1
|
Park YS, Kim OJ. Government Initiatives for Research Ethics During COVID-19 Pandemic in Korea. J Korean Med Sci 2024; 39:e116. [PMID: 38565174 PMCID: PMC10985498 DOI: 10.3346/jkms.2024.39.e116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Despite the growing necessity for government-led policy changes on clinical research ethics during pandemic, the scope of previous literature is limited to Korean government's pandemic response strategies or reflections of research ethics at the level of institutions and academic societies. This paper examines the proactive policy changes and responses by the South Korean government in addressing the challenges and issues of research ethics against the backdrop of the urgency of rapid development and emergency supply of medical products during the coronavirus disease 2019 (COVID-19) pandemic. METHODS We conducted searches of various government documents, using predetermined keywords related to research ethics and integrity during the COVID-19 pandemic. Only documents issued by governments or public institutions were included. A total of 24 documents were selected for analysis. They were divided into two phases: the first phase for urgent response (January 2020-February 2021) and the second phase (March 2021-February 2023) for long-term preparedness. RESULTS The Korean government recommended several measures of research governance to accelerate the ethical review of COVID-related research to be shortened less than one week: the joint operation of Institutional Review Boards (IRBs), exempted or expedited review by a special review committee, guidelines for urgent reviews, and designation of the Korean Academy of Medical Sciences as the supervising agency for the Clinical Trial Safety Support Institution as well as the Central IRB. It allowed temporary non-face-to-face methods for informed consent process (telephone explanations and a photo of the original signed consent) and clinical trials (telephone counselling and prescription, proxy prescription, and drug delivery and supply to clinical trial participants, and online ethics training). CONCLUSION As a result of South Korea's commitment to ethical principles in their pandemic response, the medical system did not experience collapses due to the pandemic, and pandemic research was conducted with careful ethical considerations. The pandemic ethics immunization during the Middle East respiratory syndrome epidemic in 2015 laid the foundation for prompt government initiatives that ensured both pandemic research ethics and pandemic response ethics.
Collapse
Affiliation(s)
- Young Su Park
- Department of the History of Medicine and Medical Humanities, Seoul National University College of Medicine, Seoul, Korea
| | - Ock-Joo Kim
- Department of the History of Medicine and Medical Humanities, Seoul National University College of Medicine, Seoul, Korea.
| |
Collapse
|
2
|
Yeh MJ, Lee PH. Ethical Preparedness for Health Policymaking and Implementation During Public Health Emergencies: The Role of Rapid Ethical Assessment. Health Secur 2023; 21:371-378. [PMID: 37552814 DOI: 10.1089/hs.2023.0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
Scholars have called for ethical preparedness for public health practice and research to address the challenges of special ethical considerations under time and resource pressure during emergencies like the COVID-19 pandemic. We propose the idea of a rapid ethical assessment (REA) that aims to provide ethical justifications and policy recommendations for a specific public health policy, which is necessary for the ethical legitimacy of health policymaking and implementation. We suggest that an REA task force be established and incorporated into the administrative procedure to perform an REA in the early, middle, and terminal stages of a policy proposed by the health authority and to determine to what extent the tradeoffs between values and priorities required by the policy are ethically acceptable. The REA task force's role is consultative, with the final decisionmaking power and political responsibilities falling on the health authority. The REA task force should adopt 4 substantial ethical principles: utilitarianism, equity, human rights, and solidarity. The REA task force would consist of a multidisciplinary team of experts and a group of representatives from those who would be affected by the proposed policy. The REA task force would operate with a 5-step procedure of (1) convening, (2) investigation, (3) determination, (4) reporting and communication, and (5) decision and reassessment. We use 2 real incidents in Taiwan to demonstrate how the REA task force could work to enhance the ethical acceptance of a policy.
