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TAJUDEEN RAJI, SILAIGWANA BLESSING, YAVLINSKY ALEXEI, EDWARDS SARAHJL. Research ethics during infectious disease outbreaks: A survey of African research stakeholders using the Ebola virus disease outbreak as a case. J Public Health Afr 2023; 14:1632. [PMID: 37881726 PMCID: PMC10594595 DOI: 10.4081/jphia.2023.1632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
Conducting research during disease outbreaks can be ethically challenging as evidenced in the 2014-2016 Ebola outbreak in West Africa and COVID-19 pandemic. Yet, there has been little empirical research conducted for understanding the views and perspectives of different stakeholders regarding ethical issues in conducting research during disease outbreaks. This preliminary study was conducted to empirically explore African public health research stakeholders' views about research ethics issues during infectious disease outbreaks in Africa. We conducted an online survey of 330 participants attending the International Conference on Re-emerging and Emerging Infectious Disease (ICREID) meeting that took place from 13-15 March 2019 in Addis Ababa, Ethiopia to elicit their views on various research ethics complexities experienced in the 2014 Ebola outbreak. Study results revealed some divergent views on several ethical themes including: ethics of using unregistered interventions in outbreaks; acceptable study design; ethics review processes; risks-benefit assessment; exclusion of pregnant women and children; and biological sample and data sharing. Majority (76.3%) of respondents felt that in the absence of available standard treatments or prevention modalities, the use of investigational interventions can be ethically justifiable if there is a strong scientific rationale and favorable risk-benefit ratio. Regarding conventional placebo-controlled trials during outbreaks with high case fatality rates, respondents that considered this unethical were more than three times those that felt such design were ethically justifiable. We were somewhat surprised that a majority (almost 60%) of respondents were satisfied with the exclusion of pregnant women and children in clinical trials during outbreaks. All respondents concurred with the prioritization of informed consent for research during an outbreak. Based on our findings, research ethics guidance is needed to equip research stakeholders in dealing with ethical complexities arising in the conduct of research during emerging disease outbreaks-especially regarding using experimental interventions; placebo trial design; inclusion or justified exclusion of pregnant women and children; and biological sample/data sharing. The findings will be used in ongoing efforts of developing a consultative and coherent African-centric framework to support ethical conduct of research for future emerging infectious disease outbreaks in Africa.
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Affiliation(s)
- RAJI TAJUDEEN
- African Union, Africa CDC, Division of Public Health Institutes and Research, Addis Ababa, Ethiopia
| | - BLESSING SILAIGWANA
- NIHR Group Tackling Infections to Benefit Africa (TIBA), University of Edinburgh
| | - ALEXEI YAVLINSKY
- University College London, Institute of Health Informatics, London, London NW1 2DA
| | - SARAH JL. EDWARDS
- University College London, Science & Technology Studies, Bloomsbury, London WC1H 0AW, UK
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Canario Guzmán JA, Orlich J, Mendizábal-Cabrera R, Ying A, Vergès C, Espinoza E, Soriano M, Cárcamo E, Beltrán B, Mendoza Marrero ER, Sepulveda R, Nieto Anderson C, Feune de Colombi N, Lescano R, Pérez-Then E, Lang T, Alger J. Strengthening research ethics governance and regulatory oversight in Central America and the Dominican Republic in response to the COVID-19 pandemic: a qualitative study. Health Res Policy Syst 2022; 20:138. [PMID: 36564837 PMCID: PMC9786418 DOI: 10.1186/s12961-022-00933-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Good governance and regulatory supervision are required to conduct research in an international public health emergency context and to ensure compliance with ethical standards. The "Strengthening research ethics governance and regulatory oversight in Central America and the Dominican Republic in response to the COVID-19 pandemic" study is a regional effort in which research ethics stakeholders participated in addressing research ethics governance and preparedness response challenges to the COVID-19 pandemic in Central America and the Dominican Republic. METHODS A qualitative action research study was conducted following a participatory approach. Research ethics stakeholders in Central America and the Dominican Republic were mapped; a regional webinar and three virtual workshops were conducted discussing research ethics governance, ethics review and collaborative research practice during the pandemic. A roundtable session presented results and obtained feedback on a draft of a policy to strengthen regional research ethics governance. RESULTS Countries across Central America and the Dominican Republic are at different stages in their development of research ethics systems. Countries with more established systems before COVID-19 were better organized and prepared to respond. This finding argues against improvisation and supports further work on strengthening governance of research ethics systems. Community engagement in research ethics public policy-making is practically absent in the region. Research and research ethics collaboration schemes are lacking amongst the countries; however, there are incipient initiatives in the region, such as the Central America and Caribbean Network of Research Ethics Committees. A policy brief with recommendations on how to advance towards strengthening the governance of research ethics systems was prepared and submitted to the Central American Integration System for analysis and possible approval. CONCLUSION National research ethics systems in Central America and the Dominican Republic were unprepared to respond to the COVID-19 pandemic with respect to research oversight and effective collaboration. In most cases, national research ethics systems were found to be weak, and regional research collaboration was practically absent. To promote collaboration, a joint strategy needs to be developed with a regional vision towards sharing knowledge and best practices.
