This study reports the current patterns of clinical research activities including the framework structure and the contexts in which activities evolve in a sub-Saharan African center from the perspective of its key scientists and workers. Transnational research carried out through collaborations with mainly Western partners and locally initiated academic studies seem to be distinct types of research conducted at the MRU in Lambaréné, Gabon. In transnational collaborations, from the perspective of the core-periphery model, the scientists at the MRU may be considered as the "field workers" who collect data following the study protocol design and implementation by Western partners [9
]. Additionally, the latter take care of the more complicated and demanding tasks such as managing the technical and financial side of the study and monitoring the study procedures to ensure the quality of the scientific production. Because Western partners provide outstanding scientific institutions and scientists as well as technology and financial resources, the main contents and models of scientific activities are elaborated predominantly by them. Thus, studies carried out in Africa may be late stage or confirmatory steps and not directly linked to local economic and social demands. For instance, applications of models elaborated by Western scientists and institutions on the biology and immunology of the malaria parasite in Lambaréné are likely to generate confirmatory data. Such research may be of limited value to the research center itself, which does not necessarily develop the ability to generate the models and is unlikely to stimulate innovation for economic and social development [6
Objections may point to the above as a simplistic and partial interpretation of the perceptions of MRU researchers considering the development of clinical research in sub-Saharan Africa over the last decade. Beyond a rigid labour division of central versus peripheral activities, multinational trials can be considered as social organizations that involve human and non- human components with the ultimate goal of scientific production. From this perspective, there may be an opportunity for actors to impact both the natural course of relationships and the scientific contents and surrounding contexts of research activities.
As part of multinational research, international ethical and regulatory standards have been described by our interviewees as means to perform research as elsewhere, i.e. to requirements for generation of accurate and reliable scientific information. Even though there is similarity in scientific content, as it is set up in Western countries and can be applied in Africa, ethical and regulatory rules and processes are being dynamically implemented with regard to economic, social and cultural contexts with the ultimate goal of conducting high-quality research in Lambaréné. The local community's perception of research activities may be reduced to a less biased perception through daily interaction and consistent relationships with the research team, as attested by a possible emergence of participant-investigator relationships in our study setting and elsewhere [9
Academic or ancillary studies are locally designed and conducted by MRU researchers. This type of research may be considered as an initiative to impact the course of the core-periphery relationships leading to scientific research and output that conform to the local long-term economic and social demands. Therefore, implementing international rules and guidelines while taking into account the local contexts as well as the scientific initiatives of local researchers may contribute to the emergence of biomedical institutions and scientists those activities may be more situated by the requirements and benefit of their local contexts. However, the production of science at the MRU has not been shown by researchers to be a dichotomous process of transnational versus local academic research. On the contrary, locally initiated studies are sometimes ancillary to transnational projects. This suggests that although transnational research may potentially reproduce the core-periphery model, it can also sustain the production and emergence of institutions and scientists in a peripheral region, like sub-Saharan Africa, with their own structure of centralization.
The recent development of public-private partnerships for research in sub-Saharan Africa in the context of millennium challenges and the existence of several biomedical research groups in sub-Saharan Africa countries is a new historical context. Here, we are reporting the patterns of research activities in a particular sub-Saharan research institution, namely the Medical Research Unit of Albert Schweitzer Hospital located in Lambaréné, Gabon. From the perspective of the MRU's researchers, transnational collaboration with outstanding Western institutions and scientists could limit the sub-Saharan science to subsidiary and confirmatory activities. However, this transnational collaboration, which implies scientific contents and ethical and regulatory rules, allows sub-Saharan scientists to perform more dynamically situated research and simultaneously impact the local community, its perception of research activities as well as the scientific contents with the potential of positively impacting the economic and social development in the future.
Limiting empirical material to the perceptions of the core researchers and workers at the MRU may be considered a weakness of this paper, seeing as though a single and unique conclusion and statement would be difficult. However, this study has made an important contribution to illuminating the complex and deep patterns of scientific activities and social contexts in sub-Saharan Africa while also taking international contexts into consideration. Importantly, the generation of interesting future research questions is also an important outcome of this study. So far social sciences have mainly assessed the impact and benefit of global interventions on the health-care systems in sub-Saharan Africa and the quantitative patterns of biomedical publications of the African scientists. This study points out the need for additional questions concerning the contents of scientific production as well as their links and potential impact on the long-term economic and social development in sub-Saharan Africa. To do so, we assume the posture, based on our finding, which an integrative approach would focus on specific questions to understand the dynamics of building-up the research institutions, the changes, if any on the elaboration on scientific contents considering the surrounding local economic, social and cultural needs. The methodological implications of such a project would be similar to the scientific frame at the Kenya Medical Research Institute, which considers the ethics of biomedical research in the contexts of sub-Saharan Africa and transnational research as a central process for the acceptability and validity of the global scientific enterprise in poor communities. More social science studies, research teams, and projects located within the clinical research site learning from the daily interactions with the scientists when they doing science [10
] are needed. Additionally, as suggested by our findings, social and human activities as well as organizations are embedded, which allows one to assume that they should be studied using the paradigm that they affect each other in a dynamic manner [13