disease outbreaks

• Ensure functioning national emergency response capacity, as well as a global rapid response support capacity

• Promote inter-agency and cross-sectoral collaboration and partnership

• Control HPAI and other existing and potentially re-emerging infectious diseases

• Conduct strategic research.

OWOH - challenges • Much complexity and uncertainty - and difficulty in defining

and prioritizing entry points• Limits and costs of agency interaction – bureaucratic, legal

and structural barriers• Inter-agency/ministerial competition over budgets • More interactions, more transaction costs; and opportunity

costs of lots of such interaction• Holistic and complex solutions can be difficult to sell

politically; need new messages• Resistance to change in large organisations• Shifts in attitudes and approaches across professions difficult

Workshop aims

• To review critically the papers and draw out comparative threads

• To define the key policy lessons from the HPAI response across the countries

• To identify the key principles for a OWOH approach for emerging infectious diseases

Given the lessons of the HPAI response, what features (‘governance principles’) would ensure an effective, accountable and resilient response system?

Risk, uncertainty and surprise

unproblematic

problematic

unproblematic problematic

knowledge about likelihoods

knowledge about outcomes

RISK

UNCERTAINTY

AMBIGUITY

IGNORANCE

decision rulesaggregative analysisdeliberative processpolitical closure

reductive modelingstochastic reasoningrules of thumbinsurance

evidence-basing agenda-settinghorizon scanningtransdisciplinarity

liability lawharm definitionsindicators / metricsinstitutional remits

powerful pressures to ‘justify’ favoured actions

‘Closing down’ Risk

OWOH – strategic elements• Initiating more preventive action by dealing with the root causes and

drivers of infectious diseases, particularly at the animal–human–ecosystems interface

• Building more robust public and animal health systems that are based on good governance and are compliant with the International Health Regulations (IHR) 2005 (WHO, 2005) and OIE international standards, with a shift from short-term to long-term intervention

• Strengthening the national and international emergency response capabilities to prevent and control disease outbreaks before they develop into regional and international crises

• Better addressing the concerns of the poor by shifting focus from developed to developing economies, from potential to actual disease problems, and to the drivers of a broader range of locally important diseases

• Promoting wide-ranging institutional collaboration across sectors and disciplines

• Conducting strategic research to enable targeted disease control programmes

Discussion themes?1. Pro poor approaches and livelihoods

What does this mean? Practices for engaging with marginalised groups? How does this change under rapid industry restructuring? Livelihoods audits, impact assessments?

2. Local innovation

New ways of doing things (not just capacity bldg to ‘our’ standards). Positive dimensions of local resistance – reframing. Science based alternatives to surveillance and control that actually work. Adaptive, learning approaches. Bridging emergency – long-term development.

3. Building resilience

Fine tuned, risk based, rational-technical approach or more flexible, diverse, overlapping, redundant, high reliability systems, in non-Weberian settings. What combinations where and when? What is resilience, and how do we know when the systems is more or less resilient? How to ‘sell’ this approach?

4. One World One Health in context of contemporary geopolitics and sovereign states. Challenges of making this happen……