Covid-19 vaccines and treatments: we must have raw data, now

ChatGPT and Corporations of Mega-journals Jeopardize the Norms That Underpin Academic Publishing

Those who participate in and contribute to academic publishing are affected by its evolution. Funding bodies, academic institutions, researchers and peer-reviewers, junior scholars, freelance language editors, language-editing services, and journal editors are to enforce and uphold the ethical norms on which academic publishing is founded. Deviating from such norms will challenge and threaten the scholarly reputation, academic careers, and institutional standing; reduce the publishers' true impacts; squander public funding; and erode the public trust to the academic enterprise. Rigorous review is paramount because peer-review norms guarantee that scientific findings are scrutinized before being publicized. Volunteer peer-reviewers and guest journal editors devote an immense amount of unremunerated time to reviewing papers, voluntarily serving the scientific community, and benefiting the publishers. Some mega-journals are motivated to mass-produce publications and attract the funded projects instead of maintaining the scientific rigor. The rapid development of mega-journals may diminish some traditional journals by outcompeting their impacts. Artificial intelligence (AI) tools/algorithms such as ChatGPT may be misused to contribute to the mass-production of publications which may have not been rigorously revised or peer-reviewed. Maintaining norms that guarantee scientific rigor and academic integrity enable the academic community to overcome the new challenges such as mega-journals and AI tools.

Gene-based COVID-19 vaccines: Australian perspectives in a corporate and global context

Pandemic management requires societal coordination, global orchestration, respect for human rights and defence of ethical principles. Yet some approaches to the COVID-19 pandemic, driven by socioeconomic, corporate, and political interests, have undermined key pillars of ethical medical science. We explore significant mistakes that may have occurred in recent pandemic control, in order to better navigate the future. Within corporate and geopolitical infrastructure, we review the COVID-19 pandemic and novel mRNA and viral-vector DNA COVID-19 vaccines, deployed by wealthy western countries. The pandemic, together with rollouts of unconventional, gene-based vaccine technology, has provided experimental opportunity to engineer social control of entire populations. The haste and scale of development, production, and distribution of these new pharmaceuticals is unprecedented in history. Key phase III clinical trials for these products are yet to be fully completed, despite administration to billions of people. Mass vaccination of workforces has been mandated, and vaccine mandates correlate with excess mortality. Many independent data sets concur - we have experienced a pandemic of viral illness, followed by a pandemic of vaccine injury. For Australia, matters have operated the other way around. Vaccination followed later by the main viral wave. Australian excess mortality data correlates with this. Neither risk nor cost can justify these products for the vast majority of people. Lack of efficacy against infection and transmission, and the equivalent benefits of natural immunity, obviate mandatory therapeutics. With the many gene-based pharmaceuticals planned, a new era of pathology lies ahead. We should pause, reflect, and reaffirm essential freedoms, welcome the end of the COVID-19 pandemic, embrace natural immunity, and lift all mandated medical therapy.

Heterogeneity and Utility of Pharmaceutical Company Sharing of Individual-Participant Data Packages

Importance

The pharmaceutical industry has made substantial investments in developing processes for sharing individual-participant data (IPD) from clinical trials. However, the utility and completeness of shared IPD and supporting documents must be evaluated to ensure the potential for scientific advancements from the data sharing ecosystem can be realized.

Objective

To assess the utility and completeness of IPD and supporting documents provided from industry-sponsored clinical trials.

Design, Setting, and Participants

From February 9, 2022, to February 9, 2023, 91 of 203 clinical trials supporting US Food and Drug Administration registrations of anticancer medicines for the treatment of solid tumors from the past decade were confirmed as eligible for IPD request. This quality improvement study performed a retrospective audit of the utility and completeness of the IPD and supporting documents provided from the 91 clinical trials for a planned meta-analysis.

Exposures

Request for IPD from 91 clinical oncology trials indicated as eligible for the request.

Main Outcomes and Measures

The utility and completeness of the IPD and supporting documents provided.

Results

The IPD packages were obtained from 70 of 91 requested clinical trials (77%). The median time to data provision was 123 (range, 117-352) days. Redactions were observed in 18 of the acquired IPD packages (26%) for outcome data, 11 (16%) for assessment variables, and 19 (27%) for adjustment data. Additionally, 20 IPD packages (29%) lacked a clinical study report, 4 (6%) had incomplete or missing data dictionaries, and 20 (29%) were missing anonymization or redaction description files. Access to IPD from 21 eligible trials (23%) was not granted.

