Uncertainties beyond preparedness: COVID-19 vaccination in Senegal.

Vaccination is one of the most recognised strategies in public health for preventing the spread of epidemics, and the availability of a vaccine is often expected by health actors to be a 'game-changer'. However, the COVID-19 (coronavirus disease 2019) vaccine in Senegal was not the magic bullet that the international community expected. A very low vaccination coverage rate (less than 10% by April 2023) was observed in this country, once considered a model in West Africa for its epidemic response. Beyond the population's alleged hesitancy to be vaccinated, was a lack of preparedness to blame? Previous analyses show that outbreak preparation limited to standard interventions is not sufficient in the face of the social, cultural, and political configurations of each epidemic context and that uncertainty limits response capacity. This paper examines the social life of the COVID-19 vaccine to identify the forms and contextual dimensions of uncertainty related to immunisation in Senegal. The authors explore how vaccination was implemented and compare experiences with the preparedness process, to offer insight on uncertainties. Using Stirling's theoretical model that defines various expressions of incertitude, the authors identify four nexuses at various stages of the social life of COVID-19 vaccine in Senegal: (1) material uncertainty related to vaccine availability, (2) ambiguity of the population about the purpose of vaccination and the risks of the disease, (3) uncertainty related to side effects, and (4) uncertainty about vaccination strategies shared by scientific and health authorities. These uncertainties were only partly considered in the preparedness process, for they are related to systemic structural dimensions and reflect the impact of global/regional powers on the local level. The findings of this research are relevant not only to support better communication around vaccines in Senegal but also more generally to the prevention of emerging epidemics shaped by human behaviours.

"I take it and give it to my partners who will give it to their partners": Secondary distribution of HIV self-tests by key populations in Côte d'Ivoire, Mali, and Senegal.

INTRODUCTION: HIV epidemics in Western and Central Africa (WCA) remain concentrated among key populations, who are often unaware of their status. HIV self-testing (HIVST) and its secondary distribution among key populations, and their partners and relatives, could reduce gaps in diagnosis coverage. We aimed to document and understand secondary HIVST distribution practices by men who have sex with men (MSM), female sex workers (FSW), people who use drugs (PWUD); and the use of HIVST by their networks in Côte d'Ivoire, Mali, and Senegal. METHODS: A qualitative study was conducted in 2021 involving (a) face-to-face interviews with MSM, FSW, and PWUD who received HIVST kits from peer educators (primary users) and (b) telephone interviews with people who received kits from primary contacts (secondary users). These individual interviews were audio-recorded, transcribed, and coded using Dedoose software. Thematic analysis was performed. RESULTS: A total of 89 participants, including 65 primary users and 24 secondary users were interviewed. Results showed that HIVST were effectively redistributed through peers and key populations networks. The main reported motivations for HIVST distribution included allowing others to access testing and protecting oneself by verifying the status of partners/clients. The main barrier to distribution was the fear of sexual partners' reactions. Findings suggest that members of key populations raised awareness of HIVST and referred those in need of HIVST to peer educators. One FSW reported physical abuse. Secondary users generally completed HIVST within two days of receiving the kit. The test was used half the times in the physical presence of another person, partly for psychological support need. Users who reported a reactive test sought confirmatory testing and were linked to care. Some participants mentioned difficulties in collecting the biological sample (2 participants) and interpreting the result (4 participants). CONCLUSION: The redistribution of HIVST was common among key populations, with minor negative attitudes. Users encountered few difficulties using the kits. Reactive test cases were generally confirmed. These secondary distribution practices support the deployment of HIVST to key populations, their partners, and other relatives. In similar WCA countries, members of key populations can assist in the distribution of HIVST, contributing to closing HIV diagnosis gaps.

[Preparing for epidemics. A strategy for strengthening social science skills in Africa]. / Se préparer face aux épidémies Une stratégie de renforcement des compétences en sciences sociales en Afrique.