Collapse
Affiliation(s)
- Ming-Jui Yeh
- Ming-Jui Yeh, PhD, is Assistant Professors, Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taiwan
| | - Po-Han Lee
- Po-Han Lee, PhD, is Assistant Professors, Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taiwan
| |
Collapse
|
3
|
Holm S, Lewis J, Dal-Ré R. Equipoise, standard of care and consent: responding to the authorisation of new COVID-19 treatments in randomised controlled trials. JOURNAL OF MEDICAL ETHICS 2023; 49:465-470. [PMID: 35606010 PMCID: PMC9157327 DOI: 10.1136/medethics-2022-108182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
In response to the COVID-19 pandemic, large-scale research and pharmaceutical regulatory processes have proceeded at a dramatically increased pace with new and effective, evidence-based COVID-19 interventions rapidly making their way into the clinic. However, the swift generation of high-quality evidence and the efficient processing of regulatory authorisation have given rise to more specific and complex versions of well-known research ethics issues. In this paper, we identify three such issues by focusing on the authorisation of molnupiravir, a novel antiviral medicine aimed at reducing the ability of SARS-CoV-2 to multiply in the body, for clinical use by the National Health Service in England and the concomitant testing of molnupiravir through the large-scale Platform Adaptive trial of Novel antiviRals for eArly treatMent of COVID-19 In the Community randomised control trial. By analysing the ways in which the authorisation and clinical use of molnupiravir complicate standard approaches to clinical equipoise, standard of care and participant consent in the PANORAMIC randomised control trial, we will explain some of ethical implications for clinical trials that aim to study the efficacy and safety of new COVID-19 and other therapeutics when conditional authorisation has already been granted and when such treatments have already been made available to patients by national health providers.
Collapse
Affiliation(s)
- Soren Holm
- Centre for Social Ethics and Policy, The University of Manchester, Manchester, Manchester, UK
- HELSAM, Center for Medical Ethics, University of Oslo Faculty of Medicine, Oslo, Oslo, Norway
| | - Jonathan Lewis
- Centre for Social Ethics and Policy, The University of Manchester, Manchester, Manchester, UK
| | - Rafael Dal-Ré
- Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autonoma de Madrid, Madrid, Spain
| |
Collapse
|
4
|
Bhattarai S, Adhikari A, Rayamajhee B, Dhungana J, Singh M, Koirala S, Shakya DR. Participatory Approach to Develop Evidence-Based Clinical Ethics Guidelines for the Care of COVID-19 Patients: A Mixed Method Study From Nepal. Front Public Health 2022; 10:873881. [PMID: 35832276 PMCID: PMC9272001 DOI: 10.3389/fpubh.2022.873881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
During health emergencies such as the COVID-19 pandemic, healthcare workers face numerous ethical challenges while catering to the needs of patients in healthcare settings. Although the data recapitulating high-income countries ethics frameworks are available, the challenges faced by clinicians in resource-limited settings of low- and middle-income countries are not discussed widely due to a lack of baseline data or evidence. The Nepali healthcare system, which is chronically understaffed and underequipped, was severely affected by the COVID-19 pandemic in its capacity to manage health services and resources for needy patients, leading to ethical dilemmas and challenges during clinical practice. This study aimed to develop a standard guideline that would address syndemic ethical dilemmas during clinical care of COVID-19 patients who are unable to afford standard-of-care. A mixed method study was conducted between February and June of 2021 in 12 government designated COVID-19 treatment hospitals in central Nepal. The draft guideline was discussed among the key stakeholders in the pandemic response in Nepal. The major ethical dilemmas confronted by the study participants (50 healthcare professionals providing patient care at COVID-19 treatment hospitals) could be grouped into five major pillars of ethical clinical practice: rational allocation of medical resources, updated treatment protocols that guide clinical decisions, standard-of-care regardless of patient's economic status, effective communication among stakeholders for prompt patient care, and external factors such as political and bureaucratic interference affecting ethical practice. This living clinical ethics guideline, which has been developed based on the local evidence and case stories of frontline responders, is expected to inform the policymakers as well as the decision-makers positioned at the concerned government units. These ethics guidelines could be endorsed with revisions by the concerned regulatory authorities for the use during consequent waves of COVID-19 and other epidemics that may occur in the future. Other countries affected by the pandemic could conduct similar studies to explore ethical practices in the local clinical and public health context.
