The practice and ethics of collaboration in transnational medical research in East Africa. An ethnographic approach

International collaboration is essential for progress in global health research, especially for the development of innovative and effective drugs, interventions and vaccines. The main aim of this project has been to study such transnational collaborations from a social science perspective, and through its findings contribute to innovative, sustainable and effective, and fair and equitable global health research partnerships. In order to explore how international medical research collaborations work in practice, this project employed the methods of social anthropology - presence, engagement and participation. It examined the opportunities arising, challenges faced, and mechanisms and strategies pursued to make collaborations, from the perspectives of different stakeholders, including African, European and American scientists and ethicists. In addition, the project studied African study populations and publics. The project found that collaborations remain the key source of funding and expertise for biomedical research in East Africa, and that the expectation that East African governments will fund and direct research within their jurisdiction is unlikely to be fulfilled in the foreseeable future. Due to the largely unidirectional flow of collaborative resources and expertise, scientific research agendas mostly still come from the Global North, although Global Southern scientists have gradually increased their potential to shape collaborative research. One of the reasons for this is that the interest of Northern scientists and institutions interests tend to focus around successive cutting edge-topics, publishable in top journals, which limits research in East Africa to few areas that do not necessarily reflect research priorities as seen by local scientists. At the same time, Southern scientists have to adapt to shifting, short-term collaborative research opportunities, which prevents them from building coherent scientific lives - i.e. accumulating expertise and authority in their own fields and mentoring junior colleagues. For the same reason, and the lack of local sources of funding, collaborations rarely lead to local research groups consistently working on specific research areas over time. This makes it all the more difficult for the research groups to gain international leadership, and accumulate knowledge and mentor future African researchers. The project found that lasting research groups and predictable research funding are found only in international, foreign-funded research sites outside formal academic institutions. There were no long-lasting research groups, sustained by predictable funding sources and led by permanently employed academics to be found in established East African universities. Based on these findings, the project recommends that the creation of sustainable, locally rooted, enduring and productive cutting-edge research groups, anchored in leading East African Universities should be a priority for international scientific collaborations. Ultimately, collaborative mechanisms should foreground the interests and capabilities of Southern researchers over those of Northern institutions. Finally, the project found that there is a clear need for frank, consistent and progressive dialogue between researchers, funders and administrators in the Global North and South on questions of scientific pursuit and capacity building. The project recommends that in order to strengthen international medical research collaborations, we need an open and critical dialogue about what kinds of capacities and capabilities are and should be enabled and/or disenabled through collaborations. This project is funded by GLOBVAC and is part of the EDCTP2-Program supported by the European Union.

This project will benefit society in two interrelated ways: (1) internationally, it will contribute to the making of more equitable and truly collaborative scientific partnerships, thus enabling the full scientific potential of all partners and facilitating stronger health science, which is urgently needed to face up to key global challenges in health and social justice; (2) nationally, it will help to generate cutting-edge empirically-based expertise on transnational global health collaboration, which is in short supply, and position global health ethicists and social scientists in a good position to provide important recommendations and make a distinct contribution to the growing global health landscape. The proceedings of the end of project dissemination conference that brought together leading scholars on global health collaborations will be published as a book to stimulate debate on inequalities in global health research collaborations with view to finding lasting solutions.

This anthropological project will ethnographically study the work of scientific collaboration around East Africa's two leading research universities, Nairobi and Makerere. International collaboration is essential for progress in global health research, and especially for the development of innovative and effective drugs, interventions and vaccines, as well as for the sustainable implementations of research findings under diverse epidemiological and health systems conditions. Such collaboration operates across stark differences in medical, technical, educational, and socio-economic conditions, which in themselves are often key to the health problems global health research is about. Hence, collaboration is at times challenging work, which in addition to scientists, involves local technicians, laboratories and health providers, research participants and their communities, local publics and media, and ethicists, policy makers and funders. The proposed study will use ethnographic methods, including long-term presence in research sites, observation and conversations, interviews discussions, case studies and surveys, to examine motivations, experiences and perceptions of different stakeholders, the challenges they face, their divergent interests and alliances, and their strategies to create and sustain various models of collaborative research. This research is timely in view of recent debates about global health North/South collaboration among scientists, ethicists and funders, and social scientists; and it responds to calls for more empirically grounded social research on the ethical and practical challenges of global health science. Such research will enhance the understanding of international collaborative research work, facilitate more open debate about challenges and solutions, including scientists and other stakeholders in the conversation, and thus further better, more equitable collaborative health research to take on mounting global health challenges. This project is funded by GLOBVAC and is part of the EDCTP2-Program supported by the European Union.