Definition of Public Problems in Global Health, Competition between Epistemic Communities and Interactions with National Health Policy-making in West Africa: The Construction of Hepatitis as a Global Health Problem

The literature on agenda-setting that was traditionally used to study national political agendas (Stephen Hilgartner 1988; Baumgartner and Jones 1993; Kingdon 1984; Sabatier and Weible 2014; Stone 1989 among others) has recently been used in global health to explain the prioritisation of certain issues and not others, with promising perspectives (Shiffman, Beer, and Wu 2002; Shiffman 2009). Shiffman and Smith published two framework in 2007 and 2015 to analyse priority-setting in global health and to study the importance of actor networks in this process, thus using both the political science and sociology approaches of public problems and agenda setting. In this paper, I present the first results of a research project in which I used a similar approach to further understand both problem definition and agenda-setting in global health with the case study of the recent international mobilisation on viral hepatitis. I intend to explain interactions between Global Health institutions and the national level in West Africa with a comparison of the evolution of the fight against hepatitis B in Senegal and The Gambia. Hepatitis has emerged as a new global health problem since 2010, but it had been known to be a major health problem in West Africa for the past fifty years. Thus, I start with a history of the responses to the hepatitis B epidemic worldwide, with a focus on Senegal and The Gambia, explaining why the repeated political and scientific attempts to prioritize hepatitis B as a major health issue have failed at the national and global level. Then, I explore the primary factors responsible for defining viral hepatitis as a new global health priority since 2010 and I present the key actors who played -and are still playing- a role in the global mobilisation.