The Covid pandemic was a reminder of the need to be prepared for epidemics and pandemics and to take into account their socio-political dimensions by developing socioanthropological and interdisciplinary approaches. In the post-crisis era, the challenge is one of operationality. How can these dimensions be made more visible? How can we develop analyses that can help to humanize institutional responses, make inequalities visible to limit them during the crisis, reveal structural determinants of transmission, and define interventions that are scientifically sound, ethically just and respectful of diversity?Three strategies are relevant to meet these challenges: (1) more social scientists in Frenchspeaking Africa must get expertise on epidemics to investigate associated issues before, during and after epidemic crisis; (2) public health professionals, health and social workers must get informed about social, historical, economic and political aspects of epidemics that shape risk, care and control; (3) collaborations between researchers and those involved in responding to epidemics on the basis of shared knowledge must develop.This article presents a capacity-building initiative developed in French-speaking West Africa by the Anthropology of Emerging Epidemics Network (RAAE), in conjunction with other networks (Sonar-Global) and institutions (CRCF, IRD). It describes and analyzes a program that combines a working method, a scientific content and teaching tools. This program benefited from previous training experiences and gathered expertise from about 25 social scientists, mainly medical anthropologists, who have worked on various epidemics and pandemics such as AIDS, Ebola, plague, Covid and dengue in West Africa and beyond. The process to develop the course was based on workshops followed by redaction periods, then testings for content and tools during training sessions.The course focuses on two audiences: social science researchers (with a Master degree level and above) and social and health workers (public health, community health, NGOs, social workers). For the former, the course aims at reinforcing theoretical and methodological skills through the presentation of issues, key concepts, selected theoretical developments, themes and bibliographical references. For the latter, the course is based on modules about operational issues that can be taken separately, to better adapt the content of trainings to local teams' needs. For both, a glossary includes 100 definitions of public health, medical and social science vocabulary, relevant to epidemics. The content in terms of skills to be acquired (knowledge, know-how) is presented briefly in the article. Both the scientific content and learning methods and tools are presented in a manual (Desclaux et al., Anthropologie appliquée aux épidémies émergentes, 2022 [5]) as well as on Sonar-Global (English) and RAEE (French) websites (www.sonar-global.eu, www.raee.fr).The knowledge to be imparted is organized into 13 modules: introduction; the framework for responding to epidemics; emergence and One Health; antimicrobial resistance; infectious risk (inequalities, stigmatization and prevention); knowledge (circulation and interpretation); health services (places of risk and care); public health measures (lockdown and distancing); experiences (suffering of the sick and mobilization); death (meaning and rituals); vaccination (innovation, equity and hesitation); epidemic cycles (preparation, response and recovery); challenges, methods, ethics and governance; and conclusion.The first training courses held in Senegal and Burkina Faso for university researchers and young scholars from Africa and France were positively evaluated by the participants. They report that they have acquired knowledge in epidemic social science, but also in public health, which has given them the necessary basis for communicating and developing collaborations (in research and intervention) with social and health actors. The model could be duplicated with adaptation for new training sessions organized by other institutions, for which a manual is available.

Willingness to use and distribute HIV self-test kits to clients and partners: A qualitative analysis of female sex workers' collective opinion and attitude in Côte d'Ivoire, Mali, and Senegal.

BACKGROUND: In West Africa, female sex workers are at increased risk of HIV acquisition and transmission. HIV self-testing could be an effective tool to improve access to and frequency of HIV testing to female sex workers, their clients and partners. This article explores their perceptions regarding HIV self-testing use and the redistribution of HIV self-testing kits to their partners and clients. METHODS: Embedded within ATLAS, a qualitative study was conducted in Côte-d'Ivoire, Mali, and Senegal in 2020. Nine focus group discussions were conducted. A thematic analysis was performed. RESULTS: A total of 87 participants expressed both positive attitudes toward HIV self-testing and their willingness to use or reuse HIV self-testing. HIV self-testing was perceived to be discreet, confidential, and convenient. HIV self-testing provides autonomy from testing by providers and reduces stigma. Some perceived HIV self-testing as a valuable tool for testing their clients who are willing to offer a premium for condomless sex. While highlighting some potential issues, overall, female sex workers were optimistic about linkage to confirmatory testing following a reactive HIV self-testing. Female sex workers expressed positive attitudes toward secondary distribution to their partners and clients, although it depended on relationship types. They seemed more enthusiastic about secondary distribution to their regular/emotional partners and regular clients with whom they had difficulty using condoms, and whom they knew enough to discuss HIV self-testing. However, they expressed that it could be more difficult with casual clients; the duration of the interaction being too short to discuss HIV self-testing, and they fear violence and/or losing them. CONCLUSION: Overall, female sex workers have positive attitudes toward HIV self-testing use and are willing to redistribute to their regular partners and clients. However, they are reluctant to promote such use with their casual clients. HIV self-testing can improve access to HIV testing for female sex workers and the members of their sexual and social network.

