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RESEARCH Open Access
Social sciences research in neglected tropical
diseases 2: A bibliographic analysis
Daniel D Reidpath1*, Pascale Allotey1, Subhash Pokhrel2
Abstract
Background: There are strong arguments for social science and interdisciplinary research in the neglected tropical
diseases. These diseases represent a rich and dynamic interplay between vector, host, and pathogen which occurs
within social, physical and biological contexts. The overwhelming sense, however, is that neglected tropical
diseases research is a biomedical endeavour largely excluding the social sciences. The purpose of this review is to
provide a baseline for discussing the quantum and nature of the science that is being conducted, and the extent
to which the social sciences are a part of that.
Methods: A bibliographic analysis was conducted of neglected tropical diseases related research papers published
over the past 10 years in biomedical and social sciences. The analysis had textual and bibliometric facets, and
focussed on chikungunya, dengue, visceral leishmaniasis, and onchocerciasis.
Results: There is substantial variation in the number of publications associated with each disease. The proportion
of the research that is social science based appears remarkably consistent (<4%). A textual analysis, however,
reveals a degree of misclassification by the abstracting service where a surprising proportion of the “social
sciences” research was pure clinical research. Much of the social sciences research also tends to be “hand maiden”
research focused on the implementation of biomedical solutions.
Conclusion: There is little evidence that scientists pay any attention to the complex social, cultural, biological, and
environmental dynamic involved in human pathogenesis. There is little investigator driven social science and a
poor presence of interdisciplinary science. The research needs more sophisticated funders and priority setters who
are not beguiled by uncritical biomedical promises.
Introduction
I have never read a research proposal written by a social
scientist that was worth funding.1
Human pathogens have adapted to take advantage of
the behaviour and social and nature of their human
hosts, including adaptations to take advantage of the
structured nature of the societies in which humans live
[1,2]. The survival of a subset of those pathogens, the
ones that are vector borne, relies on the pathogens con-
comitant adaptation to the vector-arthropods that have
themselves adapted (and continue to adapt) to take
advantage of the behaviour and social nature of humans,
including the structured nature of the societies in which
humans live [3-5]. Vector borne diseases represent a
rich and dynamic interplay between the vector, the host,
and the pathogen; but it is an interaction that occurs
within a social and cultural context as much as it is one
that occurs within a physical and biological context.
Critically, aspects of pathogenesis as diverse, and prima
facie non-social, as the jump of a pathogen from one host
species to another [6,7], or the development of drug resis-
tance [3,8] have significant social components. As an
example, consider drug resistance, particularly arising
from the counterfeiting of drugs [9,10]. Counterfeiting is
an entirely social phenomenon driven by healthy profits
margins. Counterfeit antimalarial drugs which contain
sub-clinical doses of artesunate have been identified, and
their presence has plausibly driven drug resistance [11,12].
Drug resistance, however, does not only occur because of
the malign intentions of criminal elements, and can also
be driven by other social and behavioural phenomenon
such as poor prescribing practices of medical practitioners
* Correspondence: daniel.reidpath@monash.edu
1Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences,
Monash University, Malaysia
Full list of author information is available at the end of the article
Reidpath et al. Health Research Policy and Systems 2011, 9:1
http://www.health-policy-systems.com/content/9/1/1
� 2011 Reidpath et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
and pharmacists, or poor compliance by patients [13,14].
Drug resistance arises, therefore, out of a social and cul-
tural context within which drug treatment is delivered and
managed, and the biological context of the hosts’ and
agents’ response to the drug delivery regime.
Under this scenario of complex interactions between
social and biological forces, one might imagine that the
social sciences would play a significant, if not central
role, in the development of evidence related to under-
standing and managing pathogenesis in general, and in
the management of the arthropod borne, neglected tro-
pical diseases (NTDs) in particular.
As an entry point for thinking more concretely about
where the social sciences contribution to NTDs research
may lie, consider the kinds of litter that humans generate,
and the manner in which they manage that litter. The crea-
tion and management of litter has a social, cultural, and
behavioural basis related to (but not limited to) our diets
and shopping habits, the kinds of packaging that industries
use, our housing, our cultural views and practices related
to the management of waste (and even the definition of
one thing as waste and another as a possession), the local
municipal infrastructure for the collection and manage-
ment of waste, government policies, and physical isolation.
For Aedes albopictus, one of the mosquito vectors of the
dengue virus, the generation and management of litter
around the home will have a direct impact on whether
there is an abundance of breeding sites conveniently close
to human blood meals, or whether the breeding sites are
sparse [15]. Furthermore, and in keeping with the dynamic
nature of the relationship between the vector and the host,
variations in social structure, cultural practice, or indivi-
dual behaviour, will also affect the need for the mosquito
to adapt its breeding habits in response to changes in the
nature and quantity of the human litter [15,16].
