Clinical Trial Designs for Emerging Infectious Diseases (Day 2)

The Ebola Virus Disease (EVD) epidemic has highlighted the importance of being able to rapidly evaluate investigational products during a public health emergency, including in resource limited settings. It is generally agreed that access to early investigational interventions that have not yet been well characterized should be provided in a setting that allows for the reliable assessment of benefits and harms. Ascertaining the safety and efficacy of an investigational product is an important step that is necessary to protect and promote the public health now and in the future. A critical aspect of the response effort is the ability to rapidly establish and conduct clinical trials that are both scientifically valid and ethically appropriate. During the course of the EVD epidemic, there has been significant debate over the design of trials to evaluate investigational therapies and vaccines. Among the trial designs employed during the EVD epidemic to evaluate experimental therapeutics were (1) open-label product administration compared to historical controls, and (2) randomized open-label product administration compared to concurrent “standard of care” controls. Among the proposed trial designs for EVD vaccines are (1) randomized controlled trials, (2) clustered randomized trials, (3) stepped wedge trials, and (4) ring vaccination trials. Trials to support alternative licensure pathways under FDA regulations, such as accelerated approval or the animal rule, have also been p...
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