Why did clinical trial registries fail to prevent Covid research chaos?

“There is a long-standing global ethical obligation to register all trials before they start, shored up by regulatory requirements in some jurisdictions. Data from 18 registries worldwide feed into the WHO-managed International Clinical Trials Registry Platform (ICTRP), providing a continuously updated overview of who is researching what, when, where and how – at least in theory.

 

 

If the registry infrastructure had worked and been used as intended, much of the COVID-19 research chaos would have been avoided.

 

 

For example, researchers considering launching a hydroxychloroquine trial could have searched ICTRP and discovered that the drug was already being investigated by numerous other trials. Those researchers could accordingly have focused on investigating other treatment options instead, or aligned their outcome measures with existing trials. …

The global registry infrastructure has long been inadequately supported by legislators and regulators, and is woefully underfunded.

 

 

 

This persistent neglect of the world’s only comprehensive directory of medical research led to costly research waste on an incredible scale during the pandemic.

 

 

The WHO recommends that member states should by law require every interventional trial to be registered and reported. In addition, WHO recommends that all trial results should be made public specifically on a registry within 12 months, and that registry data should be kept up to date.

 

 

 

By enforcing these three simple rules, regulators would ensure that there is a comprehensive, up-to-date global database of all trials and their results.

 

In reality, existing laws in the EU and the US only cover a small minority of trials and are not being effectively enforced, while many other jurisdictions have no relevant laws at all. …”

 

 

WHA 75: UK draft resolution on Strengthening Clinical Trials to Improve Public Health – Knowledge Ecology International

“On 30 March 2022, Knowledge Ecology International (KEI) published the text of the draft resolution on social media. The text of the UK draft resolution on Strengthening Clinical Trials to Improve Public Health can be found here: Strengthening Clinical Trials to Improve Public Health – zero draft …”

Open Access Publishing: Issues and Way Forward – Predatory Journals and Conferences

“One of the major challenges the world has faced the past two years has been the onset of the COVID-19 pandemic. With scientists putting up lot of research on COVID, the World Health Organization (WHO) came up with a WHO: COVID-19 Literature on corona virus disease. This database provides a way for the general public, along with scientists, to check the scientific literature on COVID-19, in one place, and this also results in wider reach/dissemination.

However, we do not have a common database for other important research areas concerning the general public, such as “Cancer Research” or “Climate Change”. When we say open access, the main aim should be open science to all, and we need more such databases by international agencies like the United Nations to collate research articles on important areas such as the 17 UN Sustainable Development Goals, which should be the need of the hour. Such initiatives will help in the real dissemination of science to the general public, and give authors of important research contributions, the visibility they deserve. This will be unlike publishers asking authors to promote their articles and measuring them with their commercial metrics….”

Changes in Users Trends Before and During the COVID-19 Pandemic on WHO’s Online Learning Platform

Abstract:  OpenWHO provides open access, online, free and real time learning responses to health emergencies. Before the pandemic, courses on 18 diseases were provided. The increase to 38 courses in response to COVID-19 have led to a massive increase in the number of new learners. As a result, the COVID-19 pandemic affected learners’ trends. This paper presents initial findings of changes perceived in the use and user groups’ attendance to the World Health Organization’s (WHO) health emergency learning platform OpenWHO. Enrolment statistics were based on data collected in December 2019 and March 2021. A descriptive analysis was conducted to explore changes in the usage pattern of the platform. Several user characteristics shifted between before and during the pandemic. More women, younger and older learners joined the learning during the pandemic. Public health education leaned toward a more equitable reach including previously underrepresented groups.

 

WHO starts data-sharing effort to prevent pandemics. Will nations cooperate? | South China Morning Post

“WHO Hub for Pandemic and Epidemic Intelligence opens in Berlin backed by initial US$100 million from Germany

It aims to pool global disease data, and produce tools to predict outbreaks – but is reliant on countries taking part.”

Joint Statement on transparency and data integrity International Coalition of Medicines Regulatory Authorities (ICMRA) and WHO

“ICMRA1 and WHO call on the pharmaceutical industry to provide wide access to clinical data for all new medicines and vaccines (whether full or conditional approval, under emergency use, or rejected). Clinical trial reports should be published without redaction of confidential information for reasons of overriding public health interest….