Some of the social and behavioural aspects associated
with pathogenesis may, thus, be quite micro-level in
their scope. These would include household factors
associated with pathogenesis such as physical location,
the civil engineering of the housing [17], demographic
profile, and individual knowledge and behaviour [18-21].
Micro-level factors will be more readily influenced by
individual and household level activities. Other macro-
level factors associated with pathogenesis will include
levels of poverty in the region, the level of development,
the town planning codes and practices [22], the sanita-
tion services infrastructure, the political and economic
capacity (or desire) to restructure those things, and the
cultural views and practices of the community.
Once one understands that the relationship in the
host, agent (vector), and environment “triad” embeds
inescapable social dimensions, the nature and scope of
those social dimensions become available for systematic
investigation as a part of a larger NTDs research agenda.
One could, by way of examples, investigate social and
behavioural aspects that affect: (i) the pre-existing risk
of pathogenesis, (ii) the prevention of pathogenesis, and
(iii) the treatment and management of pathogenesis and
the morbidities arising from it. At a micro-level one
could examine, for instance, the presence of social risk
factors and the distribution of a particular known social
risk factor in the population, or the local understanding
of a disease so that more appropriate management stra-
tegies could be developed [23-25]. At a macro-level one
could, for instance, investigate the political economy of
disease and how it effects health resource priorities in
government and their impact on one or more NTDs.
One could also look at the interrelationship between
arms of government such as Agriculture, Education,
Health, Finance, Transportation, and Communication
and consider the effects that these individually or in
aggregate have on the spread or control of disease.
A research agenda with this kind of scope would have
a considerable amount to offer in the understanding,
control, and management of NTDs. It would also carry
the risks of any activity carried out in a silo: when one
has a hammer, everything looks like a nail. Understand-
ing and managing human pathogenesis may have ines-
capably social dimensions, but it is equally bound to
biological and clinical dimensions. The potential of
inter- and multi-disciplinary research2, therefore, com-
bining social and biological facets (e.g., social factors
affecting the physical and economic distribution of
onchocercal drug resistance in the population), social
and clinical questions (e.g., social factors affecting the
sustained implementation of a treatment strategy in a
community), or indeed social questions with questions
from other entirely different disciplines such as architec-
ture or engineering would be significant (e.g., social
dimensions of housing design and infection rates [17]).
This kind of call for interdisciplinary research, particu-
larly with social sciences inclusion, is not new [26]. Indi-
vidual researchers, and organizations working in the
NTDs and infectious disease more generally, have
argued explicitly for the value of social sciences research
[27-29], or have used social science arguments to
advance the political cause of NTDs research3. At the
same time, however, researchers have argued that too
much weight is being given to the social sciences, and
more weight needs to be given to other disciplines, par-
ticularly the laboratory based sciences [30]. Against this
backdrop of disciplinary demarcation disputes in what is
clearly a multidisciplinary field, there are likely to be
three problems for social sciences research:
1. Research will remain largely within disciplinary
silos;
2. Biomedical research will dominate; and
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3. Where efforts are made to encourage more than
one discipline engaging with a problem, the work
will be multidisciplinary rather than interdisciplinary:
The contributions from different disciplines
will be treated hierarchically, and
The social sciences research will be responsive
rather than investigator driven.
As a consequence of the last of these sub-points one
would anticipate that the social science research will be
conducted under the mantle of disease/cure focussed,
biomedical research. This would arise if the role of the
social research is as an adjuvant activity to support the
curative activities of biomedical research. For an exam-
ple, see Parker and Allen [31] in this series. Under these
conditions the research will often reduce to a “cook-
book” style of evaluation in support of some program-
matic intervention. For examples, see Pokhrel et al. in
this series [32]. One might anticipate that if this were
the research being conducted, it would have a limited or
peripheral impact on understanding or managing of
NTDs.
In this paper, we examine the contribution of different
disciplines to NTDs research in the published literature
focusing on the role of the social sciences. The purpose
of the review is to provide a baseline for discussing the
quantum and nature of the science that is being
conducted.
Method
A bibliographic analysis was conducted of NTDs related
research papers published over the past 10 years in (a)
biomedical sciences (i.e., medicine and the human
health sciences), and in (b) the social sciences. The ana-
lysis had textual and bibliometric facets. Our reason for
looking at only published papers is straight forward.
Unpublished research does not have the breadth of
impact that is achieved by published research. It is often
not peer reviewed, and is not open to the same scrutiny
and discussion often required to influence policy.
Definitions
Defining, or operationalising “the social sciences” is key
to determining the quantum and nature of the contribu-
tion they make to NTDs research. Unfortunately, what
defines a social science is itself perennially contested
[33], and methodological and disciplinary debates about
what is or is not a science, a social science, or whether
social science is even a science, are commonplace (see
for instance [34]). Colleagues, particularly in disciplines
such as psychology and economics - in which the focus
can be (but often is not) on the individual - have at
times been quick to distance themselves from the social
sciences. Although it is not uncommon for researchers
from these disciplines to take up positions or research
funding designated for social scientists.
