Department of Global Health and Social Medicine, King's College London, United Kingdom.
Institute for Science, Innovation and Society, School of Anthropology and Museum Ethnography, University of Oxford, United Kingdom.
Soc Sci Med. 2020 Feb;246:112787. doi: 10.1016/j.socscimed.2020.112787. Epub 2020 Jan 7.
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.
不确定性是 2015-2016 年巴西寨卡危机的一个显著特征。2015 年下半年,该国东北部地区发现了一系列新生儿小头畸形病例,并且有可能是由埃及伊蚊传播的一种新病毒导致了这种新综合征,这在巴西乃至全世界都引起了深深的震惊和困惑。2016 年 2 月,世界卫生组织宣布发生国际关注的突发公共卫生事件(PHEIC)时指出,之所以这样做,是因为人们对该病毒及其发病潜力知之甚少。为了更好地了解未知知识在巴西寨卡危机中的作用,我们将不确定性分为三种不同类型:全球卫生不确定性、公共卫生不确定性和临床不确定性。虽然这三种形式的不确定性在危机的早期几周很难区分,但很快每一种都开始形成独特的轨迹。全球卫生不确定性集中在寨卡病毒感染与先天畸形之间的因果关系问题上,到 2016 年 11 月 PHEIC 解除时,该问题已被宣布解决。相比之下,公共卫生和临床不确定性持续的时间更长,并且在某些重要方面变得根深蒂固。这种不确定性分类法使我们能够探索医学紧急情况下系统地产生知识的问题,并表明全球卫生机构为应对意外威胁而制定的“应急研究”框架存在结构性限制。