Organization: Novartis Vaccines Academy (Master Coordination) Venue: University of Siena Medical School, Siena - Italy (Hospital and Laboratories) Novartis Vaccines and Diagnostics S.r.l., Siena - Italy (Development Departments, Research Center and Laboratories) Novartis Vaccines Institute for Global Health S.r.l., Siena - Italy Sanofi Pasteur S.A., Lyon - France University of Oxford – Oxford Vaccine Group, Oxford - UK University of Surrey, Guildford - UK Public Health (Immunization Centers), Siena - Italy Duration: May 2015 – November 2016 Sponsors Letter from the Director Sue Ann Costa Clemens, MD,PhD Prof. Pediatric Infectious Diseases Director Novartis Vaccines Academy To this date much of the developing world poses many challenges to enjoying life free of vaccine preventable diseases; despite most government’s good-will and the desire to ease the burden of these diseases. To achieve this goal, developing countries need to have native, well-rounded professionals in the fields of immunization, public health and infectious diseases. Professionals who can appreciate the impact of vaccine preventable diseases from different angles: value of vaccines, vaccine research and development, vaccine safety, vaccine procurement and vaccine delivery. Likewise, health care professionals from developed countries would benefit for themselves and would contribute to global health by more in-depth understanding of the contribution of immunization and vaccines to global development. The Master Program in Vaccinology and Pharmaceutical Development provides high quality education involving world-wide key opinion leaders. This program which started in 2008, has graduated more than 30 students from the developing world who are now making a difference in their countries. This year, 15 new Vaccinology professionals from Africa, Asia and Latin America will go back to their countries to start new careers. I am confident that very soon we will see the impact that they will have through their contributions. This program demands excellence in every aspect, from the worldwide expertise of the teaching staff to the student’s level of commitment and dedication. I am particularly impressed with their true desire to learn, improve and make a difference in their countries. The success of this program is a collaborative effort and a unique partnership between industry and academia to help developing countries to overcome some of the gaps in vaccinology, via a very solid tool - Education. This program helps the countries to build their own resources, to disseminate knowledge, to develop new professionals and specially helps the developing countries to be independent on key aspects as pharmacovigilance, regulatory and epidemiology. Sincerely, Prof. Dr. Sue Ann Costa Clemens The Technical Scientific Committee Prof. Emanuele Montomoli Director TSC Head Department of Molecular and Developmental, University of Siena Prof. Sue Ann Costa Clemens Director Novartis Vaccines Academy Prof. In Pediatrics Infectious Diseases Prof. Ranuccio Nuti Department of Internal Medicine, University of Siena Dr. Stefania Rossi Researcher of Public Health Dept. of Molecular and Developmental Medicine Area of Public Health, University of Siena Prof. Franco Laghi Pasini Head Department of Clinical Medicine and Immunology, University of Siena Dr. Audino Podda Head Clinical Development and Regulatory Affairs, Novartis Vaccines Institute for Global Health Dr. Giovanni Della Cioppa Head Clinical Development Clusters, Novartis Vaccines Dr. Emanuela Palla Head Early Projects GPT Head Italy RSO, Novartis Vaccines Content The Master Course ............................................................................................................................................................... 1 Goals ................................................................................................................................................................................. 1 Concept............................................................................................................................................................................ 1 Program overview ........................................................................................................................................................ 2 Program agenda (One year) .......................................................................................................................... 2 Internship (Six months) ................................................................................................................................... 2 Students Evaluation .................................................................................................................................................... 2 Thesis ...................................................................................................................................................................... 2 Module I .................................................................................................................................................................................... 4 Public Health and Vaccine Development Process ......................................................................................... 4 Module Directors ................................................................................................................................................ 4 Aim ........................................................................................................................................................................... 4 Contents ................................................................................................................................................................. 4 Module II ................................................................................................................................................................................... 