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Mtunthama Toto N, Gooding K, Kapumba BM, Jambo K, Rylance J, Burr S, Morton B, Gordon SB, Manda-Taylor L. "At first, I was very afraid"-a qualitative description of participants' views and experiences in the first Human Infection Study in Malawi. Wellcome Open Res 2021; 6:89. [PMID: 35187267 PMCID: PMC8825950 DOI: 10.12688/wellcomeopenres.16587.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Human infection studies (HIS) involve deliberately infecting healthy volunteers with a pathogen in a controlled environment to understand infection and support the development of effective vaccines or treatments. HIS research is expanding to many low and middle-income settings to accelerate vaccine development. Given the implementation of the first HIS research to establish the experimental human pneumococcal carriage model's feasibility, we sought to understand the participant's opinions and experiences. Methods: We used a qualitative, descriptive approach to understand participants perceptions and experiences on HIS participation. Sixteen healthy adult participants were invited to participate in in-depth exit interviews to discuss their experiences, motivations and concerns. Results: Our findings showed that the likelihood of participation in HIS research rests on three essential conditions: motivation to participate, compensation and advocacy. The motivation and decision to participate was based on reasons including altruism, patriotism, monetary and material incentives, and while compensation was deemed appropriate, concerns about unanticipated research-related risks were raised. Participant advocate groups were recommended for increasing awareness and educating others in the broader community about HIS research. Conclusions: Participants' experiences of HIS in Malawi provide the basis of what can be acceptable in HIS research in lower-income countries and areas where study procedures could be adjusted.
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Affiliation(s)
- Neema Mtunthama Toto
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
| | | | - Blessings M. Kapumba
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
| | - Kondwani Jambo
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
- Clinical Services, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Jamie Rylance
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
- Clinical Services, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Sarah Burr
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
- Clinical Services, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Ben Morton
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
- Clinical Services, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Stephen B. Gordon
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
- Clinical Services, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
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Mtunthama Toto N, Gooding K, Kapumba BM, Jambo K, Rylance J, Burr S, Morton B, Gordon SB, Manda-Taylor L. "At first, I was very afraid"-a qualitative description of participants' views and experiences in the first Human Infection Study in Malawi. Wellcome Open Res 2021; 6:89. [PMID: 35187267 PMCID: PMC8825950 DOI: 10.12688/wellcomeopenres.16587.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Human infection studies (HIS) involve deliberately infecting healthy volunteers with a pathogen in a controlled environment to understand infection and support the development of effective vaccines or treatments. HIS research is expanding to many low and middle-income settings to accelerate vaccine development. Given the implementation of the first HIS research to establish the experimental human pneumococcal carriage model's feasibility, we sought to understand the participant's opinions and experiences. Methods: We used a qualitative, descriptive approach to understand participants perceptions and experiences on HIS participation. Sixteen healthy adult participants were invited to participate in in-depth exit interviews to discuss their experiences, motivations and concerns. Results: Our findings showed that the likelihood of participation in HIS research rests on three essential conditions: motivation to participate, compensation and advocacy. The motivation and decision to participate was based on reasons including altruism, patriotism, monetary and material incentives, and while compensation was deemed appropriate, concerns about unanticipated research-related risks were raised. Participant advocate groups were recommended for increasing awareness and educating others in the broader community about HIS research. Conclusions: Participants' experiences of HIS in Malawi provide the basis of what can be acceptable in HIS research in lower-income countries and areas where study procedures could be adjusted.
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Affiliation(s)
- Neema Mtunthama Toto
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
| | | | - Blessings M. Kapumba
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
| | - Kondwani Jambo
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
- Clinical Services, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Jamie Rylance
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
- Clinical Services, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Sarah Burr
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
- Clinical Services, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Ben Morton
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
- Clinical Services, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Stephen B. Gordon
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
- Clinical Services, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
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Chapman CR, Sukumaran S, Tsegaye GT, Shevchenko Y, Caplan AL. The Quest for Compensation for Research-Related Injury in the United States: A New Proposal. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2019; 47:732-747. [PMID: 31957586 DOI: 10.1177/1073110519897737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In the U.S., there is no requirement for research sponsors to compensate human research subjects who experience injuries as a result of their participation. In this article, we review the moral justifications that compel the establishment of a better research-related injury compensation system. We explore how other countries and certain institutions within the U.S. have adopted various systems of compensation. The existence of these systems demonstrates both that the U.S. lags behind other nations in its protection of human research subjects and that the establishment of a compensation system is both practical and feasible. We then examine factors which have prevented the U.S. from establishing its own compensation system. We consider possible alternatives for the U.S. by examining the advantages and disadvantages of both established and proposed systems. We offer a new proposal that addresses the justice concerns which compel the establishment of a national compensation system, distributes the burdens of such a system on multiple stakeholders that benefit from research, and has the additional advantage of minimizing the administrative and logistical challenges associated with initiating such a system.