Collapse
Affiliation(s)
- Suraj Bhattarai
- Department of Global Health, Global Institute for Interdisciplinary Studies (GIIS), Kathmandu, Nepal
| | - Anurag Adhikari
- Department of Infection and Immunology, Kathmandu Research Institute for Biological Sciences (KRIBS), Lalitpur, Nepal
| | - Binod Rayamajhee
- Department of Infection and Immunology, Kathmandu Research Institute for Biological Sciences (KRIBS), Lalitpur, Nepal
- School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW, Sydney, NSW, Australia
| | - Jaya Dhungana
- Department of Global Health, Global Institute for Interdisciplinary Studies (GIIS), Kathmandu, Nepal
| | - Minu Singh
- Department of Infection and Immunology, Kathmandu Research Institute for Biological Sciences (KRIBS), Lalitpur, Nepal
| | - Sarun Koirala
- Department of Anatomy, B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
- Nepali Unit of International Chair in Bioethics, Dharan, Nepal
| | - Dhana Ratna Shakya
- Nepali Unit of International Chair in Bioethics, Dharan, Nepal
- Department of Psychiatry, B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| |
Collapse
|
5
|
Rohrig A, Eyal N. A new day for human challenge trials? Trends Mol Med 2022; 28:531-532. [PMID: 35610124 PMCID: PMC9124157 DOI: 10.1016/j.molmed.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/03/2022] [Indexed: 11/30/2022]
Abstract
Two years into the coronavirus disease 2019 (COVID-19) pandemic and following several hot debates, the world’s first COVID-19 human challenge trial has recently been published by Killingley et al. We review its findings and explain why this particular juncture in time makes additional challenge trials for COVID-19 and for other diseases justified and important.
Collapse
Affiliation(s)
| | - Nir Eyal
- Center for Population-Level Bioethics, Rutgers University, New Brunswick, NJ, USA.
| |
Collapse
|
6
|
Tuczyńska M, Matthews-Kozanecka M, Baum E. Accessibility to Non-COVID Health Services in the World During the COVID-19 Pandemic: Review. Front Public Health 2022; 9:760795. [PMID: 34976922 PMCID: PMC8716399 DOI: 10.3389/fpubh.2021.760795] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/10/2021] [Indexed: 01/05/2023] Open
Abstract
Background: COVID-19 pandemic caused by SARS-CoV2 has seriously impacted the global economy. Medical facilities around the world were not prepared for the enormous challenges posed by the growing number of patients each day, the shortage of personal protective equipment, and insufficient numbers of medical staff. Governments have tried to counteract the impact of the pandemic, but the measures taken have not always been sufficient to maintain access to and quality of health services at the same level as before the pandemic. The disruption of health services has resulted in more and more research reports from different parts of the world on the accessibility of health services during the COVID-19 pandemic. Methodology: This review article presents 21 selected scientific studies on access to health services in different regions of the world. Articles were found in PubMed, GoogleScholar, Medline, and ScienceDirect databases, then grouped, and significant data were extracted from each article. The results were summarized in a table. Results: The range of limited health services included a variety of specialties, including primary care, psychiatry, orthopedics, cardiology, neurosurgery, and more. Methods used in the studies were based on retrospective analysis or on the subjective assessment of patients in the form of a questionnaire or interview. Most authors claimed a decrease in accessibility to health services during the COVID-19 pandemic compared to the pre-pandemic period, including a decrease in planned surgeries, doctor appointments, patient admission to hospital or ER, and access to medicines. Additionally, some authors observed an increase in the mortality rate. One of the few medical services that have expanded rapidly during the pandemic was online appointments. Conclusions: The COVID-19 pandemic has most certainly affected the accessibility of health services worldwide. Lessons should be learned to prevent inaccessibility to medical services, especially as experts predict another wave of COVID-19 cases.