5 Vaccine Immunology and Pre-Clinical Research ........................................................................................... 5 Module Directors ................................................................................................................................................ 5 Aim ........................................................................................................................................................................... 5 Contents ................................................................................................................................................................. 5 Module III ................................................................................................................................................................................. 6 Vaccine Manufacturing and Quality Control Processes............................................................................... 6 Module Directors ................................................................................................................................................ 6 Aim ........................................................................................................................................................................... 6 Contents ................................................................................................................................................................. 6 Module IV ................................................................................................................................................................................. 7 Infectious Diseases and Vaccine Prevention .................................................................................................... 7 Module Directors ................................................................................................................................................ 7 Aim ........................................................................................................................................................................... 7 Contents ................................................................................................................................................................. 7 Module V .................................................................................................................................................................................. 9 Clinical Development Methodology, Biostatistics and Data Management .......................................... 9 Module Directors ................................................................................................................................................ 9 Aim ........................................................................................................................................................................... 9 Contents ................................................................................................................................................................. 9 Module VI .............................................................................................................................................................................. 12 Pharmacovigilance ................................................................................................................................................... 12 Module Directors ............................................................................................................................................. 12 Aim ........................................................................................................................................................................ 12 Contents .............................................................................................................................................................. 12 Module VII ............................................................................................................................................................................. 13 Epidemiology, Health Systems and Health Economics ............................................................................ 13 Module Directors ............................................................................................................................................. 13 Aim ........................................................................................................................................................................ 13 Contents .............................................................................................................................................................. 13 Module VIII ............................................................................................................................................................................ 14 Good Clinical Practice, Clinical Quality Assurance and Clinical Trial Operations .......................... 14 Module Directors ............................................................................................................................................. 14 Aim ........................................................................................................................................................................ 14 Contents .............................................................................................................................................................. 14 Module IX .............................................................................................................................................................................. 