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

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75<br />

WHO/BS/10.2155<br />

Page 75<br />

meet<strong>in</strong>g or work. "Organization" <strong>in</strong>cludes a governmental, <strong>in</strong>ternational or non-pr<strong>of</strong>it organization.<br />

"Meet<strong>in</strong>g" <strong>in</strong>cludes a series or cycle <strong>of</strong> meet<strong>in</strong>gs.<br />

EMPLOYMENT AND CONSULTING<br />

With<strong>in</strong> <strong>the</strong> past 4 years, have you received remuneration from a commercial entity or o<strong>the</strong>r<br />

organization with an <strong>in</strong>terest related to <strong>the</strong> subject <strong>of</strong> <strong>the</strong> meet<strong>in</strong>g or work?<br />

1a Employment Yes/No<br />

1b Consult<strong>in</strong>g, <strong>in</strong>clud<strong>in</strong>g service as a technical or o<strong>the</strong>r advisor Yes/No<br />

RESEARCH SUPPORT<br />

With<strong>in</strong> <strong>the</strong> past 4 years, have you or has your research unit received support from a<br />

commercial entity or o<strong>the</strong>r organization with an <strong>in</strong>terest related to <strong>the</strong> subject <strong>of</strong> <strong>the</strong><br />

meet<strong>in</strong>g or work?<br />

2a Research support, <strong>in</strong>clud<strong>in</strong>g grants, collaborations, sponsorships, and o<strong>the</strong>r fund<strong>in</strong>g Yes/No<br />

2b Non-monetary support valued at more than US $1000 overall (<strong>in</strong>clude equipment, facilities, research<br />

assistants, paid travel to meet<strong>in</strong>gs, etc.<br />

Support (<strong>in</strong>clud<strong>in</strong>g honoraria) <strong>for</strong> be<strong>in</strong>g on a speakers bureau, giv<strong>in</strong>g speeches or tra<strong>in</strong><strong>in</strong>g <strong>for</strong> a<br />

commercial entity or o<strong>the</strong>r organization with an <strong>in</strong>terest related to <strong>the</strong> subject <strong>of</strong> <strong>the</strong> meet<strong>in</strong>g or work?<br />

Yes/No<br />

INVESTMENT INTERESTS<br />

Do you have current <strong>in</strong>vestments (valued at more than US $10 000 overall) <strong>in</strong> a<br />

commercial entity with an <strong>in</strong>terest related to <strong>the</strong> subject <strong>of</strong> <strong>the</strong> meet<strong>in</strong>g or work? Please<br />

also <strong>in</strong>clude <strong>in</strong>direct <strong>in</strong>vestments such as a trust or hold<strong>in</strong>g company. You may<br />

exclude mutual funds, pension funds or similar <strong>in</strong>vestments that are broadly diversified<br />

and on which you exercise no control.<br />

3a Stocks, bonds, stock options, o<strong>the</strong>r securities (e.g. short sales) Yes/No<br />

3b Commercial bus<strong>in</strong>ess <strong>in</strong>terests (e.g. proprietorships, partnerships, jo<strong>in</strong>t ventures, board memberships,<br />

controll<strong>in</strong>g <strong>in</strong>terest <strong>in</strong> a company) Yes/No<br />

INTELLECTUAL PROPERTY<br />

Do you have any <strong>in</strong>tellectual property rights that might be enhanced or dim<strong>in</strong>ished by <strong>the</strong> outcome <strong>of</strong>

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