Living with Disease: Rethinking Endemicity and the Mathematics of “Permanent Epidemics” in African Contexts

Global infectious disease research is largely structured around the logic of outbreaks: sudden events that demand rapid control, elimination, and return to “normal.” Yet in much of Africa, including Nigeria, many infectious diseases—such as malaria, Lassa fever, and cholera—are not exceptional events but enduring features of social, ecological, and economic life. This project proposes a conceptual and mathematical rethinking of infectious disease dynamics by shifting the focus from outbreaks to endemicity, understood as a condition of long-term co-existence rather than a temporary crisis. Using mathematical modelling as a central analytical tool, the project will examine how standard epidemiological frameworks implicitly assume stability, compliance, and institutional capacity that often do not hold in contexts of structural inequality. It will develop alternative modelling perspectives that better capture chronic instability, seasonal resurgence, multi-pathogen environments, and adaptive human behaviour. Nigeria will serve as an empirically grounded case, with the aim of generating insights of broader relevance to the Global South. Situated within the interdisciplinary environment of STIAS, the project will engage with scholars in public health, sociology, history, and ethics to reflect on how notions of control, risk, and normality are embedded in mathematical models. By reconceptualising endemic disease as a “permanent epidemic,” the project seeks to contribute to more context-sensitive and theoretically robust approaches to infectious disease modelling and policy thinking in Africa and beyond.