The matter is further complicated, because the bound-
aries between the social sciences and biomedicine are
not fixed, with many clinicians, identifying strongly with
Rudolph Virchow’s famous view that medicine is a
social science [35]:
Die Medizin ist eine soziale Wissenschaft, und die
Politik ist nichts weiter als Medizin im Gro�en.
Medicine is a social science, and politics is nothing
more than medicine writ large.
Some even hold the disturbingly arrogant position that
medicine is, in fact,"the most scientific of social
sciences” (p.55) [36].
For our purposes, we operationalised the social
sciences according to the database abstracting services
definition, to include the key areas of arts, business, eco-
nomics, psychology, and decision science. The Medical
and human health sciences were similarly operationa-
lised according to the abstracting services approach. The
definition, is thus, instrumental in nature. An article
belongs, prima facie, to the social sciences if, in con-
ducting a search using the social science disciplinary
categories provided by the database abstracting service,
that article is returned. This means that medicine and
the human health sciences may be social sciences, but
only when the work for medicine and human health
sciences is abstracted simultaneously under the social
sciences.
The reasonableness of this approach is discussed later,
and caveats occur in the analysis of the Results.
The Diseases
The aim of this review was not the comprehensive cov-
erage of the social sciences in all NTDs research, but to
examine a handful of examplar diseases. The choice of
the diseases was somewhat arbitrary settled on by
mutual agreement of the authors. Four arbor NTDs
were the focus of the present analysis: chikungunya [37],
dengue [38], visceral leishmaniasis [39], and onchocer-
ciasis [40] - see Table 1. Three of the diseases were of
direct interest to the original funders of this review -
dengue, visceral leishmaniasis and onchocerciasis (see
Acknowledgements), and one of the diseases (chikungu-
nya) was selected because of the recent increase in pro-
file that it appeared to have achieved.
Data
Source
The data for the bibliometric and textual analyses were
obtained from Scopus™, an on-line, commercial abstract
and citation database service offered by the publishing
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house, Elsevier. According to Elsevier, Scopus is the lar-
gest abstracts and citation database in the world. “All
titles that conform to academic quality norms, specifi-
cally peer-review, and are published in a timely manner
are accepted for consideration [in the Scopus database]”
[41]. Significantly, the Scopus database also includes all
articles abstracted in the US National Library of Medi-
cine’s Medline, PubMed databases, and it abstracts 350
book series. The lack of books in the database may bias
the findings, particularly in the social sciences which
historically have favoured books and book chapters. The
bias is likely to be less than in the past, however, with
an increasing trend in the social sciences towards the
publication of research in journals [42].
Extraction
Articles relating to the four NTDs were identified by
searching against the title, abstract and key words fields
(i.e., TITLE-ABS-KEY). for “chikungunya”, “dengue”, “visc-
eral leishmaniasis”, and “onchocerciasis,” respectively. It
was possible to limit searches further to those articles that
fell within particular disciplines, or subject areas. For the
social sciences articles, searches were limited to the Scopus
subject areas of: arts, busi[ness], dec[sion], econ[omics],
psyc[hology], and soci[al] - this conforms with the Scopus
definition of social sciences. For searches against the bio-
medical literature, searches were limited to the Scopus
subject areas of: medi[cine], nurs[ing], and heal[th]. Veter-
inary science, for instance was excluded from the search,
because the focus was human health. Only documents of
type “ar[ticle]” were selected, to focus on research articles
rather that reviews - although the separation between
these activities is certainly open to debate, and the data-
base itself is not consistent on this. The searches were also
limited to those papers published in the last 10 years (i.e.,
published after 1999)..
By way of an example, the search in the social sciences
for onchocerciasis literature was:
TITLE-ABS-KEY (onchocerciasis). AND DOCTYPE
(ar). AND SUBJAREA (arts OR busi OR deci OR econ
OR psyc OR soci). AND PUBYEAR AFT 1999 and the
equivalent search in the biomedical literature was:
TITLE-ABS-KEY (onchocerciasis). AND DOCTYPE
(ar). AND SUBJAREA (medi OR nurs OR heal). AND
PUBYEAR AFT 1999
After the relevant articles were identified, selected
fields including a unique identifier for each article, the
year of publication, the number of citations, the article
title, the journal title, the authors, the abstract, and the
authors’ affiliations were downloaded.
Analysis
The analysis combined exploratory and descriptive techni-
ques for the available quantitative data, and textual analy-
sis for the published abstracts The data from each search
was imported into its own table in a relational database.
Using the unique article identifier as the primary key it
was possible to examine the degree of overlap between the
biomedical and social sciences searches for each disease.
The research was conducted entirely on Open Source
platforms [43]. The operating system was the GNU/
Linux based Ubuntu 9.10 [44]. Word processing and
database management was handled in OpenOffice [45]
using the Zotero bibliographic database [46]. The data
analysis was handled in the R statistical package [47].