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Affiliation(s)
- Carolyn Riley Chapman
- Carolyn Riley Chapman, Ph.D., M.S., is a Faculty Affiliate of the Division of Medical Ethics at NYU School of Medicine. Dr. Chapman received her B.A. from Dartmouth College (Hanover, NH), her Ph.D. from Harvard University (Cambridge, MA) and her M.S. in Bioethics at Columbia University (New York, NY). Sangita Sukumaran, M.D., is Professor and Head of Department of Pharmacology at Terna Medical College, Navi Mumbai, India. She received her MD (Pharmacology) degree from Lokmanya Tilak Municipal Medical College, Mumbai, India and her MBBS (Bachelors in Medicine & Bachelors in Surgery) from Grant Medical College, Mumbai, India. She received her Post Graduate Diploma in Bioethics from Indira Gandhi National Open University (IGNOU), India and received her International Fellowship in Bioethics & Ethics Committee administration from Western IRB, Puyallup, Washington, USA. Geremew Tarekegne Tsegaye, M.D., M.P.H., M.Sc., Pg. Dip., is a Program manager for Grand Challenges Ethiopia and IRB chair at Armauer Hansen Research Institute, Addis Ababa, Ethiopia. He received his MD (Medicine) degree from Jimma University, Ethiopia, and his MPH from Universite Libre De Bruxulles (Belgium) and Advanced Master of Bioethics of Erasmus Mundus program, organized by a consortium of three European Universities: Katholieke Universiteit Leuven (Belgium), Radboud Universiteit Nijmegen (The Netherlands) and Università di Padova (Italy). He has received an Advanced Post Graduate Diploma in African Bioethics from Stellenbosch University, South Africa, and an International Fellowship in Bioethics & Ethics Committee administration from Western IRB, Puyallup, USA. Yelena Shevchenko, Ph.D., is a Head of Strategic Planning and Analytics Department in the Science Fund of the Republic of Kazakhstan and a member of the Central State Ethics Commission under the Ministry of Health of the Republic of Kazakhstan. She has been conferred her Ph.D. in Economics by the decision of the Control Committee in Education and Science under the Ministry of Education and Science of the Republic of Kazakhstan. She has received her International Fellowship in Bioethics & Ethics Committee administration from Western IRB, Puyallup, USA. Arthur L. Caplan, Ph.D., is the Drs. William F and Virginia Connolly Mitty Professor and founding head of the Division of Medical Ethics at NYU School of Medicine. He received his B.A. from Brandeis University (Waltham, MA) and an M.A., M.Phil, and Ph.D. from Columbia University (New York, NY)
| | - Sangita Sukumaran
- Carolyn Riley Chapman, Ph.D., M.S., is a Faculty Affiliate of the Division of Medical Ethics at NYU School of Medicine. Dr. Chapman received her B.A. from Dartmouth College (Hanover, NH), her Ph.D. from Harvard University (Cambridge, MA) and her M.S. in Bioethics at Columbia University (New York, NY). Sangita Sukumaran, M.D., is Professor and Head of Department of Pharmacology at Terna Medical College, Navi Mumbai, India. She received her MD (Pharmacology) degree from Lokmanya Tilak Municipal Medical College, Mumbai, India and her MBBS (Bachelors in Medicine & Bachelors in Surgery) from Grant Medical College, Mumbai, India. She received her Post Graduate Diploma in Bioethics from Indira Gandhi National Open University (IGNOU), India and received her International Fellowship in Bioethics & Ethics Committee administration from Western IRB, Puyallup, Washington, USA. Geremew Tarekegne Tsegaye, M.D., M.P.H., M.Sc., Pg. Dip., is a Program manager for Grand Challenges Ethiopia and IRB chair at Armauer Hansen Research Institute, Addis Ababa, Ethiopia. He received his MD (Medicine) degree from Jimma University, Ethiopia, and his MPH from Universite Libre De Bruxulles (Belgium) and Advanced Master of Bioethics of Erasmus Mundus program, organized by a consortium of three European Universities: Katholieke Universiteit Leuven (Belgium), Radboud Universiteit Nijmegen (The Netherlands) and Università di Padova (Italy). He has received an Advanced Post Graduate Diploma in African Bioethics from Stellenbosch University, South Africa, and an International Fellowship in Bioethics & Ethics Committee administration from Western