Conclusions and Relevance

In this quality improvement study, there was substantial variability within the provided IPD packages regarding the completeness of key data variables and supporting documents. To improve the data sharing ecosystem, key areas for enhancement include (1) ensuring that clinical trials are eligible for IPD sharing, (2) making eligible IPD transparently accessible, and (3) ensuring that IPD packages meet a standard of utility and completeness.

A 10-year update to the principles for clinical trial data sharing by pharmaceutical companies: perspectives based on a decade of literature and policies

Data sharing is essential for promoting scientific discoveries and informed decision-making in clinical practice. In 2013, PhRMA/EFPIA recognised the importance of data sharing and supported initiatives to enhance clinical trial data transparency and promote scientific advancements. However, despite these commitments, recent investigations indicate significant scope for improvements in data sharing by the pharmaceutical industry. Drawing on a decade of literature and policy developments, this article presents perspectives from a multidisciplinary team of researchers, clinicians, and consumers. The focus is on policy and process updates to the PhRMA/EFPIA 2013 data sharing commitments, aiming to enhance the sharing and accessibility of participant-level data, clinical study reports, protocols, statistical analysis plans, lay summaries, and result publications from pharmaceutical industry-sponsored trials. The proposed updates provide clear recommendations regarding which data should be shared, when it should be shared, and under what conditions. The suggested improvements aim to develop a data sharing ecosystem that supports science and patient-centred care. Good data sharing principles require resources, time, and commitment. Notwithstanding these challenges, enhancing data sharing is necessary for efficient resource utilization, increased scientific collaboration, and better decision-making for patients and healthcare professionals.

A risk science perspective on vaccines

Vaccines can be seen as one of the greatest successes in modern medicine. Good examples are the vaccines against smallpox, polio, and measles. Unfortunately, vaccines can have side effects, but the risks are considered by the health authorities and experts to be small compared to their benefits. Nevertheless, there are many who are skeptical of vaccination, something which has been very clearly demonstrated in relation to the COVID-19 disease. Risk is the key concept when evaluating a vaccine, in relation to both its ability to protect against the disease and its side effects. However, risk is a challenging concept to measure, which makes communication about vaccines' performance and side effects difficult. The present article aims at providing new insights into vaccine risks-the understanding, perception, communication, and handling of them-by adopting what is here referred to as a contemporary risk science perspective. This perspective clarifies the relationships between the risk concept and terms like uncertainty, knowledge, and probability. The skepticism toward vaccines is multifaceted, and influenced by concerns that extend beyond the effectiveness and safety of the vaccines. However, by clarifying the relationships between key concepts of risk, particularly how uncertainty affects risk and its characterization, we can improve our understanding of this issue.

A perspective on new dilemmas in scientific publishing in the time of a pandemic

BACKGROUND

The COVID-19 pandemic exerted manifold pressures on the public health framework globally, but it also in a way unified different genres and allowed for strategizing and implementing regulatory decisions as best as possible, especially in India. There is an unmet need for such a unified and integrative approach in the area of scientific publishing which has also been touched by various dilemmas, either emergent or propagated during this pandemic.

OBJECTIVES

This article intends to re-visit some of the dilemmas in scientific publishing, which have taken centre stage owing to a healthcare emergency, with the objective of highlighting an unmet need for developing unified criteria for research conduction and publishing from a futuristic view point, as one is not without the other.

CONTENT

While a fast track delivery of research data has been a priority for research journals, the due pressures in the process management of the same while skimming the ethical boundaries of responsible mediation through a Journal platform has remained a challenge globally for various reasons. Furthermore, the inevitability of a healthcare emergency inadvertently led to some cumulative off-target effects including accumulation of research waste, diminishing validity of academic metrics, short data set publications, hasty zombie clinical trials publishing merely an overview of the actual data, etc, which are major issues not only for journal Editors or the research community as a whole, but also for regulatory authorities and policy makers. As a step towards future pandemic preparedness, strategizing and streamlining research and publication processes ensuing responsible reporting should be treated as a topic of paramount significance. Hence, through debating on these dilemmas as well as potential integrative approaches, unified guiding criteria in the area of scientific publishing may be developed in lieu of preparedness for such future pandemic scenarios.

