20.03.2013 Views

Procedure for assessing the acceptability, in principle, of vaccines ...

Procedure for assessing the acceptability, in principle, of vaccines ...

Procedure for assessing the acceptability, in principle, of vaccines ...

SHOW MORE
SHOW LESS

Create successful ePaper yourself

Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.

74<br />

WHO/BS/10.2155<br />

Page 74<br />

meet<strong>in</strong>g or work related to <strong>the</strong> declared <strong>in</strong>terest and from <strong>the</strong> correspond<strong>in</strong>g decision mak<strong>in</strong>g<br />

process); or (iii) mandates total exclusion (i.e. you will not be able to participate <strong>in</strong> any part <strong>of</strong><br />

<strong>the</strong> meet<strong>in</strong>g or work).<br />

All potentially significant <strong>in</strong>terests will be disclosed to <strong>the</strong> o<strong>the</strong>r participants at <strong>the</strong> start<br />

<strong>of</strong> <strong>the</strong> activity and you will be asked if <strong>the</strong>re have been any changes. A summary <strong>of</strong> all<br />

declarations and actions taken to manage any declared <strong>in</strong>terests will be published <strong>in</strong> result<strong>in</strong>g<br />

reports and work products. Fur<strong>the</strong>rmore, if <strong>the</strong> objectivity <strong>of</strong> <strong>the</strong> work or meet<strong>in</strong>g <strong>in</strong> which you<br />

are <strong>in</strong>volved is subsequently questioned, <strong>the</strong> contents <strong>of</strong> your DOI <strong>for</strong>m may be made available<br />

by <strong>the</strong> Secretariat to persons outside WHO if <strong>the</strong> Director-General considers such disclosure to<br />

be <strong>in</strong> <strong>the</strong> best <strong>in</strong>terest <strong>of</strong> <strong>the</strong> Organization, after consult<strong>in</strong>g with you. Complet<strong>in</strong>g this DOI <strong>for</strong>m<br />

means that you agree to <strong>the</strong>se conditions.<br />

If you are unable or unwill<strong>in</strong>g to disclose <strong>the</strong> details <strong>of</strong> an <strong>in</strong>terest that may pose a real or<br />

perceived conflict, you must disclose that a conflict <strong>of</strong> <strong>in</strong>terest may exist and <strong>the</strong> Secretariat may<br />

decide that you be totally recused from <strong>the</strong> meet<strong>in</strong>g or work concerned, after consult<strong>in</strong>g with you.<br />

Name: ________________________________________<br />

Institution: ____________________________________<br />

Email: ________________________________________<br />

Date and title <strong>of</strong> meet<strong>in</strong>g or work, <strong>in</strong>clud<strong>in</strong>g description <strong>of</strong> subject matter to be considered<br />

(if a number <strong>of</strong> substances or processes are to be evaluated, a list should be attached by <strong>the</strong><br />

organizer <strong>of</strong> <strong>the</strong> activity):<br />

_____________________________________________________________________________<br />

___________________________________________________________________<br />

Please answer each <strong>of</strong> <strong>the</strong> questions below. If <strong>the</strong> answer to any <strong>of</strong> <strong>the</strong> questions is "yes", briefly<br />

describe <strong>the</strong> circumstances on <strong>the</strong> last page <strong>of</strong> <strong>the</strong> <strong>for</strong>m.<br />

The term "you" refers to yourself and your immediate family members (i.e. spouse (or partner<br />

with whom you have a similar close personal relationship) and your children). "Commercial entity"<br />

<strong>in</strong>cludes any commercial bus<strong>in</strong>ess, an <strong>in</strong>dustry association, research <strong>in</strong>stitution or o<strong>the</strong>r enterprise whose<br />

fund<strong>in</strong>g is significantly derived from commercial sources with an <strong>in</strong>terest related to <strong>the</strong> subject <strong>of</strong> <strong>the</strong>

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!