1
|
Orievulu K, Hinga A, Nkosi B, Ngwenya N, Seeley J, Akanlu A, Tindana P, Molyneux S, Kinyanjui S, Kamuya D. A scoping review of ethics review processes during public health emergencies in Africa. BMC Med Ethics 2024; 25:63. [PMID: 38778293 PMCID: PMC11110293 DOI: 10.1186/s12910-024-01054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic forced governments, multilateral public health organisations and research institutions to undertake research quickly to inform their responses to the pandemic. Most COVID-19-related studies required swift approval, creating ethical and practical challenges for regulatory authorities and researchers. In this paper, we examine the landscape of ethics review processes in Africa during public health emergencies (PHEs). METHODS We searched four electronic databases (Web of Science, PUBMED, MEDLINE Complete, and CINAHL) to identify articles describing ethics review processes during public health emergencies and/or pandemics. We selected and reviewed those articles that were focused on Africa. We charted the data from the retrieved articles including the authors and year of publication, title, country and disease(s) reference, broad areas of (ethical) consideration, paper type, and approach. RESULTS Of an initial 4536 records retrieved, we screened the titles and abstracts of 1491 articles, and identified 72 articles for full review. Nine articles were selected for inclusion. Of these nine articles, five referenced West African countries including Liberia, Guinea and Sierra Leone, and experiences linked to the Ebola virus disease. Two articles focused on South Africa and Kenya, while the other two articles discussed more general experiences and pitfalls of ethics review during PHEs in Africa more broadly. We found no articles published on ethics review processes in Africa before the 2014 Ebola outbreak, and only a few before the COVID-19 outbreak. Although guidelines on protocol review and approval processes for PHEs were more frequently discussed after the 2014 Ebola outbreak, these did not focus on Africa specifically. CONCLUSIONS There is a gap in the literature about ethics review processes and preparedness within Africa during PHEs. This paper underscores the importance of these processes to inform practices that facilitate timely, context-relevant research that adequately recognises and reinforces human dignity within the quest to advance scientific knowledge about diseases. This is important to improve fast responses to PHEs, reduce mortality and morbidity, and enhance the quality of care before, during, and after pandemics.
Collapse
Affiliation(s)
- Kingsley Orievulu
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
- Centre for Africa China Studies, University of Johannesburg, Johannesburg, South Africa.
| | - Alex Hinga
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | - Busisiwe Nkosi
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
- University of Toledo, Ohio, Toledo, USA
| | - Nothando Ngwenya
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Global Health and Development Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Anthony Akanlu
- West Africa Centre for Cell Biology and Infectious Pathogens, University of Ghana, Accra, Ghana
| | - Paulina Tindana
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Sassy Molyneux
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Samson Kinyanjui
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Dorcas Kamuya
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
2
|
Jamrozik E, Littler K, Meln I, Van Molle W, Morel S, Olesen OF, Rubbrecht M, Balasingam S, Neels P. Ethical approval for controlled human infectious model clinical trial protocols - A workshop report. Biologicals 2024; 85:101748. [PMID: 38350349 PMCID: PMC11004724 DOI: 10.1016/j.biologicals.2024.101748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/28/2024] [Indexed: 02/15/2024] Open
Abstract
Controlled Human Infectious Model studies (CHIM) involve deliberately exposing volunteers to pathogens. To discuss ethical issues related to CHIM, the European Vaccine Initiative and the International Alliance for Biological Standardization organised the workshop "Ethical Approval for CHIM Clinical Trial Protocols", which took place on May 30-31, 2023, in Brussels, Belgium. The event allowed CHIM researchers, regulators, ethics committee (EC) members, and ethicists to examine the ethical criteria for CHIM and the role(s) of CHIM in pharmaceutical development. The discussions led to several recommendations, including continued assurance that routine ethical requirements are met, assurance that participants are well-informed, and that preparation of study documents must be both ethically and scientifically sound from an early stage. Study applications must clearly state the rationale for the challenge compared to alternative study designs. ECs need to have clear guidance and procedures for evaluating social value and assessing third-party risks. Among other things, public trust in research requires minimisation of harm to healthy volunteers and third-party risk. Other important considerations include appropriate stakeholder engagement, public education, and access to health care for participants after the study.
Collapse
Affiliation(s)
- Euzebiusz Jamrozik
- The Ethox Centre & Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, United Kingdom
| | - Katherine Littler
- Health Ethics and Governance Unit, Research for Health Department, Science Division, World Health Organization, Geneva, Switzerland
| | - Irina Meln
- European Vaccine Initiative, Heidelberg, Germany
| | | | | | - Ole F Olesen
- European Vaccine Initiative, Heidelberg, Germany
| | | | | | - Pieter Neels
- International Alliance for Biological Standardization (IABS), Lyon, France.
| |
Collapse
|
3
|
Tulsawani R, Verma K, Kohli E, Sharma P, Meena YS, Amitabh, Ponmariappan S, Kumar P, Maithani R. Anti-microbial efficacy of a scientifically developed and standardized herbal-alcohol sanitizer. Arch Microbiol 2024; 206:77. [PMID: 38270599 DOI: 10.1007/s00203-023-03805-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/04/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024]
Abstract
Hands are the primary mode of transmission of microbe-based infections, as they harbor normal microbiota and pathogenic microbes. SARS-CoV-2 has endangered lives worldwide, and WHO has recommended good hygiene practices, especially hand hygiene. In addition, other infectious diseases like diphtheria, measles, tuberculosis, HIV, malaria, etc. are spreading in the shadow of the COVID-19 pandemic. The anti-microbial efficiency of two in-house developed herbal-alcohol based hand sanitizers containing Azadirachta indica, Citrus limon, Zingiber officinale, and Aloe vera (HS1) and Zingiber officinale replaced with Ocimum sanctum (HS2) was evaluated. HS1, with Zingiber officinale, and HS2, with Ocimum sanctum, herbal sanitizers showcased in-vitro anti-viral activity on MDCK cells using the reference strain of influenza A virus, A/PR/8/34 (H1N1), and reduced 99.99% of microbial load within 30 s of contact time, estimated by the Antimicrobial Susceptibility Testing Method. On volunteers, HS1 and HS2 were more effective than alcohol-based WHO sanitizers. Moreover, HS2 sanitizer is more effective against viruses and has better efficiency and hedonic qualities in volunteers than HS1. These sanitizers don't irritate or dry up the skin and have a longer shelf life. Overall, findings reveal that herbal-alcohol-based sanitizers are promising hand hygiene products with the capability of reducing microbial load.
Collapse
Affiliation(s)
- Rajkumar Tulsawani
- Defence Institute of Physiology and Allied Sciences (DIPAS), Lucknow Road, Timarpur, New Delhi, India.
