Endgames: Disease eliminations and their politics

Background

The elimination of disease is an endgame of sorts. The hepatitis C endgame is partly made up in elimination targets and measures of progress. The endgame is also made up in the translations of global biomedical promise into local practices through interventions, community actions and policies. The sense of endgame is intensifying as we enter the ‘final phase’ of global targets to eliminate hepatitis C, among other viruses, by 2030.

Analysis

In this introduction to the session, we take the ‘endgame’ as a site of analysis and reflection to think critically about the science, policy and politics of hepatitis C’s elimination. Rather than taking the endgame for granted, we will reflect on what we mean by progress as well as how the endgame is being played. This presentation introduces two themes. The first is ‘structuration’. Here, we look at how the ending of hepatitis C is increasingly cast as a structural problem of final hurdles and barriers to be overcome. This highlights the uneven progress of endgames in the realization of global biomedical promise. Second, we look at ‘evidencing’. Here, we see the endgame as a site of knowledge contestation, and even controversy. This highlights how the endgame itself is performed through claims of progress.  

Conclusions

The endgame cannot be taken for granted, is shaped by science, intervention and policy itself, and is not free of politics. Whether there is an endgame and how this is made possible in particular contexts relates to how structural interventions and evidencing of progress is done. The presentations in this session pick-up on the themes of structural intervention and evidencing introduced here to consider what the endgame is and how to play it better.