Policymaking aside, clinical trial findings involving the immunocompromised can bring about benefits at the individual level. This is what will happen with Ubuntu, says Ivy Fikelephi Kaunda, who works with Caprisa to help recruit participants for clinical trials. Based outside the east coast city of Durban, Kaunda spends much of her time engaging on healthcare issues with residents in the surrounding townships, where over the course of the Covid-19 pandemic, she says she has encountered resistance when encouraging people to take the vaccine. "The ones who are HIV positive will turn and say 'Oh, this is not for us, because we are HIV-positive'." This fear is rooted in the fact that people living with HIV often feel like they are left out, she explains, because they are routinely told that regular treatments are not suitable for them.
But according to Kaunda, this changed with the launch of the Ubuntu trial. When, during her community rounds to recruit participants, Kaunda was able to explain that the trial was tailor-made for people living with HIV, she noticed increasing enthusiasm for the study. Now "when you go to the community people are saying 'I'm part of Ubuntu'... People understand that we also have something for them, and they'll say 'I was part of this change'."
Kaunda speculates that feeling represented by the trial might ultimately encourage more HIV-positive people to get the vaccine which could be a positive stimulus for vaccination rates.
There's another benefit to the trial, which may play out in the longer term: knowing the precise effectiveness of a vaccine can lay a foundation for improved general healthcare, Bekker believes. "It becomes great advocacy to say to people that the vaccine works, but it's better if your immune system is fully constituted therefore it's another reason to get tested and to take your [antiretroviral drugs]," she says. "So it's sort of a secondary public health outcome that is ideal in many ways."
Back at the health centre in Masiphumelele, the circle of women fan themselves with wads of paper consent forms that they need to fill in before the vaccinations can begin. In the centre of the ring, a nurse explains the process, which could take most of the day and will stretch over lunch, which is cooking fragrantly in the nearby kitchen. Their willingness to devote hours of their time could perhaps be taken as an indication that, at the very least, the trial's focus on inclusion is paying off.
"In a world where we recognise that people are marginalised, stigmatised, left behind in clinical research," says Bekker, "we should do our bit to say we don't want to leave people behind."
*This article was supported with funding from the European Journalism Centre, through the Global Health Security Call. This programme is supported by the Bill & Melinda Gates Foundation
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