Factors that impact on recruitment to vaccine trials in the context of a pandemic or epidemic: a qualitative evidence synthesis

Background The World Health Organization declared the COVID‐19 pandemic on 11 March 2020. Vaccine development and deployment were swiftly prioritised as a method to manage and control disease spread. The development of an effective vaccine relies on people's participation in randomised trials. Recruitment to vaccine trials is particularly challenging as it involves healthy volunteers who may have concerns around the potential risks and benefits associated with rapidly developed vaccines. Objectives To explore the factors that influence a person's decision to participate in a vaccine trial in the context of a pandemic or epidemic. Search methods We used standard, extensive Cochrane search methods. The latest search date was June 2021. Selection criteria We included qualitative studies and mixed‐methods studies with an identifiable qualitative component. We included studies that explored the perspectives of adults aged 18 years or older who were invited to take part in vaccine trials in the context of a pandemic or epidemic. Data collection and analysis We assessed the title, abstracts and full texts identified by the search. We used a sampling frame to identify data‐rich studies that represented a range of diseases and geographical spread. We used QSR NVivo to manage extracted data. We assessed methodological limitations using an adapted version of the Critical Skills Appraisal Programme (CASP) tool for qualitative studies. We used the 'best‐fit framework approach' to analyse and synthesise the evidence from our included studies. We then used the Confidence in the Evidence from Reviews of Qualitative research (GRADE‐CERQual) assessment to assess our confidence in each finding and develop implications for practice. Main results We included 34 studies in our review. Most studies related to HIV vaccine trials. The other studies related to Ebola virus, tuberculosis, Zika virus and COVID‐19. We developed 20 key findings, under three broad themes (with seven subthemes), that described the factors that people consider when deciding whether to take part in a vaccine trial for a pandemic or epidemic disease. Our GRADE‐CERQual confidence was high in nine of the key findings, moderate in 10 key findings and low in one key finding. The main reason for downgrading review findings were concerns regarding the relevance and adequacy of the underlying data. As a result of the over‐representation of HIV studies, our GRADE‐CERQual assessment of some findings was downgraded in terms of relevance because the views described may not reflect those of people regarding vaccine trials for other pandemic or epidemic diseases. Adequacy relates to the degree of richness and quantity of data supporting a review finding. Moderate concerns about adequacy resulted in a downgrading of some review findings. Some factors were considered to be under the control of the trial team. These included how trial information was communicated and the inclusion of people in the community to help with trial information dissemination. Aspects of trial design were also considered under control of the trial team and included convenience of participation, provision of financial incentives and access to additional support services for those taking part in the trial. Other factors influencing people's decision to take part could be personal, from family, friends or wider society. From a personal perceptive, people had concerns about vaccine side effects, vaccine efficacy and possible impact on their daily lives (carer responsibilities, work, etc.). People were also influenced by their families, and the impact participation may have on relationships. The fear of stigma from society influenced the decision to take part. Also, from a societal perspective, the level of trust in governments' involvement in research and trial may influence a person's decision. Finally, the perceived rewards, both personal and societal, were influencing factors on the decision to participate. Personal rewards included access to a vaccine, improved health and improved disease knowledge, and a return to normality in the context of a pandemic or epidemic. Potential societal rewards included helping the community and contributing to science, often motivated by the memories of family and friends who had died from the disease. Authors' conclusions This review identifies many of the factors that influence a person's decision to take part in a vaccine trial, and these reflect findings from reviews that examine trials more broadly. However, we also recognise some factors that become more important in connection with a vaccine trial in the context of a pandemic or epidemic. These factors include the potential stigma of taking part, the possible adverse effects of a vaccine, the added motivation for helping society, the role of community leaders in trial dissemination, and the level of trust placed in governments and companies developing vaccines. These specific influences need to be considered by trial teams when designing, and communicating about, vaccine trials in the context of a pandemic or epidemic

‘Who do you want to kill?’ Affectual and relational understandings at a sorcery rock art site in the southwest Gulf of Carpentaria, northern Australia

This article explores the affectual and relational contexts in which rock art is embedded through an exploration of the encounters, reactions, and responses to a well‐known sorcery rock art site known as Kurrmurnnyini in northern Australia\u27s southwest Gulf country. These encounters with a culturally powerful place, and the emotions derived from people\u27s personal memories and experiences of Kurrmurnnyini and its sorcery‐infused rock art, are vital to establishing an understanding of contemporary perceptions of what is clearly more than an ‘archaeological site’. We contend that by turning our attention to the often‐overlooked affectual and relational dimensions of rock art and the contexts in which it is found, researchers place themselves in a better position to access and become aware of the agency and affect of graphic imagery as well as the significance these powerful images and places hold for people today

Lives in Fragments? Personhood and the European Neolithic

The European Neolithic has often been figured in ideational terms. The transformations that gave rise to sedentism, agriculture and the construction of monuments have been explained either in terms of abstract symbolic schemes or as a change in worldview and cosmology. As an alternative, this article suggests that a greater emphasis needs to be placed on the constitution of the person during this period of transformation. Instead of focusing on the playing out of symbolic structures, it is instead important to consider the role that materiality plays in forming social relations. By focusing on the treatment of material culture, human remains and the use of architecture, we begin to understand in concrete terms not only how the European Neolithic was built, but also how people were transformed through this process