Vaccine anxieties, vaccine preparedness: Perspectives from Africa in a Covid-19 era.

Global debates about vaccines as a key element of pandemic response and future preparedness in the era of Covid-19 currently focus on questions of supply, with attention to global injustice in vaccine distribution and African countries as rightful beneficiaries of international de-regulation and financing initiatives such as COVAX. At the same time, vaccine demand and uptake are seen to be threatened by hesitancy, often attributed to an increasingly globalised anti-vaxx movement and its propagation of misinformation and conspiracy, now reaching African populations through a social media 'infodemic'. Underplayed in these debates are the socio-political contexts through which vaccine technologies enter and are interpreted within African settings, and the crucial intersections between supply and demand. We explore these through a 'vaccine anxieties' framework attending to both desires for and worries about vaccines, as shaped by bodily, societal and wider political understandings and experiences. This provides an analytical lens to organise and interpret ethnographic and narrative accounts in local and national settings in Uganda and Sierra Leone, and their (dis)connections with global debates and geopolitics. In considering the socially-embedded reasons why people want or do not want Covid-19 vaccines, and how this intersects with the dynamics of vaccine supply, access and distribution in rapidly-unfolding epidemic situations, we bring new, expanded insights into debates about vaccine confidence and vaccine preparedness.

Negotiating Intersecting Precarities: COVID-19, Pandemic Preparedness and Response in Africa.

This article shares findings on COVID-19 in Africa across 2020 to examine concepts and practices of epidemic preparedness and response. Amidst uncertainties about the trajectory of COVID-19, the stages of emergency response emerge in practice as interconnected. We illustrate how complex dynamics manifest as diverse actors interpret and modify approaches according to contexts and experiences. We suggest that the concept of "intersecting precarities" best captures the temporalities at stake; that these precarities include the effects of epidemic control measures; and that people do not just accept but actively negotiate these intersections as they seek to sustain their lives and livelihoods.

Enthusiasm for Introducing and Integrating HIV Self-Testing but Doubts About Users: A Baseline Qualitative Analysis of Key Stakeholders' Attitudes and Perceptions in Côte d'Ivoire, Mali and Senegal.

Since 2019, the ATLAS project, coordinated by Solthis in collaboration with national AIDS programs, has introduced, promoted and delivered HIV self-testing (HIVST) in Côte d'Ivoire, Mali and Senegal. Several delivery channels have been defined, including key populations: men who have sex with men, female sex workers and people who use injectable drugs. At project initiation, a qualitative study analyzing the perceptions and attitudes of key stakeholders regarding the introduction of HIVST in their countries and its integration with other testing strategies for key populations was conducted. The study was conducted from September to November 2019 within 3 months of the initiation of HIVST distribution. Individual interviews were conducted with 60 key informants involved in the project or in providing support and care to key populations: members of health ministries, national AIDS councils, international organizations, national and international non-governmental organizations, and peer educators. Semi structured interviews were recorded, translated when necessary, and transcribed. Data were coded using Dedoose© software for thematic analyses. We found that stakeholders' perceptions and attitudes are favorable to the introduction and integration of HIVST for several reasons. Some of these reasons are held in common, and some are specific to each key population and country. Overall, HIVST is considered able to reduce stigma; preserve anonymity and confidentiality; reach key populations that do not access testing via the usual strategies; remove spatial barriers; save time for users and providers; and empower users with autonomy and responsibility. It is non-invasive and easy to use. However, participants also fear, question and doubt users' autonomy regarding their ability to use HIVST kits correctly; to ensure quality secondary distribution; to accept a reactive test result; and to use confirmation testing and care services. For stakeholders, HIVST is considered an attractive strategy to improve access to HIV testing for key populations. Their doubts about users' capacities could be a matter for reflective communication with stakeholders and local adaptation before the implementation of HIVST in new countries. Those perceptions may reflect the West African HIV situation through the emphasis they place on the roles of HIV stigma and disclosure in HIVST efficiency.

Challenges of HIV Self-Test Distribution for Index Testing When HIV Status Disclosure Is Low: Preliminary Results of a Qualitative Study in Bamako (Mali) as Part of the ATLAS Project.

