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Doe-Anderson J, Baseler B, Driscoll P, Johnson M, Lysander J, McNay L, Njoh W, Smolskis M, Wehrlen L, Zuckerman J. Beating the Odds: Successful Establishment of a Phase II/III Clinical Research Trial in Resource-Poor Liberia during the Largest-Ever Ebola Outbreak. Contemp Clin Trials Commun 2016; 4:68-73. [PMID: 28042619 PMCID: PMC5198894 DOI: 10.1016/j.conctc.2016.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
It has been argued that a country such as Liberia, not fully recovered from the devastation of decades of civil unrest, lacked the appropriate ethical and regulatory framework, basic human and health care services, and infrastructure to carry out clinical trials according to international standards of quality during a public health emergency. However, as Liberia, Sierra Leone, and Guinea were being ravaged by the largest and most devastating Ebola Virus Disease (EVD) outbreak ever recorded, the topic of conducting clinical trials of experimental vaccine and treatment candidates in these resource-poor countries generated the keen interest and concern of scientists, researchers, physicians, bioethicists, philanthropists, and even politicians. Decisive action on behalf of the Liberian government, and a timely positive and supportive response from the United States (U.S.) government, led to the formation of PREVAIL (Partnership for Research on Ebola Vaccines in Liberia) – a clinical research partnership between the two governments. Within a span of 12 weeks, this partnership accomplished the unimaginable: the successful initiation of a Phase II/III vaccine clinical trial for EVD in Liberia. This paper will discuss the dynamics of the research collaboration, barriers encountered, breakthroughs realized, key elements of success, and lessons learned in the process.
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Affiliation(s)
- J. Doe-Anderson
- Clinical Research Directorate, Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, 21702, USA
- Corresponding author.
| | - B. Baseler
- Clinical Research Directorate, Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, 21702, USA
| | - P. Driscoll
- Intramural Clinical Management and Operations Branch, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
| | | | | | - L. McNay
- Office of Strategic Planning and Assessment, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
| | - W.S. Njoh
- Clinical Research Directorate, Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, 21702, USA
| | - M. Smolskis
- Office of Strategic Planning and Assessment, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
| | - L. Wehrlen
- Nursing Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - J. Zuckerman
- Office of Strategic Planning and Assessment, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
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Abstract
How international research might contribute to justice in global health has not been substantively addressed by bioethics. Theories of justice from political philosophy establish obligations for parties from high-income countries owed to parties from low and middle-income countries. We have developed a new framework that is based on Jennifer Ruger's health capability paradigm to strengthen the link between international clinical research and justice in global health. The 'research for health justice' framework provides direction on three aspects of international clinical research: the research target, research capacity strengthening, and post-trial benefits. It identifies the obligations of justice owed by national governments, research funders, research sponsors, and investigators to trial participants and host communities. These obligations vary from those currently articulated in international research ethics guidelines. Ethical requirements of a different kind are needed if international clinical research is to advance global health equity.
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