Power, fairness and trust: understanding and engaging with vaccine trial participants and communities in the setting up the EBOVAC-Salone vaccine trial in Sierra Leone.
This paper discusses the establishment of a clinical trial of an Ebola vaccine candidate in Kambia District, Northern Sierra Leone during the epidemic, and analyses the role of social science research in ensuring that lessons from the socio-political context, the recent experience of the Ebola outbreak, and learning from previous clinical trials were incorporated in the development of community engagement strategies. The paper aims to provide a case study of an integrated social science and communications system in the start-up phase of the clinical trial.



The paper is based on qualitative research methods including ethnographic observation, interviews with trial participants and key stakeholder interviews.



Through the case study of EBOVAC Salone, the paper suggests ways in which research can be used to inform communication strategies before and during the setting up of the trial. It explores notions of power, fairness and trust emerging from analysis of the Sierra Leonean context and through ethnographic research, to reflect on three situations in which social scientists and community liaison officers worked together to ensure successful community engagement. Firstly, a section on "power" considers the pitfalls of considering communities as homogeneous and shows the importance of understanding intra-community power dynamics when engaging communities. Secondly, a section on "fairness" shows how local understandings of what is fair can help inform the design of volunteer recruitment strategies. Finally, a section on "trust" highlights how historically rooted rumours can be effectively addressed through active dialogue rather than through an approach focused on correcting misinformation.



The paper firstly emphasises the value of social science in the setting up of clinical trials, in terms of providing an in depth understanding of context and social dynamics. Secondly, the paper suggests the importance of a close collaboration between research and community engagement to effectively confront political and social dynamics, especially in the context of an epidemic.
University of Bath, Claverton Down Road, Bath, BA2 7AY, UK. l.enria@bath.ac.uk.
Luisa
0000-0002-6336-6531
L
Enria
London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Shelley
S
Lees
London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Elizabeth
E
Smout
London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Thomas
T
Mooney
College of Medicine and Allied Health Sciences (COMAHS), University of Sierra Leone, Fourah Bay College Campus, Freetown, Sierra Leone.
Angus F
AF
Tengbeh
College of Medicine and Allied Health Sciences (COMAHS), University of Sierra Leone, Fourah Bay College Campus, Freetown, Sierra Leone.
Bailah
B
Leigh
London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Brian
B
Greenwood
London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.|Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.
Deborah
D
Watson-Jones
London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Heidi
H
Larson
D000883:Anthropology; D000884:Anthropology, Cultural; D035843:Biomedical Research; D003142:Communication; D055812:Community-Based Participatory Research; D032882:Comprehension; D003299:Cooperative Behavior; D004196:Disease Outbreaks / Q000517:prevention & control; D046129:Ebola Vaccines; D058872:Epidemics; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D011209:Power, Psychological; D036301:Qualitative Research; D012111:Residence Characteristics; D012807:Sierra Leone / Q000453:epidemiology; D012935:Social Justice; D035502:Trust
D046129:Ebola Vaccines
Anthropology; Community engagement; Ebola; Sierra Leone; Vaccine trials