COVID-19 vaccination requirements for Ireland's healthcare students

International debate on COVID-19 policy issues, notably negative social consequences, is vital when grappling with the pandemic legacy. Drawing from the second author's experiences in the Irish healthcare and higher education sectors, this commentary scrutinises measures that discriminated against students who declined novel COVID-19 pharmaceuticals. In so doing, it serves as a point of contrast to fear-based interventions. Connections are made with relevant literature when urging those in authority to ensure that policies intended to maximise vaccine coverage are seen to be fair and convincing. The commentary concludes with some reflections that could underpin more defensible policymaking and inform future research.

Systematic Guidelines for Effective Utilization of COVID-19 Databases in Genomic, Epidemiologic, and Clinical Research

The pandemic has led to the production and accumulation of various types of data related to coronavirus disease 2019 (COVID-19). To understand the features and characteristics of COVID-19 data, we summarized representative databases and determined the data types, purpose, and utilization details of each database. In addition, we categorized COVID-19 associated databases into epidemiological data, genome and protein data, and drug and target data. We found that the data present in each of these databases have nine separate purposes (clade/variant/lineage, genome browser, protein structure, epidemiological data, visualization, data analysis tool, treatment, literature, and immunity) according to the types of data. Utilizing the databases we investigated, we created four queries as integrative analysis methods that aimed to answer important scientific questions related to COVID-19. Our queries can make effective use of multiple databases to produce valuable results that can reveal novel findings through comprehensive analysis. This allows clinical researchers, epidemiologists, and clinicians to have easy access to COVID-19 data without requiring expert knowledge in computing or data science. We expect that users will be able to reference our examples to construct their own integrative analysis methods, which will act as a basis for further scientific inquiry and data searching.

How missing evidence-based medicine indicators can inform COVID-19 vaccine distribution policies: a scoping review and calculation of indicators from data in randomised controlled trials

OBJECTIVE

Reports of efficacy, effectiveness and harms of COVID-19 vaccines have not used key indicators from evidence-based medicine (EBM) that can inform policies about vaccine distribution. This study aims to clarify EBM indicators that consider baseline risks when assessing vaccines' benefits versus harms: absolute risk reduction (ARR) and number needed to be vaccinated (NNV), versus absolute risk of the intervention (ARI) and number needed to harm (NNH).

METHODS

We used a multimethod approach, including a scoping review of the literature; calculation of risk reductions and harms from data concerning five major vaccines; analysis of risk reductions in population subgroups with varying baseline risks; and comparisons with prior vaccines.

FINDINGS

The scoping review showed few reports regarding ARR, NNV, ARI and NNH; comparisons of benefits versus harms using these EBM methods; or analyses of varying baseline risks. Calculated ARRs for symptomatic infection and hospitalisation were approximately 1% and 0.1%, respectively, as compared with relative risk reduction of 50%-95% and 58%-100%. NNV to prevent one symptomatic infection and one hospitalisation was in the range of 80-500 and 500-4000. Based on available data, ARI and NNH as measures of harm were difficult to calculate, and the balance between benefits and harms using EBM measures remained uncertain. The effectiveness of COVID-19 vaccines as measured by ARR and NNV was substantially higher in population subgroups with high versus low baseline risks.

CONCLUSIONS

Priorities for vaccine distribution should target subpopulations with higher baseline risks. Similar analyses using ARR/NNV and ARI/NNH would strengthen evaluations of vaccines' benefits versus harms. An EBM perspective on vaccine distribution that emphasises baseline risks becomes especially important as the world's population continues to face major barriers to vaccine access-sometimes termed 'vaccine apartheid'.

Serious adverse events of special interest following mRNA COVID-19 vaccination in randomized trials in adults

INTRODUCTION

In 2020, prior to COVID-19 vaccine rollout, the Brighton Collaboration created a priority list, endorsed by the World Health Organization, of potential adverse events relevant to COVID-19 vaccines. We adapted the Brighton Collaboration list to evaluate serious adverse events of special interest observed in mRNA COVID-19 vaccine trials.

METHODS

Secondary analysis of serious adverse events reported in the placebo-controlled, phase III randomized clinical trials of Pfizer and Moderna mRNA COVID-19 vaccines in adults (NCT04368728 and NCT04470427), focusing analysis on Brighton Collaboration adverse events of special interest.

