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Hossain I, Osei I, Lobga G, Wutor BM, Olatunji Y, Adefila W, Adeshola B, Isa Y, Nguyen C, Sonko K, Ceesay L, Baldeh B, Barrow O, Young B, Ceesay S, Nyassi A, Sarwar G, Barjo O, M Drammeh M, Salaudeen R, Mackenzie G. Impact of the COVID-19 pandemic on a clinical trial of pneumococcal vaccine scheduling (PVS) in rural Gambia. Trials 2023; 24:271. [PMID: 37055788 PMCID: PMC10101732 DOI: 10.1186/s13063-023-07298-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/30/2023] [Indexed: 04/15/2023] Open
Abstract
The COVID-19 pandemic represents an unprecedented challenge for clinical research. The Pneumococcal Vaccine Schedules (PVS) study is a non-inferiority, interventional trial in which infants resident in 68 geographic clusters are randomised to two different schedules for pneumococcal vaccination. From September 2019 onwards, all infants resident in the study area became eligible for trial enrolment at all Expanded Programme on Immunisation (EPI) clinics in the study area. Surveillance for clinical endpoints is conducted at all 11 health facilities in the study area. PVS is conducted as a collaboration between the Medical Research Council Unit The Gambia (MRCG) at LSHTM and the Gambian Ministry of Health (MoH). The COVID-19 pandemic caused many disruptions to PVS. MRCG instructed interventional studies that participant enrolment be suspended on 26 March 2020, and a public health emergency was declared in The Gambia on 28 March 2020. Enrolment in PVS restarted on 1 July 2020 and was suspended again on 5 August 2020 after The Gambia experienced a sharp increase in COVID-19 cases in late July 2020 and restarted again on 1 September 2020. During periods of suspended enrolment of infants at EPI clinics, PVS continued safety surveillance at health facilities, albeit with disruptions. During the periods of suspended enrolment, infants who had been enrolled before 26 March 2020 continued to receive the PCV schedule to which they had been randomly allocated based on their village of residence, whereas all other infants received the standard PCV schedule. Throughout 2020 and 2021, the trial faced numerous technical and operational challenges: disruption to MoH delivery of EPI services and clinical care at health facilities; episodes of staff illness and isolation; disruption of MRCG transport, procurement, communications and human resource management; and also a range of ethical, regulatory, sponsorship, trial monitoring and financial challenges. In April 2021, a formal review concluded that the pandemic had not compromised the scientific validity of PVS and that the trial should continue as per protocol. The continuing challenges that COVID-19 poses to PVS, and other clinical trials will persist for some time.
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Affiliation(s)
- Ilias Hossain
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia.
| | - Isaac Osei
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Galega Lobga
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Baleng M Wutor
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Yekini Olatunji
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Williams Adefila
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Banjo Adeshola
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Yasir Isa
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Cattram Nguyen
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Kemo Sonko
- Regional Health Directorate, Upper River Region, Ministry of Health, Basse, The Gambia
| | - Lamin Ceesay
- Regional Health Directorate, Upper River Region, Ministry of Health, Basse, The Gambia
| | - Bubacarr Baldeh
- Regional Health Directorate, Central River Region, Ministry of Health, Bansang, The Gambia
| | - Omar Barrow
- Regional Health Directorate, Central River Region, Ministry of Health, Bansang, The Gambia
| | - Benjamin Young
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Saidina Ceesay
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Abdoullah Nyassi
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Golam Sarwar
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Ousman Barjo
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Momodou M Drammeh
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Rasheed Salaudeen
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Grant Mackenzie
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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