Results
Of the four NTDs investigated in this paper, over the
past 10 years dengue had the most publications (n =
2,344), followed by visceral leishmaniasis (n = 1,648),
onchocerciasis (n = 483), and chikungunya (n = 274).
The relative lack of publications associated with chikun-
gunya prompted an investigation of earlier citations.
Scopus records a total of 774 articles associated with
chikungunya, the first of which was published in 1957
[48]. Scientific interest in the disease, as demonstrated
by publications, remained at low levels, rising in the late
1960’s but declining again by the early 1980’s. It was not
until 2006 that there was a resurgence in scientific pub-
lications in the area. In contrast the annual number of
dengue publications has increased steadily from the
1960’s, a picture that is somewhat similar to that of visc-
eral leishmaniasis and onchocerciasis - although the lat-
ter has never attracted quite the same level of interest
as dengue or visceral leishmaniasis.
Table 1 The disease, agent vector, and general geographical distribution of the four reviewed diseases
Disease Agent Vector Distribution
Chikungunya Virus Mosquito species:
Aedes aegypti/Aedes albopictus
Asia, Africa, islands of the Indian Ocean
Dengue Virus (genus Flavivirus). Mosquito species:
Aedes aegypti/Aedes albopictus
South Asia and South East Asia, the Pacific and
South and Central America
Visceral
Leishmaniasis
Protozoan (various species
of the genus Leishmania).
Sandfly: Various species of sandfly (genus Lutzomyia in
the New World, and Phlebotomus in the Old World).
South America, East Africa, Mediterranean,
South Asia, China
Onchocerciasis Microfilarial nematode
(Species: O. volvulus).
Blackflies of the genus Simulium 99% of cases occur in Africa, mainly in the
central belt of Africa from the West to East
coast
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The quantum of disease specific research conducted in
the biomedical sciences and social sciences is shown in
Table 2. For all four diseases, the biomedical sciences,
unshared with the social sciences, account for more
than 95% of the publications, and in the case of visceral
leishmaniasis, it accounts for more than 99% of the pub-
lications. Conversely, the social sciences, unshared with
the biomedical sciences, usually accounts for less than
1.5% of the publications, and in one case around 0.1%.
Joint biomedical and social sciences publications are
similarly sparse. In aggregate, as a percentage of the
published research related to chikungunya, dengue,
onchocerciasis and visceral leishmaniasis, the research
identified as belonging to the social sciences represents
about 2.1% of the total output.
The Scopus abstracting service further divides the bio-
medical literature into component disciplines, and
within this there was overlap. Thus, almost all the
papers were indexed as medicine, and some were asso-
ciated with other disciplines as well. Immunology and
microbiology accounted for around 50% of the biomedi-
cal literature for all diseases except chikungunya (34%).
Biochemistry, genetics and molecular biology accounted
for between 3% (onchocerciasis) and 9% (visceral leish-
maniasis) of the biomedical literature. This analysis by
component disciplines makes less sense for the social
sciences literature, because those disciplines were so
poorly represented; and allocating one or two papers to
this discipline or that discipline, is hardly informative.
Of more interest in this case is to turn to the
abstracted data themselves to obtain a sense of the kind
of social science research that was being conducted in
these NTDs. The social sciences articles and the joint
social sciences and biomedical articles are discussed as a
whole.
There were few social sciences articles in the chikun-
gunya, visceral leishmaniasis, or onchocerciasis literature
over the past 10 year, so the presentation of data is in
the form of a series of cases. Nonetheless, there are per-
tinent themes that emerge.
A cursory examination of the institutional affiliation of
the authors reveals an interesting phenomenon. Depart-
ments of zoology, virology, molecular biology, microbiol-
ogy, etc., that is, departments associated with strong
clinical and biomedical disciplines, are producing a sur-
prising number of the social sciences papers. In contrast,
there are no departments of sociology or psychology pro-
ducing biomedical papers. One of two possibilities come
to mind. The first, and most positive interpretation, is that
biomedical departments are broad-based inter- or multi-
disciplinary centres of NTDs research. The second, and
less benign interpretation is that “social science research”
has become a cookbook activity in the NTDs area, with all
the attendant dangers of thoughtless research. For a dis-
cussion of some of these issues, see for instance [49-51].
Sensitivity analysis
The search strategy itself could miss studies that others
might consider to be social science research, because of
limitations in the database abstraction process. By way
of a sensitivity analysis, this was checked for the disease
onchocerciasis by removing any disciplinary restriction
and using the more inclusive search term:
TITLE-ABS-KEY (onchocerciasis). AND DOCTYPE
(ar). AND PUBYEAR AFT 1999,
The titles of all the extracted papers were examined,
and a subset were identified for which the abstracts
were also read. Studies judged by the authors (all of
whom are social scientists from three distinct disci-
plines) to have a social sciences component were then
compared with the papers identified using the Scopus
disciplinary identifiers.
