Mazingira and the malady of malaria: Perceptions of malaria as an environmental disease in contemporary Zanzibar.

This paper addresses how contemporary Zanzibaris perceive the relationship between the mazingira (roughly translated as "environment") and the malady of malaria. More broadly, this article presents data exploring Zanzibari conceptions of the mazingira, the relationship between the mazingira and malaria, and who Zanzibaris believe are responsible for acting on, or for, the mazingira in regards to malaria. We use the biomedical disease malaria-and the local syncretic understanding of it, which we recognize by referring to it as the "malady of malaria"-as a lens to investigate Zanzibari conceptions of the mazingira. We highlight the need to integrate local forms of knowledge, which we refer to as vernacular knowledge. 50 interviews show that Zanzibaris believe the mazingira can be modified in positive ways to cleaner, safer spaces that will also reduce malaria levels. People expressed widespread agreement that there is a clear relationship between the mazingira and the malady of malaria, though they differed in what exactly the relationship was.

Vaccine decision making among people who inject drugs: Improving on the WHO's 3C model of vaccine hesitancy.

The objectives of this study were to 1) identify vaccination rates among PWID in Oregon at a time when vaccines were easily accessible, 2) quantitatively identify convergence with demographic correlates of vaccination willingness and uptake to promote generalizability, and 3) explore the factors PWID were considering when deciding whether or not to receive the COVID-19 vaccine. We conducted a mixed-methods study design including 260 quantitative surveys and 41 in-depth qualitative interviews with PWID, conducted July - September 2021 at syringe services programs in Lane County, Oregon. Among the 260 survey respondents, 37.3% indicated that they had received a COVID-19 vaccine by October 1, 2021. In the same period, an estimated 70.1% of the total Lane County population had completed their COVID-19 vaccinations (not including booster rounds). We explored alignment with the WHO's 3C model of vaccine hesitancy and identified, instead, five common factors as key motivators for vaccine decisions: confidence, convenience, concern, communication, and community implications among PWID. Interviews with PWID describe systemic barriers which prevented them from accessing healthcare resources. We highlight that our proposed 5C model may more accurately depict how PWID navigate vaccine decisions by incorporating the ways that social inequities, infrastructural barriers, and community values influence an individual's vaccine deliberation.

Rebounding Malaria and the failures of eradication in Zanzibar: The World Health Organization campaign and the after effects, 1957-1985.

This article presents a case study of the WHO's malaria elimination attempt in Zanzibar and the decades after the program's conclusion in 1968. Drawing on archival, ethnographic, and interview data, we find that Zanzibar experienced a rebound malaria epidemic in the 1970s-1980s when prevalence rates surged higher than they were prior to the WHO's intervention. We show that scientists were aware of the risks of rebound before it happened and recognized the rebound epidemic as it was happening. We argue that many of the challenges facing Zanzibar in the 1960s remain dilemmas today, and many of the ethical questions about rebound malaria remain unaddressed.

Introduction to the special section: Histories of Global Health in Africa.

Global health is a multidisciplinary field, yet rarely productively incorporates historical knowledge. Local historical processes, interactions with past biomedical campaigns, and dynamic ecological narratives shape how disease outbreaks, health crises, and international interventions are received and remembered. The residues and afterlives of past interactions influence contemporary understandings. We argue for a broadening of the types of knowledge that are integrated into global health research, interventions, and policymaking by paying attention to project afterlives and better integrating forms of vernacular knowledge. Recognizing, understanding, respecting, and incorporating this knowledge is critical to the efficacy of global health-related interventions and the resulting outcomes.

Fines, orders, fear . . . and consent? Medical research in East Africa, C. 1950s.

This article reconstructs the history of medical research in East Africa (Kenya, Tanganyika, Uganda), laying out the lies, rumours, and oppressive techniques that made research such a fraught enterprise during the colonial era. The focus is on the beginning stages of medical research: researchers' arrivals, villagers' responses, the gathering of subjects and consent. New archival and oral sources gathered in East Africa illuminate the research encounter and reintegrate the perspective of villagers cum subjects. Data from the 1950s shows that upon arrival in a village, researchers regularly lied in order to avoid sensitive topics and sidestep potential opposition. Misinformation fuelled villagers' fears, skepticism and rumours of blood stealing researchers. When it came to gathering subjects, researchers were rarely involved in the challenging work of enticing villagers to participate, preferring to rely on chiefs. Chiefs, however, often relied on heavy-handed and ethically questionable techniques. The article concludes by looking at the much-discussed concept of group consent, and showing that historically a chief never had the authority to consent on behalf of villagers.