| | - Kalyani Verma
- Defence Institute of Physiology and Allied Sciences (DIPAS), Lucknow Road, Timarpur, New Delhi, India
| | - Ekta Kohli
- Defence Institute of Physiology and Allied Sciences (DIPAS), Lucknow Road, Timarpur, New Delhi, India
| | - Purva Sharma
- Defence Institute of Physiology and Allied Sciences (DIPAS), Lucknow Road, Timarpur, New Delhi, India
| | - Yogesh Singh Meena
- Defence Institute of Physiology and Allied Sciences (DIPAS), Lucknow Road, Timarpur, New Delhi, India
| | - Amitabh
- Defence Institute of Physiology and Allied Sciences (DIPAS), Lucknow Road, Timarpur, New Delhi, India
| | | | - Prashant Kumar
- Amity Institute of Virology and Immunology (AIVI), Amity University, Sector-125, Noida, India
| | - Rekha Maithani
- Defence Institute of Physiology and Allied Sciences (DIPAS), Lucknow Road, Timarpur, New Delhi, India
| |
Collapse
|
4
|
Miura F, Klinkenberg D, Wallinga J. Quantifying the Individual Variation in Susceptibility to Endemic Coronavirus and SARS-CoV-2 with Human Challenge Trials. Epidemiology 2024; 35:113-117. [PMID: 38032803 PMCID: PMC10683973 DOI: 10.1097/ede.0000000000001679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/22/2023] [Indexed: 12/02/2023]
Abstract
Human challenge trials reveal how the infection risk depends on a given infectious dose. We propose a mathematical framework to analyze and interpret the outcomes of human challenge trials by incorporating the variability between individuals in susceptibility to infection. We illustrate the framework for two distinctive diseases; endemic diseases where a fraction of the study population has been exposed to the target pathogen previously and is thus immune, and novel diseases where the study population is fully susceptible. Based on available data from published trials, we estimate the immune proportion and the variation in susceptibility to endemic HCoV-229E and present plausible infection risks with SARS-CoV-2 over multiple orders of magnitude of the infectious dose. The results show that the proposed method captures heterogeneous background susceptibility in the study population, and we suggest ways to improve the design of future trials and to translate their outcomes to the general population.
Collapse
Affiliation(s)
- Fuminari Miura
- From the Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Center for Marine Environmental Studies, Ehime University, Matsuyama, Japan
| | - Don Klinkenberg
- From the Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Jacco Wallinga
- From the Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
5
|
Dorey RB, Theodosiou AA, Read RC, Vandrevala T, Jones CE. Qualitative interview study exploring the perspectives of pregnant women on participating in controlled human infection research in the UK. BMJ Open 2023; 13:e073992. [PMID: 38151279 PMCID: PMC10753751 DOI: 10.1136/bmjopen-2023-073992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 12/11/2023] [Indexed: 12/29/2023] Open
Abstract
INTRODUCTION Pregnant women have been historically excluded from interventional research. While recent efforts have been made to improve their involvement, there remains a disparity in the evidence base for treatments available to pregnant women compared with the non-pregnant population. A significant barrier to the enrolment of pregnant women within research is risk perception and a poor understanding of decision-making in this population. OBJECTIVE Assess the risk perception and influences on decision-making in pregnant women, when considering whether to enrol in a hypothetical interventional research study. DESIGN Semistructured interviews were undertaken, and thematic analysis was undertaken of participant responses. PARTICIPANTS Twelve pregnant women were enrolled from an antenatal outpatient clinic. RESULTS Participants were unanimously positive about enrolling in the proposed hypothetical interventional study. Risk perception was influenced by potential risks to their fetus and their previous experiences of healthcare and research. Participants found the uncertainty in quantifying risk for new research interventions challenging. They were motivated to enrol in research by altruism and found less invasive research interventions more tolerable. CONCLUSION It is vital to understand how pregnant women balance the perceived risks and benefits of interventional research. This may help clinicians and scientists better communicate risk to pregnant women and address the ongoing under-representation of pregnant women in interventional research.
Collapse
Affiliation(s)
- Robert B Dorey
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Anastasia A Theodosiou
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Robert C Read
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tushna Vandrevala
- Centre for Applied Health and Social Care Research, Kingston University and St George's University of London, London, UK
| | - Christine E Jones
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
6
|
Drewett GP. The Case for Human Challenge Trials in COVID-19. JOURNAL OF BIOETHICAL INQUIRY 2023:10.1007/s11673-023-10309-9. [PMID: 37721594 DOI: 10.1007/s11673-023-10309-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 03/12/2023] [Indexed: 09/19/2023]
Abstract
The COVID-19 pandemic has necessitated rapid research to aid in the understanding of the disease and the development of novel therapeutics. One option is to conduct controlled human infection trials (CHITs). In this article I examine the history of deliberate human infection and CHITs and their utilization prior to the COVID-19 pandemic, key ethical considerations of CHITs in the COVID-19 setting, an analysis of the World Health Organization's (WHO) Key criteria for the ethical acceptability of COVID-19 human challenge studies, and a review of the two COVID-19 CHITs that have already commenced, their compliance with the WHO criteria and other ethical considerations.
Collapse
Affiliation(s)
- George P Drewett
- Melbourne Law School, University of Melbourne, Parkville, VIC, Australia.
- The Northern Hospital, Epping, VIC, Australia.
| |
Collapse
|
7
|
Rid A, Feld JJ, Liang TJ, Weijer C. Ethics of Controlled Human Infection Studies With Hepatitis C Virus. Clin Infect Dis 2023; 77:S216-S223. [PMID: 37579202 PMCID: PMC10425137 DOI: 10.1093/cid/ciad382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Global elimination of hepatitis C virus (HCV) will be difficult to attain without an effective HCV vaccine. Controlled human infection (CHI) studies with HCV were not considered until recently, when highly effective treatment became available. However, now that successful treatment of a deliberate HCV infection is feasible, it is imperative to evaluate the ethics of establishing a program of HCV CHI research. Here, we evaluate the ethics of studies to develop an HCV CHI model in light of 10 ethical considerations: sufficient social value, reasonable risk-benefit profile, suitable site selection, fair participant selection, robust informed consent, proportionate compensation or payment, context-specific stakeholder engagement, fair and open collaboration, independent review and oversight, and integrated ethics research. We conclude that it can be ethically acceptable to develop an HCV CHI model. Indeed, when done appropriately, developing a model should be a priority on the path toward global elimination of HCV.
Collapse
Affiliation(s)
- Annette Rid
- Department of Bioethics, The Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - T Jake Liang
- Liver Diseases Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Charles Weijer
- Department of Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
- Department of Philosophy, Western University, London, Ontario, Canada
| |
Collapse
|
8
|
Kolstoe SE, Pugh J. The trinity of good research: Distinguishing between research integrity, ethics, and governance. Account Res 2023:1-20. [PMID: 37475134 DOI: 10.1080/08989621.2023.2239712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/18/2023] [Indexed: 07/22/2023]
Abstract
The words integrity, ethics, and governance are used interchangeably in relation to research. This masks important differences that must be understood when trying to address concerns regarding research culture. While progress has been made in identifying negative aspects of research culture (such as inequalities in hiring/promotion, perverse incentives, etc.) and practical issues that lead to research waste (outcome reporting bias, reproducibility, etc.), the responsibility for addressing these problems can be unclear due to the complexity of the research environment. One solution is to provide a clearer distinction between the perspectives of "Research Integrity," "Research Ethics," and "Research Governance." Here, it is proposed that Research Integrity should be understood as focused on the character of researchers, and consequently the responsibility for promoting it lies primarily with researchers themselves. This is a different perspective from Research Ethics, which is focused on judgments on the ethical acceptability of research, and should primarily be the responsibility of research ethics committees, often including input from the public as well as the research community. Finally, Research Governance focuses on legal and policy requirements, and although complementary to research integrity and ethics, is primarily the responsibility of expert research support officers with the skills and experience to address technical compliance.