Context: The rate of HIV status disclosure to partners is low in Mali, a West African country with a national HIV prevalence of 1.2%. HIV self-testing (HIVST) could increase testing coverage among partners of people living with HIV (PLHIV). The AutoTest-VIH, Libre d'accéder à la connaissance de son Statut (ATLAS) program was launched in West Africa with the objective of distributing nearly half a million HIV self-tests from 2019 to 2021 in Côte d'Ivoire, Mali, and Senegal. The ATLAS program integrates several research activities. This article presents the preliminary results of the qualitative study of the ATLAS program in Mali. This study aims to improve our understanding of the practices, limitations and issues related to the distribution of HIV self-tests to PLHIV so that they can offer the tests to their sexual partners. Methods: This qualitative study was conducted in 2019 in an HIV care clinic in Bamako. It consisted of (i) individual interviews with eight health professionals involved in the distribution of HIV self-tests; (ii) 591 observations of medical consultations, including social service consultations, with PLHIV; (iii) seven observations of peer educator-led PLHIV group discussions. The interviews with health professionals and the observations notes have been subject to content analysis. Results: HIVST was discussed in only 9% of the observed consultations (51/591). When HIVST was discussed, the discussion was almost always initiated by the health professional rather than PLHIV. HIVST was discussed infrequently because, in most of the consultations, it was not appropriate to propose partner HIVST (e.g., when PLHIV were widowed, did not have partners, or had delegated someone to renew their prescriptions). Some PLHIV had not disclosed their HIV status to their partners. Dispensing HIV self-tests was time-consuming, and medical consultations were very short. Three main barriers to HIVST distribution when HIV status had not been disclosed to partners were identified: (1) almost all health professionals avoided offering HIVST to PLHIV when they thought or knew that the PLHIV had not disclosed their HIV status to partners; (2) PLHIV were reluctant to offer HIVST to their partners if they had not disclosed their HIV-positive status to them; (3) there was limited use of strategies to support the disclosure of HIV status. Conclusion: It is essential to strengthen strategies to support the disclosure of HIV+ status. It is necessary to develop a specific approach for the provision of HIV self-tests for the partners of PLHIV by rethinking the involvement of stakeholders. This approach should provide them with training tailored to the issues related to the (non)disclosure of HIV status and gender inequalities, and improving counseling for PLHIV.

Describing, analysing and understanding the effects of the introduction of HIV self-testing in West Africa through the ATLAS programme in Côte d'Ivoire, Mali and Senegal.

BACKGROUND: The ATLAS programme aims to promote and implement HIV self-testing (HIVST) in three West African countries: Côte d'Ivoire, Mali, and Senegal. During 2019-2021, in close collaboration with the national AIDS implementing partners and communities, ATLAS plans to distribute 500,000 HIVST kits through eight delivery channels, combining facility-based, community-based strategies, primary and secondary distribution of HIVST. Considering the characteristics of West African HIV epidemics, the targets of the ATLAS programme are hard-to-reach populations: key populations (female sex workers, men who have sex with men, and drug users), their clients or sexual partners, partners of people living with HIV and patients diagnosed with sexually transmitted infections and their partners. The ATLAS programme includes research support implementation to generate evidence for HIVST scale-up in West Africa. The main objective is to describe, analyse and understand the social, health, epidemiological effects and cost-effectiveness of HIVST introduction in Côte d'Ivoire, Mali and Senegal to improve the overall HIV testing strategy (accessibility, efficacy, ethics). METHODS: ATLAS research is organised into five multidisciplinary workpackages (WPs): Key Populations WP: qualitative surveys (individual in-depth interviews, focus group discussions) conducted with key actors, key populations, and HIVST users. Index testing WP: ethnographic observation of three HIV care services introducing HIVST for partner testing. Coupons survey WP: an anonymous telephone survey of HIVST users. Cost study WP: incremental economic cost analysis of each delivery model using a top-down costing with programmatic data, complemented by a bottom-up costing of a representative sample of HIVST distribution sites, and a time-motion study for health professionals providing HIVST. Modelling WP: Adaptation, parameterisation and calibration of a dynamic compartmental model that considers the varied populations targeted by the ATLAS programme and the different testing modalities and strategies. DISCUSSION: ATLAS is the first comprehensive study on HIV self-testing in West Africa. The ATLAS programme focuses particularly on the secondary distribution of HIVST. This protocol was approved by three national ethic committees and the WHO's Ethical Research Committee.

