A University of Sussex PhD thesis Available online via Sussex Research Online: http://sro.sussex.ac.uk/ This thesis is protected by copyright which belongs to the author. This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the Author The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the Author When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given Please visit Sussex Research Online for more information and further details Working Together for Prevention and Control of Zoonoses in India Syed Shahid Abbas submitted for the qualification of Doctor of Philosophy Institute of Development Studies University of Sussex September 2018 2 Declaration I hereby declare that this thesis, whether in the same or different form, has not been previously submitted to this or any other University for a degree. 3 For Ammar & Zahra 4 University of Sussex Syed Shahid Abbas Doctor of Philosophy Working Together for Prevention and Control of Zoonoses in India Summary Despite calls for collaborations across animal and human health sectors to control zoonoses, a ‘black-box’ approach to collaborations means there is limited understanding of their drivers, characteristics and dynamics. In this thesis, I develop insights into multisector ‘One Health’ collaborations by examining the case of three zoonotic diseases in two states in India. Over nine months of fieldwork, I interviewed policy actors spread across different sectors, functions and administrative levels, and observed the practices of professionals in the field and in their offices. I used the examples of anthrax, brucellosis and leptospirosis to examine One Health collaborations in the states of Tamil Nadu and Gujarat in India. The identification, measurement and response to zoonoses are complex undertakings requiring specialist expertise. Consequently, discourses and practices around zoonotic diseases are dominated by technical experts. The process of synthesizing and reinterpreting scientific knowledge, in turn, is influenced by politics and power dynamics underlying the experts’ disciplines, sectors and institutions. Across all three zoonoses, I found that it is narratives about diseases, rather than actual disease burdens or risks, which drive public perception and policy response. The way collaborations ultimately emerge is conditioned by the disease characteristics and is influenced by an interplay of the disease discourses, the political cultures of the state and the practices employed by decision-makers at all levels. In all cases, collaborations do occur, sometimes facilitated by formal guidelines, but very often through everyday practices, in spite of bureaucratic strictures. All cases of collaboration are underpinned by informal networks. Such initiatives, frequently led by middle-level bureaucrats, while responsive to local concerns, are much messier than the processes envisioned in the dominant programmatic literature on ‘One Health’. In order for One Health partnerships to be sustainable, I argue that it is important to develop a nuanced approach to understanding the politics and dynamics underlying multisector collaborations. 5 ACKNOWLEDGMENT They say it takes a village to raise a child. Having produced this dissertation while raising two children, I am convinced that the same holds true for a PhD as well. It is a long list of individuals who have supported me in different ways over the last few years; any listing would therefore, have to be a selective one. Rest assured, I do remember and acknowledge your support, even if not mentioned here. First, as a Commonwealth scholar, funded by the UK government, I gratefully acknowledge its role in enabling my PhD. I am especially thankful to both my supervisors, Hayley MacGregor, and Ian Scoones for their constant encouragement, and ensuring that I left all my supervision meetings in much happier frame of mind than when I started them. Ian deserves a special thanks for giving me more time and attention than I expected, and I suspect, he could afford to. I also want to acknowledge the intellectual support and mentorship provided to me by Manish Kakkar at Public Health Foundation of India. Had it not been for Manish’s encouragement, I would not have realised the importance and thrill of working on zoonoses, nor would have been able to meet some of the greatest minds in the country working on the topic. I and my family owe a special debt of thanks to the UK National Health Service, without whose professionals and care, we would not have seen this day. I am also grateful for the support given to me by the Teaching Office at IDS, including Angela Dowman, Julia Brown and Stephanie Watson. Thanks are also due to Linda Waldman for her stewardship of the PhD programme. There is one other office at the University whose efforts made a direct impact on my PhD. Jo Chee of the International Student Support office was very helpful and her thoughtful advice was instrumental in helping me navigate the UK immigration paperwork and focus on my research. The many workshops organised by Catherine Pope for the Doctoral School proved very useful in helping me think of writing as a learnable skill and teaching me how to write more effectively. I huge debt of gratitude is also due to all friends in Brighton and beyond who gave me and my family a community and sense of belonging. Deepta Chopra has been a huge source of support both within and outside IDS, so have Mark, Ayesha, Deepak uncle and Geeta aunty. The presence of Youssra and Basim, in Brighton, with their children, has been another source of support and belonging. 6 There have been many friends and colleagues who have inhabited the PhD room at IDS at different parts of my PhD and have, without exception, been generous with their time, advice and support. Members of the PhD community at IDS include Aparna, Tom, Shilpi, Maysa, SungKyu, Hadeer, Yashodhan, Marika, Teesa, Aly, Egidio, Thomas, Tanvir, Ting, Mireille, and Beatriz. Thanks also to my fellow ‘One Health PhDs’ – Sophie and Violet for letting me know I am not alone in this quest. I have been very fortunate to have friends going back to more than two decades and who are still a source of support and encouragement. Gulrez, with his own PhD predicaments, was always available to lend a sympathetic ear from the US. Khalid, thanks for putting me up for all my stay in Delhi. Colleagues from PHFI who kept me abreast of the happenings in India, include Manu, Maulik and Habib. My PhD would never have completed, had it not been for the multiple levels of support and encouragement from my family. I would like to thank my parents for encouraging me to follow my interests and commitments. Thanks to Mona and Shozeb bhai for welcoming us and helping us settle in the UK. Thanks also to Mama and Mami for being at home, so I could step out and work on my PhD. Ammar deserves the most special thanks for his enthusiasm in seeing my PhD through and Zahra for reminding me what’s truly important in life. Finally, a huge thanks to my wife, Aalia, for taking on more responsibilities on herself, than was fair to her, just so that I could work on finishing my PhD. 7 CONTENTS 1 Introduction ................................................................................................................................................ 12 1.1 A focus on zoonoses and collaboration .................................................................................. 13 1.2 Zoonoses in India ............................................................................................................................ 15 1.3 Personal motivations ..................................................................................................................... 17 1.4 Research Question .......................................................................................................................... 18 1.5 Thesis organisation ........................................................................................................................ 19 2 Understanding collaborations: Literature review and analytical framework ................ 22 2.1 Disease characteristics ................................................................................................................. 22 2.2 Politics ................................................................................................................................................. 25 2.3 Discourses .......................................................................................................................................... 29 2.4 Practices .............................................................................................................................................. 34 2.5 An emergent analytic framework............................................................................................. 38 3 Methodology ............................................................................................................................................... 41 3.1 Study design ...................................................................................................................................... 41 3.2 Case definition .................................................................................................................................. 43 3.3 Selection of study