Outbreak narratives have justified rapid and sometimes draconian international policy responses and control measures. Yet there is a variety of other ways of framing haemorrhagic fevers. There present different views concerning who is at risk, and how? Is the ‘system’ of interacting social-disease ecological processes a local or a global one, and how do scales intersect? Should haemorrhagic fevers be understood in terms of short-term outbreaks, or as part of more ‘structural’, long-term social-disease-ecological interactions?

What of the perspectives of people living with the diseases in African settings? And what of uncertainties about disease dynamics, over longer as well as short time scales? This paper contrasts global outbreak narratives with three others which consider haemorrhagic fevers as deadly local disease events, in terms of culture and context, and in terms of long-term social and environmental dynamics. It considers the pathways of disease response associated with each, and how they might be better integrated to deal with haemorrhagic fevers in more effective, Sustainable and socially just ways.