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Integrating Clinical Research into Epidemic Response: The Ebola Experience (2017)

Chapter: Appendix C: Ethical Principles for Research with Human Subjects

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Suggested Citation:"Appendix C: Ethical Principles for Research with Human Subjects." National Academies of Sciences, Engineering, and Medicine. 2017. Integrating Clinical Research into Epidemic Response: The Ebola Experience. Washington, DC: The National Academies Press. doi: 10.17226/24739.
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Appendix C

Ethical Principles for Research with Human Subjects

TABLE C-1 Basic Ethical Principles That Should Govern Research with Human Subjects

Seven Key Requirements Used to Review Trials Conducted During the 2014–2015 Ebola Outbreak Source Guidance Documents Key Principles

1. Scientific and Social Value

CIOMS Ethical Guidelines, 2016

Nuremburg Code, 1947

WMA Declaration of Helsinki, 2013

HHS Common Rule, 2009

Convention on Human Rights and Biomedicine, 1997

  • The knowledge to be gained through the conduct of the research must be of direct or incremental value to the development of clinical or public health advancements.
  • The value of the research must be such that it (1) justifies any direct or indirect risks and burdens to participants and their communities and (2) justifies the allocation of resources away from other emergency response activities.
Suggested Citation:"Appendix C: Ethical Principles for Research with Human Subjects." National Academies of Sciences, Engineering, and Medicine. 2017. Integrating Clinical Research into Epidemic Response: The Ebola Experience. Washington, DC: The National Academies Press. doi: 10.17226/24739.
×
Seven Key Requirements Used to Review Trials Conducted During the 2014–2015 Ebola Outbreak Source Guidance Documents Key Principles

2. Respect for Persons

CIOMS Ethical Guidelines, 2016

UNESCO Declaration, 2005

Belmont Report, 1979

Nuremburg Code, 1947

WMA Declaration of Helsinki, 2013

HHS Common Rule, 2009

Convention on Human Rights and Biomedicine, 1997

  • Research must honor the rights and welfare of participants by (1) providing prospective participants with clear and accessible information on the possible benefits and risks to participation and the research purpose; and (2) obtaining voluntary consent and ensuring that participants understand that they are able to withdraw consent at will and without reprisal.

3. Community Engagement

CIOMS Ethical Guidelines, 2016

  • Research activities must by centered on an ongoing commitment to sustaining community engagement focusing on communication about the research purpose, design, and possible risks and benefits at the individual and societal level and elicitation of community concerns and preferences.

4. Concern for Participant Welfare and Interests

CIOMS Ethical Guidelines, 2016

UNESCO Declaration, 2005

Belmont Report, 1979

Nuremburg Code, 1947

WMA Declaration of Helsinki, 2013

HHS Common Rule, 2009

  • Gratuitous risks to participants cannot be justified, and protections must be taken to limit violation of privacy and potential stigma associated with participation.
  • Efforts must be made to increase benefits to participants to the extent possible, including access to interventions that are found to be efficacious.
Suggested Citation:"Appendix C: Ethical Principles for Research with Human Subjects." National Academies of Sciences, Engineering, and Medicine. 2017. Integrating Clinical Research into Epidemic Response: The Ebola Experience. Washington, DC: The National Academies Press. doi: 10.17226/24739.
×
Seven Key Requirements Used to Review Trials Conducted During the 2014–2015 Ebola Outbreak Source Guidance Documents Key Principles

5. Favorable Risk–Benefit Ratio

CIOMS Ethical Guidelines, 2016

UNESCO Declaration, 2005

Belmont Report, 1979

WMA Declaration of Helsinki, 2013

HHS Common Rule, 2009

Convention on Human Rights and Biomedicine, 1997

  • The expected knowledge to be gained by the research must be justified in relation to the expected benefits and burdens associated with participation.

6. Justice in the Distribution of Benefits and Burdens

CIOMS Ethical Guidelines, 2016

Belmont Report, 1979

HHS Common Rule, 2009

  • The research must not focus inequitably on the health needs of a specific group, and, relatedly, a specific group should not disproportionately bear the burden and risks associated with the research.

