EBOLA VACCINE PROJECTS
Anthropology of Ebola Vaccine Trials in Sierra Leone and the Democratic Republic of Congo
We are conducting long-term anthropological research and a wide range of social science studies alongside Ebola vaccine trials in Sierra Leone and DRC. Our multifaceted studies are exploring understand vaccine and trial acceptability and outbreak preparedness.by conducting in depth social science research (anthropology). This research has examined understandings and experiences of Ebola and vaccines, as well as perspectives of the vaccine and theconcerns and rumors surrounding the trials as well as rumours, and concerns in Sierra Leone, and the Democratic Republic of Congo.
As part of the EBOVAC1 consortium(https://www.ebovac.org/the-trials/) we are conducting anthropological research alongside the EBOVAC Salone trial (https://www.ebovac.org/the-trials/the-trials-phase-3/) in Kambia, Sierra Leone. In Kambia, this research, led by Luisa Enria and Shelley Lees, has involved in-depth anthropological research with participants and local communities to explore acceptability of vaccines and the trial itself. We have taken an in-depth critical perspective to explore broader political economy questions of vaccine trials and future vaccine deployment.
Lees S & Enria L (2020) Comparative Ethnographies of Medical Research: Materiality, Social Relations, Citizenship and Hope in Tanzania and Sierra Leone. International Health (Special Issue: Spotlight on Global Health Research)
Enria L & Lees S (2018) Citizens, Dependents, Sons of the Soil: Defining Political Subjectivities through Encounters with Biomedicine during the Ebola epidemic in Sierra Leone Medical Anthropology Theory
Tengbeh, A.F. ; Enria, L. ; Smout, E. ; Mooney, T. ; Callaghan, M. ; Ishola, D. ; Leigh, B. ; Watson-Jones, D. ; Greenwood, B. ; Larson, H. ; Lees, S. ; "We are the heroes because we are ready to die for this country": Participants' decision-making and grounded ethics in an Ebola vaccine clinical trial. Soc Sci Med (2018) 203:35-42; DOI: 10.1016/j.socscimed.2018.03.008; PMID: 29544144 Open Access
Enria, L. ; Lees, S. ; Smout, E. ; Mooney, T. ; Tengbeh, A.F. ; Leigh, B. ; Greenwood, B. ; Watson-Jones, D. ; Larson, H. ; 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. BMC Public Health (2016) 16(1):1140; DOI: 10.1186/s12889-016-3799-x; PMID: 27821112 Open Access
The PREVAC study is a large, international clinical trial which in Sierra Leone is sponsored by the London School of Hygiene & Tropical Medicine (LSHTM) . PREVAC has been designed to gather some of the missing data on the three vaccine strategies. The study is evaluating the speed, intensity and duration of the immune responses generated by the vaccine strategies, as well as the safety and tolerability of the Ebola vaccines, particularly in children. See https://www.lshtm.ac.uk/newsevents/news/2018/prevac-ebola-vaccine-trial-begins-sierra-leone
Led by Luisa Enria and Shelley Lees social science research at the trial site in Mambolo is exploring acceptability of vaccines and the trial itself by participants, including children, as well as the local community. We have taken an in-depth critical perspective to explore broader political economy questions of vaccine trials and future vaccine deployment
The project PREVAC-UP (https://prevac-up.eu) is built around the PREVAC consortium and its main objective is to evaluate the long-term safety and the durability immune responses of three different Ebola vaccine regimens previously tested by the consortium for 5 years after vaccination, as well as to provide a trans-national platform for social and health science research, and sustain capacity building and training of scientists in the four participant African countries (Guinea, Liberia, Mali and Sierra Leone).
A social science workpackagework package led by Shelley Lees and Rose Burns is collaboration with colleagues at INSERM[SL1] (https://www.inserm.fr), COMAHS[SL2] (Sierra Leone)( https://usl.edu.sl/comahs/), CNFRSR [SL3] (Guinea)( http://mo.maferinyah.org), NPHIL (Liberia), USTTB [SL4] (Mali)( http://www.usttb.edu.ml) is collating evidence from ongoing social science research in the EBOVAC-Salone and the PREVAC trials described above. This research has revealed issues of power, fairness and trust surrounding the recruitment of participants into Ebola vaccine trials, which link to political and cultural concerns as well as participant’s motivations to take part in the trial was based on altruism, sacrifice, curiosity, and hope about the vaccine. Drawing on this experience this work package will involve expanding the social science activities to explore 1) Different models of community engagement at each site; 2) participant experiences of vaccine development and the clinical trials; and 3) the longer term impact of epidemics on people’s lives, and their experiences of epidemic responses as well as their understandings and experiences of health care
EBOVAC 3 Sierra Leone
EBOVAC3 is running clinical trials to gather safety and immunogenicity data on a two-dose Ebola vaccine regimen in infants in Sierra Leone and Guinea; as well as health care workers in an area affected by Ebola in the Democratic Republic of Congo (DRC). It will also follow up participants who received the vaccine regimen in the EBOVAC-Salone trial in Sierra Leone to assess the safety and immunogenicity of the regimen in the longer term
As part of the EBOVAC 3 consortium [SL5] (https://www.ebovac.org/ebovac-3/) a social science work package[SL6] is being conducting in three countries (Sierra Leone, Guinea and DRC) focussing on outbreak preparedness in order to garner recommendations for future responses to outbreaks. These studies will explore the legacy of the EBOVAC trial, future epidemic preparedness and community surveillance, perceptions of vaccination and vaccination strategies, and social network and contact pattern dynamics. a group of studies on preparedness. This includes exploring community experiences and perceptions of previous disease outbreaks, and perceptions and experiences of different Ebola vaccine deployment in three countries (Sierra Leone, Guinea and DRC) in order to garner recommendations for future responses to outbreaks. Secondly,
The Sierra Leone based research is led by Luisa Enria, Anthony Mansaray, Rose Burns and Shelley Lees (and formally Shona Lee) and includes the following components
- Legacy of the EBOVAC-Salone Trial
We are examining is the economic, infrastructural, and social impact of the EBOVAC-Salone trial in Kambia to understand the material and social legacies of the trial. This study aims to capture and preserve the institutional memory of EBOVAC1, as well as to trace post-trial career trajectories and explore capacities in human resources, research skills, and expertise built by the trial. Not only would this capture and preserve the institutional memory of EBOVAC1 before key members leave the project, but additionally serves as a baseline from which to trace post-trial career trajectories and the capacities in human resources, research skills, and expertise built by the trial.
