• 1.

    World Medical Association, 2008. Declaration of Helsinki. Available at: http://www.wma.net/e/policy/b3.htm. Accessed March 17, 2009.

  • 2.

    Sreenivasan G, 2003. Does informed consent to research require comprehension? Lancet 362: 20162018.

  • 3.

    CIOMS/WHO, 2002. International Ethical Guidelines for Biomedical Research Involving Human Subjects. Available at: http://www.cioms.ch/frame_guidelines_nov_2002.htm. Accessed March 17, 2009.

    • Search Google Scholar
    • Export Citation
  • 4.

    International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use, 1996. ICH Harmonized Tripartite Guideline—Guideline for Good Clinical Practice. Geneva: WHO. http://www.ich.org/LOB/media/MEDIA482.pdf. Accessed March 17, 2009.

    • Search Google Scholar
    • Export Citation
  • 5.

    Thiers FA, Sinskey AJ, Berndt ER, 2008. Trends in the globalization of clinical trials. Nat Rev Drug Discov 7: 1314.

  • 6.

    Annas GJ, Grodin MA, 1998. Human rights and maternal-fetal HIV transmission prevention trials in Africa. Am J Public Health 88: 560563.

  • 7.

    Christakis NA, 1988. The ethical design of an AIDS vaccine trial in Africa. Hastings Cent Rep 18: 3137.

  • 8.

    Flory JH, Wendler D, Emanuel EJ, 2008. Empirical issues in informed consent for research. Emanuel E, Grady C, Crouch R, Lie R, Miller F, Wendler D, eds. The Oxford Textbook of Clinical Research Ethics. New York: Oxford University Press.

    • Search Google Scholar
    • Export Citation
  • 9.

    Pace C, Grady C, Emanuel E, 2003. What we don't know about informed consent. SciDevNet, August 28, 2003. Available at: http://www.scidev.net/en/opinions/what-we-dont-know-about-informed-consent.html. Accessed July 21, 2010.

    • Search Google Scholar
    • Export Citation
  • 10.

    Abdool Karim Q, Abdool Karim SS, Coovadia HM, Susser M, 1998. Informed consent for HIV testing in a South African hospital: is it truly informed and truly voluntary? Am J Public Health 88: 637640.

    • Search Google Scholar
    • Export Citation
  • 11.

    Lynoe N, Hyder Z, Chowdhury M, Ekstrom L, 2001. Obtaining informed consent in Bangladesh. N Engl J Med 344: 460461.

  • 12.

    Pace C, Talisuna A, Wendler D, Maiso F, Wabwire-Mangen F, Bakyaita N, Okiria E, Garrett-Mayer ES, Emanuel E, Grady C, 2005. Quality of parental consent in a Ugandan malaria study. Am J Public Health 95: 11841189.

    • Search Google Scholar
    • Export Citation
  • 13.

    Ellis RD, Mullen GE, Pierce M, Martin LB, Miura K, Fay MP, Long CA, Shaffer D, Saul A, Miller LH, Durbin AP, 2009. A Phase 1 study of the blood-stage malaria vaccine candidate AMA1-C1/Alhydrogel with CPG 7909, using two different formulations and dosing intervals. Vaccine 27: 41044109.

    • Search Google Scholar
    • Export Citation
  • 14.

    Ellis RD, Martin LB, Shaffer D, Long CA, Miura K, Fay MP, Narum DL, Zhu D, Mullen GE, Mahanty S, Miller LH, Durbin AP, 2010. Phase 1 trial of the Plasmodium falciparum blood stage vaccine MSP142-C1/Alhydrogel with and without CPG 7909 in malaria naïve adults. PLoS One 5: e8787.

    • Search Google Scholar
    • Export Citation
  • 15.

    Sagara I, Ellis RD, Dicko A, Niambele MB, Kamate B, Guindo O, Sissoko MS, Fay MP, Guindo MA, Kante O, Saye R, Miura K, Long C, Mullen GE, Pierce M, Martin LB, Rausch K, Dolo A, Diallo DA, Miller LH, Doumbo OK, 2009. A randomized and controlled Phase 1 study of the safety and immunogenicity of the AMA1-C1/Alhydrogel + CPG 7909 vaccine for Plasmodium falciparum malaria in semi-immune Malian adults. Vaccine 27: 72927298.

    • Search Google Scholar
    • Export Citation
  • 16.

