When the spread of disease becomes a global event: The classification of pandemics

Abstract

The classification of novel disease events is central to public health action surrounding them. Drawing upon the sociology of scientific classification, this article examines the role and contestation of the World Health Organization’s Pandemic Alert Phases, as applied to the spread of 2009/10 H1N1 Influenza. The analysis of World Health Organization texts, including policy documents, public statements and epidemiological documents, has been utilized to examine the Organization’s actions and public narratives around the event of H1N1. Analytically, the functional role of such classificatory schemes and the social construction of scientific classifications are examined. It is argued that in understanding the World Health Organization’s 2009/10 application of the Pandemic Alert Phases, the critical limitation of the functions served by the classificatory scheme led to the breakdown of its construction. This case study highlights the importance of classification for the successful production of scientific ‘facts’, the constructed nature of classificatory systems and the potential for contestation that arises when such classifications do not adequately fulfil their functional roles.

An Uncertain Risk: The World Health Organization's Account of H1N1

“…Instead, the definition of pandemic revealed an assumption that pandemics would necessarily be severe, and therefore focused upon other measurable characteristics (e.g. geographical spread) in determining risk (see Abeysinghe 2013).…”

“…These criticisms were underpinned by the fact that, by the WHO's immediate count, the H1N1 pandemic had resulted in only approximately 18,500 laboratory-confirmed deaths worldwide. Further, the fact that the WHO had altered the definition of “pandemic” within its Pandemic Alert Phases immediately prior to the advent of H1N1 was also highlighted by critics as a sign of mismanagement (International Health Regulations [IHR] 2011; Watson 2010; see also Abeysinghe 2013).…”

Revisiting the pharmaceuticalisation of pandemic influenza using Lukes’ framework of power

“…Devolving definitional power to the WHO appeared uncontroversial when the APAs were signed (D1–D7; S1–S5; S7–S8). During and after the pandemic, however, debate erupted over why the WHO's pandemic definition was based on the infection's extent of geographical spread rather than on its severity (Abeysinghe , Doshi ).…”

Portable sequencing, genomic data, and scale in global emerging infectious disease surveillance

“…The fundamental unpredictability of such events means that the dominant method of relying on targeted surveillance narrowly focused on specific sources risks failure to detect outbreaks emerging from other sources. A perception that the quantity or quality of data available is inadequate can also render judgements with important political consequences more controversial, such as the categorisation of an ongoing incident as a pandemic (Abeysinghe, ) or the predicted number of future cases. The latter is a highly politicised figure that frequently dominates the discourse around EID response, but is often based on assumptions about the poor quality of available data.…”