Mesures visant à renforcer l'observance pour les antirétroviraux : perceptions et expérience des PVVIH au Burkina Faso.

INTRODUCTION: Adherence to antiretroviral therapy is a major obstacle to achieving WHO target 3. In West Africa, however, there is a lack of evidence on the most feasible, acceptable and effective adherence reinforcement measures and users' perceptions of these measures. The purpose of this article is to analyze the perceptions of PLHIV (people living with HIV) on ART reinforcement measures in Burkina Faso. METHOD: In Ouagadougou and Bobo-Dioulasso care centers, THILAO Research Project (ANRS 12269) enrolled PLHIV experiencing therapeutic failure on 2nd line antiretroviral treatment, and offered to them adherence reinforcement measures. We conducted a qualitative socio-anthropological study to explore their perceptions. Data were collected through repeated individual interviews with 37 PLHIV. RESULTS: The 31 participants who completed interviews were relatively satisfied with the measures to support adherence. Three measures (pill organizer, weekly phone calls by a member of the team, cellphone alarm reminders) were perceived as simple, effective, discreet, adapted to both illiterate and educated people. Three other measures (home visits, involvement of a member of the family and SMS) were not highly appreciated as they expose to the disclosure of HIV+ status and /or stigmatization. Two measures (support group, frequent visits to the care center) were less selected because considered tedious. CONCLUSION: PLHIV chosed and used the most appropriate adherence measures for their profile / context. The most feasible and acceptable measures identified could be offered to PLHIV at risk of non-compliance in West African ART programs.

'They'll inject you and you'll die': from medication non-compliance to acceptance in Guinea's Ebola treatment units.

During the 2013-2016 West African Ebola epidemic, medical emergency response teams negotiated a context marked by public hysteria and fear to prevent the spread of the virus and treat those already infected. However, the presence and work of Ebola response teams added to suspicions provoked by the rapid increase in numbers of dead and dying and by locally unintelligible emergency measures. Based on data collected from 40 young adult 'survivors' between 16 and 29 years of age who were hospitalized for Ebola during the epidemic, this article examines how pharmaceutical treatments were accepted (or not) by patients in ebola treatment units (ETU). Three key questions guide this analysis: (1) Did hospitalized individuals adhere with or refuse treatments offered at ETUs? (2) Did their attitudes change over the course of their hospitalization? (3) Which factors influenced refusal of treatment or compliance? To the authors' knowledge, no previous studies have explored the resistance of hospitalized patients to treatment in Ebola centers. This article, in addition to exploring patients' practices and related perceptions of treatment with evolving meanings in this outbreak crisis situation, also presents practical recommendations for future Ebola interventions as well as theoretical knowledge about the circulation and transformation of socially constructed representations of medications.

Understanding Ebola virus and other zoonotic transmission risks through human-bat contacts: Exploratory study on knowledge, attitudes and practices in Southern Cameroon.

The ecology of Ebola virus (EBV) remains largely unknown, but the previous detection of viral RNA and anti-EBV antibodies in African bats suggests that they might play a role in the EBV reservoir. Moreover, African bats also carry other potentially zoonotic agents such as Henipah-like viruses, coronaviruses and lyssaviruses. Today only little information is available on interactions between humans and bats. The objective of our exploratory study was to describe the extent and modes of contacts between humans and bats in southern Cameroon, considered as an area at risk for future EBV outbreaks. The survey was conducted in 11 villages of four distinct rural areas in southern Cameroon. A total of 135 respondents were interviewed using semi-structured questionnaires, between February and May 2017. The study showed that direct contacts between bats and humans are relatively common. Bat bushmeat appeared to be an occasional meat resource; 40% of respondents consume bats with a median annual consumption of three, and 28% of respondents hunt them. About 22% of the respondents reported children catching bats. Indirect contact also appeared to be common; 55% of hunters use caves as shelters and 67% of interviewees eat fruits previously chewed by bats. Bat consumption varied significantly between regions (from 0% to 87%) and between pygmies and bantus in the extreme south-east of Cameroon. The study revealed considerable diversity in practices among interviewees, most of them being subsistence cultivators and relying on self-hunted bushmeat. Geographical diversity of contacts and perceptions regarding bats in Cameroon emphasizes the need to adjust zoonotic pathogen surveillance and education campaigns to the specificities of the communities and their context of interaction with wildlife.