- Future Epidemic Preparedness and Community Surveillance
An important aspect of outbreak response preparedness for vaccination deployment is surveillance. Toward the end of the West African epidemic, community health workers and volunteers came to play a key role in early detection and timely reporting to the health system during the West African Ebola outbreak. Given the infrastructural paucities in Sierra Leone’s health system exposed by the epidemic, interest in establishing community-based surveillance (CBS) mechanisms and improving contact tracing methods have gained momentum among the global health security community as an approach to address barriers to public health surveillance. Engaging community members to collect health information from within their communities and report it for public health surveillance purposes is increasingly gaining interest., and aA recently published output from a global technical meeting on Community Based Surveillance has sought to provide more clarity on a shared definition of CBS and establish guiding principles of best practice.
There is also increasing awareness that women, girls and other marginalised groups bear the heaviest burden of epidemics. Ebola and other recent epidemics such as COVID-19 have highlighted the urgent need for ‘gender responsive’ outbreak preparedness, response and recovery. The study will explore gendered ‘gaps’ in outbreak preparedness and develop recommendations for preparedness efforts through using both gender and health systems lenses.
- Perceptions of Vaccination and Acceptance of Vaccination Strategies
We are conducting a study to explore about community level hesitancancye towards such different vaccination approaches. Recent data emerging from the ongoing outbreak in the DRC demonstrates high acceptance of the Ebola vaccine, yet low acceptance of the ring vaccination and healthcare worker targeted strategies which are often characterised by perceptions of exclusion, political favouritism, and nepotism. This research is thus exploring vaccination strategies not as universally applicable policies, but within local contexts of implementation governed by institutional (mis)trust, memories of public health interventions, geopolitical landscapes, as well as trust in sources and methods of communication, to identify potential challenges and opportunities to different vaccination approaches. To identify the potential challenges and opportunities of various vaccination approaches, the research is exploring vaccination strategies not as universally applicable policies, but as situated within local contexts of implementation, governed by institutional (mis)trust, memories of public health interventions, geopolitical landscapes, as well as trust in sources and methods of communication
Following the outbreak of COVID-19 in March 2020, methods were adapted to ensure the safe conduct of continued research on community preparedness and response against the backdrop of an active epidemic. Research questions were also adapted to take into account recent deployments of COVID-19 and Ebola vaccines (deployed in view of a recent outbreak in Guinea), to consider how these experiences shape and are shaped by local perspectives on vaccination strategies. c.
- Social network and contact pattern dynamics
How people interact, including patterns of social contact, shape the transmission of infections. The majority of social contact survey studies have been carried out in Europe among general populations and communities, with far fewer focusing on household contacts. In addition, much less is known about physical contact patterns in African settings.
How people interact at different stages affects how infections can be transmitted and it is also important however to understand what happens to contact patterns between people. A systematic review of social contact survey studies revealed that the vast majority of social contact survey studies have been conducted in Europe among general populations and communities, with much fewer focusing on household contacts. Much less is known about physical contact patterns in African countries,
Anthropological approaches can aid mathematical modelling by helping to define the appropriate model and its structure. Participatory research can also be highly valuable in ensuring a meaningful interpretations of the model’s findings. This study aims to inform and improve estimations on the spread of infections by providing insights into contact patterns in West African settings. A fundamental way in which anthropological approaches can aid mathematical modelling is by helping to define the appropriate model and its structure. This could be the choice of modelling approach, model specification, and the domain of interest. Furthermore, participatory research can be highly valuable is the meaningful interpretation of the findings of the model.
A quantitative survey and geo-tracing methods are being piloted, alongside ethnographic observation and qualitative interview approaches, to test the practical application of these methods, which could be scaled to understand the complexities and differences in contact patterns within and between households. Data is being collected on movement and contact patterns among members of different age groups and genders in both rural (Kambia district) and urban (Freetown) settings.