Regulators continue to spend considerable resources negotiating transparency with sponsors. Both positive and negative clinically relevant data should be made available, while only personal data and individual patient data should be redacted. In any case, aggregated data are unlikely to lead to re-identification of personal data and techniques of anonymisation can be used….

 

Providing systematic public access to data supporting approvals and rejections of medicines reviewed by regulators, is long overdue despite existing initiatives, such as those from the European Medicines Agency and Health Canada. The COVID-19 pandemic has revealed how essential to public trust access to data is. ICMRA and WHO call on the pharmaceutical industry to commit, within short timelines, and without waiting for legal changes, to provide voluntary unrestricted access to trial results data for the benefit of public health.”

 

 

Completeness of open access FluNet influenza surveillance data for Pan-America in 2005–2019 | Scientific Reports

Abstract:  For several decades, the World Health Organization has collected, maintained, and distributed invaluable country-specific disease surveillance data that allow experts to develop new analytical tools for disease tracking and forecasting. To capture the extent of available data within these sources, we proposed a completeness metric based on the effective time series length. Using FluNet records for 29 Pan-American countries from 2005 to 2019, we explored whether completeness was associated with health expenditure indicators adjusting for surveillance system heterogeneity. We observed steady improvements in completeness by 4.2–6.3% annually, especially after the A(H1N1)-2009 pandemic, when 24 countries reached?>?95% completeness. Doubling in decadal health expenditure per capita was associated with?~?7% increase in overall completeness. The proposed metric could navigate experts in assessing open access data quality and quantity for conducting credible statistical analyses, estimating disease trends, and developing outbreak forecasting systems.

 

Vigilance for Medical Products of Human Origin—Progress on t… : Transplantation

Abstract:  World Health Assembly Resolution WHA 63.22 mandated WHO to facilitate Member State access to appropriate information on Medical Products of Human Origin (MPHO), including collecting data on serious adverse events and reactions. To meet this challenge, the Italian National Transplant Center, with a mandate from WHO, has built and maintains an open access searchable database of instructive records on disease transmission and other MPHO adverse occurrences.

 

Reducing bias and improving transparency in medical research: a critical overview of the problems, progress and suggested next steps – Stephen H Bradley, Nicholas J DeVito, Kelly E Lloyd, Georgia C Richards, Tanja Rombey, Cole Wayant, Peter J Gill, 2020

Abstract:  In recent years there has been increasing awareness of problems that have undermined trust in medical research. This review outlines some of the most important issues including research culture, reporting biases, and statistical and methodological issues. It examines measures that have been instituted to address these problems and explores the success and limitations of these measures. The paper concludes by proposing three achievable actions which could be implemented to deliver significantly improved transparency and mitigation of bias. These measures are as follows: (1) mandatory registration of interests by those involved in research; (2) that journals support the ‘registered reports’ publication format; and (3) that comprehensive study documentation for all publicly funded research be made available on a World Health Organization research repository. We suggest that achieving such measures requires a broad-based campaign which mobilises public opinion. We invite readers to feedback on the proposed actions and to join us in calling for their implementation.

 

Reducing bias and improving transparency in medical research: a critical overview of the problems, progress and suggested next steps – Stephen H Bradley, Nicholas J DeVito, Kelly E Lloyd, Georgia C Richards, Tanja Rombey, Cole Wayant, Peter J Gill, 2020

Abstract:  In recent years there has been increasing awareness of problems that have undermined trust in medical research. This review outlines some of the most important issues including research culture, reporting biases, and statistical and methodological issues. It examines measures that have been instituted to address these problems and explores the success and limitations of these measures. The paper concludes by proposing three achievable actions which could be implemented to deliver significantly improved transparency and mitigation of bias. These measures are as follows: (1) mandatory registration of interests by those involved in research; (2) that journals support the ‘registered reports’ publication format; and (3) that comprehensive study documentation for all publicly funded research be made available on a World Health Organization research repository. We suggest that achieving such measures requires a broad-based campaign which mobilises public opinion. We invite readers to feedback on the proposed actions and to join us in calling for their implementation.

 

The World Health Organization and Wikimedia Foundation expand access to trusted information about COVID-19 on Wikipedia

“The World Health Organization (WHO) and the Wikimedia Foundation, the nonprofit that administers Wikipedia, announced today a collaboration to expand the public’s access to the latest and most reliable information about COVID-19. 

