"Are You Sure It's Not the Corona Vaccine?" An Ebola Vaccine Trial During COVID-19 in DRC

"Critiques of clinical trials have become a means to discuss the influence of the past in the present, and the way that power continues to operate through biomedical intervention."

In April 2020, the DRC-EB-001 Ebola vaccine trial in the Democratic Republic of the Congo (DRC) was suspended for five months to avoid potential COVID-19 transmission in its clinics. When the trial restarted vaccination, a rumour circulated in Goma that the second dose of the Ebola vaccine had been replaced with an experimental COVID-19 vaccine that pharmaceutical companies were clandestinely testing on Africans. In light of reignited criticism of Western-led clinical research on the continent, the ethnographic research detailed in this article highlights how COVID-19 influenced experiences of the Ebola vaccine trial and attitudes towards medical research in Goma, DRC.

To begin, the article outlines the political context during and after the Ebola epidemic in eastern DRC, the two vaccine trials in the region, and the arrival of the first wave of COVID-19. In brief, between August 2018 and June 2020, the DRC's 10th Ebola epidemic occurred in the east of the country, leading to 2,287 deaths. The introduction of the well-funded Ebola response into an area where basic services remain underfunded and people feel abandoned by the ruling class created distrust and even hostility. During the 22-month epidemic, two vaccines were deployed; there was popular debate about whose interests a second vaccine served. In this context of debate about clinical research in epidemics, the COVID-19 pandemic began. Rumours circulated that COVID-19, like Ebola, was a business opportunity for pharmaceutical companies and their Western backers. In particular, there was anxiety about COVID-19 vaccines.

The second section describes the impact of the COVID-19 pandemic on participant experiences of the DRC-EB-001 trial: the delayed second dose; the reignited controversy about medical experimentation in Africa; and the rumours that the second dose was an experimental COVID-19 vaccine, reinforcing the impression that Africans were being used disproportionately as the world's "guinea pigs".

The third section examines how the COVID-19 pandemic reignited medical research as a political space to discuss broader concerns about inequality, political economy, and social justice - both in a broader post-colonial context and in a specific context of local contestation. Cited here is White (2000), whose history of colonial Africa describes rumours not as misinformation but epistemologies through which people describe the "extractions and invasions" and "the working of power and knowledge" in their daily lives. As the authors of the present article write, rather than a rejection of medical research altogether, the critiques in Goma "represented a call for local ownership of science as well as investment in traditional forms of medical knowledge....Criticism of foreign-led vaccine trials can be understood as part of a popular demand for medical self-determination..."

Thus, by tracing the impact of the COVID-19 pandemic on experiences of the DRC-EB-001 Ebola vaccine trial in eastern DRC, this case illustrates the difficulties of adapting trial operations in contexts of uncertainty, while maintaining trust in trial procedures. In concluding, the authors argue that "discussions about clinical research have become a space for people to discuss broader concerns about inequality and governance, which are inseparable both from long-standing local contests, as well as historical and contemporary global inequalities....There is a need to recognize, and engage with, the popular political critiques of international intervention embedded in mistrust of vaccine trials, and the politics of inequality in which medical research is embedded..."