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'He is now like a brother, I can even give him some blood' - Relational ethics and material exchanges in a malaria vaccine 'trial community' in The Gambia

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  • Geissler, P. Wenzel
  • Kelly, Ann
  • Imoukhuede, Babatunde
  • Pool, Robert

Abstract

This paper explores social relations within the 'trial community' (staff and volunteers) of a Malaria Vaccine Trial (MVT), implemented by the Medical Research Council (MRC) in The Gambia between 2001 and 2004. It situates ethical concerns with medical research within the everyday life of scientific fieldwork. Based upon discussions with volunteers and staff, we explore processes of mediation between scientific project and study population, and between formal ethics, local ethical debates and everyday practice. We observe that material contact and substantial transactions, notably of blood and medicine, are central to the construction of the MVT. These transactions are guided by a concrete and relational form of ethics, which contrasts with the abstract and vertical formal ethical principles underwriting the scientific study protocol. The success of the MVT owed much to these kinship-like ethics. One possible conclusion from these observations is that research ethics should be understood, not just as a quasi-legal frame but also as an open, searching movement, much in the same way that kinship is not merely a juridical institution and a prescriptive frame of rules, but a network made through relational work. However, this conclusion raises new problems: by contrasting formal, abstract principles to intimate, immediate relations, and economic justice to personal morality, we accept that the order of medical research is moved further out of the public and political, and into the domains of either quasi-legal claims or of private morality. Irrespective of the undeniable importance of clear-cut rules and of good face-to-face relations, a third essential foundation of medical research ethics is the democratically constituted public sphere, including equitable health services, and transparent institutions to facilitate open debate and regulate particular interests. Ultimately, the ethics of global science can rely neither on principles nor trust but requires citizenship and democratic government.

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  • Geissler, P. Wenzel & Kelly, Ann & Imoukhuede, Babatunde & Pool, Robert, 2008. "'He is now like a brother, I can even give him some blood' - Relational ethics and material exchanges in a malaria vaccine 'trial community' in The Gambia," Social Science & Medicine, Elsevier, vol. 67(5), pages 696-707, September.
    • Handle: RePEc:eee:socmed:v:67:y:2008:i:5:p:696-707
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    References listed on IDEAS

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    1. Molyneux, C.S. & Peshu, N. & Marsh, K., 2005. "Trust and informed consent: insights from community members on the Kenyan coast," Social Science & Medicine, Elsevier, vol. 61(7), pages 1463-1473, October.
    2. Fairhead, James & Leach, Melissa & Small, Mary, 2006. "Where techno-science meets poverty: Medical research and the economy of blood in The Gambia, West Africa," Social Science & Medicine, Elsevier, vol. 63(4), pages 1109-1120, August.
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    Cited by:

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    2. Sheikh, Zainab Afshan & Jensen, Anja M.B., 2019. "Channeling hope: An ethnographic study of how research encounters become meaningful for families suffering from genetic disease in Pakistan," Social Science & Medicine, Elsevier, vol. 228(C), pages 103-110.
    3. Reynolds, Lindsey & Cousins, Thomas & Newell, Marie-Louise & Imrie, John, 2013. "The social dynamics of consent and refusal in HIV surveillance in rural South Africa," Social Science & Medicine, Elsevier, vol. 77(C), pages 118-125.
    4. Hutchinson, Eleanor & Nayiga, Susan & Nabirye, Christine & Taaka, Lilian & Staedke, Sarah G., 2018. "Data value and care value in the practice of health systems: A case study in Uganda," Social Science & Medicine, Elsevier, vol. 211(C), pages 123-130.
    5. Molyneux, Sassy & Geissler, P. Wenzel, 2008. "Ethics and the ethnography of medical research in Africa," Social Science & Medicine, Elsevier, vol. 67(5), pages 685-695, September.
    6. Sariola, Salla & Simpson, Bob, 2011. "Theorising the 'human subject' in biomedical research: International clinical trials and bioethics discourses in contemporary Sri Lanka," Social Science & Medicine, Elsevier, vol. 73(4), pages 515-521, August.
    7. Wahlberg, Ayo & Rehmann-Sutter, Christoph & Sleeboom-Faulkner, Margaret & Lu, Guangxiu & Döring, Ole & Cong, Yali & Laska-Formejster, Alicja & He, Jing & Chen, Haidan & Gottweis, Herbert & Rose, Nikol, 2013. "From global bioethics to ethical governance of biomedical research collaborations," Social Science & Medicine, Elsevier, vol. 98(C), pages 293-300.
    8. Lawrence, David S. & Ssali, Agnes & Moshashane, Neo & Nabaggala, Georgina & Maphane, Lebogang & Harrison, Thomas S. & Meya, David B. & Jarvis, Joseph N. & Seeley, Janet, 2022. "Decision making in a clinical trial for a life-threatening illness: Therapeutic expectation, not misconception," Social Science & Medicine, Elsevier, vol. 305(C).
    9. Brisbois, Ben & Plamondon, Katrina, 2018. "The possible worlds of global health research: An ethics-focused discourse analysis," Social Science & Medicine, Elsevier, vol. 196(C), pages 142-149.
    10. Fehr, Alexandra & Muela, Joan & Nieto-Sanchez, Claudia & Manneh, Ebrima & Baldeh, Dullo & Ceesay, Omar & Bardají, Azucena & Zuiderent-Jerak, Teun & Bunders-Aelen, Joske, 2021. "The role of social cohesion in the implementation and coverage of a mass drug administration trial for malaria control in the Gambia: An in-depth comparison of two intervention villages," Social Science & Medicine, Elsevier, vol. 291(C).
    11. Gouda, H.N. & Kelly-Hanku, A. & Wilson, L. & Maraga, S. & Riley, I.D., 2016. "“Whenever they cry, I cry with them”: Reciprocal relationships and the role of ethics in a verbal autopsy study in Papua New Guinea," Social Science & Medicine, Elsevier, vol. 163(C), pages 1-9.
    12. Kelly, Ann H. & Ameh, David & Majambere, Silas & Lindsay, Steve & Pinder, Margaret, 2010. "'Like sugar and honey': The embedded ethics of a larval control project in The Gambia," Social Science & Medicine, Elsevier, vol. 70(12), pages 1912-1919, June.

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