16 Regulatory Affairs ..................................................................................................................................................... 16 Module Directors ............................................................................................................................................. 16 Aim ........................................................................................................................................................................ 16 Contents .............................................................................................................................................................. 16 Module X ............................................................................................................................................................................... 17 Policies and recommendations for vaccines in the world ....................................................................... 17 Module Directors ............................................................................................................................................. 17 Aim ........................................................................................................................................................................ 17 Contents .............................................................................................................................................................. 17 Special Topics ..................................................................................................................................................................... 19 Aim ........................................................................................................................................................................ 19 First and second semester .......................................................................................................................... 19 How to proceed .................................................................................................................................................................. 20 Entry Requirements ................................................................................................................................................. 20 Funding ......................................................................................................................................................................... 20 Application & Information ..................................................................................................................................... 20 Application to the University of Siena .................................................................................................... 20 Contact information .......................................................................................................................................................... 21 Introduction The Master Course Goals • • Capacity building in vaccinology and vaccine development; To prepare students for a career in academia, public health and research and development in public and private vaccine institutes. Concept • To provide graduates in medicine with training in epidemiology and disease burden of vaccine preventable infectious diseases, vaccine development from research to licensure and vaccine policy and funding; • • Is a collaborative effort between academia and vaccine industry; Combines theoretical and practical training in immunology, infectious diseases and vaccinology, from research to licensure. The training is given by worldwide experts from academia, well known international universities, supranational organizations (e.g. EMA, Sabin Institute, Bill & Melinda Gates Foundation) and industry. Master in Vaccinology and Pharmaceutical Clinical Development IV Edition - 2015 Page 1 of 22 The Program Program overview Program agenda (One year) • • • • • Module I: Public Health and Vaccine Development Process; • • • Module VI: Pharmacovigilance; • • • Module IX: Regulatory Affairs; Module II: Vaccine Immunology and Preclinical Research; Module III: Vaccine Manufacturing and Quality Control Processes; Module IV: Infectious Diseases and Vaccine Prevention; Module V: Clinical Development Methodology, Biostatistics and Clinical Data management; Module VII: Epidemiology, Health Systems and Economics; Module VIII: Good Clinical Practices, Clinical Quality Assurance and Clinical Trial Operations; Module X: Policies and Recommendations for Vaccines in the World; Extra Curriculum Modules: Special Topics. Internship (Six months) • six-month internship: o within different departments of the Novartis Vaccines, Sanofi-Pasteur, Universities of Surrey and Oxford; o at the University Hospital of Siena; • clinical site visits: o investigators meeting / site feasibility o study start/closure o monitoring Students Evaluation • • Written exams after each module and a cumulative one at the end of the first year; Internship: students’ performance is assessed by supervisors and master coordination based on activities and overall training and deliverables during the 6 month internship period. Thesis • • Each student will select a subject for a written thesis; The thesis will be submitted to University of Siena and discussed at the end of the Program. Master in Vaccinology and Pharmaceutical Clinical Development IV Edition - 2015 Page 2 of 22 Master in Vaccinology and Pharmaceutical Clinical Development IV Edition - 2015 Page 3 of 22 Modular Program Module I Public Health and Vaccine Development Process Module Directors • • Prof. Emanuele Montomoli - Professor of Public Health, University of Siena, Italy Prof. Sue Ann Costa Clemens - Prof. Pediatric Infectious Diseases, Director Novartis Vaccines Academy Aim To get a general overview on immunization and