Onchocerciasis was used as a test of the comprehen-
siveness of the Scopus search engine to identify social
science research. When the search was conducted with-
out any disciplinary restriction, 701 articles were identi-
fied. Of these 701 articles, 24 were social science articles
that had not been identified in the original search using
the Scopus disciplinary restrictions. This represents a
substantial increase over the 14 originally identified arti-
cles, but only brings the total number of social science
articles up to 38, or 7.5% of the 507 biomedical and
social sciences articles. The 24 newly identified studies
were almost exclusively joint social science and biomedi-
cine publications, and the majority (n = 14) related to
implementation research, such as studies of particular
strategies for the community directed delivery of iver-
mectin or doxycycline [52-56].
Chikungunya
Three of the chikungunya papers could be characterised
as socioepidemiological. Each one focused on a particu-
lar outbreak: one each from the the islands of Mayotte
and Reunion in the Indian Ocean [57,58], and a third
Table 2 For each disease, the number of publications is a
discipline and disease area is shown
Disease Biomedical
Science
Joint Social
Science
Total
Chikungunya 267
(97.4)
4
(1.5)
3
(1.1)
274
Dengue 2,270
(96.8)
33
(1.4)
41
(1.7)
2,344
Visceral
Leishmaniasis
1,641
(99.6)
5
(0.3)
2
(0.1)
1,648
Onchocerciasis 469
(97.1)
8
(1.7)
6
(1.2)
483
The percentage of the total number of publication for a disease is shown in
parentheses.
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described an outbreak in Italy [59]. The Mayotte and
Reunion papers were multidisciplinary looking at clini-
cal, behavioural, attitudinal, and environmental factors.
Two papers were discussion pieces on the globalisation
of infectious diseases [60,61]; and one paper was a tex-
tual analysis of the political discourse of risk that
occurred in Metropolitan France as it managed the out-
break on Reunion [37]. This latter paper is the only one
that could be described as an empirical, macro-level
study, and stands out for this as unusual across the four
NTDs areas examined.
Visceral Leishmaniasis
The visceral leishmaniasis literature is quite different,
with most of the studies barely (or not at all) characteri-
sable as coming out of the social sciences. Three of the
“social science” studies described n-of-1 clinical case
studies [62-64]. One “social science” study was of
asymptomatic individuals who were antibody positive
for T. Cruzi, and the serological complications asso-
ciated with those who were infected with visceral leish-
maniasis [65]; one study was of the distribution of the
sand-fly around US military bases in North America
(pre-empting the accidental importation of visceral
leishmaniasis by troops returning from Iraq) [66] There
was a case-control study of environmental risks asso-
ciated with having visceral leishmaniasis [67], and
another study looking at the distribution of canine and
human visceral leishmaniasis in Venezuala [68] These
latter two studies have broadly social components, but
remain largely biomedical in nature.
Onchocerciasis
The social sciences literature relating to onchocerciasisis
is larger (i.e., twice as many papers as the chikungunya
or the visceral leishmaniasis literature) and more
focussed. Speculatively, this may be attributable to the
presence of the unifying onchocerciasis control pro-
grammes in Africa [69]. Furthermore a significant pro-
portion of this literature was produced by TDR
supported scientists as part of a concerted effort to
increase the engagement of social science in disease
control programmes [29]. A control programme pro-
vides a clear line of research, for instance, around imple-
mentation and programmatic evaluation [26]. Two of
the studies (one qualitative and one qualitative and
quantitative) examined community directed treatment
programs [70,71], one study looked at social inequity in
treatment seeking [72], and another study looked at the
implications of the gender of the community workers
on the delivery of treatment [73]. There was research
from a large multi-country study looking at gender dif-
ferences associated with the stigma of onchocercal skin
disease [74]; and a qualitative study examined the com-
munity perceived benefits of ivermectin use in the treat-
ment of onchocerciasis revealed an under-estimation of
the district’s ivermectin needs [54]. It should also be
noted that most of the studies have been poorly cited,
with an average of 2.5 citations for each of the imple-
mentation research studies.
One study was misclassified as onchocerciasis
research, and a few studies had too little information to
evaluate. There was also a paper discussing tensions
between the need to preserve wetlands, and the poten-
tial health hazards posed by arbor infectious diseases,
including onchocerciasis [75].
One research note that stood out for its potential
described a “multidisciplinary project [that] aims to
investigate historical aspects of the arrival and spread of
the disease in Latin America and, to make comparative
studies of the history of the disease on both [the African
and South American] continents” [76]. The lack of any
follow up papers reporting substantial results suggests
that this incipient idea was not further developed.
Dengue
Of the four areas of NTDs research examined here, the
largest body of social sciences research identified in Sco-
pus belonged to dengue. A number of the studies identi-
fied by Scopus, however, were discarded from this
analysis because they failed even the most basic test of
being characterised as social sciences. Around 25% of
the studies were on the relationship of climate change
and the spread of dengue, but did not develop any parti-
cular social sciences theme e.g., [60,77-87]. A further
group of studies covered a diversity of subjects from the
development of insecticide impregnated fabrics [88,89],
drug development [90], and clinical case studies [91], to
mathematical models of disease transmission [92-94].