Collapse
Affiliation(s)
- Simon E Kolstoe
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - Jonathan Pugh
- Faculty of Philosophy, University of Oxford, Oxford, UK
| |
Collapse
|
9
|
Ward AL, Cruickshank S, Forbat L. Features that hindered the capacity development of a national prostate cancer service. FRONTIERS IN HEALTH SERVICES 2023; 3:1173143. [PMID: 37533703 PMCID: PMC10391644 DOI: 10.3389/frhs.2023.1173143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/15/2023] [Indexed: 08/04/2023]
Abstract
Introduction In Scotland, prostate cancer services have struggled to meet demand, and urological cancer services have missed Scottish Government waiting time targets to a greater extent than other cancer services. This study provides understanding of the capacity development needs of a national prostate cancer service including why the service had been unable to adapt to meet demand and how capacity could be developed. Methods Delphi technique was applied to a purposive sample of prostate cancer clinicians working across Scotland between 2015 and 2017. Interviews were conducted with healthcare professionals involved in delivery of care to people with prostate cancer including General Practitioners, followed by questionnaires which were distributed to Specialist Nurses, Oncologists and Urologists involved in delivering specialist prostate cancer services within NHS Scotland. Findings are reported from interviews analysed using a directed approach to content analysis, followed by three rounds of iterative online questionnaires analysed using descriptive statistics. Results Reform is needed to meet demand within prostate cancer services in Scotland. Barriers to capacity development included: lack of shared understanding of quality of care between policy makers and healthcare professionals; lack of leadership of service developments nationally and regionally; and difficulties in drawing on other capacities to support the service. Cohesive working and a need for efficient training for nurse specialists were needed to develop capacity. Consensus was reached for development of national working groups to set standards for quality care (100% agreement) and further development of existing regional working groups (100% agreement) to implement this care (91% agreement), which should include input from primary and community care practitioners (100% agreement) to meet demand. Discussion This work provides important understanding of barriers and facilitators to service development across a national service, including highlighting the importance of a shared vision for quality care between policy makers and healthcare professionals. Mechanisms to support service change are identified.
Collapse
Affiliation(s)
- Ashleigh Lauren Ward
- Directorate of Nursing, NHS Forth Valley, Larbert, United Kingdom
- School of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Susanne Cruickshank
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Faculty of Social Sciences, University of Stirling, Stirling, United Kingdom
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, United Kingdom
| |
Collapse
|
10
|
Morrison H, Jackson S, McShane H. Controlled human infection models in COVID-19 and tuberculosis: current progress and future challenges. Front Immunol 2023; 14:1211388. [PMID: 37304270 PMCID: PMC10248465 DOI: 10.3389/fimmu.2023.1211388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Controlled Human Infection Models (CHIMs) involve deliberately exposing healthy human volunteers to a known pathogen, to allow the detailed study of disease processes and evaluate methods of treatment and prevention, including next generation vaccines. CHIMs are in development for both tuberculosis (TB) and Covid-19, but challenges remain in their ongoing optimisation and refinement. It would be unethical to deliberately infect humans with virulent Mycobacteria tuberculosis (M.tb), however surrogate models involving other mycobacteria, M.tb Purified Protein Derivative or genetically modified forms of M.tb either exist or are under development. These utilise varying routes of administration, including via aerosol, per bronchoscope or intradermal injection, each with their own advantages and disadvantages. Intranasal CHIMs with SARS-CoV-2 were developed against the backdrop of the evolving Covid-19 pandemic and are currently being utilised to both assess viral kinetics, interrogate the local and systemic immunological responses post exposure, and identify immune correlates of protection. In future it is hoped they can be used to assess new treatments and vaccines. The changing face of the pandemic, including the emergence of new virus variants and increasing levels of vaccination and natural immunity within populations, has provided a unique and complex environment within which to develop a SARS-CoV-2 CHIM. This article will discuss current progress and potential future developments in CHIMs for these two globally significant pathogens.
Collapse
|
11
|
Ford A, Hwang A, Mo AX, Baqar S, Touchette N, Deal C, King D, Earle K, Giersing B, Dull P, Hall BF. Meeting Summary: Global Vaccine and Immunization Research Forum, 2021. Vaccine 2023; 41:1799-1807. [PMID: 36803897 PMCID: PMC9938725 DOI: 10.1016/j.vaccine.2023.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 01/17/2023] [Accepted: 02/09/2023] [Indexed: 02/21/2023]
Abstract
The 2021 Global Vaccine and Immunization Research Forum highlighted the considerable advances and recent progress in research and development for vaccines and immunization, critically reviewed lessons learned from COVID-19 vaccine programs, and looked ahead to opportunities for this decade. For COVID-19, decades of investments in basic and translational research, new technology platforms, and vaccines targeting prototype pathogens enabled a rapid, global response. Unprecedented global coordination and partnership have played an essential role in creating and delivering COVID-19 vaccines. More improvement is needed in product attributes such as deliverability, and in equitable access to vaccines. Developments in other priority areas included: the halting of two human immunodeficiency virus vaccine trials due to lack of efficacy in preventing infection; promising efficacy results in Phase 2 trials of two tuberculosis vaccines; pilot implementation of the most advanced malaria vaccine candidate in three countries; trials of human papillomavirus vaccines given in single-dose regimens; and emergency use listing of a novel, oral poliomyelitis type 2 vaccine. More systematic, proactive approaches are being developed for fostering vaccine uptake and demand, aligning on priorities for investment by the public and private sectors, and accelerating policy making. Participants emphasized that addressing endemic disease is intertwined with emergency preparedness and pandemic response, so that advances in one area create opportunities in the other. In this decade, advances made in response to the COVID-19 pandemic should accelerate availability of vaccines for other diseases, contribute to preparedness for future pandemics, and help to achieve impact and equity under Immunization Agenda 2030.
Collapse
Key Words
- bcg, bacille calmette-guérin
- bnab, broadly neutralizing antibody
- cepi, coalition for epidemic preparedness innovations
- chim, controlled human infection model
- ecvp, evidence considerations for vaccine policy
- eua, emergency use authorization
- eul, emergency use listing
- gvap, global vaccine action plan
- gvirf, global vaccine and immunization research forum
- hiv, human immunodeficiency virus
- hpv, human papillomavirus
- ia2030, immunization agenda 2030
- mers, middle east respiratory syndrome
- nopv-2, novel oral poliomyelitis type 2 vaccine
- ppp, public–private partnership
- r&d, research and development
- sars, severe acute respiratory syndrome
- vips, vaccine innovation prioritisation strategy
Collapse
Affiliation(s)
- Andrew Ford
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, MSC 9825, Bethesda, MD 20892-9825, USA.
| | - Angela Hwang
- Angela Hwang Consulting, PO Box 6601, Albany, CA 94706, USA.
| | - Annie X. Mo
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, MSC 9825, Bethesda, MD 20892-9825, USA
| | - Shahida Baqar
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, MSC 9825, Bethesda, MD 20892-9825, USA.
| | - Nancy Touchette
- Office of Global Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
| | - Carolyn Deal
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, MSC 9825, Bethesda, MD 20892-9825, USA.
| | - Deborah King
- Infectious Disease Health Challenge - Prevention, Wellcome Trust, London NW1 2BE, United Kingdom.
| | - Kristen Earle
- Vaccine Development & Surveillance, Bill & Melinda Gates Foundation, PO Box 23350, Seattle, Washington 98102, USA.
| | - Birgitte Giersing
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland.
| | - Peter Dull
- Vaccine Development & Surveillance, Bill & Melinda Gates Foundation, PO Box 23350, Seattle, Washington 98102, USA.
