Editorials

Ebola: evaluating vaccines during epidemics

BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h3861 (Published 29 July 2015) Cite this as: BMJ 2015;351:h3861
  1. Chee Fu Yung
  1. 1Infectious Disease Service, Department of Paediatric Medicine, KK Women’s and Children’s Hospital, Singapore 229899
  1. cheefu.yung{at}gmail.com

Innovative, flexible, and validated study designs need to be ready for next time

Will vaccines be effective? Would trials be ethical? Are trials even required? These are some of the questions that dominated health policy discourse throughout the current Ebola tragedy in West Africa. The epidemic of Ebola viral disease resulted in almost 27 000 cases, more than 11 000 deaths, and crippled already weak public health infrastructures.1 The welcome reduction in numbers of cases has, however, produced another conundrum and highlighted the challenges in evaluating the efficacy of vaccines in the middle of unpredictable epidemics. The linked paper by the Ebola ça suffit ring vaccination trial consortium (doi:10.1136/bmj.h3740) describes a novel trial design using “ring vaccination” to test one of the early Ebola vaccine candidates (rVSV-ZEBOV) in Guinea.2 The dwindling number of cases means that phase III studies may not have enough power to demonstrate or rule out efficacy using the gold standard of individual randomisation trials.3 Since we still do not have markers for correlates of protection against the Ebola virus, we need efficacy studies …

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