Paper short abstract:

This paper explores the ways in which a research institute has altered the local context of health seeking and delivery through the ground-level conduct of TB vaccine trials.

Paper long abstract:

Clinical trials on new vaccines remain a high priority on the global TB research agenda given the devastating impact TB is having in the developing world and the continuing proliferation of drug resistant strains of the disease. The South African Tuberculosis Vaccines Initiative (SATVI) has been conducting vaccine trials in the Western Cape for 15 years, acting under the self-professed mandate to contribute to the 'greater good' of a new vaccine that will radically strengthen efforts at the primary healthcare level to combat TB.

This paper explores the differential relationship that SATVI has with the TB hospital in which it is based and the primary healthcare clinics in the region. In particular, SATVI has contributed technologies such as digital X-ray machines to the hospital, greatly improving the ability of doctors to diagnose and manage complex cases of TB. Yet SATVI's 'contributions' at the primary healthcare level, where the majority of SATVI's day-to-day research activity takes place, are less to do with resource donation and more the indirect spinoffs of the research process (e.g. early case detection among participants). In fact, filling the voids left by, and even bypassing, the local clinic structures, SATVI's research potentially thrives at the expense of primary healthcare. This paper therefore examines the implication of clinical research in enduring inequities between primary and secondary care in post-apartheid South Africa.