IDS working papers;218

Childhood vaccination and society in The Gambia : public engagement with science and delivery

Published on 1 January 2004

This paper examines public engagement with routine vaccination delivery, and vaccine trials and related
medical research, in The Gambia. Its approach is rooted in social and medical anthropology and ethnographic
methods, but combines insights from the sociology of scientific knowledge, and ‘actor-oriented” sociology in
development. Current analysis and professional reflection on public engagement with vaccination reflects the
concepts and imperatives of health-providing and research institutions. In contrast Gambian parents’
perspectives are couched in very different conceptual and experiential terms, linked to the wider dilemmas of
raising infants in a hazardous world. In this context the paper traces parents’ experiences of routine infant
welfare clinics and then how they narrate their experiences with two vaccine related studies orchestrated by
the Medical Research Council laboratories. A range of contrasts emerges. Whereas health professionals tend
to attribute vaccination acceptance to the acquisition of modern scientific attitudes, and talk of “defaulters” as
misinformed, parents understand vaccination as a complement to other forms of infant therapy and
protection and miss vaccinations through a combination of contingent circumstances and specific worries
about vaccination delivery practices. Most parents consider medical research studies less as a separate
“scientific” activity than as part of the nexus of normal health practices, and their longer-term experiences and
perceptions of MRC as an institution matter more than the aims of any particular study. Whereas medical
research staff often perceive public engagement as a matter of understanding or misunderstanding aims and
procedures, or of trust and distrust, parental narratives reveal research engagement as a balance of danger and
benefit. Study participation depends more on how people’s particular calculus is shaped by social and gender
relations, than on issues of knowledge or trust.

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