RESULTS

Pfizer and Moderna mRNA COVID-19 vaccines were associated with an excess risk of serious adverse events of special interest of 10.1 and 15.1 per 10,000 vaccinated over placebo baselines of 17.6 and 42.2 (95 % CI -0.4 to 20.6 and -3.6 to 33.8), respectively. Combined, the mRNA vaccines were associated with an excess risk of serious adverse events of special interest of 12.5 per 10,000 vaccinated (95 % CI 2.1 to 22.9); risk ratio 1.43 (95 % CI 1.07 to 1.92). The Pfizer trial exhibited a 36 % higher risk of serious adverse events in the vaccine group; risk difference 18.0 per 10,000 vaccinated (95 % CI 1.2 to 34.9); risk ratio 1.36 (95 % CI 1.02 to 1.83). The Moderna trial exhibited a 6 % higher risk of serious adverse events in the vaccine group: risk difference 7.1 per 10,000 (95 % CI -23.2 to 37.4); risk ratio 1.06 (95 % CI 0.84 to 1.33). Combined, there was a 16 % higher risk of serious adverse events in mRNA vaccine recipients: risk difference 13.2 (95 % CI -3.2 to 29.6); risk ratio 1.16 (95 % CI 0.97 to 1.39).

DISCUSSION

The excess risk of serious adverse events found in our study points to the need for formal harm-benefit analyses, particularly those that are stratified according to risk of serious COVID-19 outcomes. These analyses will require public release of participant level datasets.

Audit of Data Sharing by Pharmaceutical Companies for Anticancer Medicines Approved by the US Food and Drug Administration

Question

What proportion of clinical trials that underpin registration of contemporary anticancer medicines are eligible for individual participant data (IPD) sharing with qualified researchers?

Findings

In this quality improvement study of the 304 trials that underpinned the US Food and Drug Administration (FDA) registration of 115 anticancer medicines over the past 10 years, 136 (45%) were eligible for IPD sharing.

Meaning

Although inroads have been made toward improving IPD transparency over the past 5 years, these findings suggest that a substantial portion of pivotal oncology trials that support the FDA registration of modern anticancer medicines remain unavailable to qualified researchers.

Importance

Emerging policies drafted by the pharmaceutical industry indicate that they will transparently share clinical trial data. These data offer an unparalleled opportunity to advance evidence-based medicine and support decision-making.

Objective

To evaluate the eligibility of independent, qualified researchers to access individual participant data (IPD) from oncology trials that supported US Food and Drug Administration (FDA) approval of new anticancer medicines within the past 10 years.

Design, Setting, and Participants

In this quality improvement study, a cross-sectional analysis was performed of pivotal clinical trials whose results supported FDA-approved anticancer medicines between January 1, 2011, and June 30, 2021. These trials’ results were identified from product labels.

Exposures

Eligibility for IPD sharing was confirmed by identification of a public listing of the trial as eligible for sharing or by receipt of a positive response from the sponsor to a standardized inquiry.

Main Outcomes and Measures

The main outcome was frequency of IPD sharing eligibility. Reasons for data sharing ineligibility were requested and collated, and company-, drug-, and trial-level subgroups were evaluated and presented using χ² tests and forest plots.

Results

During the 10-year period examined, 115 anticancer medicines were approved by the FDA on the basis of evidence from 304 pharmaceutical industry–sponsored trials. Of these trials, 136 (45%) were eligible for IPD sharing and 168 (55%) were not. Data sharing rates differed substantially among industry sponsors, with the most common reason for not sharing trial IPD being that the collection of long-term follow-up data was still ongoing (89 of 168 trials [53%]). Of the top 10 anticancer medicines by global sales, nivolumab, pembrolizumab, and pomalidomide had the lowest eligibility rates for data sharing (<10% of trials).

Conclusions and Relevance

There has been a substantial increase in IPD sharing for industry-sponsored oncology trials over the past 5 years. However, this quality improvement study found that more than 50% of queried trials for FDA-approved anticancer medicines were ineligible for IPD sharing. Data accessibility would be substantially improved if, at the time of FDA registration of a medicine, all data that support the registration were made available.

The unintended consequences of COVID-19 vaccine policy: why mandates, passports and restrictions may cause more harm than good

