Guidance on the Need to Make Protocol Changes Due to a Public Health Emergency or Pandemic

What changes require IRB review and approval related to mitigating risk to participants during a pandemic or other health emergency? According to IRB policy, any changes in IRB-approved research procedures must be reported to the IRB and may not be implemented prior to review and approval by the IRB, except when necessary to eliminate apparent immediate hazards to the subject. This is permitted by both the Common Rule (45 CFR §46.108(a)(3)(iii)) and by FDA regulations (21 CFR §56.108(a)(4)).

If you are changing the protocol procedures temporarily, to eliminate immediate hazards to subject safety due to the pandemic, there is no need to wait for IRB approval. However, the IRB would ask that you submit documentation of the changes in HSERA within 10 business days.

NOTE: Any changes or deviations that may increase risk of harm to participants or adversely affect the scientific integrity of the data should wait for IRB review. 

Consent Process Options

In situations where in-person informed consent or procedures are not possible, the Penn IRB supports the use of remote consent and remote study procedures, when appropriate. However, the use of remote methods must be outlined for IRB review to ensure that risks to subjects continue to be minimized and the data integrity of the study can be maintained. This guidance is meant to serve as a resource to guide research teams considering the use of remote procedures for research.

IRB Requirements for Research During a Public Health Emergency

The IRB expects Penn research teams to follow any applicable and current guidelines and laws set forth by the country, state/ province, and city / town in which the research is taking place. Additionally, Penn research teams should follow any applicable policies in place at the University and associated Schools. Researchers should be prepared to respond to local government directives, as well as University alerts, and potential short-notice announcements that would require ramp-downs of activity in labs, floors, and buildings.

Vaccination Requirements for Research

Can researchers incorporate a blanket requirement for research participants to be vaccinated against COVID-19 or another such virus? The IRB recommends this be determined on a study-by-study basis. Eligibility requirements should be carefully considered in the context of the Belmont Ethical principles and IRB Criteria for Approval, notably, the following:

1. Risks to subjects are minimized … by using sound research design… and risks to subjects are reasonable in relation to anticipated benefits

   For FDA regulated studies, FDA guidance notes that “there may be valid scientific reasons to have an exclusion criterion” [or inclusion criterion] for a medical product. These scientific reasons may include risks to an individual if they enroll or continue to participate in a clinical trial after receiving or not receiving the product, or the potential impact of the use of the product on trial objectives, such as confounding the determination of effectiveness of the product under investigation.

2. Selection of subjects is equitable

   It may be possible that requiring a vaccine for research participation could violate the ethical principles of justice and respect for persons. For example, if someone is not vaccinated, or can’t be for a particular reason (due to anaphylactic reaction), are there alternative steps/provisions that may be taken to ensure equitable subject selection while still maintaining the safety of those involved?
   
   

   Likewise, requiring vaccination for participation could also complicate the issues of vaccine hesitancy and public trust in research.
   
   

   It is also important to note the following FDA guidance in relation to Emergency Use Authorized products such as vaccines that have not yet been FDA approved: “When a medical product is being used under an EUA, it is an authorized (though not an approved or cleared) medical product for use in clinical care that has met the statutory criteria under section 564 of the FD&C Act.” Given the investigational nature of the product, when Congress granted the authority to issue EUAs, it chose to require that every individual should be allowed to decide whether or not to receive an EUA product. The FDA and CDC considered this requirement of choice important enough that they reinforced that policy decision when issuing their guidance related to the Covid-19 vaccines. This again ties back to the ethical principle of respect for persons.

Scientific or safety-based rationale for requiring vaccination (or excluding those who are not vaccinated) should be outlined in the study protocol. The IRB will evaluate the rationale in the context of the criteria for approval.