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Affiliation(s)
- Julio Arturo Canario Guzmán
- Fundación Etikos, Inc., Santo Domingo, Dominican Republic
- Centro Nacional de Investigaciones en Salud Materno Infantil Dr. Hugo Mendoza (CENISMI), Santo Domingo, Dominican Republic
| | - Jessie Orlich
- Instituto Costarricense de Investigaciones Clínicas, San Jose, Costa Rica
| | | | | | | | - Eleonora Espinoza
- Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, Honduras
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Mario Soriano
- Comisión Nacional Ética de Investigación en Salud, San Salvador, El Salvador
| | - Elsy Cárcamo
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Briana Beltrán
- Centro Nacional de Educación Médica Continua (CENEMEC), Colegio Médico de Honduras, Tegucigalpa, Honduras
| | | | | | - Claudia Nieto Anderson
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | | | - Roxana Lescano
- Asociación para el Empleo de Animales en Investigación y Docencia, ASOPEBAID, Lima, Peru
| | | | - Trudie Lang
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jackeline Alger
- Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, Honduras
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
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Maketa V, Luzolo F, Muhindo Mavoko H, Claeys Y, Munday F, Yemesi Benge R, Bongo Pasi W, Mankindu D, Mampunza S, Lukanu P, Kasongo M, Ntabe Namegabe E, Kambale Karafuli L, Phanzu Mavinga D, Milandu Massamba E, Muaka Khoso C, Ravinetto R. Boosting ethics review capacity in public health emergency situations: Co-creation of a training model for French-speaking research ethics committees. Trop Med Int Health 2022; 27:934-940. [PMID: 36053926 PMCID: PMC9826200 DOI: 10.1111/tmi.13815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Ethics review preparedness is a major foundation for national effective response to public health emergencies, because it promotes pertinent research and enhances the protection of research participants and communities. In low-income countries, it can also promote equitable research partnership. However, most relevant literature is in English and not easily accessible for the members of research ethics committees in French-speaking African countries. METHODS A training module in French, addressing the issue of research ethics review during outbreaks and other public health emergencies, was designed based on a non-systematic literature review, and in order to be complementary to the Democratic Republic of Congo (DRC) national guidelines for ethics review. The module was administered to 42 members of the five ethics committees in DRC that expressed their interest for the training. RESULT This training, co-designed with local stakeholders, in the local working language and taking into account local circumstances and regulation, provided participants with up-to-date insights of research ethics (and research ethics preparedness) in public health emergencies. It resulted in rich reflection and knowledge-sharing on good practices across the ethics committees. CONCLUSION As most participating ethics committees do not have yet explicit standard operating procedures for expedited review of protocols submitted in emergency situations, this would be a next important step to facilitate emergency reviews in the most efficient way.
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Affiliation(s)
- Vivi Maketa
- University of KinshasaKinshasaDemocratic Republic of Congo
| | - Flory Luzolo
- University of KinshasaKinshasaDemocratic Republic of Congo
| | | | - Yves Claeys
- Institute of Tropical MedicineAntwerpBelgium
| | - Felicien Munday
- Comité National d'Ethique de la SantéKinshasaDemocratic Republic of Congo
| | | | - Willy Bongo Pasi
- Comité d'Ethique de l'Ecole de Santé Publique de KinshasaKinshasaDemocratic Republic of Congo
| | - Darius Mankindu
- Comité d'Ethique de l'Ecole de Santé Publique de KinshasaKinshasaDemocratic Republic of Congo
| | - Samuel Mampunza
- Comité d'Ethique de l'Université Protestante au CongoKinshasaDemocratic Republic of Congo
| | - Philippe Lukanu
- Comité d'Ethique de l'Université Protestante au CongoKinshasaDemocratic Republic of Congo
| | - Muteho Kasongo
- Comité d'Ethique de l'Université Libre des Pays des Grands LacsGomaDemocratic Republic of Congo
| | - Edmond Ntabe Namegabe
- Comité d'Ethique de l'Université Libre des Pays des Grands LacsGomaDemocratic Republic of Congo
| | | | - Delphin Phanzu Mavinga
- Comité d'Ethique du Centre de Recherche en Santé de KimpeseKimpeseDemocratic Republic of Congo
