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Special article
Available online 26 November 2024
The rights and interests of participants as limits to clinical trials
Los derechos e intereses de los participantes como límites de los ensayos clínicos
Rafael Dal-Ré
Corresponding author
rafael.dalre@quironsalud.es

Corresponding author.
Unidad de Epidemiología, Instituto de Investigación Sanitaria-Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
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Tables (3)
Table 1. Historical evolution of how the Declaration of Helsinki understands the interests of science versus the interests of research participants. Text of the current version of the CIOMS (Council for International Organizations of Medical Sciences) guidelines regarding the same subject.
Table 2. Attitude to take toward participants in SARS-CoV-2 vaccine clinical trials when efficacy of one of the vaccines is demonstrated and it is available to the public. Recommendations of the Regulatory Agencies and of the World Health Organization.
Table 3. Attitude to take toward participants in SARS-CoV-2 vaccine clinical trials when efficacy of one of the vaccines is demonstrated and it is available to the public. Opinions of experts in bioethics and clinical research.
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Abstract

Point 8 of the Declaration of Helsinki requires that the rights and interests of research participants must always prevail over the scientific interests of the research. Recently, it has been proposed that point 8 be modified to indicate the opposite, that is, that it is acceptable for scientific interests to prevail over the interests of the participants. This article argues against this change. What happened with the masked placebo-controlled trials of experimental vaccines against SARS-CoV-2 is held up as an example. When the high efficacy of the vaccines became evident, questions arose as to what should be done, whether to keep the trials masked until data on long-term efficacy, immunogenicity, and safety were obtained or to unmask the trials and offer the vaccine that had been shown to be efficacious to participants who received the placebo. The latter was the correct approach, which translates point 8 into practice.

Keywords:
Experimental vaccines
SARS-CoV-2
COVID-19
Placebo
Efficacy
Safety
Emergency use authorization
WHO
CIOMS
Declaration of Helsinki
Resumen

El punto 8 de la Declaración de Helsinki exige que los derechos e intereses de los participantes en una investigación deban prevalecer siempre sobre los intereses científicos de aquella. Recientemente se ha propuesto que se modifique el punto 8 en sentido opuesto, es decir, que sea aceptable que los intereses científicos prevalezcan sobre los intereses de los participantes. En este artículo se argumenta en contra de este cambio. Se emplea como ejemplo lo que aconteciera con los ensayos enmascarados frente a placebo de vacunas experimentales frente al SARS-CoV-2. Cuando se evidenció la alta eficacia de las vacunas, se planteó qué se debería hacer, si mantener los ensayos enmascarados hasta obtener datos de eficacia, inmunogenicidad y seguridad a largo plazo, o si romper el enmascaramiento y ofrecer a los participantes que recibieron placebo la vacuna que había demostrado ser eficaz. Esta última era la actitud correcta que traducía a la práctica el punto 8.

Palabras clave:
Vacunas experimentales
SARS-CoV-2
COVID-19
Placebo
Eficacia
Seguridad
Autorización de emergencia
OMS
CIOMS
Declaración de Helsinki

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