[Adherence reinforcement for antiretroviral therapy: PLHIV's perceptions and experience in Burkina Faso]. / Mesures visant à renforcer l'observance pour les antirétroviraux : perceptions et expérience des PVVIH au Burkina Faso.

INTRODUCTION: Adherence to antiretroviral therapy is a major obstacle to achieving WHO target 3. In West Africa, however, there is a lack of evidence on the most feasible, acceptable and effective adherence reinforcement measures and users' perceptions of these measures. The purpose of this article is to analyze the perceptions of PLHIV (people living with HIV) on ART reinforcement measures in Burkina Faso. METHOD: In Ouagadougou and Bobo-Dioulasso care centers, THILAO Research Project (ANRS 12269) enrolled PLHIV experiencing therapeutic failure on 2nd line antiretroviral treatment, and offered to them adherence reinforcement measures. We conducted a qualitative socio-anthropological study to explore their perceptions. Data were collected through repeated individual interviews with 37 PLHIV. RESULTS: The 31 participants who completed interviews were relatively satisfied with the measures to support adherence. Three measures (pill organizer, weekly phone calls by a member of the team, cellphone alarm reminders) were perceived as simple, effective, discreet, adapted to both illiterate and educated people. Three other measures (home visits, involvement of a member of the family and SMS) were not highly appreciated as they expose to the disclosure of HIV+ status and /or stigmatization. Two measures (support group, frequent visits to the care center) were less selected because considered tedious. CONCLUSION: PLHIV chosed and used the most appropriate adherence measures for their profile / context. The most feasible and acceptable measures identified could be offered to PLHIV at risk of non-compliance in West African ART programs.

[Neglected patients, unexpected effects. Ebola virus disease suspected case experience.] / Patients négligés, effets imprévus. L'expérience des cas suspects de maladie à virus Ebola.

INTRODUCTION: In an epidemic context, the identification of suspected cases, among alert or contact cases, leads to caring for persons for whom only a minority will be confirmed cases, with a laboratory diagnosis positive for Ebola. How are suspected cases treated that are not subsequently confirmed and how do they feel about this experience ? What are the medical or social consequences ? METHODS: A qualitative study was conducted in two countries with a high Ebola risk epidemic situation in 2015-2016 (Senegal, Côte d'Ivoire). Based on interviews with suspected cases and caregivers, 12 referral itineraries were identified for 20 people. RESULTS: Narratives are dominated by the perception of failures at several levels: insufficient means and service preparation; lack of care for patients' vital needs and lack of treatment for their diseases; lack of listening, explanation and consideration for their families; patients' suffering from being isolated and facing violence; unexpected secondary social effects. These findings can be explained partly by caregivers' focus on Ebola diagnosis more than patients, fear of contagion, and by the insufficient preparation of isolation spaces at the time of the survey. CONCLUSION: The results show the possible pitfalls of surveillance systems which increase the number of persons identified as suspected cases, if care services are not sufficiently prepared. Recommendations based on these results should be considered particularly to define operational procedures and trainings for health professionals.

[Anthropology engaged against Ebola (2014-2016): approaches, contributions and new questions]. / L'anthropologie engagée dans la lutte contre Ebola (2014-2016) : approches, contributions et nouvelles questions.

Anthropologists contributed to the response to the 2014-2016 Ebola outbreak in three ways : as Ebola experts, cultural mediators between populations and caregivers, and researchers. This article presents a preliminary review of approaches, contributions and related issues based on a literature review, case studies and debates. The anthropological research discussed in this article concerns four themes : epidemiological contexts of transmission ; cultural interpretation of illness and social responses ; social construction of stakeholders' experience ; critical analysis of public health interventions. In addition to insightful contributions, particularly regarding the socio-political contexts and their interfaces with global public health measures, anthropologists tested forms of communication to facilitate access of public health actors to their results. However, these heterogeneous forms of engagement raise a number of questions, especially when they reflect anthropological interpretations that exclude any critical or reflexive dimension, or when anthropology is considered to be similar to social intervention. Nevertheless, anthropological research provides a major contribution, which could be even greater if transnational networks set up by researchers to analyse the socio-political, economic and biocultural dimensions of emerging epidemics are supported in order to improve ?preparedness? for future health crises.