Altruism, Scepticism, and collective decision-making in foreign-born U.S. residents in a tuberculosis vaccine trial

Sienna R Craig, Timothy Lahey, Apoorva Dixit, C Fordham von Reyn, Sienna R Craig, Timothy Lahey, Apoorva Dixit, C Fordham von Reyn

Abstract

Background: The current vaccine against tuberculosis, BCG, is effective when given in most TB-endemic countries at birth but has diminished efficacy against pulmonary TB after 15-20 years. As a result, new booster vaccines for adolescents and adults are being developed to realize the World Health Organization target of global elimination of TB by 2035. Multiple TB candidates thus are in active clinical development.

Methods: One of these, DAR-901, is advancing in human clinical trials. These clinical trials are conducted in BCG immunized adults with and without HIV infection in order to assess safety and efficacy among the people most in need of a new vaccine. A Phase I dose escalation trial of DAR-901 in BCG-immunized adults with or without HIV infection was conducted between 2014 and 2016. This offered an unusual opportunity to qualitatively examine why foreign-born adults living in the United States - a poorly studied population - decide to participate, or not, in clinical trials.

Results: We conducted a qualitative study of individuals who were recruited to participate in this Phase I vaccine trial, interviewing those who agreed and declined to participate. We found diverse motivations for participation or refusal; varied understandings of tuberculosis and vaccines; and complex views about how 'informed consent' can be at odds with cultural understandings of power, authority, and medical decision-making. These dynamics included: knowledge (direct or indirect) of tuberculosis, a desire to be altruistic and simultaneous hopes for personal gain as well as concerns over what remuneration for participation could mean, the importance of personal relationships with care providers in shaping volunteerism, concerns over privacy, and evidence of how culture and history shape medical decision-making.

Conclusions: This US-based trial, aimed at addressing a crucible global health issue, raises productive questions about the interface between altruism and scepticism regarding clinical research participation.

Trial registration: NCT02063555 .

Keywords: Clinical trials; Collective decision-making; Tuberculosis; Vaccine; Volunteerism.

Conflict of interest statement

Ethics approval and consent to participate

The Dartmouth Committee for the Protection of Human Subjects, which is the name for Dartmouth’s Institutional Review Board/Ethics Committee, approved this study (CPHS #28941). In the ethics review process, we received permission for a waiver of written consent, and instead the researchers obtained verbal consent from all of the participants. We documented this verbal consent on a password-protected information sheet and de-identified transcript of the interview. The study also provided all participants with an information sheet detailing the purpose of the study and how their information would be shared and used.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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