7. Post-Trial Access

CIOMS Ethical Guidelines, 2016, UNESCO Declaration, 2005

WMA Declaration of Helsinki, 2013

  • There is an obligation to provide the communities that supported research with access to post-trial investigational products.
Suggested Citation:"Appendix C: Ethical Principles for Research with Human Subjects." National Academies of Sciences, Engineering, and Medicine. 2017. Integrating Clinical Research into Epidemic Response: The Ebola Experience. Washington, DC: The National Academies Press. doi: 10.17226/24739.
×

REFERENCES

CIOMS (Council for International Organizations of Medical Sciences). 2016. International ethical guidelines for biomedical research involving human subjects. http://www.cioms.ch/ethical-guidelines-2016 (accessed January 20, 2017).

COE (Council of Europe). 1997. Convention for the protection of human rights and dignity of the human being with regard to the application of biology and medicine: Convention on Human Rights and Biomedicine. Kennedy Institute of Ethics Journal 7(3):277–290.

HHS (U.S. Department of Health and Human Services). 2009. 45 CFR 46, Common Rule for the Protection of Human Subjects in Research.

National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. 1979. The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. DHEW Publication No. (OS) 78-0013 and No. (OS) 78-0014. Washington, DC: U.S. Government Printing Office.

Nuremberg Code (1947). 1996. BMJ 313(7070):1448.

UNESCO (United Nations Educational, Scientific and Cultural Organization). 2006. Universal declaration on bioethics and human rights. Paris, France: UNESCO. http://unesdoc.unesco.org/images/0014/001461/146180E.pdf (accessed January 25, 2017).

WMA (World Medical Association). 2013. World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA 310(20):2191–2194.

Suggested Citation:"Appendix C: Ethical Principles for Research with Human Subjects." National Academies of Sciences, Engineering, and Medicine. 2017. Integrating Clinical Research into Epidemic Response: The Ebola Experience. Washington, DC: The National Academies Press. doi: 10.17226/24739.
×
Page 297
Suggested Citation:"Appendix C: Ethical Principles for Research with Human Subjects." National Academies of Sciences, Engineering, and Medicine. 2017. Integrating Clinical Research into Epidemic Response: The Ebola Experience. Washington, DC: The National Academies Press. doi: 10.17226/24739.
×
Page 298
Suggested Citation:"Appendix C: Ethical Principles for Research with Human Subjects." National Academies of Sciences, Engineering, and Medicine. 2017. Integrating Clinical Research into Epidemic Response: The Ebola Experience. Washington, DC: The National Academies Press. doi: 10.17226/24739.
×
Page 299
Suggested Citation:"Appendix C: Ethical Principles for Research with Human Subjects." National Academies of Sciences, Engineering, and Medicine. 2017. Integrating Clinical Research into Epidemic Response: The Ebola Experience. Washington, DC: The National Academies Press. doi: 10.17226/24739.
×
Page 300
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The 2014–2015 Ebola epidemic in western Africa was the longest and most deadly Ebola epidemic in history, resulting in 28,616 cases and 11,310 deaths in Guinea, Liberia, and Sierra Leone. The Ebola virus has been known since 1976, when two separate outbreaks were identified in the Democratic Republic of Congo (then Zaire) and South Sudan (then Sudan). However, because all Ebola outbreaks prior to that in West Africa in 2014–2015 were relatively isolated and of short duration, little was known about how to best manage patients to improve survival, and there were no approved therapeutics or vaccines. When the World Heath Organization declared the 2014-2015 epidemic a public health emergency of international concern in August 2014, several teams began conducting formal clinical trials in the Ebola affected countries during the outbreak.

Integrating Clinical Research into Epidemic Response: The Ebola Experience assesses the value of the clinical trials held during the 2014–2015 epidemic and makes recommendations about how the conduct of trials could be improved in the context of a future international emerging or re-emerging infectious disease events.

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