| | - B. Fenton Hall
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, MSC 9825, Bethesda, MD 20892-9825, USA
| |
Collapse
|
12
|
Sharma A, Apte A, Rajappa M, Vaz M, Vaswani V, Goenka S, Malhotra S, Sangoram R, Lakshminarayanan S, Jayaram S, Mathaiyan J, Farseena K, Mukerjee P, Jaswal S, Dongre A, Timms O, Shafiq N, Aggarwal R, Kaur M, Juvekar S, Sekhar A, Kang G. Perceptions about controlled human infection model (CHIM) studies among members of ethics committees of Indian medical institutions: A qualitative exploration. Wellcome Open Res 2023; 7:209. [PMID: 36969719 PMCID: PMC10031138 DOI: 10.12688/wellcomeopenres.17968.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/04/2023] Open
Abstract
Introduction: Controlled Human Infection Model (CHIM) studies provide a unique platform for studying the pathophysiology of infectious diseases and accelerated testing of vaccines and drugs in controlled settings. However, ethical issues shroud them as the disease-causing pathogen is intentionally inoculated into healthy consenting volunteers, and effective treatment may or may not be available. We explored the perceptions of the members of institutional ethics committees (IECs) in India about CHIM studies. Methods: This qualitative exploratory study, conducted across seven sites in India, included 11 focused group discussions (FGD) and 31 in-depth interviews (IDI). A flexible approach was used with the aid of a topic guide. The data were thematically analyzed using grounded theory and an inductive approach. Emerging themes and sub-themes were analyzed, and major emergent themes were elucidated. Results: Seventy-two IEC members participated in the study including 21 basic medical scientists, 29 clinicians, 9 lay people, 6 legal experts and 7 social scientists. Three major themes emerged from this analysis—apprehensions about conduct of CHIM studies in India, a perceived need for CHIM studies in India and risk mitigation measures needed to protect research participants and minimize the associated risks. Conclusion: Development of a specific regulatory and ethical framework, training of research staff and ethics committee members, and ensuring specialized research infrastructure along with adequate community sensitization were considered essential before initiation of CHIM studies in India.
Collapse
Affiliation(s)
- Abhishek Sharma
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Aditi Apte
- KEM Hospital Research Centre, Pune, Maharashtra, 411011, India
| | - Medha Rajappa
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Manjulika Vaz
- St John's Medical College, Bengaluru, Karnataka, 560034, India
| | - Vina Vaswani
- Yenepoya University, Mangalore, Karnataka, 575018, India
| | - Shifalika Goenka
- Centre for Chronic Disease Control (CCDC), Delhi, Delhi, 110016, India
| | - Samir Malhotra
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Rashmi Sangoram
- KEM Hospital Research Centre, Pune, Maharashtra, 411011, India
| | - Subitha Lakshminarayanan
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Suganya Jayaram
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Jayanthi Mathaiyan
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | | | - Prarthna Mukerjee
- Centre for Chronic Disease Control (CCDC), Delhi, Delhi, 110016, India
| | - Surinder Jaswal
- Tata Institute of Social Sciences, Mumbai, Maharashtra, 400088, India
| | - Amol Dongre
- Pramukhswami Medical College, Karamsad, Gujarat, 388325, India
| | - Olinda Timms
- St John's Medical College, Bengaluru, Karnataka, 560034, India
| | - Nusrat Shafiq
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Rakesh Aggarwal
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Manmeet Kaur
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Sanjay Juvekar
- KEM Hospital Research Centre, Pune, Maharashtra, 411011, India
| | - Amrita Sekhar
- Translational Health Science and Technology Institute, Faridabad, Haryana, 101213, India
| | - Gagandeep Kang
- Christian Medical College, Vellore, Tamil Nadu, 632004, India
| |
Collapse
|
13
|
Piggin M, Smith E, Mankone P, Ndegwa L, Gbesemete D, Pristerà P, Bahrami-Hessari M, Johnson H, Catchpole AP, Openshaw PJM, Chiu C, Read RC, Ward H, Barker C. The role of public involvement in the design of the first SARS-CoV-2 human challenge study during an evolving pandemic. Epidemics 2022; 41:100626. [PMID: 36088739 PMCID: PMC9434955 DOI: 10.1016/j.epidem.2022.100626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 08/11/2022] [Accepted: 08/31/2022] [Indexed: 02/08/2023] Open
Abstract
High quality health care research must involve patients and the public. This ensures research is important, relevant and acceptable to those it is designed to benefit. The world's first human challenge study with SARS-CoV-2 undertook detailed public involvement to inform study design despite the urgency to review and establish the study. The work was integral to the UK Research Ethics Committee review and approval of the study. Discussion with individuals from ethnic minorities within the UK population supported decision-making around the study exclusion criteria. Public review of study materials for consent processes led to the addition of new information, comparisons and visual aids to help volunteers consider the practicalities and risks involved in participating. A discussion exploring the acceptability of a human challenge study with SARS-CoV-2 taking place in the UK, given the current context of the pandemic, identified overall support for the study. Public concern for the wellbeing of trial participants, as a consequence of isolation, was identified. We outline our approach to public involvement and its impact on study design.
Collapse
Affiliation(s)
- Maria Piggin
- NIHR Imperial Biomedical Research Centre, Patient Experience Research Centre, Imperial College London, St Mary's Campus, Norfolk Place, Paddington, London W2 1NY, UK.
| | - Emma Smith
- National Heart and Lung Institute, Imperial College London, London W2 1NY, UK
| | | | | | - Diane Gbesemete
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, SO16 6YD, UK; School of Clinical and Experimental Sciences, Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton General Hospital, Mailpoint 806, Level D, Southampton SO16 6YD, UK
| | - Philippa Pristerà
- NIHR Imperial Biomedical Research Centre, Patient Experience Research Centre, Imperial College London, St Mary's Campus, Norfolk Place, Paddington, London W2 1NY, UK
| | - Michael Bahrami-Hessari
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, SO16 6YD, UK
| | - Halle Johnson
- NIHR Imperial Biomedical Research Centre, Patient Experience Research Centre, Imperial College London, St Mary's Campus, Norfolk Place, Paddington, London W2 1NY, UK
| | | | - Peter J M Openshaw
- National Heart and Lung Institute, Imperial College London, London W2 1NY, UK
| | - Christopher Chiu
- Department of Infectious Diseases, Imperial College London, London W2 1NY, UK
| | - Robert C Read
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, SO16 6YD, UK; School of Clinical and Experimental Sciences, Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton General Hospital, Mailpoint 806, Level D, Southampton SO16 6YD, UK
| | - Helen Ward
- NIHR Imperial Biomedical Research Centre, Patient Experience Research Centre, Imperial College London, St Mary's Campus, Norfolk Place, Paddington, London W2 1NY, UK
| | - Caroline Barker
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, SO16 6YD, UK; NIHR Applied Research Collaboration Wessex, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| |
Collapse
|
14
|
Fernandes N, Sani AI, Barra M. “MIÚDOS CO(N)VIDA”: DESENVOLVER PESQUISA COM CRIANÇAS EM TEMPOS DE PANDEMIA COVID-19. CADERNOS CEDES 2022. [DOI: 10.1590/cc262470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
RESUMO A pandemia da Covid-19 é um exemplo poderoso do modo como os nossos direitos são reconfigurados e, em especial, os direitos das crianças. Mobilizadas pela exigência de assegurar que, no contexto de crise pandémica, as vozes das crianças não ficassem invisíveis, foram desenvolvidas algumas estratégias de investigação que assumiram um caráter inovador, dadas as contingências decorrentes da situação de confinamento. Este texto visou à reflexão sobre os desafios éticos e metodológicos na pesquisa com crianças, atendendo ao quadro de pandemia e confinamento, repensando estratégias e o processo de construção de conhecimento com estas e acerca das suas vidas.
Collapse
Affiliation(s)
| | - Ana Isabel Sani
- Universidade Fernando Pessoa, Portugal; Universidade do Minho, Portugal
| | | |
Collapse
|
15
|
Fernandes N, Sani AI, Barra M. ‘MIÚDOS CO(N)VIDA’: DEVELOPING RESEARCH WITH CHILDREN IN TIMES OF PANDEMIC COVID-19. CADERNOS CEDES 2022. [DOI: 10.1590/cc262470_en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
ABSTRACT The Covid-19 pandemic is a powerful example of how our rights and, in particular, children’s rights are reconfigured. In order to ensure that, in a pandemic context, children’s voices were not kept invisible, we developed some research strategies, which assumed an innovative character, given the contingencies resulting from the lockdown situation. This text aimed to reflect on the ethical and methodological challenges in research with children, taking into account the pandemic and confinement, rethinking strategies and the process of building knowledge with them and about their lives.
