Key points are not available for this paper at this time.
Vampire stories are, then, confusions and misunderstandings of the best kind: they reveal the world of power and uncertainty in which Africans have lived in this century. Their very falseness is what gives them meaning: they are a way of talking that encourages a reassessment of everyday experience to address the workings of power and knowledge and how regimes use them. (White 2000) Popular concerns about blood-stealing, trade in body parts, surreptitious birth control and the deliberate spreading of disease are common across sub-Saharan Africa, and there are indications that they are becoming more common in pace with the process of deprivation that economic and political destructuring has, over the last quarter century, set in motion across most of the continent (Comaroff but as they are told, they contain different empirical elements that carry different weights: stories are told with truths, commentaries, and statements of ignorance’ (White 2000). By telling these stories, relating them to empirical facts in a given locality and at a particular moment, and intertwining them with other seemingly unrelated tales, people make new connections and reveal hitherto unseen links, weaving wide, often global connections into local patterns of relatedness (Geissler 2005). When, below, we speak of ‘rumour’ we are not expressing our scepticism; rather, we are reflecting the scepticism of those who tell these stories: their ambiguity towards formations of knowledge and power that reach deep into their everyday lives, and which are set in a world order that provokes their doubts. Medical research and the ‘trial communities’ it constitutes by linking scientists and subjects, institutions and funders, media and publics, is one of the networks of global connections that has been particularly prolific in the generation of rumours (P.W. Geissler and C. Molyneux, in press). The sort of rumours mentioned above, particularly those about blood, are often directly related to medical research and health interventions. During 15 years of involvement in medical research in Africa we have repeatedly encountered such rumours. From friends and colleagues we have heard many more reports of such rumours, sometimes impeding recruitment to research, affecting adherence to interventions and even threatening the continuation of whole research projects while more commonly providing a background noise without direct impact (Geissler 2005; Molyneux et al. 2005a; Pool Fairhead et al. 2006; for a rare note in a medical paper, see Nchito et al. 2003; for the potential detrimental impact of public debates see most recently Singh Ellis Ceyssens 1975). Without totally rejecting such explanations, we suggest that these rumours also contain local interpretations of medical research ethics – especially relating to the problem of resource transfers and flows of value (see Varmus Angell 2000). The frequency and urgency of these rumours, and their potential effect on medical research and public health interventions, implies that they should not be ignored, and we argue that engaging with them could enrich medical research ethics debates and improve relations between medical researchers and study communities. To supplement our own experience of rumours relating to seven separate medical research projects in Africa, we carried out a small e-mail ‘survey’ among African colleagues and researchers involved in medical research in Africa (the results will be published separately). We received reports from 29 colleagues referring to rumours relating to 30 different research projects in 14 African countries over the last 20 years. Due to the sampling frame, most of the reports came from English-speaking, strongly researched countries in southern and eastern Africa. The literature makes clear, however, that these rumours are found across Africa, in countries with different histories and political, social and economic structures (Musambachime 1988; Lewis 1993; White 1995). Our anecdotal data do not enable us to quantify the incidence of particular concerns, their prevalence in specific populations, or the intensity of belief in them. It is not our concern, at this point, what proportion of research projects encounter rumours, nor which proportion of a particular population believes them or even acts according to them. Our aim is not an epidemiology of rumour, but rather to present a range of cases and ask whether these rumours could add a voice to research ethics debates. In trying to extract what appear to be general themes and common concerns, we necessarily reduce the local and historical particularities of people's situated concerns. It is our hope that this editorial, with its broad generalizations, will raise interest and provoke more detailed anthropological and historical studies of specific sites and relations and particular moments and processes in which concerns like these take shape and effect. Before we discuss the rumours in more detail, let us make it plain that we think it is necessary to look at these rumours, in this editorial and in further research, not in order to criticise the work of scientists, or even biomedical science as such, but to critique the unequal distribution of the benefits of science. This in our view is the thrust of the rumours themselves and that of medical anthropology, moving beyond the ‘critique of biomedicine’ that has occupied our discipline for a good while. Rumours about blood stealing, which we have personally encountered in Kenya, Zambia, Mozambique, The Gambia, Tanzania and Uganda, are the most widespread. They have been reported in sub-Saharan Africa since colonial times (White 2000). The blood-thieves in colonial rumours were often described as white people or their black collaborators, who often wore uniforms and operated at night using European technology – cars, fire engines, torches, medicines, electricity, syringes (see Figure 1 for a Congolese artist's imagination of