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

London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Social Science & Medicine (Impact Factor: 2.89). 06/2008; 67(5):696-707. DOI: 10.1016/j.socscimed.2008.02.004
Source: PubMed


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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Available from: Ann Horton Kelly, Jul 24, 2014
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    • "Failure pertains to the functions of (bio)ethics, which has been analyzed by scholars (and edited volumes) as variable, singular and universal, context driven, and embedded in regulation, knowledge production, economic disparities, and political economy to name a few (Cooper and Waldby 2014; Fisher 2009; Geissler 2015; Geissler and Molyneux 2011; Kingori 2013; Petryna 2009; Molyneux and Geissler 2008; Rosengarten and Michael 2013; Sunder Rajan 2012; see also Cohen 1999 and Hamdy 2012). Failure might be inevitable (or not), given the inequalities found between wealthy overseas research institutions and their impoverished neighboring communities and research collaborators (Crane 2013; Farmer 2002; Fairhead, Leach, and Small 2006; Geissler et al. 2008; Gikonyo et al. 2008; Reynolds et al. 2012; Wendland 2008). 14 In analyzing the politics of PrEP in Malawi, we wish to draw upon many of these insights, especially Cooper and Waldby (2014); Fisher (2009); and Sunder Rajan (2009; 2012) who examine the politics of neoliberalism and imperialism when it comes to offshored and privatized research. "
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    • "When we visited the country programme for malaria – which also received Global Fund money – they demonstrated that they knew there were high levels of endemic malaria in the country, including among pregnant women and small children (Geissler, Kelly, Imoukhuede, & Pool, 2008). They also found an alarming prevalence of endemic anaemia, both findings that are important for strategies into MCH. "
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    • "Please cite this article in press as: Wahlberg, A., et al., From global bioethics to ethical governance of biomedical research collaborations, Social Science & Medicine (2013), variously posed relational and situational ethics as counters to the claims of universal systemic ethics " (see also Bharadwaj & Glasner, 2009; Molyneux & Geissler, 2008; Petryna, 2007; Sleeboom- Faulkner, 2010), since ethics are seen as emerging in response to particular practices rather than as something that can be imposed from without. Ethnographic studies of 'research subject communities' show how there is considerable 'ethical variability' or 'ethical flexibility' depending on the context within which research is being carried out, most visibly perhaps in contexts of public health crisis, raising questions about the feasibility of a universalised bioethics. "
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