Collapse
Affiliation(s)
| | - Ana Isabel Sani
- Universidade Fernando Pessoa, Portugal; Universidade do Minho, Portugal
| | | |
Collapse
|
16
|
Early SARS-CoV-2 dynamics and immune responses in unvaccinated participants of an intensely sampled longitudinal surveillance study. COMMUNICATIONS MEDICINE 2022; 2:129. [PMID: 36238348 PMCID: PMC9553075 DOI: 10.1038/s43856-022-00195-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/29/2022] [Indexed: 11/08/2022] Open
Abstract
Background A comprehensive understanding of the SARS-CoV-2 infection dynamics and the ensuing host immune responses is needed to explain the pathogenesis as it relates to viral transmission. Knowledge gaps exist surrounding SARS-CoV-2 in vivo kinetics, particularly in the earliest stages after exposure. Methods An ongoing, workplace clinical surveillance study was used to intensely sample a small cohort longitudinally. Nine study participants who developed COVID-19 between November, 2020 and March, 2021 were monitored at high temporal resolution for three months in terms of viral loads as well as associated inflammatory biomarker and antibody responses. CD8 + T cells targeting SARS-CoV-2 in blood samples from study participants were evaluated. Results Here we show that the resulting datasets, supported by Bayesian modeling, allowed the underlying kinetic processes to be described, yielding a number of unexpected findings. Early viral replication is rapid (median doubling time, 3.1 h), providing a narrow window between exposure and viral shedding, while the clearance phase is slow and heterogeneous. Host immune responses different widely across participants. Conclusions Results from our small study give a rare insight into the life-cycle of COVID-19 infection and hold a number of important biological, clinical, and public health implications.
Collapse
|
17
|
Walker RL, MacKay D, Waltz M, Lyerly AD, Fisher JA. Ethical Criteria for Improved Human Subject Protections in Phase I Healthy Volunteer Trials. Ethics Hum Res 2022; 44:2-21. [PMID: 36047278 PMCID: PMC9931499 DOI: 10.1002/eahr.500139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Phase I healthy volunteer trials test the safety and tolerability of investigational pharmaceuticals. In them, participants are exposed to study-drug risks without the possibility of direct medical benefit and typically must spend days or weeks in a residential research facility. Monetary payments are used to incentivize enrollment and compensate participants for their time. Together, these features of phase I healthy volunteer trials create a research context that differs markedly from most other clinical research, including by enrolling disproportionate numbers of economically disadvantaged people of color as participants. Due to these unique trial features and participation patterns, traditional biomedical research oversight offers inadequate ethical and policy guidance for phase I healthy volunteer research. This article details five ethical criteria crafted to be responsive to the particularities of this type of research: translational science value, fair opportunity and burden sharing, fair compensation for service, experiential welfare, and enhanced voice and recourse.
Collapse
Affiliation(s)
- Rebecca L Walker
- Professor of social medicine and of philosophy at the University of North Carolina at Chapel Hill
| | - Douglas MacKay
- Associate professor of public policy at the University of North Carolina at Chapel Hill
| | - Margaret Waltz
- Research associate in the Department of Social Medicine at the University of North Carolina at Chapel Hill
| | - Anne D Lyerly
- Professor of social medicine and on the core faculty in the Center for Bioethics at the University of North Carolina at Chapel Hill
| | - Jill A Fisher
- Professor of social medicine and on the core faculty in the Center for Bioethics at the University of North Carolina at Chapel Hill
| |
Collapse
|
18
|
Sharma A, Apte A, Rajappa M, Vaz M, Vaswani V, Goenka S, Malhotra S, Sangoram R, Lakshminarayanan S, Jayaram S, Mathaiyan J, Farseena K, Mukerjee P, Jaswal S, Dongre A, Timms O, Shafiq N, Aggarwal R, Kaur M, Juvekar S, Sekhar A, Kang G. Perceptions about controlled human infection model (CHIM) studies among members of ethics committees of Indian medical institutions: A qualitative exploration. Wellcome Open Res 2022; 7:209. [PMID: 36969719 PMCID: PMC10031138 DOI: 10.12688/wellcomeopenres.17968.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: Controlled Human Infection Model (CHIM) studies provide a unique platform for studying the pathophysiology of infectious diseases and accelerated testing of vaccines and drugs in controlled settings. However, ethical issues shroud them as the disease-causing pathogen is intentionally inoculated into healthy consenting volunteers, and effective treatment may or may not be available. We explored the perceptions of the members of institutional ethics committees (IECs) in India about CHIM studies. Methods: This qualitative exploratory study, conducted across seven sites in India, included 11 focused group discussions (FGD) and 31 in-depth interviews (IDI). A flexible approach was used with the aid of a topic guide. The data were thematically analyzed using grounded theory and an inductive approach. Emerging themes and sub-themes were analyzed, and major emergent themes were elucidated. Results: Seventy-two IEC members participated in the study including 21 basic medical scientists, 29 clinicians, 9 lay people, 6 legal experts and 7 social scientists. Three major themes emerged from this analysis—apprehensions about conduct of CHIM studies in India, a perceived need for CHIM studies in India and risk mitigation measures needed to protect research participants and minimize the associated risks. Conclusion: Development of a specific regulatory and ethical framework, training of research staff and ethics committee members, and ensuring specialized research infrastructure along with adequate community sensitization were considered essential before initiation of CHIM studies in India.
Collapse
Affiliation(s)
- Abhishek Sharma
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Aditi Apte
- KEM Hospital Research Centre, Pune, Maharashtra, 411011, India
| | - Medha Rajappa
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Manjulika Vaz
- St John's Medical College, Bengaluru, Karnataka, 560034, India
| | - Vina Vaswani
- Yenepoya University, Mangalore, Karnataka, 575018, India
| | - Shifalika Goenka
- Centre for Chronic Disease Control (CCDC), Delhi, Delhi, 110016, India
| | - Samir Malhotra
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Rashmi Sangoram
- KEM Hospital Research Centre, Pune, Maharashtra, 411011, India
| | - Subitha Lakshminarayanan
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Suganya Jayaram
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Jayanthi Mathaiyan
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | | | - Prarthna Mukerjee
- Centre for Chronic Disease Control (CCDC), Delhi, Delhi, 110016, India
| | - Surinder Jaswal
- Tata Institute of Social Sciences, Mumbai, Maharashtra, 400088, India
| | - Amol Dongre
- Pramukhswami Medical College, Karamsad, Gujarat, 388325, India
| | - Olinda Timms
- St John's Medical College, Bengaluru, Karnataka, 560034, India
| | - Nusrat Shafiq
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Rakesh Aggarwal
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Manmeet Kaur
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Sanjay Juvekar
- KEM Hospital Research Centre, Pune, Maharashtra, 411011, India
| | - Amrita Sekhar
- Translational Health Science and Technology Institute, Faridabad, Haryana, 101213, India
| | - Gagandeep Kang
- Christian Medical College, Vellore, Tamil Nadu, 632004, India
| |
Collapse
|
19
|
Bigay J, Le Grand R, Martinon F, Maisonnasse P. Vaccine-associated enhanced disease in humans and animal models: Lessons and challenges for vaccine development. Front Microbiol 2022; 13:932408. [PMID: 36033843 PMCID: PMC9399815 DOI: 10.3389/fmicb.2022.932408] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
The fight against infectious diseases calls for the development of safe and effective vaccines that generate long-lasting protective immunity. In a few situations, vaccine-mediated immune responses may have led to exacerbated pathology upon subsequent infection with the pathogen targeted by the vaccine. Such vaccine-associated enhanced disease (VAED) has been reported, or at least suspected, in animal models, and in a few instances in humans, for vaccine candidates against the respiratory syncytial virus (RSV), measles virus (MV), dengue virus (DENV), HIV-1, simian immunodeficiency virus (SIV), feline immunodeficiency virus (FIV), severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1), and the Middle East respiratory syndrome coronavirus (MERS-CoV). Although alleviated by clinical and epidemiological evidence, a number of concerns were also initially raised concerning the short- and long-term safety of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is causing the ongoing COVID-19 pandemic. Although the mechanisms leading to this phenomenon are not yet completely understood, the individual and/or collective role of antibody-dependent enhancement (ADE), complement-dependent enhancement, and cell-dependent enhancement have been highlighted. Here, we review mechanisms that may be associated with the risk of VAED, which are important to take into consideration, both in the assessment of vaccine safety and in finding ways to define models and immunization strategies that can alleviate such concerns.
