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Vaccine clinical trials are necessary in low- and middle-income countries (LMICs) because new vaccine candidates are developed against diseases found mainly in these settings, the results of trials done in industrialized countries may not be generalizable to LMICs and more institutions in middle-income countries are producing vaccines for use in LMICs. We searched PubMed and conducted a narrative review on standard, newer and proposed approaches toward obtaining data supportive for vaccine licensure, with a special focus in LMICs. Of the vaccine trials done worldwide, only a small proportion is conducted in LMICs, but this is likely to increase as more research experience and infrastructure is developed. At present, the majority of vaccine trials follows the standard paradigm of fixed phase 1 to 3 trials, the latter with clinical endpoints, or immunobridging studies when a valid immunocorrelate of vaccine protection exists. Other study designs may help facilitate the generation of data toward licensure of and recommendations for needed vaccines. Increased international collaboration is needed for local capacity building and regulatory oversight to ensure that all studies are conducted under good clinical practice.

Vaccine clinical trials in low- and middle-income countries: a brief review of standard, newer and proposed approaches