public health in the world and to understand the overall principles of pharmaceutical development process from research to the market. Contents • • • • • • • • • • Public Health basic concepts; The role of vaccines in public health; Role of stakeholders; Governments, NGO’s, Supranational Organizations; Academia; Vaccine industry; Vaccine development process; From research to licensure and recommendations; How vaccine companies function; How to manage projects in vaccine companies; Master in Vaccinology and Pharmaceutical Clinical Development IV Edition - 2015 Page 4 of 22 Module II Vaccine Immunology and Pre-Clinical Research Module Directors • Prof. Emanuele Montomoli - Head Department of Molecular and Developmental, University of Siena, Italy • • Dr. Giuseppe Del Giudice - Global Head Translational Medicine, Novartis Vaccines Dr. Emanuela Palla - Head Early Projects GPT, Head Italy RSO, Novartis Vaccines Aim To understand the basic concepts of immunology, immune response to vaccines and how to translate this into vaccine development and licensing. Contents • Historical background to vaccination: o Human Immune response: Innate immunity; B-cell and T-cell responses; How to measure B and T cell function. • Identification of vaccine targets: o Antigen structures as potential vaccine candidates; o Conventional and novel approaches to vaccine development. • • • • Type of vaccines; The role of adjuvants; Pre-clinical evaluation of vaccine immunology and safety; Analysis of immune response to vaccines in humans: o Antibody response; o Functional assays versus quantitative assays. Master in Vaccinology and Pharmaceutical Clinical Development IV Edition - 2015 Page 5 of 22 Module III Vaccine Manufacturing and Quality Control Processes Module Directors • • Prof. Emanuele Montomoli - Professor of Public Health, University of Siena, Italy Dr. Massimo Bugnoli - Technical Operations, Novartis Vaccines Aim To get an understanding of concepts, methods and challenges of technical operations and quality of vaccine manufacturing. Contents • • History of vaccine production, challenges and advances; • Organization: o Procedures and flows in manufacturing and control vaccines; o Plant structure and layout, shifts. • Importance of Good Manufacturing Practices (GMP) to guarantee an immunogenic and safe product: o Selection of raw materials; o Systems as tools to monitor and control quality. • • • Labeling and packaging; Production processes in bacterial and viral vaccines: o Working seed, bulk formulation, filling and packaging; o Products in development; o Industrialization (scale-up); o From idea to product. Differences between vaccine and pharmaceutical production; Inspections by authorities. Master in Vaccinology and Pharmaceutical Clinical Development IV Edition - 2015 Page 6 of 22 Module IV Infectious Diseases and Vaccine Prevention Module Directors • • Prof. Roberto Gasparini - Director Public Health Department, University of Genoa, Italy Dr. Audino Podda - Head Clinical Development & Regulatory Affairs, Novartis Vaccines Institute for Global Health Aim To get familiar with the most important vaccine preventable infectious diseases from a clinical and from a global epidemiological perspective. To learn which vaccines are already available against these infectious diseases and which new vaccines are being developed. Contents • Bacterial diseases: clinical profile, epidemiology, and vaccines: o Diphtheria o Tetanus o Pertussis o Haemophilus influenza type b disease o Meningococcal disease o Pneumococcal disease o Lyme disease/ Borreliosis o Group A Streptococcal diseases o Group B Streptococcal disease o Staphylococcal disease o Tuberculosis o Helicobacter pylori infection o Cholera o Enterotoxigenic Escherichia coli o Salmonellosis o Shigellosis o Others Master in Vaccinology and Pharmaceutical Clinical Development IV Edition - 2015 Page 7 of 22 • Viral diseases : clinical profile, epidemiology, and vaccines: o Hepatitis A, B, C and E o Measles o Mumps o Rubella o Varicella & Zoster o Influenza & Pandemic Influenza o Respiratory syncytial virus o Cytomegalovirus o HIV/AIDS o Tick Borne encephalitis o Japanese encephalitis o Yellow Fever o Dengue Fever o Rabies o Human papillomavirus o Herpes Simplex virus o Rotavirus o Others • Parasitic diseases: clinical profile, epidemiology, and vaccines: o Malaria o Others Master in Vaccinology and Pharmaceutical Clinical Development IV Edition - 2015 Page 8 of 22 Module V Clinical Development Methodology, Biostatistics and Data Management Module Directors • Dr. Stefania Rossi - Researcher of Public Health, Dept. of Molecular and Developmental Medicine Area of Public Health, University of Siena, Italy • • Dr. Giovanni Della Cioppa – Head Clinical Development Clusters, Novartis Vaccines Dr. Uwe Nicolay - Head Biostatistics, Novartis Vaccines Aim To understand the basic principles of clinical trial methodology, especially in vaccine development. To understand basic concepts of statistics and data management for clinical trials. Contents • Overview of the clinical development: o Clinical development plans; o Phases of the clinical development process: Phase I - II - III - IV trials; o Experimental studies (clinical trials) vs. epidemiological (observational) studies; o Life-cycle of a product; o Geographical, logistical & economic considerations. • Clinical trial methodology and protocol development: o Why clinical trials? Variability of biological phenomena and measurement errors; o Defining the treatment effect: from measurements to end-points; o The choice of the sample: which subjects, how many subjects; o The choice of treatments: study treatments, concomitant treatments; o Experimental designs; o The protocol approval processes: internal, external, amendments. Master in Vaccinology and Pharmaceutical Clinical Development IV Edition - 2015 Page 9 of 22 • Vaccine trial methodology: o Safety, immunogenicity, efficacy