    Dicko A, Sagara I, Ellis RD, Miura K, Guindo O, Kamate B, Sogoba M, Niambelé MB, Sissoko M, Baby M, Dolo A, Mullen GE, Fay MP, Pierce M, Diallo DA, Saul A, Miller LH, Doambo OK, 2008. Phase 1 study of a combination AMA1 blood stage malaria vaccine in Malian children. PLoS ONE 3: e1563.

    • Search Google Scholar
    • Export Citation
  • 17.

    Sagara I, Dicko A, Ellis RD, Fay MP, Diawara SI, Assadou MH, Sissoko MS, Kone M, Diallo AI, Saye R, Guindo MA, Kante O, Niambele MB, Miura K, Mullen GE, Pierce M, Martin LB, Dolo A, Diallo DA, Doumbo OK, Miller LH, Saul A, 2009. A randomized controlled phase 2 trial of the blood stage AMA1-C1/Alhydrogel malaria vaccine in children in Mali. Vaccine 27: 30903098.

    • Search Google Scholar
    • Export Citation
  • 18.

    United States Code of Federal Regulations, 2005. Title 45 Public Welfare Part 46.

  • 19.

    Agresti A, 2002. Categorical Data Analysis. Hoboken, NJ: John Wiley and Sons.

  • 20.

    Krosin MT, Klitzman R, Levin B, Cheng J, Ranney ML, 2006. Problems in comprehension of informed consent in rural and peri-urban Mali, West Africa. Clin Trials 3: 306313.

    • Search Google Scholar
    • Export Citation
  • 21.

    Minnies D, Hawkridge T, Hanekom W, Ehrlich R, London L, Hussey G, 2008. Evaluation of the quality of informed consent in a vaccine field trial in a developing country setting. BMC Med Ethics 9: 15.

    • Search Google Scholar
    • Export Citation
  • 22.

    Joffe S, Cook EF, Cleary PD, Clark JW, Weeks JC, 2001. Quality of informed consent in cancer clinical trials: a cross-sectional survey. Lancet 358: 17721777.

    • Search Google Scholar
    • Export Citation
  • 23.

    Pace C, Emanuel EJ, Chuenyam T, Duncombe C, Bebchuk JD, Wendler D, Tavel JA, McNay LA, Phanuphak P, Forster HP, Grady C, 2005. The quality of informed consent in a clinical research study in Thailand. IRB 27: 917.

    • Search Google Scholar
    • Export Citation
  • 24.

    Taiwo OO, Kass N, 2009. Post-consent assessment of dental subjects' understanding of informed consent in oral health research in Nigeria. BMC Med Ethics 10: 11.

    • Search Google Scholar
    • Export Citation
  • 25.

    Kodish E, Eder M, Noll RB, Ruccione K, Lange B, Angiolillo A, Pentz R, Zyzanski S, Siminoff LA, Drotar D, 2004. Communication of randomization in childhood leukemia trials. JAMA 291: 470475.

    • Search Google Scholar
    • Export Citation
  • 26.

    Hietanen P, Aro AR, Holli K, Absetz P, 2000. Information and communication in the context of a clinical trial. Eur J Cancer 36: 20962104.

  • 27.

    van Stuijvenberg M, Suur MH, de Vos S, Tjiang GC, Steyerberg EW, Derksen-Lubsen G, Moll HA, 1998. Informed consent, parental awareness, and reasons for participating in a randomised controlled study. Arch Dis Child 79: 120125.

    • Search Google Scholar
    • Export Citation
  • 28.

    Taub HA, 1980. Informed consent, memory and age. Gerontologist 20: 686690.

Past two years Past Year Past 30 Days
Abstract Views 1 1 1
Full Text Views 321 137 1
PDF Downloads 61 44 1
 
 
 
 
 
 
 
 
 
 
 

Comparing the Understanding of Subjects Receiving a Candidate Malaria Vaccine in the United States and Mali

Ruth D. EllisMalaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland; Malaria Research and Training Center, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, Bamako, Mali; Johns Hopkins Center for Immunization Research, Washington, DC; Biostatistics Research Branch, NIAID/NIH; Clinical Center Department of Bioethics, NIH; Clinical Center Department of Bioethics/Fogarty International Center, NIH, Bethesda, Maryland

Search for other papers by Ruth D. Ellis in
Current site
Google Scholar
PubMed
Close
,
Issaka SagaraMalaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland; Malaria Research and Training Center, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, Bamako, Mali; Johns Hopkins Center for Immunization Research, Washington, DC; Biostatistics Research Branch, NIAID/NIH; Clinical Center Department of Bioethics, NIH; Clinical Center Department of Bioethics/Fogarty International Center, NIH, Bethesda, Maryland

