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PAPER SESSIONS
Health and medicine sociology

Social Justice in Times of Uncertainty: perspectives from health and medical sociology (Session 2 of 2)

From
June 29, 2021 15:00
to
June 29, 2021 16:30
Replay
Organizers

Stéphane Cullati and Raphaël Hammer, for the RN-SHM

Speakers

Rubis Le Coq, UMR5206 Triangle, ENS de Lyon

Michael J. Deml¹⁻²*, Léna G. Dietrich²⁻³*, Alyssa Lüthy²⁻³, Pia Lucas Ramanathan²⁻³, Nadja Baldesberger²⁻³, Andrea Buhl¹⁻², L. Suzanne Suggs⁴⁻⁵, Benedikt M. Huber⁶⁻⁷, Philip E. Tarr²⁻³⁻*, for the Swiss National Research Program (NRP) 74 on Vaccine Hesitancy

¹Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland; ²University of Basel, Basel, Switzerland; ³University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, Bruderholz, Switzerland; ⁴Institute for Public Communication, Università della Svizzera italiana, Lugano, Switzerland; ⁵Swiss School of Public Health, Zurich, Switzerland; ⁶Center for Integrative Pediatrics, Department of Pediatrics, Fribourg Hospital HFR, Fribourg, Switzerland; ⁷Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland

In contemporary societies, uncertainty is part of the lives of individuals, regardless of where and when they live. Societies, communities, and other social institutions are meant to reduce the uncertainty of lives by offering protection, education, work, and especially health and access to healthcare. Uncertainty can be a driver for the life course, a motivation to surpass oneself, a source of change or an obstacle to initiative but, also, a factor of ill health. Growing up in unstable families (divorce, property taken away, violence, poverty, etc.) can direct children on socially disadvantaged life course pathways, and ultimately to poorer health. Uncertainty at work cause psychosocial stress to employees and workers. Uncertainty about future pensions received at retirement can increase anxiety and worries. And, recently, the onset of the COVID-19 pandemic has plunged our societies into great uncertainties, both in the short term at the sanitarian level and in the medium and long term at the social and economic levels.

Just and egalitarian societies can mitigate the negative impact of uncertainties on the lives and health of individuals. Recent trends in contemporary societies showed both increase of living standards and security, but also increase of social and health inequalities, which have been accentuated by the COVID-19 pandemic in 2020.  Is the impact temporary or structural? Are inequalities at the micro, meso and macro level cumulating? The health care system itself and the medical and health personnel have also been under pressure, pointing to vulnerability of hospitals. 

Moreover, suddenly arrived, the COVID-19 pandemic has been concurrently studied by the scientific community and managed by public health authorities while in the media spotlights. The convergence of this viral epidemic with an “infodemic”, or “digital epidemic”, is not trivial. Media and social media are saturated with information, potentially reassuring, but also contradictory and generating uncertainty. Controversies that have aroused in the public debate about wearing a mask and potential treatments for example have also emphasised scientific uncertainty and the importance of lay population trust in expert authorities. 

SESSION 2:  SOCIAL JUSTICE IN TIMES OF UNCERTAINTY: PERSPECTIVES FROM HEALTH AND MEDICAL SOCIOLOGY

Doing research in times of uncertainty: Rethink thesis on Ebola in the light of the Covid-19

Rubis Le Coq, UMR5206 Triangle, ENS de Lyon

June 2016, the WHO officially declares the end of the Ebola Virus Disease epidemic in the Mano River countries. A few months later I arrived in Conakry in the aftermath of Ebola, with the goal of reporting on the lived history of Conakry's inhabitants throughout the epidemic and in their interactions with the various representatives of the Ebola response. I soon found myself confronted with a methodological difficulty: Although the "side effects" of Ebola were perceptible, the epidemic was over by then. Five years later, while I was writing my PhD thesis, the threat of a coronavirus epidemic from Wuhan appeared. Soon, this epidemic arrived on our doorstep, in France, like a wave that we see coming from afar, from which we try to escape but which ends up irremediably crashing on our feet. Very quickly we find ourselves confined, masked, tested, socially distanced. As an anthropologist of epidemics, I found myself the protagonist of a pandemic in the present time. 

In this article I wish to question the impact of this new epidemic and the moment it appeared in my research career, on the construction of the analysis of my field data: How to think my interpretations in the light of a new pandemic? To what extent does this change the relationship to the field and to the respondents? 

First, I will pay attention to what Frédéric Le Marcis calls "the shadow cast by Ebola" on the covid. How has the Ebola experience in West Africa impacted the management of the arrival of the covid on the continent? What can we conclude about the effectiveness of preparedness projects and can this experience explain the smaller scale of the epidemic in these countries? What other hypotheses have been put forward about the smaller covid-19 outbreak in this region of the world? 

In a second step, I will see how this epidemic has led me to take a different look at my work and to feel closer to the experience of the people surveyed. Here I consider the abundance of information on epidemics, from mediatic or scientific sources, called in these circumstances "Infodemic", as a source of scientific uncertainty. It reminds me of the infodemic that I discuss in my work on Ebola in order to understand the gap between this profusion of information and the reality of the epidemic as experienced by the population. Moreover, finding myself at the heart of an epidemic and its repercussions allowed me to better understand the experience of my respondents. The country of occurrence and the disease being quite different, experiencing mistrust, rumors, conspiracy, adaptation of care strategies and social distance, both in France and in Guinea, made me reconsider the importance of context.

Finally, drawing from my own experience in a test center for covid19, I will be comparing this event with elements of my ethnography in Guinea.  The comparison between this participant observation and my fieldwork data reveal similarities in the management of the two epidemics and in their reception by the population. 


