On 21 April Manoela Louise Assayag de Magalhães Souza defended her PhD thesis in International Relations/Political Science, entitled “Agenda Politics: Issue Entrepreneurship and Priority-Setting in Global Governance for Health”, at the Graduate Institute. Professor Cédric Dupont presided the committee, which included Professor Liliana Andonova, Thesis Director, as well as Professor William C. Clark, from Harvard University. Ms Assayag tells us about her attachment to her subject matter, her research findings and her professional perspectives.

Why did you decide to work on priority-setting in global governance for health?

Because one of my grandmothers was victim of liver disease caused by hepatitis C, an overlooked blood-borne virus for which there is no vaccine, I have been interested in health issues from early age. Academically, I have worked with this since college, when I had a governmental fellowship to conduct research on transnational activism for the promotion of health-related flexibilities to the global intellectual property regime. Furthermore, I was always intrigued by how ideas came about and decisions were made – to some extent, every work I have been involved with had a huge historical research and decision-making component. So when I found myself at a global symposium hearing how non-communicable diseases were the next big priority in global health after HIV/AIDS, I felt dragged into understanding why. As I often put, it was a combination of pedestrian curiosity with my academic interest for both public health and public policy that led me to conduct interdisciplinary research on prioritisation in global governance for health.

What are your major findings?

Some of my major findings are very intuitive. For instance, I have found out that scientists, experts and policymakers who become issue entrepreneurs (that is, advocates of health issues) dwell a lot on their reputation to attract a web of actors to join their cause and to “convince” institutions such as intergovernmental organisations and foundations to support their quest to give space to these issues on the global agenda.

Another finding has to do with the role of knowledge (by means of what I call “knowledge power”) as a source of advantage at the core of successful mobilisation for the inclusion of new health priorities on both the WHO and the UN agendas. To a certain extent, when an advocate can “show and tell” to potential donors or institutional supporters a promising health intervention, linked to a reasonably priced drug treatment, an effective vaccine or a chemical product, he will more likely gather support. We have considered the “business case” aspect of health prioritisation for a while, but this link both to scientific discovery and to the ability of scientists to communicate business-effective discoveries to wider audiences was missing.

A third finding has to do with what we call “issue packaging”, that is, the decision to group various issues into a single label, in an attempt to concentrate attention to matters that could individually be overlooked. Indeed, speaking of “neglected tropical diseases” or “non-communicable diseases” helps creating a compelling discourse of unity and urgency for more or less interrelated health issues.

A fourth finding is that longstanding structural transformations, such as the emergence of a new international order or the consolidation of the sustainable development paradigm, can transform how priority-thinking takes place and create new avenues for advocacy.

Finally, an interesting finding is that issue entrepreneurs are familiar with the public-policy literature and effectively use lessons from previous successful and not-so-successful stories when preparing their campaigns. This adds an extra-responsibility to the work we are doing, as our production becomes a source of policy influence over new cycles of attention to health issues.

Can you illustrate those findings with a current example?

We can shed a new light on how malaria eradication is gradually becoming a global priority again. As we know, a Global Malaria Eradication Campaign led by the World Health Organization and sponsored by the United States aimed at promoting the eradication of this disease by means of elimination of the Anopheles mosquito through DDT spraying. The failure of this campaign to reach its intended result, as well as the controversy raised about the environmental impact of DDT, made malaria eradication an unspoken taboo on the global health agenda.

In the 1990s, when people like Gro Harlem Brundtland (the then new Director General of WHO) and Jeffrey Sachs (the scholar-turned-advocate) started speaking again of addressing the deadly impact of malaria in the developing world, our focus was on malaria control. With the help of two health tools (insecticide-treated bed nets and artemisinin-based combination therapies), the priority of new governance arrangements such as the Roll Back Malaria Partnership and the Global Fund went to the implementation and financing of prevention and treatment.

But this has begun to change: in the view of people like Bill and Melinda Gates, we should now redirect our efforts to eradicating malaria worldwide by 2040. My research not only helps telling the story leading to this moment, but also provides the framework with which to look at how issue entrepreneurs such as large foundation runners, who are at once major donors, high profile individuals and media personalities with access to top-notch knowledge, can help “shaping” the global health priorities closer to their visions. At the end of the day, this raises questions about how democratic priority-setting really is, considering that few powerful actors seem to be able to influence so much.

What will you remember from your doctoral experience?

It was a very enriching experience. As part of it I had the opportunity of working both as a teaching assistant at the Department of International Relations/Political Science and as a research assistant at the Centre for International Environmental Studies, which taught me various important skills, such as didactics and self-organisation. I also had the chance of spending one year as a Giorgio Ruffolo Doctoral Research Fellow at the Sustainability Science Program at Harvard Kennedy School, and in that capacity I conducted an independent research project linked to my dissertation topic and engaged in interdisciplinary research about sustainable development. I am currently teaching at Getúlio Vargas Foundation in Brazil, and I feel that this broad world experience and access to different approaches to knowledge have made me a much better scholar.

What are your plans for the next few years?

The contact with the policy world that I had thanks to my dissertation topic and broader research interests make me consider dividing myself between academia and politics, be it through working for an intergovernmental organisation or launching a political career in the future.

Full citation of the thesis: Assayag de Magalhães Souza, Manoela Louise. “Agenda Politics: Issue Entrepreneurship and Priority-Settings in Global Governance for Health”. PhD thesis, Graduate Institute of International and Development Studies, 2016.

Illustration: WHO Director General Chan and Bill Gates Lead Discussion on Polio in Geneva, 17 May 2011. United States Mission Geneva Photo by Eric Bridiers, licensed under CC BY-ND 2.0.