The collaboration will make trusted, public health information available under the Creative Commons Attribution-ShareAlike license at a time when countries face continuing resurgences of COVID-19 and social stability increasingly depends on the public’s shared understanding of the facts. 

Through the collaboration, people everywhere will be able to access and share WHO infographics, videos, and other public health assets on Wikimedia Commons, a digital library of free images and other multimedia. 

With these new freely-licensed resources, Wikipedia’s more than 250,000 volunteer editors can also build on and expand the site’s COVID-19 coverage, which currently offers more than 5,200 coronavirus-related articles in 175 languages. This WHO content will also be translated across national and regional languages through Wikipedia’s vast network of global volunteers.”

[KEI recommendations to WHO on COVID-related research]

“The WHO secretariat should request in writing that the funders of COVID-19 R&D including in particular governments and philanthropies include language in contracts and use their financial leverage to enable sharing of know-how, cell lines and rights in data and patents, for COVID-19 related technologies.

The WHO secretariat should request in writing that the funders of COVID-19 R&D including in particular governments and philanthropies include language in contracts and use their financial leverage to enable sharing of know-how, cell lines and rights in data and patents, for COVID-19 related technologies.

There should be no monopolies on patents, regulatory exclusivities, data or know-how in this pandemic. All relevant technology for COVID-19 products should be available either free or openly licensed with non-discriminatory, reasonable and affordable royalties….”

Countries Are Adapting Intellectual Property Laws to Prioritise Health During COVID-19

“Intellectual property (IP) rights can potentially impede mass production of existing health products, as well as innovation and research and development of new products. IP rights can be exercised by their owners to grant or withhold from licensing the technology required for manufacturing or further developing a product. If a license is denied, the technology will not be available for other firms to manufacture or supply.

Usually, a bundle of several IP rights can exist around a particular technology. It is very common patenting strategy in the pharmaceutical industry to take separate patents on the main compound of a drug and a large number of secondary patents on different formulations and combinations, dosage, as well as other possible therapeutic use of a drug. This can make it difficult for follow on innovators to invent around the thicket of IP rights….

Through a resolution of the World Health Assembly on COVID-19, member states of the WHO have recognised the possible need for countries to adopt measures to ensure that IP rights do not constrain global equitable access to health technologies for COVID-19 through the full use of the flexibilities of the agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) as well as voluntary pooling of patented technologies, data and know-how….

A number of flexibilities available under the TRIPS Agreement can be applied by governments to ensure that IP rights do not constrain innovation and availability of health technologies required for responding to COVID-19….

It is time for developing countries to review the extent to which such measures can be adopted, or what changes, if any, need to be introduced into their legal regimes so as to be able to act effectively and timely to address the devastating effects of the COVID-19 pandemic….”

New COVID-19 Legal Database | O’Neill Institute

“Launching today, the COVID-19 Law Lab initiative gathers and shares legal documents from over 190 countries across the world to help states establish and implement strong legal frameworks to manage the pandemic. The goal is to ensure that laws protect the health and wellbeing of individuals and communities and that they adhere to international human rights standards.

The new Lab (at www.COVIDLawLab.org) is a joint project of United Nations Development Programme (UNDP), the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the O’Neill Institute for National and Global Health Law at Georgetown University….”

Pharma CEOs and IFPMA comment on WHO proposal for COVID 19 technology pool. – YouTube

“At a May 28 press briefing organized by the international Federation of Pharmaceutical Manufacturers & Associations (IFPMA), Pharma CEOs and the IFPMA DG comment on WHO proposal for global pool for rights in technologies for the diagnosis, prevention and treatment of COVID-19. Pascale Soriot, the CEO of AstaZeneca, a company receiving a reported $1.2 billion in funding from the US agency BARDA, claims he was “not aware” of the WHO proposal. Pfizer CEO Albert Bourla is the most negative, calling the proposal, dangerous. At 2:30 on this clip, Thomas Cueni of IFPMA claims that a focus on vaccine patents is misplaced since know-how is the larger issue, and he claims that there has never been a compulsory license on a vaccine patent.

There have been, of course, many disputes over patent rights for vaccines, and know-how, data and even access to cell lines, is actually part of the Costa Rica/WHO proposal for a COVID-19 technology pool, which, Thomas Cueni, a former journalist, certainly understands. The full IFPMA briefing is here: https://www.youtube.com/watch?v=0wMMwDshed0 …”