Clean Blood, Religion, and Moral Triage in Tuberculosis Vaccine Trials

ABSTRACT

During ethnographic research at a tuberculosis vaccine trial site in South Africa, trial participants often evoked the idiom of “clean blood.” In this article, we illustrate how the trials enacted a form of moral triage in which “objective” bioscientific knowledge and moral subjectivity were coproduced. Participation created possibilities to demonstrate healthiness, respectability, and godliness in a context where positive self-imaginings were hard won, but could also lead to dejection and shame. We suggest that struggles to be recognized as virtuous are often overlooked in anthropological critiques of clinical trials and bioethics, but are important for understanding how trials meld with local moral worlds.

KEYWORDS:

• South Africa
• bioethics
• clinical trials
• morality
• religion
• tuberculosis

Acknowledgments

We would like to thank all of the clinical trial participants, researchers and public clinic staff who were a part of this study. We also thank three anonymous reviewers for their insightful comments. This study received ethical approval from the University of Cape Town’s Human Research Ethics Committee.

Notes

1. All personal names are pseudonyms.

2. Approximately £8 at the time of writing.

3. Participants quite often expressed more than one reason for taking part.

4. This trip was part of an anthropology methods course at the University of Cape Town, in which students asked local residents about SATVI’s work. We use two quotes from the students’ field reports, for which permissions have been obtained.

Additional information

Funding

This study was funded by a Collaborative PhD Studentship from the Economic and Social Research Council, United Kingdom [1332788].

Notes on contributors

Justin Dixon

Justin Dixon is a research fellow in Medical Anthropology at the London School of Hygiene and Tropical Medicine. Justin is also an honorary fellow in Anthropology at Durham University, which is where his PhD graduate studies were conducted, including the research for this article.

Michèle Tameris

Michèle Tameris is a clinical researcher at the South African Tuberculosis Vaccine Initiative (SATVI), Department of Pathology, University of Cape Town and since 2005 has been involved in 21 clinical trials of 9 candidate TB vaccines. She is also the recipient of two Wellcome Trust International Engagement awards.