Search for other papers by Issaka Sagara in
Current site
Google Scholar
PubMed
Close
,
Anna DurbinMalaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland; Malaria Research and Training Center, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, Bamako, Mali; Johns Hopkins Center for Immunization Research, Washington, DC; Biostatistics Research Branch, NIAID/NIH; Clinical Center Department of Bioethics, NIH; Clinical Center Department of Bioethics/Fogarty International Center, NIH, Bethesda, Maryland

Search for other papers by Anna Durbin in
Current site
Google Scholar
PubMed
Close
,
Alassane DickoMalaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland; Malaria Research and Training Center, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, Bamako, Mali; Johns Hopkins Center for Immunization Research, Washington, DC; Biostatistics Research Branch, NIAID/NIH; Clinical Center Department of Bioethics, NIH; Clinical Center Department of Bioethics/Fogarty International Center, NIH, Bethesda, Maryland

Search for other papers by Alassane Dicko in
Current site
Google Scholar
PubMed
Close
,
Donna ShafferMalaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland; Malaria Research and Training Center, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, Bamako, Mali; Johns Hopkins Center for Immunization Research, Washington, DC; Biostatistics Research Branch, NIAID/NIH; Clinical Center Department of Bioethics, NIH; Clinical Center Department of Bioethics/Fogarty International Center, NIH, Bethesda, Maryland

Search for other papers by Donna Shaffer in
Current site
Google Scholar
PubMed
Close
,
Louis MillerMalaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland; Malaria Research and Training Center, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, Bamako, Mali; Johns Hopkins Center for Immunization Research, Washington, DC; Biostatistics Research Branch, NIAID/NIH; Clinical Center Department of Bioethics, NIH; Clinical Center Department of Bioethics/Fogarty International Center, NIH, Bethesda, Maryland

Search for other papers by Louis Miller in
Current site
Google Scholar
PubMed
Close
,
Mahamadoun H. AssadouMalaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland; Malaria Research and Training Center, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, Bamako, Mali; Johns Hopkins Center for Immunization Research, Washington, DC; Biostatistics Research Branch, NIAID/NIH; Clinical Center Department of Bioethics, NIH; Clinical Center Department of Bioethics/Fogarty International Center, NIH, Bethesda, Maryland

Search for other papers by Mahamadoun H. Assadou in
Current site
Google Scholar
PubMed
Close
,
Mamady KoneMalaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland; Malaria Research and Training Center, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, Bamako, Mali; Johns Hopkins Center for Immunization Research, Washington, DC; Biostatistics Research Branch, NIAID/NIH; Clinical Center Department of Bioethics, NIH; Clinical Center Department of Bioethics/Fogarty International Center, NIH, Bethesda, Maryland

Search for other papers by Mamady Kone in
Current site
Google Scholar
PubMed
Close
,
Beh KamateMalaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland; Malaria Research and Training Center, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, Bamako, Mali; Johns Hopkins Center for Immunization Research, Washington, DC; Biostatistics Research Branch, NIAID/NIH; Clinical Center Department of Bioethics, NIH; Clinical Center Department of Bioethics/Fogarty International Center, NIH, Bethesda, Maryland

Search for other papers by Beh Kamate in
Current site
Google Scholar
PubMed
Close
,
Ousmane GuindoMalaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland; Malaria Research and Training Center, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, Bamako, Mali; Johns Hopkins Center for Immunization Research, Washington, DC; Biostatistics Research Branch, NIAID/NIH; Clinical Center Department of Bioethics, NIH; Clinical Center Department of Bioethics/Fogarty International Center, NIH, Bethesda, Maryland

Search for other papers by Ousmane Guindo in
Current site
Google Scholar
PubMed
Close
,
Michael P. FayMalaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland; Malaria Research and Training Center, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, Bamako, Mali; Johns Hopkins Center for Immunization Research, Washington, DC; Biostatistics Research Branch, NIAID/NIH; Clinical Center Department of Bioethics, NIH; Clinical Center Department of Bioethics/Fogarty International Center, NIH, Bethesda, Maryland

