James Myfanwy, Kasereka Joseph Grace, Kasiwa Benjamin, Kavunga-Membo Hugo, Kambale Kasonia, Grais Rebecca, Muyembe-Tamfum Jean-Jacques, Bausch Daniel G, Watson-Jones Deborah, Lees Shelley
London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom; Department of International Development, University of Oxford, Oxford, United Kingdom.
Ebola Vaccine Deployment Acceptance and Compliance, Goma, Congo.
Soc Sci Med. 2023 Apr;323:115833. doi: 10.1016/j.socscimed.2023.115833. Epub 2023 Mar 15.
During the 10th Ebola virus disease (EVD) epidemic in the eastern Democratic Republic of the Congo (DRC) (2018-2020), two experimental EVD vaccines were deployed in North Kivu. This province has been at the centre of conflict in the region for the last 25 years. Amidst ambivalence towards protracted foreign intervention and controversy about introducing two experimental vaccines, the existing literature has focused on mistrust and 'resistance' towards the Ebola response and vaccines. In this article, we examine why people in the eastern DRC did decide to volunteer for a trial of a second EVD vaccine in North Kivu, despite the controversy. Drawing on ethnographic observation, interviews, and focus groups with trial participants conducted between September 2020 and April 2021, we analyse three motivations for participating: protection, health seeking, and expectations surrounding travel requirements. We make three points. First, participation in vaccine trials may be understood locally to have advantages which have not been considered by the trial, because they go beyond medical considerations and are specific to a particular social setting. Second, despite much of the literature focusing on a causal relationship between rumours and 'vaccine hesitancy', some rumours may in fact encourage participation. Third, material objects associated with trial participation - such as participant vaccine cards - can hold social and political meaning beyond the confines of the vaccine clinic, and influence decisions surrounding participation. Empirical investigation of how medical interventions become entangled in political economies is essential to understanding the perceived functions of participation, and thus the reasons why people volunteer in clinical trials. Participants' narratives about their decision-making provide an insight into how international bioethical debates interact with, but may also stand apart from, the situated social and economic realities driving decision-making around clinical trials on the ground. This highlights the need for ethical approaches that foreground the political, social, and economic context.
在刚果民主共和国（DRC）东部发生的第十次埃博拉病毒病（EVD）疫情期间（2018 - 2020年），两种实验性埃博拉病毒病疫苗在北基伍省进行了部署。在过去25年里，该省一直是该地区冲突的中心。在对长期外国干预的矛盾态度以及引入两种实验性疫苗的争议中，现有文献聚焦于对埃博拉应对措施和疫苗的不信任及“抵制”。在本文中，我们探究了尽管存在争议，但刚果民主共和国东部的人们为何仍决定自愿参与北基伍省第二种埃博拉病毒病疫苗的试验。通过2020年9月至2021年4月期间对试验参与者进行的人种志观察、访谈和焦点小组讨论，我们分析了参与试验的三个动机：保护、寻求健康以及围绕出行要求的期望。我们提出三点看法。第一，在当地，参与疫苗试验可能被认为具有试验未考虑到的优势，因为这些优势超越了医学考量，且特定于某一特定社会背景。第二，尽管许多文献关注谣言与“疫苗犹豫”之间的因果关系，但有些谣言实际上可能会鼓励参与。第三，与试验参与相关的实物——如参与者疫苗接种卡——在疫苗诊所范围之外可能具有社会和政治意义，并影响有关参与的决策。对医疗干预如何在政治经济中相互交织进行实证研究，对于理解参与的感知功能以及人们自愿参与临床试验的原因至关重要。参与者关于其决策过程的叙述，有助于深入了解国际生物伦理辩论如何与推动实地临床试验决策的具体社会和经济现实相互作用，但也可能与之有所不同。这凸显了需要采用突出政治、社会和经济背景的伦理方法。