The extent to which these latter studies actually devel-
oped a social theme is hard to gauge. In a handful of
studies the information contained in Scopus was too
vague to make a determination. This left 42 studies
from the originally extracted 74; and even among these
42 there was some doubt in our minds about whether
they were truly social sciences articles.
The research did not divide neatly into themes in any
single area, such as “implementation research”, or stu-
dies of “knowledge attitude and behaviour”, but could
encompass multiple theme [95]. Health education
[96-100], and related community perceptions studies
were also themes of the social science research in den-
gue literature [101,102]. A common theme across many
of the papers was the inclusion of a spatio-temporal
component and the the use of geographic information
systems (GIS) [103-107].
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Discussion
The major limitation of this review, as in most, is in the
range and source of papers explored. The data were
restricted by a search of the literature on only four of
the NTDs, using one, albeit substantial database, with
one set of rules defining social and biomedical sciences.
Furthermore, the focus was on journals and not books.
The choice of disease was arbitrary and one might try
to argue that different choices would see substantially
different patterns of results. With the exception of HIV
which is admittedly not a NTD, it is difficult to bring to
mind any infectious disease that has a substantial social
sciences research presence. This is an empirical ques-
tion, however, and worthy of further research. Further-
more, alternative databases with alternative operational
definitions of the sciences could yield somewhat differ-
ent results. It should be remembered that in the sensi-
tivity analysis of the onchocerciasis literature, a
subsequent hand search of the database revealed many
more social sciences research articles than were identi-
fied using the Scopus operational definition. If a hand
search were conducted with the other diseases, similar
results may occur - providing a possible explanation for
the almost total absence of social science research in
visceral leishmaniasis. This too is an empirical question
and may be worthy of further investigation. The lack of
books and book chapters in the database will also
reduce the apparent presence of social science research.
It is worth bearing three points in mind, however:
1. If the existence of a research article cannot be
readily found in a search of the worlds largest data-
base of research articles, then the impact of that arti-
cle will be necessarily limited [108]. A search using
typical default options is going to be preferred, and
the literature identified in this way is more likely to
inform policy, practice, and future research. This may
also explain why the social sciences are tending to
favour journals more than they have in the past [42].
2. Even if the number of social research articles
(including interdisciplinary articles) identified in a
hand search doubled or even tripled the total num-
ber of social science articles, it remains a disturb-
ingly small quantum of the total research.
3. A substantial number of those articles identified
in the default search as social science research were
not. This creates a “two steps forward, one step
backwards” effect, further reinforcing the point
above about the proportionately small contribution
of pure and interdisciplinary social science research
to NTDs research.
The concern of this article was with the nature of the
research as much as it was with the quantum of
research. Although alternative search strategies may
improve the identified quantum of research, there is no
evidence to suggest that the nature of the unidentified
research is substantially different from the identified
research. It would be particularly disturbing if the uni-
dentified research was in fact different in approach or
better in quality.
The vast majority of the research literature related to
the four NTDs chikungunya, dengue, onchocerciasis and
visceral leishmaniasis belongs to biomedical research;
and, most of that research belongs to the discipline of
“medicine.” Aggregating the abstracted research across
all the disciplines of the social sciences and comparing
it to the total published research, it is clear that the
social sciences are neither a credible nor an important
part of the research agenda for these NTDs.
The direction (although not the magnitude) of our
findings could hardly be considered surprising. One
would readily anticipate that biomedical research would
form the greatest quantum of work in the field that is
specifically disease focussed. That the social sciences
contribution is only 2.1%, however, is confronting evi-
dence of how inconsequential the social sciences are
considered to be for understanding and managing these
NTDs. Unfortunately, even among that 2.1%, significant
amounts of research that were abstracted as associated
with the social sciences, clearly were not. For instance, 5
out of the total of 7 “social sciences” research papers in
the visceral leishmaniasis literature, were clearly unre-
lated to the social sciences. In the dengue literature,
over 40% of the 74 purportedly social sciences research
papers could be excluded on the basis of the title and
abstracts alone, with a number of the remaining papers
appearing not, or barely, to be social science related.
Things deteriorate on further examination. The figure
of 2.1% combined the “pure” social sciences research
with the cross disciplinary social and biomedical
sciences research. This of course is inflated, because the
incorrectly identified social science papers have not
been excluded. If one disaggregates the cross disciplin-
ary research and the “pure” social sciences research, the
contributions were around 1% and 1.1% of the research
literature, respectively.
One might counter that the social scientists are more
likely to publish book chapters and books that may not
be counted in this process. This is true. However, the
approach we have taken to investigating the extent of
the literature is also the kind of approach that
We would argue that, for the reasons previously iden-
tified, the social sciences, in and of themselves, have
important contributions to make to NTDs research.
