Community &Vaccine Bill Brieger | 19 Jun 2009 02:19 am
Malaria immunization involves more than an effective vaccine
On Wednesday the Globe and Mail reported on efforts of a malaria vaccine trial in the Kenyan coastal district of Kilifi. The researchers are happy that the “vaccine reduced the risk of clinical episodes of malaria by 53 per cent over an eight-month period.” According to GSK, “large-scale phase lll vaccine efficacy trials in seven African countries across 11 sites. If these trials confirm the safety and efficacy of the candidate vaccine, it could be filed for registration.”
The villagers in Kilifi may have other concerns. Zoe Alsop in the Globe and Mail outlines several of these:
- the Caduseus medical symbol on project vehicles contains a snake, but this is a ‘demonic symbol’ to the villagers
- as a research project, blood samples are taken, but villagers fear this is ‘a lot’ and may be used for evil purposes
- villagers are generally skeptical because of “a long history of neglect and corruption in Kenya’s public health-care sector and government in general”
- people do not fully understand the nature of research trials and believe the vaccine is already approved
The researchers are facing the practical problems of any drug trial in communities that do not have good experiences with or full understandings of the workings of western science. ‘Meticulous explanations‘ may not be enough to overcome fears, and trust can be shattered when a person in a control group gets sick from the drug that was supposed to prevent or heal. The process of signing formal consent documents itself may cause suspicion.
Vaccine programs over the years have faced their own hurdles, even when the offered on a regular basis. One only has to witness the enormous challenges that the polio vaccine effort confronted in the face of widespread community resistance in Nigeria. Ordinary occurrences such as side effects like fever or redness/pain at the immunization site discourage people.
Then there are the unethical research practices like Pfizer’s testing of a meningitis antibiotic in Kano, Nigeria that result in death and widespread fears of any future effort to help people.
The malaria vaccine researchers have conducted the perfunctory meetings with village chiefs and village information sessions. It is not clear if the team involved social scientists in advance to learn more about people’s views and experiences of malaria and vaccines and engage the community in full dialogue about these issues. It is not too late, but a word to the wise for any health research or intervention program: learn from the people first before you can expect them to learn something new from you. These villagers have lived in the community for generations and will be left behind when your program finished – show them some respect, and your own efforts will be rewarded.