The impact of the global COVID-19 pandemic on the conduct of clinical trials. Return to normalcy by considering the practical impact of a structured ethical analysis.

During the outbreak of the COVID-19 pandemic many clinical trials were abruptly halted. Measures to contain the pandemic are currently taking effect and societies in general and health care systems in particular are considering how to return to normalcy. This opens-up the discussion when and how clinical trials should be restarted while the COVID-19 pandemic has not yet resolved, and what should happen in case of a resurgence of the virus in the coming months. This article uses the Four Ethical Principles framework as a structured approach to come to a set of practical, ethically grounded guidelines for halting and relaunching clinical trials during the SARS-CoV-2 pandemic. The framework applied provides a structured approach for all clinical trials stakeholders and thereby prevents unclear reasoning in a complex situation. While it is essential to prevent the virus from resurging and focus on developing a COVID-19 treatment as soon as possible, it is just as important to our society that we continue developing new drugs for other conditions. In this article we argue that the situation for clinical trials is not essentially different from the pre-COVID-19 era and that an overcautious approach will have negative consequences.