IRB, Puyallup, USA. Yelena Shevchenko, Ph.D., is a Head of Strategic Planning and Analytics Department in the Science Fund of the Republic of Kazakhstan and a member of the Central State Ethics Commission under the Ministry of Health of the Republic of Kazakhstan. She has been conferred her Ph.D. in Economics by the decision of the Control Committee in Education and Science under the Ministry of Education and Science of the Republic of Kazakhstan. She has received her International Fellowship in Bioethics & Ethics Committee administration from Western IRB, Puyallup, USA. Arthur L. Caplan, Ph.D., is the Drs. William F and Virginia Connolly Mitty Professor and founding head of the Division of Medical Ethics at NYU School of Medicine. He received his B.A. from Brandeis University (Waltham, MA) and an M.A., M.Phil, and Ph.D. from Columbia University (New York, NY)
| | - Geremew Tarekegne Tsegaye
- Carolyn Riley Chapman, Ph.D., M.S., is a Faculty Affiliate of the Division of Medical Ethics at NYU School of Medicine. Dr. Chapman received her B.A. from Dartmouth College (Hanover, NH), her Ph.D. from Harvard University (Cambridge, MA) and her M.S. in Bioethics at Columbia University (New York, NY). Sangita Sukumaran, M.D., is Professor and Head of Department of Pharmacology at Terna Medical College, Navi Mumbai, India. She received her MD (Pharmacology) degree from Lokmanya Tilak Municipal Medical College, Mumbai, India and her MBBS (Bachelors in Medicine & Bachelors in Surgery) from Grant Medical College, Mumbai, India. She received her Post Graduate Diploma in Bioethics from Indira Gandhi National Open University (IGNOU), India and received her International Fellowship in Bioethics & Ethics Committee administration from Western IRB, Puyallup, Washington, USA. Geremew Tarekegne Tsegaye, M.D., M.P.H., M.Sc., Pg. Dip., is a Program manager for Grand Challenges Ethiopia and IRB chair at Armauer Hansen Research Institute, Addis Ababa, Ethiopia. He received his MD (Medicine) degree from Jimma University, Ethiopia, and his MPH from Universite Libre De Bruxulles (Belgium) and Advanced Master of Bioethics of Erasmus Mundus program, organized by a consortium of three European Universities: Katholieke Universiteit Leuven (Belgium), Radboud Universiteit Nijmegen (The Netherlands) and Università di Padova (Italy). He has received an Advanced Post Graduate Diploma in African Bioethics from Stellenbosch University, South Africa, and an International Fellowship in Bioethics & Ethics Committee administration from Western IRB, Puyallup, USA. Yelena Shevchenko, Ph.D., is a Head of Strategic Planning and Analytics Department in the Science Fund of the Republic of Kazakhstan and a member of the Central State Ethics Commission under the Ministry of Health of the Republic of Kazakhstan. She has been conferred her Ph.D. in Economics by the decision of the Control Committee in Education and Science under the Ministry of Education and Science of the Republic of Kazakhstan. She has received her International Fellowship in Bioethics & Ethics Committee administration from Western IRB, Puyallup, USA. Arthur L. Caplan, Ph.D., is the Drs. William F and Virginia Connolly Mitty Professor and founding head of the Division of Medical Ethics at NYU School of Medicine. He received his B.A. from Brandeis University (Waltham, MA) and an M.A., M.Phil, and Ph.D. from Columbia University (New York, NY)
| | - Yelena Shevchenko
- Carolyn Riley Chapman, Ph.D., M.S., is a Faculty Affiliate of the Division of Medical Ethics at NYU School of Medicine. Dr. Chapman received her B.A. from Dartmouth College (Hanover, NH), her Ph.D. from Harvard University (Cambridge, MA) and her M.S. in Bioethics at Columbia University (New York, NY). Sangita Sukumaran, M.D., is Professor and Head of Department of Pharmacology at Terna Medical College, Navi Mumbai, India. She received her MD (Pharmacology) degree from Lokmanya Tilak Municipal Medical College, Mumbai, India and her MBBS (Bachelors in Medicine & Bachelors in Surgery) from Grant Medical College, Mumbai, India. She received her Post Graduate Diploma in Bioethics from Indira Gandhi National Open University (IGNOU), India and received her International Fellowship in Bioethics & Ethics Committee administration