Community-rooted science: a pathway to accelerating vaccine discovery

The field of vaccine discovery has been characterized by rapid advances in the science, technology, and platforms used. There is an abundance of vaccine approaches, and targets being explored and vaccine delivery approaches — all aimed at securing the future of disease prevention. In all these advances, the contribution of communities remains a constant ingredient for success in advancing research and development (R&D).

Dancan Otieno of KEMRI Malindi addressing young people at Malindi Hospital in August 2022

From reviewing study protocols to participation in clinical trials, communities serve as active contributors in vaccine discovery and testing. This involvement is guided by deliberate and meaningful engagement that promotes mutual learning and benefit for scientists and communities.

In some instances, community engagement has been used primarily as a tool for recruitment of clinical trial participants. While involving communities might be effective in enrolling volunteers, effective engagement of communities in vaccine research has the more meaningful benefit of fostering local ownership and building sustainable capacity for R&D. It also contributes to stronger health systems while ensuring the ethical conduct of research, including the availability of high quality on-site health services and referral pathways for volunteers and communities.

“In our quest to translate science into global health impact, we prioritize community engagement so that we can develop tools that are acceptable, affordable, and accessible to those who will benefit most,” says Jauhara Nanyondo, associate director, community engagement, IAVI. “Research that helps us understand the potential end-users is key to this process, as it provides additional insights into product development, including formulation, device, delivery, and packaging decisions,” she adds.

This careful and informed approach to community engagement is central to IAVI’s HIV vaccine research through the ADVANCE (Accelerate the Development of Vaccines and New Technologies to Combat the AIDS Epidemic) program. Communities are empowered to make informed choices and to demand prevention products that meet their needs. The IAVI model of community engagement is implemented by partner clinical research centers working among marginalized and vulnerable communities. This model has proven that with thoughtful outreach initiatives, communities are eager to participate in research to develop potentially lifesaving products — for example, the fisherfolk at the shores of Lake Victoria in Uganda, the key population groups at the margins of the Indian Ocean in Kenya, or healthy adults and couples in Rwanda and Zambia as well as adolescent girls and young women in South Africa.

The engagement between ADVANCE researchers and communities is enhanced by the long-standing support from community leaders, political leaders, civil society, well-trained committed community advisory boards, and adherence to international standards for biomedical prevention trials such as Good Participatory Practice.

“We focus on creating real interpersonal relationships because we believe every community member has a stake in driving the success of clinical research. We also encourage scientists to demonstrate that they recognize the values and interests that matter to community members as people,” says Fredrick Chisakuta, community engagement officer, Center for Family Health Research in Zambia.

John Mdluli, the community engagement manager at the Aurum Institute in South Africa, notes that in his 15 years of working with communities, he’s found that one must be deliberate to address the power dynamics in community-engaged research partnerships. He underscores the need to truly listen to communities as a precursor to leveling the playing field.

“The true essence of community-rooted science is listening. Listening allows the voices of all stakeholders to meet as equals on the same table. It is from this table of equals that the work can move forward. It is from this table of equals that the work can move forward,” says Mdluli.

Having overseen community engagement in South Africa for scientific research around HIV and other infectious diseases, Mdluli emphasizes the intrinsic ethical importance of demonstrating respect for communities. He reveals that winning community engagement strategies must inspire communities to appreciate their role in the research, not just as beneficiaries but as partners. This, he notes, helps with overcoming deep skepticism that sometimes comes from communities questioning the value of clinical trials. His counterpart Roselyn Malogo, community engagement officer at KAVI-ICR in Kenya, concurs. Malogo underlines that individuals must be educated about the personal and communal benefits as well as the risks associated with participating in clinical research. However, she notes that this level of community education must explore new, creative, and memorable ways to make the science.

“As scientific research advances so must the community engagement approaches. Today, we incorporate experiential learning, interactive theatre, and creative arts-based approaches to demystify science to communities. Such work is essential for ensuring a fully informed and balanced representation of key populations in clinical research,” says Malogo.

In the wake of cutting-edge science, the need to nurture a participant-centered approach to accelerate vaccine research remains vital. It begs the question: how do researchers increase the cultural relevance and enhance the applicability and use of the end products in clinical research? By so doing, researchers create an opportunity to recognize communities for their agency rather than the assumed role of passive beneficiaries or merely research participants. A vivid example is the ongoing IAVI-sponsored study, IAVI G003. In this study, socio-behavioral research (SBR) is employed to help generate an understanding of the acceptability of the sampling techniques used in the trial, as well as their impact on the recruitment and retention of participants in studies employing similar sampling techniques. SBR offers great potential for sustainable engagement with everyone actively participating on their own and meaningfully contributing to the production of knowledge for disease prevention.

“If we are to accelerate vaccine research, we must tap into the resourcefulness, resilience, and knowledge of communities. When the science is community-rooted, it shall yield relevance, appropriateness, and the effectiveness required to build long-lasting global health solutions,” says Yvonne Wangũi Machira, director, socio behavioral research, IAVI.