Collapse
Affiliation(s)
| | | | - Frédéric Martinon
- Immunology of Viral Infections and Autoimmune Diseases (IMVA), IDMIT Department, Institut de Biologie François-Jacob (IBJF), University Paris-Sud-INSERM U1184, CEA, Fontenay-Aux-Roses, France
| | | |
Collapse
|
20
|
Oxford JS, Catchpole A, Mann A, Bell A, Noulin N, Gill D, Oxford JR, Gilbert A, Balasingam S. A Brief History of Human Challenge Studies (1900-2021) Emphasising the Virology, Regulatory and Ethical Requirements, Raison D'etre, Ethnography, Selection of Volunteers and Unit Design. Curr Top Microbiol Immunol 2022. [PMID: 35704095 DOI: 10.1007/82_2022_253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Venetian quarantine 400 years ago was an important public health measure. Since 1900 this has been refined to include "challenge" or deliberate infection with pathogens be they viruses, bacteria, or parasites. Our focus is virology and ranges from the early experiments in Cuba with Yellow Fever Virus to the most widespread pathogen of our current times, COVID-19. The latter has so far caused over four million deaths worldwide and 190 million cases of the disease. Quarantine and challenge were also used to investigate the Spanish Influenza of 1918 which caused over 100 million deaths. We consider here the merits of the approach, that is the speeding up of knowledge in a practical sense leading to the more rapid licensing of vaccines and antimicrobials. At the core of quarantine and challenge initiatives is the design of the unit to allow safe confinement of the pathogen and protection of the staff. Most important though is the safety of volunteers. We can see now, as in 1900, that members of our society are prepared and willing to engage in these experiments for the public good. Our ethnology study, where the investigator observed the experiment from within the quarantine, gave us the first indication of changing attitudes amongst volunteers whilst in quarantine. These quarantine experiments, referred to as challenge studies, human infection studies, or "controlled human infection models" involve thousands of clinical samples taken over two to three weeks and can provide a wealth of immunological and molecular data on the infection itself and could allow the discovery of new targets for vaccines and therapeutics. The Yellow Fever studies from 121 years ago gave the impetus for development of a successful vaccine still used today whilst also uncovering the nature of the Yellow Fever agent, namely that it was a virus. We outline how carefully these experiments are approached and the necessity to have high quality units with self-contained air-flow along with extensive personal protective equipment for nursing and medical staff. Most important is the employment of highly trained scientific, medical and nursing staff. We face a future of emerging pathogens driven by the increasing global population, deforestation, climate change, antibiotic resistance and increased global travel. These emerging pathogens may be pathogens we currently are not aware of or have not caused outbreaks historically but could also be mutated forms of known pathogens including viruses such as influenza (H7N9, H5N1 etc.) and coronaviruses. This calls for challenge studies to be part of future pandemic preparedness as an additional tool to assist with the rapid development of broad-spectrum antimicrobials, immunomodulators and new vaccines.
Collapse
Affiliation(s)
- J S Oxford
- Blizzard Institute of Cell and Molecular Science, Queen Mary University of London, London, E1 2AT, UK
| | | | | | | | | | - D Gill
- Blizzard Institute of Cell and Molecular Science, Queen Mary University of London, London, E1 2AT, UK
| | - J R Oxford
- Inveresk Medical Practice, Edinburgh, E21 7BP, UK
| | | | | |
Collapse
|
21
|
Ethics review of COVID-19 human challenge studies: a joint HRA/WHO workshop. Vaccine 2022; 40:3484-3489. [PMID: 35210119 PMCID: PMC8841214 DOI: 10.1016/j.vaccine.2022.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/01/2022] [Indexed: 12/15/2022]
Abstract
This report of a joint World Health Organization (WHO) and United Kingdom (UK) Health Research Authority (HRA) workshop discusses the ethics review of the first COVID-19 human challenge studies, undertaken in the midst of the pandemic. It reviews the early efforts of international and national institutions to define the ethical standards required for COVID-19 human challenge studies and create the frameworks to ensure rigorous and timely review of these studies. This report evaluates the utility of the WHO’s international guidance document Key criteria for the ethical acceptability of COVID-19 human challenge studies (WHO Key Criteria) as a practical resource for the ethics review of COVID-19 human challenge studies. It also assesses the UK HRA’s approach to these complex ethics reviews, including the formation of a Specialist Ad-Hoc Research Ethics Committee (REC) for COVID-19 Human Challenge Studies to review all current and future COVID-19 human challenge studies. In addition, the report outlines the reflections of REC members and researchers regarding the ethics review process of the first COVID-19 human challenge studies. Finally, it considers the potential ongoing scientific justification for COVID-19 human challenge studies, particularly in relation to next-generation vaccines and optimisation of vaccination schedules. Overall, there was broad agreement that the WHO Key Criteria represented an international consensus document that played a powerful role in setting norms and delineating the necessary conditions for the ethical acceptability of COVID-19 human challenge studies. Workshop members suggested that the WHO Key Criteria could be practically implemented to support researchers and ethics reviewers, including in the training of ethics committee members. In future, a wider audience may be engaged by the original document and potential additional materials, informed by the experiences of those involved in the first COVID-19 human challenge studies outlined in this document.
Collapse
|
22
|
Cable J, Rappuoli R, Klemm EJ, Kang G, Mutreja A, Wright GJ, Pizza M, Castro SA, Hoffmann JP, Alter G, Carfi A, Pollard AJ, Krammer F, Gupta RK, Wagner CE, Machado V, Modjarrad K, Corey L, B Gilbert P, Dougan G, Lurie N, Bjorkman PJ, Chiu C, Nemes E, Gordon SB, Steer AC, Rudel T, Blish CA, Sandberg JT, Brennan K, Klugman KP, Stuart LM, Madhi SA, Karp CL. Innovative vaccine approaches-a Keystone Symposia report. Ann N Y Acad Sci 2022; 1511:59-86. [PMID: 35029310 DOI: 10.1111/nyas.14739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 12/03/2021] [Indexed: 12/16/2022]
Abstract
The rapid development of COVID-19 vaccines was the result of decades of research to establish flexible vaccine platforms and understand pathogens with pandemic potential, as well as several novel changes to the vaccine discovery and development processes that partnered industry and governments. And while vaccines offer the potential to drastically improve global health, low-and-middle-income countries around the world often experience reduced access to vaccines and reduced vaccine efficacy. Addressing these issues will require novel vaccine approaches and platforms, deeper insight how vaccines mediate protection, and innovative trial designs and models. On June 28-30, 2021, experts in vaccine research, development, manufacturing, and deployment met virtually for the Keystone eSymposium "Innovative Vaccine Approaches" to discuss advances in vaccine research and development.
