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

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.