such creatures, the ‘White Lions’) – to extract blood from local people, which they then either sold or transformed into other commodities, such as medicines (Pels 1992; White 2000). Very similar descriptions have been reported from Latin America (Samper 2002). In rumours related to medical research, it is the foreign researchers and their local assistants or collaborators who steal the blood, though the purpose is the same. These rumours are found across sub-Saharan Africa and arise from research into malaria, viral infections including HIV/AIDS, helminth infections including filariasis and bilharziasis, vaccinations, nutrition, and even from entomological and anthropological studies that involve no blood specimen collection (Pels 1998; Nnko et al. 2005). Indeed, ‘research’ seems to be generally associated with the collection of blood and the atttendant ambiguities. The ‘Lions from Europe’ by the Zairian painter K. M. Tshibumba. They were said to roam colonial Congo at night, catching black people, stripping them of all their belongings and killing them (from Fabian 1996). A closely related group of rumours involves organ theft. These rumours, although more common in central and South America (Scheper-Hughes 1996; Campion Vincent 2002; Samper 2002), are still significant in Africa – for example the heart thieves of Madagascar (Jarosz 1994), or the skin thieves of Tanzania (Sanders 2001). We have directly encountered fears about the theft of placentas in Kenya and anxieties about skin thieves in Tanzania (see Nnko et al. 2005). Another related cluster of rumours, more common in southern Africa, points to ‘Satanists’ as the end users of blood or body parts. Either acting independently or directly linked to medical research institutions, they allegedly use blood and body parts in sacrifices to generate wealth. Such rumours appear to have become more frequent, possibly spreading, along with more mundane forms of commerce and travel, from South Africa, over the past decade (Comaroff Nchito et al. 2003). Other rumours focus on the deliberate reduction of populations through spreading disease, reducing fertility or outright genocide. HIV/AIDS figures prominently in this connection, and fears of being infected with HIV merge with fears of being diagnosed HIV positive. In some rumours, fears are expressed of scientists purposely spreading HIV, sometimes supported by the speculative hypothesis on the origins of AIDS in oral polio vaccine research (Hooper 1999). Sometimes it is thought that HIV test results are used to identify and incarcerate HIV-positive individuals. Even demographic surveys or genealogical studies are sometimes associated with planned genocide (Geissler 2005). Some rumours portray research or medical interventions as a form of surreptitious birth control aimed at assaulting a population's ‘life-force’ and future. We have encountered such rumours relating to vitamin tablets in Kenya and Zambia and nevirapine antiretroviral therapy for pregnant women in Mozambique. These stories are often linked to the suspicion that (white) Americans or South Africans are attempting to eradicate (black) Africans in order to posses their land and riches, or that national elites are trying to reduce the populations of their (ethnic or political) enemies. Researchers are sometimes alleged to make common cause with the perceived enemies of the studied community (Geissler 2005). Since colonial times, blood collection, regular treatments (such as vitamin supplementation or malaria prophylaxis) and interventions targeting specific age or gender groups (such as vaccination), have been suspected of reducing the fertility of young girls (e.g. Bradley 1980; Feldman-Savelsberg et al. 2000). A common explanation of these rumours is that they are misunderstandings of scientific or other ‘Western’ practices, such as autopsies (Baker 1946), surgery (Evans-Pritchard 1960), blood donations (Atieno Odhiambo 1974) or even drinking red wine (Trant 1970). This view takes a clear-cut distinction between things ‘African’ and ‘Western’ for granted, and assumes that once local people become familiar with modern technology and Western practices the rumours will abate. A related explanation ascribes them to ‘traditional beliefs’ relating to witchcraft and the supernatural. While many of the stories we discuss here are probably also rooted in pre-colonial African ideas about power and the supernatural, this type of explanation implies that tradition is limited, irrational and superstitious, that these beliefs from the past will eventually be replaced by rational, modern knowledge once education and development become more widespread. This sort of explanation is based on a simplistic notion of ‘modernization’ that posits a single, scientific modern rationality as the end point of historical progress. It also ignores the echo in far-fetched stories like those cited above, of very real abuses of medical science in economically deprived countries in the past (Eckart 2004) as well as in the present (e.g. Scheper-Hughes 2000; Petryna 2006). explanations in of ignorance and the of that study medical research has sometimes (e.g. but of knowledge in the rumours. it is not to of study populations spreading rumours. Rumours sometimes in urban with of and to modern technology (e.g. Feldman-Savelsberg et al. and they arise very familiar interventions – such as Even medical that are popular among local populations, such as provoke rumours, given the rumours have even been in the of blood sampling or medical as we have in to anthropological research in Tanzania et al. 2005). explanations for these concerns in of or the of we should look to the of social and how they are in and by medical research and the historical it is The of the ‘White the of in from the of moving along the to and without further These – and the of – have stories like this the last and across Africa (White 2000). They to a of the social relations they the experience of being by who not to be seen by an and by