Collapse
Affiliation(s)
| | | | | | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Ankur Mutreja
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID) and Department of Medicine, University of Cambridge, Cambridge, UK
| | - Gavin J Wright
- Cell Surface Signalling Laboratory, Wellcome Sanger Institute, Hinxton, UK.,Department of Biology, Hull York Medical School, and York Biomedical Research Institute, University of York, York, UK
| | | | - Sowmya Ajay Castro
- Division of Molecular Microbiology, School of Life Sciences, University of Dundee, Dundee, UK
| | - Joseph P Hoffmann
- Departments of Pediatrics and Medicine, Center for Translational Research in Infection and Inflammation, Tulane University School of Medicine, New Orleans, Louisiana
| | - Galit Alter
- Ragon Institute of MGH, MIT and Harvard, Harvard Medical School, Cambridge, Massachusetts.,Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, UK
| | - Florian Krammer
- The Tisch Cancer Institute and Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ravindra K Gupta
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID) and Department of Medicine, University of Cambridge, Cambridge, UK.,Africa Health Research Institute, Durban, South Africa
| | - Caroline E Wagner
- Department of Bioengineering, McGill University, Montreal, Quebec, Canada
| | - Viviane Machado
- Measles and Respiratory Viruses Laboratory, WHO/NIC, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | - Kayvon Modjarrad
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Lawrence Corey
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington.,Department of Medicine, University of Washington School of Medicine, Seattle, Washington.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Peter B Gilbert
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Gordon Dougan
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID) and Department of Medicine, University of Cambridge, Cambridge, UK
| | - Nicole Lurie
- Coalition for Epidemic Preparedness Innovations, Oslo, Norway.,Harvard Medical School, Boston, Massachusetts
| | - Pamela J Bjorkman
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, California
| | - Christopher Chiu
- Department of Infectious Disease, Imperial College London, London, UK
| | - Elisa Nemes
- Division of Immunology, Department of Pathology, South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Andrew C Steer
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Thomas Rudel
- Microbiology Biocenter, University of Würzburg, Würzburg, Germany
| | - Catherine A Blish
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford Immunology Program, Stanford University School of Medicine, Stanford, California.,Chan Zuckerberg Biohub, San Francisco, California
| | - John Tyler Sandberg
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kiva Brennan
- National Children's Research Centre, Crumlin and School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Keith P Klugman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lynda M Stuart
- Immunology Program, Benaroya Research Institute at Virginia Mason, Seattle, Washington.,Bill & Melinda Gates Foundation, Seattle, Washington
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | |
Collapse
|
23
|
Barker C, Collet K, Gbesemete D, Piggin M, Watson D, Pristerà P, Lawerence W, Smith E, Bahrami-Hessari M, Johnson H, Baker K, Qavi A, McGrath C, Chiu C, Read RC, Ward H. Public attitudes to a human challenge study with SARS-CoV-2: a mixed-methods study. Wellcome Open Res 2022; 7:49. [PMID: 35321005 PMCID: PMC8921687 DOI: 10.12688/wellcomeopenres.17516.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Human challenge studies involve the deliberate exposure of healthy volunteers to an infectious micro-organism in a highly controlled and monitored way. They are used to understand infectious diseases and have contributed to the development of vaccines. In early 2020, the UK started exploring the feasibility of establishing a human challenge study with SARS-CoV-2. Given the significant public interest and the complexity of the potential risks and benefits, it is vital that public views are considered in the design and approval of any such study and that investigators and ethics boards remain accountable to the public. Methods: Mixed methods study comprising online surveys conducted with 2,441 UK adults and in-depth virtual focus groups with 57 UK adults during October 2020 to explore the public's attitudes to a human challenge study with SARS-CoV-2 taking place in the UK. Results: There was overall agreement across the surveys and focus groups that a human challenge study with SARS-CoV-2 should take place in the UK. Transparency of information, trust and the necessity to provide clear information on potential risks to study human challenge study participants were important. The perceived risks of taking part included the risk of developing long-term effects from COVID, impact on personal commitments and mental health implications of isolation. There were a number of practical realities to taking part that would influence a volunteer's ability to participate (e.g. Wi-Fi, access to exercise, outside space and work, family and pet commitments). Conclusions: The results identified practical considerations for teams designing human challenge studies. Recommendations were grouped: 1) messaging to potential study participants, 2) review of the protocol and organisation of the study, and 3) more broadly, making the study more inclusive and relevant. This study highlights the value of public consultation in research, particularly in fields attracting public interest and scrutiny .
Collapse
Affiliation(s)
- Caroline Barker
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.,NIHR Applied Research Collaboration Wessex, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK, UK
| | - Katharine Collet
- NIHR Imperial Biomedical Research Centre, Patient Experience Research Centre, Imperial College London, London, W2 1NY, UK
| | - Diane Gbesemete
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.,School of Clinical and Experimental Sciences, Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, S016 6YD, UK
| | - Maria Piggin
- NIHR Imperial Biomedical Research Centre, Patient Experience Research Centre, Imperial College London, London, W2 1NY, UK
| | - Daniella Watson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, S016 6YD, UK
| | - Philippa Pristerà
- NIHR Imperial Biomedical Research Centre, Patient Experience Research Centre, Imperial College London, London, W2 1NY, UK
| | - Wendy Lawerence
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.,Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| | - Emma Smith
- National Heart and Lung Institute, Imperial College London, London, W2 1NY, UK
| | - Michael Bahrami-Hessari
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Halle Johnson
- NIHR Imperial Biomedical Research Centre, Patient Experience Research Centre, Imperial College London, London, W2 1NY, UK
| | - Katherine Baker
- NIHR Applied Research Collaboration Wessex, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK, UK
| | - Ambar Qavi
- NIHR Imperial Biomedical Research Centre, Patient Experience Research Centre, Imperial College London, London, W2 1NY, UK
| | - Carmel McGrath
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.,School of Clinical and Experimental Sciences, Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, S016 6YD, UK
| | - Christopher Chiu
- Department of Infectious Diseases, Imperial College London, London, W2 1NY, UK
| | - Robert C Read
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.,School of Clinical and Experimental Sciences, Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, S016 6YD, UK
| | - Helen Ward
- NIHR Imperial Biomedical Research Centre, Patient Experience Research Centre, Imperial College London, London, W2 1NY, UK
| |
Collapse
|
24
|
Muhi S, Stinear TP. Systematic review of M. Bovis BCG and other candidate vaccines for Buruli ulcer prophylaxis. Vaccine 2021; 39:7238-7252. [PMID: 34119347 DOI: 10.1016/j.vaccine.2021.05.092] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/10/2021] [Accepted: 05/23/2021] [Indexed: 01/17/2023]
Abstract
Buruli ulcer, caused by Mycobacterium ulcerans, is a neglected tropical disease endemic to over 30 countries, with increasing incidence in temperate, coastal Victoria, Australia. Strategies to control transmission are urgently required. This study systematically reviews the literature to identify and describe candidate prophylactic Buruli ulcer vaccines. This review highlights that Mycobacterium bovis Bacillus Calmette-Guérin (BCG) vaccine is the only vaccine studied in randomised controlled trials and confirms its importance as a benchmark for comparison against putative vaccines in pre-clinical studies. Nevertheless, BCG alone is unable to offer long-term protection in humans. A number of experimental vaccines that exceed the protection provided by BCG in mice have emerged, particularly those utilising recombinant BCG expressing immunogenic M. ulcerans proteins. Although progress is promising, there remain key questions about the optimal approach to characterising the immunological correlates of protection in humans and strategies to investigate the safety and efficacy of such vaccines in humans.