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Singh S, Cadigan RJ, Moodley K. Challenges to biobanking in LMICs during COVID-19: time to reconceptualise research ethics guidance for pandemics and public health emergencies? JOURNAL OF MEDICAL ETHICS 2022; 48:466-471. [PMID: 33980656 PMCID: PMC8117471 DOI: 10.1136/medethics-2020-106858] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 03/20/2021] [Accepted: 04/20/2021] [Indexed: 06/12/2023]
Abstract
Biobanking can promote valuable health research that may lead to significant societal benefits. However, collecting, storing and sharing human samples and data for research purposes present numerous ethical challenges. These challenges are exacerbated when the biobanking efforts aim to facilitate research on public health emergencies and include the sharing of samples and data between low/middle-income countries (LMICs) and high-income countries (HICs). In this article, we explore ethical challenges for COVID-19 biobanking, offering examples from two past infectious disease outbreaks in LMICs where biobanking activities contributed to the perpetuation of global inequities. We focus on how the ethical imperative to promote the common good during public health emergencies can conflict with protecting the interests of biobank participants. We discuss how conducting biobank research under a waiver of informed consent during public health emergencies is ethically permissible, provided guidance is in place to prevent biopiracy and exploitation of vulnerable communities. We also highlight the need for biobank collaborations between LMICs and HICs to promote capacity building and benefit sharing. Finally, we offer guidance to promote the ethical oversight of biobanks and biobank research during the COVID-19 pandemic or other future public health emergencies.
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Affiliation(s)
- Shenuka Singh
- Faculty of Medicine and Health Sciences, Centre for Medical Ethics and Law, Stellenbosch University, Cape Town, South Africa
| | - Rosemary Jean Cadigan
- Social Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Keymanthri Moodley
- Faculty of Medicine and Health Sciences, Centre for Medical Ethics and Law, University of Stellenbosch, Stellenbosch, Western Cape, South Africa
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Hinga A, Jeena L, Awuor E, Kahindi J, Munene M, Kinyanjui S, Molyneux S, Marsh V, Kamuya D. Pandemic preparedness and responsiveness of research review committees: lessons from review of COVID-19 protocols at KEMRI Wellcome Trust Research Programme in Kenya. Wellcome Open Res 2022; 7:75. [PMID: 35855072 PMCID: PMC9257264 DOI: 10.12688/wellcomeopenres.17533.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 12/04/2022] Open
Abstract
Background: The scale of the COVID-19 pandemic and novelty of SARS-CoV-2 presented unprecedented challenges in the review of COVID-19 protocols. We investigated how research at the KEMRI Wellcome Trust Research Programme (KWTRP) was reviewed, including by institutional and national level committees. Methods: A document review and in-depth interviews with researchers, regulators and research reviewers were conducted. Documents reviewed included research logs of all protocols submitted between April-1-2020 and March-31-2021, feedback letters from review committees for 10 new COVID-19 protocols (n=42), and minutes from 35 COVID-19 research review meetings. Fifteen in-depth interviews were conducted with respondents purposively selected because of their experience of developing or reviewing COVID-19 protocols at the institution level (n=9 researchers, engagement officers and regulators) or their experience in reviewing proposals at a national-level (n=6 committee members). Data were managed and analyzed using MS Excel and NVivo12. Results: Between April-1-2020 and March-31-2021, 30 COVID-19-related submissions by KWTRP researchers were approved. Changes to the review system included strengthening the online system for protocol submission and review, recruiting more reviewers, and trialing a joint review process where one protocol was submitted to multiple review committees simultaneously . The turnaround time from submission to national approval/rejection over this period was faster than pre-pandemic, but slower than the national committee’s target. COVID-19-specific ethics questions centred on: virtual informed consent and data collection; COVID-19 prevention, screening and testing procedures; and the challenges of study design and community engagement during the pandemic. Conclusions: The unprecedented challenges of the pandemic and added bureaucratic requirements created a more complex review process and delayed final approval of research protocols. The feasibility of conducting joint review of research during public health emergencies in Kenya needs further investigation. Consideration of the unique COVID-19 ethics issues raised in this paper might aid expedience in current and future reviews.
