Paper short abstract:

This paper argues that those involved in international health research must address questions of inequalities and social justice openly and directly in community engagement activities, and attempt to engage materially, through a broader distribution of resources and by means of health advocacy.

Paper long abstract:

This paper discusses the understandings and practices of community engagement (CE) in vaccine trials conducted in resource-limited settings. It draws on ethnographic fieldwork conducted between 2008-2010 within the context of paediatric trials run by the Kenyan Medical Research Institute and the US Centers for Disease Control and Prevention (KEMRI/CDC) in Kenya.

My works suggests that CE is socially constructed, context-specific and that it arises out of a particular history and framing of relationships between researchers and the 'community'. It is characterised by underlying ideas and assumptions about the nature of the 'community', and distinct ideas about what 'engagement' with science and 'collaboration' in bio-medical research mean and involve. At KEMRI/CDC the 'local community' is viewed by staff as separate from the 'research community' and much emphasis is placed on information exchange to address differentials or deficiencies in experience and understanding on the community's part. CE is however more contradictory and complicated than a simple meeting or exchange between scientists, community intermediaries and lay people. Such meetings are characterized by power differentials, differential access to resources, and related expectations of material assistance. Neglecting such tensions is not helpful since it tends to relegate community concerns to being seen as less important than the transfer of knowledge. This is counterproductive since material engagements, whether in the form of care giving for vaccine trial participants or infrastructural developments at government health facilities are welcomed as an expression of solidarity, result in increased acceptance of research and closer collaboration between researchers and community members.