Nonetheless, putting this notion aside, we focus on the
cross disciplinary research. It is through inter-disciplin-
ary (and to a lesser extent multi-disciplinary) research
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that the dynamic interplay between the vector, the host,
and the pathogen within a social, cultural, physical and
biological context can be understood. This would appear
to be central to understanding and managing NTDs.
Notwithstanding the importance of understanding
NTDs as a dynamic process, the cross-disciplinary
research accounts for barely 1% of the literature.
Where cross disciplinary research does occur, much of
it is programmatic evaluation of the kind common in
the onchocercal literature (e.g., [69,73]) or fairly rudi-
mentary risk factors research (e.g., [57,58]). Programma-
tic evaluation is important, but it is also likely to
constitute “hand maiden” research designed to support
(and never challenge) the curative activities of biomedi-
cal research. If one of the core ideas underpinning
scientific research is that it should challenge and con-
front existing dogma4, then this kind of adjuvant
research, though utilitarian, does not contribute to the
advancement of science because it is intended to sup-
port the activities of a dominant paradigm5. This is not
to say that programmatic research cannot be, or is not,
important. Indeed we (DDR and PA) have argued else-
where that implementation research is critical [26], but
it should not simply be about the identification of bot-
tlenecks to programme delivery, but about generating
new science. Parker and Allen in this series [31] provide
a detailed case-study and discussion of the dangers asso-
ciated with social science research as adjuvant research
for biomedicine.
Given the paucity of “pure” social science research
into these four NTDs, one would hope that the little
research that is being conducted would be exceptional.
There is no doubt that there is some important research
being published. Examples such as the analysis of the
policies of Metropolitan France and their effect on chi-
kungunya on the Reunion and Mayotte islands [37]; the
study of onchocerchal related stigma [74]; and the hint
of a comparative, historical study of onchocerciasis in
Africa and Latin America [76]; all point to the kind of
critical social science research that is investigator driven,
and is likely to have a direct impact on our understand-
ing diseases in question, and when brought to the atten-
tion of policy makers should effect disease management.
This is not to say that other social sciences studies did
not do this, but rather that many of them conformed
more to a model of adjuvant research described above
rather than the kind of critical, investigator driven
research that can guide our understanding and manage-
ment of the NTDs in their own right.
In juxtaposing biomedical research and social science
research, there is no criticism here of biomedical
researchers. They have engaged well in that very social
process of advocating for resources to advance
their own agendas and careers (see Allotey et al. in this
series [109]). The NTDs advocacy has relied on (a)
appeals to alleviate the suffering of societies’ most
neglected, and (b) the scientific promise of the ultimate
cure. Most of us would have attended an international
conference where the promise of a vaccine to prevent,
or a drug to cure, disease X is dangled enticingly,
“because there have been important breakthroughs
recently, and with an investment of only...” Most
recently we have even had the idea of a “vaccine against
poverty” peddled in the international literature (see
Allotey et al. in this issue for a more complete discus-
sion [109]). It is not difficult to see why funders and
research priority setters are attracted to such claims;
which even if mendacious - are well intentioned.
With far less appeal, social science research never
claims cure, but it may occasionally claim prevention,
although rarely with the same strident fervour. The
“ultimate cure” claim, of course, is predicated on our
capacity to ignore the dynamic interplay between the
vector, host, and pathogen that occurs within a social,
cultural, physical and biological context. The world of
the ultimate cure is a flat, and unsubtle world, that
rarely exists outside the confines of the petri dish or the
tightly controlled clinical trial [110]. The development
of drug resistance [111], non-compliance [14], lack of
access [112], cultural beliefs [113], and the structure of
the health system are a few of the very real issues for
NTDs, which do not concern flat world science. They
are nonetheless the important reality for social scientists.
Indeed, in one very recent paper on the appearance of
ivermectin resistant onchocerciasis, the biomedical
researchers response was a textbook, flat world call for
the development of “new therapeutic targets and agents ...
desperately needed to treat and cure this devastating
disease” (p.1) [111].
Virchow claimed that politics was medicine writ large,
and it is hard not to see the links between power pro-
cesses and the choices that are made about how disease
research is conceptualised, managed, prioritised, and
funded. The choices then have a direct effect on the
ways that we come to understand and manage NTDs.
Flat world research is surely a simpler message for fun-
ders and research priority setters to digest than a
research agenda that speaks to real world complexity
and does not even pretend to promise an ultimate cure.
Solutions for this less complex world are also easier for
funders and priority setters to on-sell to their political
masters. Thus, where there is no criticism of the biome-
dical sciences, there is a serious and pointed criticism to
be made of those who fund research and those who set
research priorities.
Social science research, and interdisciplinary research
should not be funded because social scientists want a
larger piece of the pie. It should be funded because
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human pathogenesis never occurs in a Petri dish, and it
occurs only relatively rarely within the confines of the
clinical trial. If we are to understand and manage
human pathogenesis on the scale of populations, then
there are important social and interdisciplinary ques-
tions to be addressed in NTDs research.