from Western IRB, Puyallup, Washington, USA. Geremew Tarekegne Tsegaye, M.D., M.P.H., M.Sc., Pg. Dip., is a Program manager for Grand Challenges Ethiopia and IRB chair at Armauer Hansen Research Institute, Addis Ababa, Ethiopia. He received his MD (Medicine) degree from Jimma University, Ethiopia, and his MPH from Universite Libre De Bruxulles (Belgium) and Advanced Master of Bioethics of Erasmus Mundus program, organized by a consortium of three European Universities: Katholieke Universiteit Leuven (Belgium), Radboud Universiteit Nijmegen (The Netherlands) and Università di Padova (Italy). He has received an Advanced Post Graduate Diploma in African Bioethics from Stellenbosch University, South Africa, and an International Fellowship in Bioethics & Ethics Committee administration from Western IRB, Puyallup, USA. Yelena Shevchenko, Ph.D., is a Head of Strategic Planning and Analytics Department in the Science Fund of the Republic of Kazakhstan and a member of the Central State Ethics Commission under the Ministry of Health of the Republic of Kazakhstan. She has been conferred her Ph.D. in Economics by the decision of the Control Committee in Education and Science under the Ministry of Education and Science of the Republic of Kazakhstan. She has received her International Fellowship in Bioethics & Ethics Committee administration from Western IRB, Puyallup, USA. Arthur L. Caplan, Ph.D., is the Drs. William F and Virginia Connolly Mitty Professor and founding head of the Division of Medical Ethics at NYU School of Medicine. He received his B.A. from Brandeis University (Waltham, MA) and an M.A., M.Phil, and Ph.D. from Columbia University (New York, NY)
| | - Arthur L Caplan
- Carolyn Riley Chapman, Ph.D., M.S., is a Faculty Affiliate of the Division of Medical Ethics at NYU School of Medicine. Dr. Chapman received her B.A. from Dartmouth College (Hanover, NH), her Ph.D. from Harvard University (Cambridge, MA) and her M.S. in Bioethics at Columbia University (New York, NY). Sangita Sukumaran, M.D., is Professor and Head of Department of Pharmacology at Terna Medical College, Navi Mumbai, India. She received her MD (Pharmacology) degree from Lokmanya Tilak Municipal Medical College, Mumbai, India and her MBBS (Bachelors in Medicine & Bachelors in Surgery) from Grant Medical College, Mumbai, India. She received her Post Graduate Diploma in Bioethics from Indira Gandhi National Open University (IGNOU), India and received her International Fellowship in Bioethics & Ethics Committee administration from Western IRB, Puyallup, Washington, USA. Geremew Tarekegne Tsegaye, M.D., M.P.H., M.Sc., Pg. Dip., is a Program manager for Grand Challenges Ethiopia and IRB chair at Armauer Hansen Research Institute, Addis Ababa, Ethiopia. He received his MD (Medicine) degree from Jimma University, Ethiopia, and his MPH from Universite Libre De Bruxulles (Belgium) and Advanced Master of Bioethics of Erasmus Mundus program, organized by a consortium of three European Universities: Katholieke Universiteit Leuven (Belgium), Radboud Universiteit Nijmegen (The Netherlands) and Università di Padova (Italy). He has received an Advanced Post Graduate Diploma in African Bioethics from Stellenbosch University, South Africa, and an International Fellowship in Bioethics & Ethics Committee administration from Western IRB, Puyallup, USA. Yelena Shevchenko, Ph.D., is a Head of Strategic Planning and Analytics Department in the Science Fund of the Republic of Kazakhstan and a member of the Central State Ethics Commission under the Ministry of Health of the Republic of Kazakhstan. She has been conferred her Ph.D. in Economics by the decision of the Control Committee in Education and Science under the Ministry of Education and Science of the Republic of Kazakhstan. She has received her International Fellowship in Bioethics & Ethics Committee administration from Western IRB, Puyallup, USA. Arthur L. Caplan, Ph.D., is the Drs. William F and Virginia Connolly Mitty Professor and founding head of the Division of Medical Ethics at NYU School of Medicine. He received his B.A. from Brandeis University (Waltham, MA) and an M.A., M.Phil, and Ph.D. from Columbia University (New York, NY)
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