Collapse
Affiliation(s)
- Magdalena Tuczyńska
- Student Scientific Circle of Maxillofacial Orthopaedics and Orthodontics, Poznan University of Medical Sciences, Poznań, Poland
| | - Maja Matthews-Kozanecka
- Department of Social Sciences and the Humanities, Poznan University of Medical Sciences, Poznań, Poland
| | - Ewa Baum
- Department of Social Sciences and the Humanities, Poznan University of Medical Sciences, Poznań, Poland
| |
Collapse
|
7
|
Affiliation(s)
- Daniel P Sulmasy
- The Kennedy Institute of Ethics, Departments of Medicine and Philosophy, Georgetown University, Washington, DC
| |
Collapse
|
8
|
Faust A, Sierawska A, Krüger K, Wisgalla A, Hasford J, Strech D. Challenges and proposed solutions in making clinical research on COVID-19 ethical: a status quo analysis across German research ethics committees. BMC Med Ethics 2021; 22:96. [PMID: 34281535 PMCID: PMC8287116 DOI: 10.1186/s12910-021-00666-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 07/14/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND In the course of the COVID-19 pandemic, the biomedical research community's attempt to focus the attention on fighting COVID-19, led to several challenges within the field of research ethics. However, we know little about the practical relevance of these challenges for Research Ethics Committees (RECs). METHODS We conducted a qualitative survey across all 52 German RECs on the challenges and potential solutions with reviewing proposals for COVID-19 studies. We de-identified the answers and applied thematic text analysis for the extraction and synthesis of challenges and potential solutions that we grouped under established principles for clinical research ethics. RESULTS We received an overall response rate of 42%. The 22 responding RECs reported that they had assessed a total of 441 study proposals on COVID-19 until 21 April 2020. For the review of these proposals the RECs indicated a broad spectrum of challenges regarding (1) social value (e.g. lack of coordination), (2) scientific validity (e.g. provisional study planning), (3) favourable risk-benefit ratio (e.g. difficult benefit assessment), (4) informed consent (e.g. strict isolation measures), (5) independent review (e.g. lack of time), (6) fair selection of trial participants (e.g. inclusion of vulnerable groups), and (7) respect for study participants (e.g. data security). Mentioned solutions ranged from improved local/national coordination, over guidance on modified consent procedures, to priority setting across clinical studies. CONCLUSIONS RECs are facing a broad spectrum of pressing challenges in reviewing COVID-19 studies. Some challenges for consent procedures are well known from research in intensive care settings but are further aggravated by infection measures. Other challenges such as reviewing several clinical studies at the same time that potentially compete for the recruitment of in-house COVID-19 patients are unique to the current situation. For some of the challenges the proposed solutions in our survey could relatively easy be translated into practice. Others need further conceptual and empirical research. Our findings together with the increasing body of literature on COVID-19 research ethics, and further stakeholder engagement should inform the development of hands-on guidance for researchers, funders, RECs, and further oversight bodies.
Collapse
Affiliation(s)
- Alice Faust
- QUEST Center, Berlin Institute of Health (BIH), Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Sierawska
- QUEST Center, Berlin Institute of Health (BIH), Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Krüger
- Association of Medical Ethics Committees in Germany (AKEK, Arbeitskreis Der Medizinischen Ethik-Kommissionen in der Bundesrepublik Deutschland E.V.), Berlin, Germany
| | - Anne Wisgalla
- Association of Medical Ethics Committees in Germany (AKEK, Arbeitskreis Der Medizinischen Ethik-Kommissionen in der Bundesrepublik Deutschland E.V.), Berlin, Germany
| | - Joerg Hasford
- Association of Medical Ethics Committees in Germany (AKEK, Arbeitskreis Der Medizinischen Ethik-Kommissionen in der Bundesrepublik Deutschland E.V.), Berlin, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, LMU München, Munich, Germany
| | - Daniel Strech
- QUEST Center, Berlin Institute of Health (BIH), Berlin, Germany.
- Charité - Universitätsmedizin Berlin, Berlin, Germany.
| |
Collapse
|
9
|
Gordijn B, Ten Have H. COVID-19 and the ethics of human challenge trials. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:1-2. [PMID: 33454919 PMCID: PMC7811681 DOI: 10.1007/s11019-021-10001-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
|