Search for other papers by Michael P. Fay in
Current site
Google Scholar
PubMed
Close
,
Dapa A. DialloMalaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland; Malaria Research and Training Center, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, Bamako, Mali; Johns Hopkins Center for Immunization Research, Washington, DC; Biostatistics Research Branch, NIAID/NIH; Clinical Center Department of Bioethics, NIH; Clinical Center Department of Bioethics/Fogarty International Center, NIH, Bethesda, Maryland

Search for other papers by Dapa A. Diallo in
Current site
Google Scholar
PubMed
Close
,
Ogobara K. DoumboMalaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland; Malaria Research and Training Center, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, Bamako, Mali; Johns Hopkins Center for Immunization Research, Washington, DC; Biostatistics Research Branch, NIAID/NIH; Clinical Center Department of Bioethics, NIH; Clinical Center Department of Bioethics/Fogarty International Center, NIH, Bethesda, Maryland

Search for other papers by Ogobara K. Doumbo in
Current site
Google Scholar
PubMed
Close
,
Ezekiel J. EmanuelMalaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland; Malaria Research and Training Center, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, Bamako, Mali; Johns Hopkins Center for Immunization Research, Washington, DC; Biostatistics Research Branch, NIAID/NIH; Clinical Center Department of Bioethics, NIH; Clinical Center Department of Bioethics/Fogarty International Center, NIH, Bethesda, Maryland

Search for other papers by Ezekiel J. Emanuel in
Current site
Google Scholar
PubMed
Close
, and
Joseph MillumMalaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland; Malaria Research and Training Center, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, Bamako, Mali; Johns Hopkins Center for Immunization Research, Washington, DC; Biostatistics Research Branch, NIAID/NIH; Clinical Center Department of Bioethics, NIH; Clinical Center Department of Bioethics/Fogarty International Center, NIH, Bethesda, Maryland

Search for other papers by Joseph Millum in
Current site
Google Scholar
PubMed
Close
View More View Less
Restricted access

Initial responses to questionnaires used to assess participants' understanding of informed consent for malaria vaccine trials conducted in the United States and Mali were tallied. Total scores were analyzed by age, sex, literacy (if known), and location. Ninety-two percent (92%) of answers by United States participants and 85% of answers by Malian participants were correct. Questions more likely to be answered incorrectly in Mali related to risk, and to the type of vaccine. For adult participants, independent predictors of higher scores were younger age and female sex in the United States, and male sex in Mali. Scores in the United States were higher than in Mali (P = 0.005). Despite this difference participants at both sites were well informed overall. Although interpretation must be qualified because questionnaires were not intended as research tools and were not standardized among sites, these results do not support concerns about systematic low understanding among research participants in developing versus developed countries.

Author Notes

*Address correspondence to Joseph Millum, Clinical Center Department of Bioethics/Fogarty International Center, National Institutes of Health Building 10, 1C118 10 Center Drive, Bethesda, MD 20892. E-mail: millumj@cc.nih.gov

Financial support: This research was supported by the Intramural Research Program of the National Institutes of Health, National Institute of Allergy and Infectious Diseases (NIAID).

Authors' addresses: Ruth D. Ellis, Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Heath (MVDB, NIAID/NIH), Rockville, MD, E-mail: ellisru@niaid.nih.gov. Issaka Sagara, Alassane Dicko, Mahamadoun H. Assadou, Mamady Kone, Beh Kamate, Ousmane Guindo, Dapa A. Diallo, and Ogobara K Doumbo, Malaria Research and Training Center (MRTC), Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Odonto-Stomatology, University of Bamako, Bamako Mali, E-mails: isagara@icermali.org, adicko@icermali.org, mmaiga@icermali.org, mamady@icermali.org, bkamate@icermali.org, guindoous@icermali.org, dadiallo@icermali.org, and okd@icermali.org. Anna Durbin and Donna Shaffer, Johns Hopkins Center for Immunization Research, Washington, DC, E-mails: adurbin@jhsph.edu and dshaffer@jhsph.edu. Louis Miller, MVDB, NIAID/NIH, Rockville, MD, E-mail: lmiller@niaid.nih.gov. Michael P. Fay, Biostatistics Research Branch, NIAID/NIH, Bethesda, MD, E-mail: mfay@niaid.nih.gov. Ezekiel J. Emmanuel, Clinical Center Department of Bioethics, NIH, Bethesda, MD, E-mail: EEmanuel@cc.nih.gov. Joseph Millum, Clinical Center Department of Bioethics/Fogarty International Center, National Institutes of Health, Bethesda, MD, E-mail: millumj@cc.nih.gov.

Save