and effectiveness; o Surrogate end-points, correlates of protection and constrains of serological endo points; Ethical considerations in clinical development. • Statistical methodology for clinical trials: o Basics, International Conference on Harmonization (ICH) guidelines (E8, E9, E10), EMEA/FDA guidelines; o Descriptive vs. inferential statistics; o Importance of randomization to avoid bias; o Power & sample size calculations for hypothesis testing; o Superiority, equivalence, non-inferiority; o Designs & analytical approaches; o Endpoints (measures and variables), surrogate, markers; o P-values: statistical and clinical significance; o Statistical analysis plan; o Interim analyses, meta analyses; o Alignment of protocol, data collection and reports. • Clinical Data Management: o Case Report Form (CRF) design; o Electronic Data Capture and paper CRF processes and systems; o Database design and setup with edit checks, rules and derivations; o Validation of computerized systems for data management; o Data collection and data cleaning; o Data integration (e.g. lab data transfers); o Data quality, database lock, post database lock changes; o Adverse Event reporting; o Coding dictionaries (Medical Dictionary for Regulatory Activities [MedDRA], WHOdrug). Master in Vaccinology and Pharmaceutical Clinical Development IV Edition - 2015 Page 10 of 22 Master in Vaccinology and Pharmaceutical Clinical Development IV Edition - 2015 Page 11 of 22 Module VI Pharmacovigilance Module Directors • Prof. Franco Laghi Pasini - Professor of Internal Medicine and Director of Department of Internal Medicine 2, University of Siena, Italy • Dr. Bernadette Hendrickx - VP, Senior Medical and Scientific Advisor to the CEO - Sanofi Pasteur • Dr. Corinne Jouquelet-Royer - VP, Head Global Pharmacovigilance – Sanofi Pasteur Aim To understand main rational, best practice and present overview on Pharmacovigilance systems in the world. The learning is focused on: how to write an individual case narrative, how to assess causality and expectedness of cases, how to determine certainty of diagnosis according to Brighton collaboration guidelines. Contents • • • Introduction to clinical safety, Pharmacovigilance and benefit-risk management; • • • Safety data collection in clinical trials; • • Regulatory Reporting; • • Safety strategy, issue management and crisis prevention Clinical safety in the Developing World; Statutory basis for safety in humans: o Historical basis; o Governing bodies and Health Authorities: ICH, Council for International Organizations of Medical Sciences (CIOMS), WHO; Spontaneous adverse events; Adverse Events: o Definitions and classification; o Processing, archiving and retrieval; o Assessment: expectedness, listedness, causality and reference documents o Analysis and decision-making; Life-Cycle Clinical Product Safety: o Discovery and pre-clinical science; o Pre and post authorization clinical safety; o Structured benefit-risk assessment and management Communication in Pharmacovigilance Master in Vaccinology and Pharmaceutical Clinical Development IV Edition - 2015 Page 12 of 22 Module VII Epidemiology, Health Systems and Health Economics Module Directors • Prof. Felice Petraglia – Professor of Obstetrics and Gynecology, Department of Molecular and Developmental Medicine – University of Siena • Dr. John Weil - Head Epidemiology – Novartis Vaccines Aim To understand basic principles of Epidemiology and Health Economics and the relevance for vaccine development. Contents • Epidemiology: o Principles of infectious diseases epidemiology; o Measures of disease occurrence; o Measures of impact; o Sensitivity – specificity; o Observational studies: cohort and case-control, alternative designs, how to write a study protocol, choice of a reference group, synthesis causal inference, sampling; o Methodology: matching, bias, confounding, third factor, disentangling; o Calculations - analysis: sample size calculation, significance, logistic regression; o Surveillance: principles of surveillance, event based surveillance, analytical tools in surveillance, lab-based surveillance, evaluation of surveillance. • Health Systems and Economics: o Overview of key patterns and issues of health systems mainly in Low Income Countries; o Key concepts of the economics of health; o Student will simulate tools for allocating resources in local health systems assessing population health needs. Master in Vaccinology and Pharmaceutical Clinical Development IV Edition - 2015 Page 13 of 22 Module VIII Good Clinical Practice, Clinical Quality Assurance and Clinical Trial Operations Module Directors • • Prof. Stefano Gonnelli - Professor of Internal Medicine, University of Siena, Italy Dr. Elisa Marchetti - Head Clinical Operations and Training, Novartis Vaccines Institute for Global Health Aim To understand the requirements and to ensures quality in clinical trials execution and the operational requirements for planning and executing vaccines clinical trials. Contents • Introduction to Good Clinical Practice (GCP): o Regulatory requirements, ICH and GCP and regional differences; o Roles and responsibilities of sponsors, investigators and monitors; o The importance of the Informed Consent; o Essential documents. • Elements of the Clinical Quality System: o Quality Policies and Quality Manual; o Standard Operating Procedures (SOPs); o Qualification and training of staff; o Qualification of third parties (Contract Research Organizations CROs); o Trial Master File; o Auditing: internal and external auditing, system audits. • Regulatory inspections: o Preparation of an inspection (sponsor and site); o Types, procedure, reports; o Frequent findings. Master in Vaccinology and Pharmaceutical Clinical Development IV Edition - 2015 Page 14 of 22 • Introduction to Clinical Trial Operations (CTO): o From protocol to clinical study report; o Clinical project management & planning. • Clinical trials preparation: o Protocol, Informed Consent Form and related documents; o Labeling & packaging of vaccines; o Site qualification; o Clinical research organizations (CRO); o Documentation. • Clinical trial execution: o Initiation visit; o Monitoring; o Safety; o Study closure. • • Database lock and close-out data management activities; • Clinical Study Report. Operational systems and processes: o Trial management systems; o Efficiencies and quality control in process; Master in Vaccinology and Pharmaceutical Clinical Development IV Edition - 2015 Page 15 of 22 Module IX Regulatory Affairs Module Directors • Prof. Franco Laghi Pasini - Professor of Internal Medicine and Director of Department of Internal Medicine 2, University of Siena, Italy • Dr. Anne-Marie Georges, Consultant, Biological Products Development and European Pharmaceutical Law – Brussels, Belgium • Dr. Jochen Auerbach, Head Regulatory Affairs - Novartis Vaccines Institute for Global Health Aim To understand international regulatory environment and requirements related to obtain approval for vaccines and the maintenance of these licenses. Contents • Introduction: o General overview of main competent authorities (FDA, EMA, MHLW); o International Conference on Harmonization (ICH). o Drug development and life cycle from a regulatory perspective: Preclinical; Phase I – initial safety Phase II – proof of concept, dose ranging; Phase III – efficacy, large scale safety; Regulatory constraints of serological endpoints; Post Approval Commitments – studies to detect rare vaccine adverse events, impact studies; epidemiology; Health Authority review and approval procedures. • Regulatory systems: o US regulatory system; o EU regulatory system; o WHO prequalification process; o Other selected regulatory systems. • Product labeling: o US Package Insert; o EU Summary of Product Characteristics; o Package inserts and labels, what needs to be included? • • • Regulatory differences between drugs and biologics; Promotional compliance; Regulatory Inspections Master in Vaccinology and Pharmaceutical Clinical Development IV Edition - 2015 Page 16 of 22 Module X Policies and recommendations for vaccines in the world Module Directors • • Prof. Paolo Bonanni - Department of Public Health, University of Florence Dr. Audino Podda - Head Clinical Development & Regulatory Affairs, Novartis Vaccines Institute for Global Health Aim To understand that the introduction of new vaccines into the immunization calendars of different countries is dependent on a number of local and international factors. Contents • Key elements of Vaccination Systems and Policies in different countries and geographical areas: o Vaccination systems: centralized vs. decentralized; • Policies for vaccine licensure, recommendation and implementation: o data requested (epidemiological, clinical, economical etc.); o Stakeholders & decision making process (WHO, UNICEF, PAHO, local and Regional Technical Advisory Groups). • • • • • Factors influencing introduction of new vaccines; • Financing mechanisms: GAVI, AMCs, Bill & Melinda Gates Foundation, Revolving Fund, PAHO, others. Procedures for vaccine purchasing and supply; Public acceptance of vaccination; Health Technology Assessment (HTA) as a tool for prioritization; Economic analysis applied to vaccination programs: o Priority settings; o National Immunization Committees; o Vaccine schedules; o National budgets; Master in Vaccinology and Pharmaceutical Clinical Development IV Edition - 2015 Page 17 of 22 Master in Vaccinology and Pharmaceutical Clinical Development IV Edition - 2015 Page 18 of 22 Special Topics Aim To provide tools for the students personal and professional growth. First and second semester • • • • • • • • How to read and interpret scientific papers; How to write a clinical trial protocol and a protocol synopsis; How to write an epidemiology protocol; How to write grant applications and where to apply; How to write a thesis; How to write a paper to be published; Presentation skills; Communication: crisis management (clinical studies, SAEs, marketed products). Master in Vaccinology and Pharmaceutical Clinical Development IV Edition - 2015 Page 19 of 22 How to proceed Entry Requirements • • University degree in Human Medicine; Excellent command of English, written and spoken. The full Master Program is conducted in English. * Only ADITEC sponsored candidates must be: • • Currently working in a European Union or Associated Member state or Currently working in a vaccine development project funded by the European Commission or EDCTP. Funding • A 18-month grant will be provided to students who are accepted. Application & Information Application to the University of Siena The IV Edition of the Master Program in Vaccinology will start on May 2015. The Application process is explained in the University of Siena announcement (bando) that is available at http://www.unisi.it/didattica/corsi-post-laurea/master-universitari (under the heading “Master Executive”, courses are ordered by date). Candidates must send the official application form to the University of Siena by February 05, 2015. Assistance or further information to the candidates will be provided by Novartis Vaccines Academy - Master Program Coordination. Please send an e-mail to [email protected] by November 20, 2014 Master in Vaccinology and Pharmaceutical Clinical Development IV Edition - 2015 Page 20 of 22 Contact information Master Coordination: Mrs. Tiziana Musso, +39 0577 24 5253 Web: http://www.novartisvaccines.it/ricerca/clinical-development-eng.shtml E-mail: [email protected] Master in Vaccinology and Pharmaceutical Clinical Development IV Edition - 2015 Page 21 of 22 Parts of this brochure can be updated at any time without a previous notice Master in Vaccinology and Pharmaceutical Clinical Development IV Edition - 2015 Page 22 of 22
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