Although we suggest that social scientists are not
doing as much NTDs research as they should we also
recognise the realities of the research funding landscape.
In a high profile article from the late 1990s, the epide-
miologist Kenneth Rothman objected to the view that
anyone would claim that poverty was a concern for epi-
demiologists [114]. The objection was not that, as peo-
ple, epidemiologists should not be concerned with
poverty. Rather, the objection was that poverty was not
of concern to epidemiology as a scientific endeavour.
Furthermore, he argued, epidemiologists should be free
to select the areas of research that they think are most
relevant or interesting. Perhaps social scientists hold
similar views about the irrelevance of NTDs research,
and this explains the small presence of the social
sciences in the NTDs literature.
The reality is, however, that where the funders and
research priority setters may not be able to force epide-
miologists to study poverty, or social scientists to con-
duct NTDs research, they do have powerful and
persuasive, policy and financial instruments at their dis-
posal. These instruments could make almost anything
interesting to most scientists, because the science has
not only been identified as important, it has been identi-
fied as fundable. It is for this reason that the failure to
generate more social science research and much more
interdisciplinary research on NTDs lies squarely at the
feet of funders and priority setters.
Conclusion
Infectious diseases represent a rich and dynamic inter-
play between the vector (where applicable), the host,
and the pathogen. The interaction is complex and
evolves within a social and cultural context as much as
it does within a physical and biological context. Under-
standing this complex dynamic is crucial for the sustain-
able management of the NTDs.
The evidence from the literature, however, is that
there is little investigator driven social science to speak
of in the NTDs, and a similarly poor presence of inter-
disciplinary science. Without this, our understanding
and management of NTDs is inevitably reduced to a
strategy that relies on a repetitive, reductionist, flat-
world science to overcome an acknowledged complex
system.
NTDs research needs more sophisticated funders and
priority setters who are not beguiled by pharmaceutical
fairy-tales. Pharmaceuticals (including vaccines) are
critical, but they are not the only solutions, and their
final application is in complex dynamic worlds in which
bug (and vector) evolution exploits the social nature of
humans, and our responses have counter responses.
The current understanding of the dynamic, and the
understanding of how to develop sustainable approaches
to disease management are poor. There are no research
templates to overcome this, and the silos of current
NTDs science has discouraged the development of gen-
uinely interdisciplinary research.
As a major recommendation there is a need to recon-
ceptualise the outcomes for addressing the vulnerability of
those who get NTDs, and the need to reconceptualise the
ways in which the health needs of the neglected, poor, dis-
enfranchised and dispossessed are managed. Recognising
that the challenges cannot be reduced to solutions that
exist outside a real world context is a first step.
Appendix
1. A quote from a biomedical scientist sitting on a
panel reviewing health and medical research propo-
sals. Homologues of this will be familiar to many
social scientists working in global health.
2. We use the terms “inter-disciplinary,” “multi-disci-
plinary,” and “cross disciplinary” in three distinct
ways. We use “inter-disciplinary” to refer to research
that brings different disciplines together to obtain a
synthesis of ideas that are unobtainable from any
one discipline. We use “multi-disciplinary” to refer
to research that brings together more than one disci-
pline, but the disciplinary contributions are distinct;
thus, within a single research programme microbiol-
ogists will focus on questions relevant to microbiol-
ogy and economists will focus on questions relevant
to economists. We use “cross disciplinary” to refer
to research generically that is either inter- or multi-
disciplinary.
3. See, for instance, the paper by Allotey, et al [109]
in this collection.
4. “Falsification” in a Popperian nomenclature [115]
5. “Normal science” in a Kuhnian nomenclature
[116]
Acknowledgements
This review was funded by TDR, the Special Programme for Research and
Training on Tropical Diseases, which is executed by WHO and co-sponsored
by UNICEF, UNDP, the World Bank and WHO. The views expressed are those
of the authors and do not represent or reflect the decisions, policy or views
of the World Health Organization.
We would like to thank the Referees (Sara Melville and Sharon Fonn) for
their comments and suggestions.
Author details
1Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences,
Monash University, Malaysia. 2Health Economics Research Group, Brunel
University, West London, UK.
Reidpath et al. Health Research Policy and Systems 2011, 9:1
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Page 9 of 12
Authors’ contributions
DDR, PA, and SP conceived the study jointly. DDR conducted the research
and wrote the first draft. DDR, PA, and SP edited subsequent drafts. All
authors read and approved the final manuscript.
Competing interests
The authors declare that they have no competing interests.
Received: 21 May 2010 Accepted: 6 January 2011
Published: 6 January 2011
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doi:10.1186/1478-4505-9-1
Cite this article as: Reidpath et al.: Social sciences research in neglected
tropical diseases 2: A bibliographic analysis. Health Research Policy and
Systems 2011 9:1.
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