Vaccination policies have shifted dramatically during COVID-19 with the rapid emergence of population-wide vaccine mandates, domestic vaccine passports and differential restrictions based on vaccination status. While these policies have prompted ethical, scientific, practical, legal and political debate, there has been limited evaluation of their potential unintended consequences. Here, we outline a comprehensive set of hypotheses for why these policies may ultimately be counterproductive and harmful. Our framework considers four domains: (1) behavioural psychology, (2) politics and law, (3) socioeconomics, and (4) the integrity of science and public health. While current vaccines appear to have had a significant impact on decreasing COVID-19-related morbidity and mortality burdens, we argue that current mandatory vaccine policies are scientifically questionable and are likely to cause more societal harm than good. Restricting people's access to work, education, public transport and social life based on COVID-19 vaccination status impinges on human rights, promotes stigma and social polarisation, and adversely affects health and well-being. Current policies may lead to a widening of health and economic inequalities, detrimental long-term impacts on trust in government and scientific institutions, and reduce the uptake of future public health measures, including COVID-19 vaccines as well as routine immunisations. Mandating vaccination is one of the most powerful interventions in public health and should be used sparingly and carefully to uphold ethical norms and trust in institutions. We argue that current COVID-19 vaccine policies should be re-evaluated in light of the negative consequences that we outline. Leveraging empowering strategies based on trust and public consultation, and improving healthcare services and infrastructure, represent a more sustainable approach to optimising COVID-19 vaccination programmes and, more broadly, the health and well-being of the public.

Decolonizing Knowledge Upstream: New Ways to Deconstruct and Fight Disinformation in an Era of COVID-19, Extreme Digital Transformation, and Climate Emergency

Lies and disinformation have always existed throughout human history. However, disinformation has become a "pandemic within a pandemic" with convergence of COVID-19 and digital transformation of health care, climate emergency, and pervasive human-computer interaction in all facets of life. We are living through an era of post-truth. New approaches to fight disinformation are urgently needed and of paramount importance for systems science and planetary health. In this study, we discuss the ways in which extractive and entrenched epistemologies such as technocracy and neoliberalism co-produce disinformation. We draw from the works of David Collingridge in technology entrenchment and the literature on digital health, international affairs, climate emergency, degrowth, and decolonializing methodologies. We expand the vocabulary on and interventions against disinformation, and propose the following: (1) rapid epistemic disobedience as a critical governance tool to resist the cultural hegemony of neoliberalism and its master narrative infinite growth that is damaging the planetary ecosystems, while creating echo chambers overflowing with disinformation, and (2) a two-tiered taxonomy of reflexivity, a state of self-cognizance by knowledge actors, for example, scientists, engineers, and physicians (type 1 reflexivity), as well as by chroniclers of former actors, for example, civil society organizations, journalists, social sciences, and humanities scholars (type 2 reflexivity). This article takes seriously the role of master narratives in quotidian life in production of disinformation and ecological breakdown. The infinite growth narrative does not ask critical questions such as "growth in what, at what costs to society and environment?," and is a dangerous game of brinkmanship that has been testing the planetary ecological boundaries and putting at risk the veracity of knowledge. There is a need for scholars and systems scientists who break ranks with entrenched narratives that pose existential threats to planetary sustainability and are harmful to knowledge veracity. Scholars who resist the obvious recklessness and juggernaut of the pursuit of neoliberal infinite growth would be rooting for living responsibly and in solidarity on a planet with finite resources. The interventions proposed in this study, rapid epistemic disobedience and the expanded reflexivity taxonomy, can advance progressive policies for a good life for all within planetary boundaries, and decolonize knowledge from disinformation in ways that are necessarily upstream, radical, rapid, and emancipatory.

Effectiveness of COVID-19 Vaccines in the General Population of an Italian Region before and during the Omicron Wave

We performed a cohort analysis of the entire population of Abruzzo, Italy, to evaluate the real-world effectiveness of SARS-CoV-2 vaccines against infection, COVID-19 hospitalization or death, over time and during the Omicron wave. All resident or domiciled subjects were included, and official vaccination, COVID-19, demographic, hospital and co-pay exemption datasets were extracted up to 18 February 2022. Multivariable analyses were adjusted for age, gender, hypertension, diabetes, major cardio- and cerebrovascular events, COPD, kidney diseases, and cancer. During the follow-up (average 244 days), 252,365 subjects received three vaccine doses (of BNT162b2, ChAdOx1 nCoV-19, mRNA-1273 or JNJ-78436735), 684,860 two doses, 29,401 one dose, and 313,068 no dose. Overall, 13.4% of the individuals were infected with SARS-CoV-2 (n = 170,761); 1.1% of them had severe COVID-19, and 0.6% died. Compared with the unvaccinated, those receiving two or three vaccine doses showed an 80% to 90% lower risk of COVID-19 hospitalization or death. Protection decreased during the Omicron wave and six months after the last dose, but it remained substantial. Lethal disease was uncommon during the Omicron wave and in the young population, even among the unvaccinated. Some of the current policies may need a re-evaluation in light of these findings. The results from the Omicron wave will inevitably require confirmation.