Abstract
This paper considers how parents engage with a large, internationally supported childhood pneumococcal vaccine trial in The Gambia. Current analysis and professional reflection on public engagement is strongly shaped by the imperatives of public health and research institutions, and is thus couched in terms of acceptance and refusal, and . In contrast Gambian parents in the extreme, of free medical treatment, versus onepublic engagement with science’ in a globalized context might be recast, with implications for debates in biomedical ethics, and the sustainability of public participation in medical research