Bibliography

Dourish, P. (2004). What we talk about when we talk about context. Personal and Ubiquitous Computing, 8(1), 19 30. https://doi.org/10.1007/s00779-003-0253-8

Le Marcis, F. (2020, décembre 3). L’ombre portée d’Ebola sur l’épidémie de SARS-COV-2 : Analyse anthropologique de la Covid-19 en Guinée.

Olazabal, I., & Josy Lévy, J. (2006). L’événement en anthropologie. Concepts et terrains. Québec, Les Presses de l’Université Laval, 2006, 267 p., bibliogr., index. Anthropologie et Sociétés, 30(2), 255. https://doi.org/10.7202/014131ar

Richards, P. (2020). Ebola and COVID-19 in Sierra Leone : Comparative lessons of epidemics for society. Journal of Global History, 15(3), 493 507. https://doi.org/10.1017/S1740022820000303

Healthcare Professional and Professional Stakeholders’ Perspectives on Vaccine Mandates in Switzerland: A Mixed-Methods Study

Michael J. Deml⁽¹⁾⁽²⁾⁽ᵃ⁾, Léna G. Dietrich⁽¹⁾⁽²⁾⁽ᵃ⁾, Alyssa Lüthy⁽²⁾⁽³⁾ Pia Lucas Ramanathan⁽²⁾⁽³⁾, Nadja Baldesberger⁽²⁾⁽³⁾, Andrea Buhl⁽¹⁾⁽²⁾, L. Suzanne Suggs⁽⁴⁾⁽⁵⁾, Benedikt M. Huber⁽⁶⁾⁽⁷⁾, Philip E. Tarr⁽²⁾⁽³⁾⁽ᵃ⁾, for the Swiss National Research Program (NRP) 74 on Vaccine Hesitancy

⁽¹⁾Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland; ⁽²⁾University of Basel, Basel, Switzerland; ⁽³⁾University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, Bruderholz, Switzerland; ⁽⁴⁾Institute for Public Communication, Università della Svizzera italiana, Lugano, Switzerland; ⁽⁵⁾Swiss School of Public Health, Zurich, Switzerland; ⁽⁶⁾Center for Integrative Pediatrics, Department of Pediatrics, Fribourg Hospital HFR, Fribourg, Switzerland; ⁽⁷⁾Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland

⁽ᵃ⁾Equal contribution

In Switzerland, there are no vaccine mandates in non-epidemic settings; federal legislation allows mandates for people who exercise certain activities, such as healthcare professionals (HCPs), once a serious national threat is established. Facing the coronavirus pandemic, the Swiss Federal Council declared such a threat when it announced an “extraordinary” epidemiological situation in March 2020. In June 2020, this status changed to “particular” situation. With Switzerland still in a “particular” situation in January 2021 and 2 COVID-19 vaccines approved for use, the legislative door remains open for potential vaccine mandates. Furthermore, concerns about potential COVID-19 vaccine mandates have been expressed in popular discourse and by HCPs. Since many HCPs work with vulnerable patients, are trusted information sources, a probable target population for COVID-19 vaccination, and potentially subjected to mandates, we investigated their perspectives on vaccine mandates when facing epidemiological uncertainty. 

Methods: We administered a national online survey to physicians, pharmacists, nurses, and midwives. Surveys included questions about discussions with vaccine hesitant (VH) individuals, (in consultations and within HCPs’ social networks), childhood vaccine (CHV) population mandates, and influenza vaccination (IV) HCP mandates. We qualitatively investigated Swiss vaccination policy in anticipation of COVID-19 vaccination through: (1) interviews with HCPs, HCP professional association representatives, and health authorities; (2) a focus group discussion with complementary/alternative medicine (CAM) providers and association representatives, biomedical practitioners, and Swiss Federal Vaccination Commission members. 

Results: As of 19.01.2021, 489 physicians responded to the survey. 63% (N=309) favored shared parent-HCP CHV decisions and 47% (N=231) shared IV employee-employer decisions. 29% (N=138) favored CHV mandates and 27% (N=133) IV mandates. 6% (N=27) favored individual CHV decisions and 22% (N=110) individual IV decisions. 232 nurses responded to the survey. 52% (N=120) favored shared parent-HCP CHV decisions and 26% (N=61) shared IV employee-employer decisions. 25% (N=58) favored CHV mandates and 7% (N=17) IV mandates. 18% (N=41) favored individual CHV decisions and 63% (N=145) individual IV decisions. 565 midwives had responded to the survey. 48% (N=265) favored shared parent-HCP CHV decisions and 11% (N=64) shared IV employee-employer decisions. 7% (N=36) favored CHV mandates and 1% (N=4) IV mandates. 44% (N=248) favored individual CHV decisions and 86% (N=486) individual IV decisions. The survey is ongoing and finishes 28.02.2021. Preliminary qualitative results show general HCP opposition to COVID-19 vaccine mandates due to currently insufficiently documented safety, efficacy, and long-term protection evidence, with consensus among Federal Vaccination Commission members, CAM association representatives, and biomedically- and CAM-oriented HCPs. HCPs were also uncertain about the logistics of a COVID-19 vaccine mandate in practice; specific questions about the enactment of vaccine mandates remain unanswered, such as consequences for non-vaccinators, who the enforcers of vaccine mandates are, and what circumstances would necessitate a COVID-19 vaccine mandate for HCPs.

Conclusion: As a highly trusted sources of vaccination information, HCPs play an important role in influencing vaccination attitudes in consultations, friend/acquaintance interactions, and public discourse. Our findings therefore underscore the need to engage with HCPs to understand their attitudes on vaccination policy, including potential mandatory COVID-19 vaccination.