This is in the medical on the of and but the of which ‘White to with medical scientists, and which in provokes their be a more general of African with The that the encounter between and and is set in of power and and this we we have to look for the and purpose of Some in this blood and similar stories as of the social critique 1998; Campion Vincent or resistance (Samper 2002). While these interpretations in of to rumours are at times associated with a of medical research, they to for the that most of the research not to and it this is outright and the facts that rumours, of study populations are to research. they the social in which rumours arise as between scientists, or other and and African Such limited interpretations that the between scientists and are often rumours and in contrast to economic and political and they to the and of colonial and global the concerns be to be associated with the of colonial central in interpretations of blood (Geissler rumours of blood thieves in Madagascar were with of colonial and and White even the social of colonial based on such rumours. although they are rooted in the colonial past, rumours are very much of the African in the way that medical research While one from which rumours is a particular between and as in Figure this of encounter is in and situated in a historical rumours about medical research the local the and the present its Rumours be seen as of though rooted in and using from the colonial and pre-colonial African being of they ideas the of Ellis Varmus they have been by and scientists from the economically countries of the The of the of practices – the local research populations and the from which they are – have not often been In studies research have been what they think of particular research institutions or et al. 1999; Fairhead et al. Molyneux et al. but have been to involve them in of the that the Western who on their Molyneux and in Kenya, are in very research in this et al. research populations are not usually which benefits they and what level of they 2002). local with the and of the medical ethics and the of direct of study populations in about concerns, local make use of their own and to and their concerns. They use a set of themes and that have been used to of colonial and and The rumours described be seen as to and about relating to the and of in research, and of and the distribution of benefits (see Geissler et al. 2005). These rumours are modern debates about in a in which of and form the of medical research. In White's words on colonial Such confusions a into the world as seen by people who and and a world of and The that and medical research are through the be medical research a in the local of colonial and or medical research is seen as being and The stories the of scientific research as work for the common good – a that has the of since its – and portray it as an that takes more it or in the for the We are not that local and study do not see in most cases often from medical nor do we that most study medical research as and for themselves and their they Our point is that rumours local populations a way of on medical research as of a of of rather a of modern interventions, or rumours could be seen as of talking about the of new and their In the there is much cause for concern, and medical research acts as a which these take of in the of and to to the there a to et African stories us to these In research in Africa rumours of the type here they projects by community and providing for example by showing community the that they see what to blood Rumours usually and research We are not of medical research in Africa that has to be of rumours though there have been some that came to local and study do not necessarily the rumours that they in the sense that they directly their providing rumours enable people to and concerns, and in order to do this it is not necessary that believes them. It is to that rumours are not a to medical research and be ignored, or on an they arise and in to a particular We think that this be a Rumours even among people who do not necessarily them, and our of colleagues involved in medical research in Africa that rumours are and have for medical research, especially but also for social science research. more rumours are a of a problematic between community and The expressed by rumours even without more direct an between scientists and study which is for research or term sites as well as for the of health research beyond the concerns of medical researchers, we suggest the medical researchers and those in about the ethics of medical research should take rumours in the of direct with local they one way of about their on medical research and the that arise research or with study populations are public or mentioned in scientific they have direct for the data et al. 2003). Rumours are an of local to research and the more general of and on which this is and this voice to be heard and research and local should be in the about the medical research that they are involved in rather being the of these (see et 2005). This involves local concerns and about the distribution of benefits from research should local on what should as benefits and what it to be this process could be by anthropological research aimed at understanding the national and social relations that shape medical research and the debates that arise from them. being as relations between researchers and study should be of scientific reported in scientific and to research ethics debates and good to to and concerns with this of anthropological research should the and as medical research. local community with the scientific study of the and historical in which research is could to the development of 2005). The rumours here suggest that in order to improve the ethics and the of medical research in Africa, we have to its study as in global ethics not as of We are to our colleagues in Africa and who their with and will be in a separate We and an for
Geißler et al. (Sat,) studied this question.