Global Vaccine Logics
CIHR-funded international research project
3 year Project Scheme- 1st Live Pilot
The West African Ebola virus disease (EVD) outbreak heightened global awareness that effective interventions require community engagement and trust. We will develop an evidence-based, contextually-sensitive and flexible decision-making framework for use by national health authorities in low income countries to prioritize health interventions and strengthen community health surveillance and response. Building from an existing Canadian model, the framework will integrate diverse informant understandings and logics based on experiences during the:
1) Ebola Mobile lab unit interventions and
2) Ebola vaccine trial (rVSV-ZEBOV) collaboration of the Government of Guinea, WHO, Médecins Sans Frontiéres, and the Norwegian Institute of Public Health.
Scarce knowledge exists on how EVD interventions were received in communities and how they interacted with community health workers. Understanding the social factors surrounding implementation is crucial to strengthening health systems and enhancing ability to detect and respond to future outbreaks and health emergencies. Studies show that intervention technologies subject to global decision-making rationales can impart logics that run counter to local understandings. These misunderstandings may spark rumours and even riots, wreaking havoc on emergency response team and routine immunization efforts alike. The EVD outbreak signalled an urgent need to develop more culturally-sensitive, evidence-based frameworks for rapid healthcare response. Deaths might have been reduced had a community-based surveillance and response system already been an integral part of the health system.
The scale of the Ebola outbreak could have been reduced had community surveillance and response been part of a general health system and had experimental vaccines neglected on lab shelves been tested, approved and available. To address this, we will examine the global technical mobilization and local community engagements and responses to EVD in two interventions: the i) mobile lab units and ii) Ebola vaccine trial.
This research brings together an interdisciplinary team of social science, epidemiology and clinical experts from the Guinean Ministry of Health and Ebola vaccine trials (MKK, MD), the Canadian Immunology Research Network (C Q-T, JL, ED,JG), CNRS tropical infectious diseases (HCB, OT), U Manitoba’s Centre for Global Public Health (RL), and integral collaborations with the U Florida based Ebola 100 Study (SA) and Institut Pasteur analyses of biomedical engagement in the Ebola epidemic (T G-V, AS). Our objectives are to:
1) Gather and analyze the experiential knowledge held by those directly engaged during the Ebola epidemic. Key informant interviews will be conducted with scientists, clinicians, researchers, health officials, manufacturers, community health workers and communities to analyze their roles and experiences with vaccine trials, mobile labs, surveillance and health services linkage.
2) Develop a flexible deliberative framework that enables actors to make decisions around future vaccine trials and particular health service linkages in “hard-to-reach” locations. A participatory qualitative health systems approach to knowledge exchange will be employed to develop the framework. Experts and lay communities will be guided through ethnographic scenarios based on Objective 1, to develop an analytical decision making framework that will manage a diversity of knowledge “logics” and prioritize local needs, safety and effectiveness.
3) Integrate the analytical decision-making framework within multilateral organization preparedness strategies. In collaboration with local communities, national and international health officials, our framework will integrate expert and local knowledge to develop guidelines for training local health workers as sentinels for community surveillance and response and plan intervention strategies.