Collapse
Affiliation(s)
- Stephen Muhi
- Victorian Infectious Diseases Service at the Royal Melbourne Hospital, Melbourne, Australia; Department of Microbiology and Immunology, Peter Doherty Institute at the University of Melbourne, Melbourne, Australia
| | - Timothy P Stinear
- Department of Microbiology and Immunology, Peter Doherty Institute at the University of Melbourne, Melbourne, Australia.
| |
Collapse
|
25
|
Rapeport G, Smith E, Gilbert A, Catchpole A, McShane H, Chiu C. SARS-CoV-2 Human Challenge Studies - Establishing the Model during an Evolving Pandemic. N Engl J Med 2021; 385:961-964. [PMID: 34289273 DOI: 10.1056/nejmp2106970] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Garth Rapeport
- From the National Heart and Lung Institute (G.R., E.S.) and the Department of Infectious Disease (C.C.), Imperial College London; the U.K. Vaccines Taskforce (A.G.); and hVIVO Services (A.C.) - all in London; and the Department of Paediatrics, University of Oxford, Oxford, United Kingdom (H.M.)
| | - Emma Smith
- From the National Heart and Lung Institute (G.R., E.S.) and the Department of Infectious Disease (C.C.), Imperial College London; the U.K. Vaccines Taskforce (A.G.); and hVIVO Services (A.C.) - all in London; and the Department of Paediatrics, University of Oxford, Oxford, United Kingdom (H.M.)
| | - Anthony Gilbert
- From the National Heart and Lung Institute (G.R., E.S.) and the Department of Infectious Disease (C.C.), Imperial College London; the U.K. Vaccines Taskforce (A.G.); and hVIVO Services (A.C.) - all in London; and the Department of Paediatrics, University of Oxford, Oxford, United Kingdom (H.M.)
| | - Andrew Catchpole
- From the National Heart and Lung Institute (G.R., E.S.) and the Department of Infectious Disease (C.C.), Imperial College London; the U.K. Vaccines Taskforce (A.G.); and hVIVO Services (A.C.) - all in London; and the Department of Paediatrics, University of Oxford, Oxford, United Kingdom (H.M.)
| | - Helen McShane
- From the National Heart and Lung Institute (G.R., E.S.) and the Department of Infectious Disease (C.C.), Imperial College London; the U.K. Vaccines Taskforce (A.G.); and hVIVO Services (A.C.) - all in London; and the Department of Paediatrics, University of Oxford, Oxford, United Kingdom (H.M.)
| | - Christopher Chiu
- From the National Heart and Lung Institute (G.R., E.S.) and the Department of Infectious Disease (C.C.), Imperial College London; the U.K. Vaccines Taskforce (A.G.); and hVIVO Services (A.C.) - all in London; and the Department of Paediatrics, University of Oxford, Oxford, United Kingdom (H.M.)
| |
Collapse
|
26
|
Baylor NW. Human Challenge Studies for Vaccine Development : Regulatory Aspects of Human Challenge Studies. Curr Top Microbiol Immunol 2021. [PMID: 34480650 DOI: 10.1007/82_2021_239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The traditional regulatory pathway for the evaluation of new vaccine candidates generally proceeds from preclinical through three successive phases of human trials, and the demonstration of efficacy is usually done through randomized-controlled clinical trials. However, human challenge trials or controlled human infection models have been used in vaccine clinical development to generate supportive data for establishment of correlates of protection, supportive data for licensure, as well as licensure in the case of Vaxchora® by the US FDA. Despite this, there are no codified regulations from national regulatory authorities (NRAs) that specifically address HCTs, nor guidance related to standardization of approaches to HCTs among regulators. NRAs may agree that HCTs are innovative, promising tools to accelerate vaccine development; however, a strong benefit/risk assessment is needed to ensure the safety of study participants. Lastly, it is important to consider the regulatory framework in which the human challenge trial may be conducted.
Collapse
|
27
|
Dal-Ré R, Bekker LG, Gluud C, Holm S, Jha V, Poland GA, Rosendaal FR, Schwarzer-Daum B, Sevene E, Tinto H, Voo TC, Sreeharan N. Ongoing and future COVID-19 vaccine clinical trials: challenges and opportunities. THE LANCET. INFECTIOUS DISEASES 2021; 21:e342-e347. [PMID: 34019801 PMCID: PMC8131060 DOI: 10.1016/s1473-3099(21)00263-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 12/18/2022]
Abstract
Large-scale deployment of COVID-19 vaccines will seriously affect the ongoing phases 2 and 3 randomised placebo-controlled trials assessing SARS-CoV-2 vaccine candidates. The effect will be particularly acute in high-income countries where the entire adult or older population could be vaccinated by late 2021. Regrettably, only a small proportion of the population in many low-income and middle-income countries will have access to available vaccines. Sponsors of COVID-19 vaccine candidates currently in phase 2 or initiating phase 3 trials in 2021 should consider continuing the research in countries with limited affordability and availability of COVID-19 vaccines. Several ethical principles must be implemented to ensure the equitable, non-exploitative, and respectful conduct of trials in resource-poor settings. Once sufficient knowledge on the immunogenicity response to COVID-19 vaccines is acquired, non-inferiority immunogenicity trials—comparing the immune response of a vaccine candidate to that of an authorised vaccine—would probably be the most common trial design. Until then, placebo-controlled, double-blind, crossover trials will continue to play a role in the development of new vaccine candidates. WHO or the Council for International Organizations of Medical Sciences should define an ethical framework for the requirements and benefits for trial participants and host communities in resource-poor settings that should require commitment from all vaccine candidate sponsors from high-income countries.
Collapse
Affiliation(s)
- Rafael Dal-Ré
- Epidemiology Unit, Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Christian Gluud
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Rigshospitalet, Copenhagen, Denmark; Institute for Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Søren Holm
- Centre for Social Ethics and Policy, Department of Law, University of Manchester, Manchester, UK
| | - Vivekanand Jha
- George Institute for Global Health, UNSW, New Delhi, India; Manipal Academy of Higher Education, Manipal, India
| | - Gregory A Poland
- Mayo Clinic Vaccine Research Group and Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Esperança Sevene
- Department of Physiological Sciences, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique; Manhiça Health Research Centre, Maputo, Mozambique
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de La Santé, Nanoro, Burkina Faso
| | - Teck Chuan Voo
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | |
Collapse
|
28
|
Nichol AA, Mwaka ES, Luyckx VA. Ethics in Research: Relevance for Nephrology. Semin Nephrol 2021; 41:272-281. [PMID: 34330367 DOI: 10.1016/j.semnephrol.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Research is crucial to progress in nephrology. It is important that studies are conducted rigorously from the scientific perspective, as well as in adherence to ethical standards. Traditional clinical research places a high value on individual research subject autonomy. Research questions often include the clinical effectiveness of new interventions studied under highly controlled conditions. Such research has brought the promise of new game-changers in nephrology, such as the sodium-glucose cotransporter 2 inhibitors. Implementation research takes such knowledge further and investigates how to translate it into broader-scale policy and practice, to achieve swift and global uptake, with a focus on justice and equity. Newer challenges arising globally in research ethics include those relating to oversight of innovation, biobanking and big data, human-challenge studies, and research during emergencies. This article details the history of clinical research ethics and the role of research ethics committees, describes the evolving spectrum of biomedical research in human medicine, and presents emerging clinical research ethics issues using illustrative examples and a hypothetical case study. It is imperative that researchers and research ethics committees are well versed in the ethical principles of all forms of human research such that research is conducted to the highest standards and that effective interventions can be implemented at scale as rapidly as possible.
Collapse
Affiliation(s)
- Ariadne A Nichol
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA
| | - Erisa S Mwaka
- Department of Anatomy, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Valerie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
| |
Collapse
|