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Affiliation(s)
- Alex Hinga
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
| | - Lisha Jeena
- Centre for Tropical Medicine, Nuffield Department of Medicine, Oxford University, Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Esther Awuor
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
| | - Jane Kahindi
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
| | - Marianne Munene
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
| | - Samson Kinyanjui
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
- Centre for Tropical Medicine, Nuffield Department of Medicine, Oxford University, Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
- Strathmore Business School, Strathmore University, Nairobi, Ole Sangare Road, P.O. Box 59857 – 00200, Kenya
| | - Sassy Molyneux
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
- Centre for Tropical Medicine, Nuffield Department of Medicine, Oxford University, Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Vicki Marsh
- Centre for Tropical Medicine, Nuffield Department of Medicine, Oxford University, Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Dorcas Kamuya
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
- Centre for Tropical Medicine, Nuffield Department of Medicine, Oxford University, Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
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Hinga A, Jeena L, Awuor E, Kahindi J, Munene M, Kinyanjui S, Molyneux S, Marsh V, Kamuya D. Pandemic preparedness and responsiveness of research review committees: lessons from review of COVID-19 protocols at KEMRI Wellcome Trust Research Programme in Kenya. Wellcome Open Res 2022; 7:75. [PMID: 35855072 PMCID: PMC9257264 DOI: 10.12688/wellcomeopenres.17533.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 08/31/2023] Open
Abstract
Background: The scale of the COVID-19 pandemic and novelty of SARS-CoV-2 presented unprecedented challenges in the review of COVID-19 protocols. We investigated how research at the KEMRI Wellcome Trust Research Programme (KWTRP) was reviewed, including by institutional and national level committees. Methods: A document review and in-depth interviews with researchers, regulators and research reviewers were conducted. Documents reviewed included research logs of all protocols submitted between April-1-2020 and March-31-2021, feedback letters from review committees for 10 new COVID-19 protocols (n=42), and minutes from 35 COVID-19 research review meetings. Fifteen in-depth interviews were conducted with respondents purposively selected because of their experience of developing or reviewing COVID-19 protocols at the institution level (n=9 researchers, engagement officers and regulators) or their experience in reviewing proposals at a national-level (n=6 committee members). Data were managed and analyzed using MS Excel and NVivo12. Results: Between April-1-2020 and March-31-2021, 30 COVID-19-related submissions by KWTRP researchers were approved. Changes to the review system included strengthening the online system for protocol submission and review, recruiting more reviewers, and trialing a joint review process where one protocol was submitted to multiple review committees simultaneously . The turnaround time from submission to national approval/rejection over this period was faster than pre-pandemic, but slower than the national committee's target. COVID-19-specific ethics questions centred on: virtual informed consent and data collection; COVID-19 prevention, screening and testing procedures; and the challenges of study design and community engagement during the pandemic. Conclusions: The unprecedented challenges of the pandemic and added bureaucratic requirements created a more complex review process and delayed final approval of research protocols. The feasibility of conducting joint review of research during public health emergencies in Kenya needs further investigation. Consideration of the unique COVID-19 ethics issues raised in this paper might aid expedience in current and future reviews.
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Affiliation(s)
- Alex Hinga
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
| | - Lisha Jeena
- Centre for Tropical Medicine, Nuffield Department of Medicine, Oxford University, Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Esther Awuor
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
| | - Jane Kahindi
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
| | - Marianne Munene
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
| | - Samson Kinyanjui
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
- Centre for Tropical Medicine, Nuffield Department of Medicine, Oxford University, Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
- Strathmore Business School, Strathmore University, Nairobi, Ole Sangare Road, P.O. Box 59857 – 00200, Kenya
| | - Sassy Molyneux
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
- Centre for Tropical Medicine, Nuffield Department of Medicine, Oxford University, Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Vicki Marsh
- Centre for Tropical Medicine, Nuffield Department of Medicine, Oxford University, Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Dorcas Kamuya
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
- Centre for Tropical Medicine, Nuffield Department of Medicine, Oxford University, Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
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Palmero A, Carracedo S, Cabrera N, Bianchini A. Governance frameworks for COVID-19 research ethics review and oversight in Latin America: an exploratory study. BMC Med Ethics 2021; 22:147. [PMID: 34742278 PMCID: PMC8571668 DOI: 10.1186/s12910-021-00715-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/20/2021] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Research has been an essential part of the COVID-19 pandemic response, including in Latin American (LA) countries. However, implementing research in emergency settings poses the challenge of producing valuable knowledge rapidly while upholding research ethical standards. Research ethics committees (RECs) therefore must conduct timely and rigorous ethics reviews and oversight of COVID-19 research. In the LA region, there is limited knowledge on how countries have responded to this need. To address this gap, the objective of our project is to explore if LA countries developed policies to streamline ethics review and oversight of research in response to the pandemic while ensuring its adherence to ethical standards, and to analyze to what extent these governance frameworks are in accordance with international guidance. METHODS We conducted a descriptive and exploratory study assessing the COVID-19 research ethics governance frameworks of 19 LA countries, considering 4 dimensions based on international COVID-19 ethics guidance documents: (i) ethics review organizational model adopted, (ii) measures to coordinate between RECs and other research stakeholders, (iii) operational guidance for RECs, and (iv) key ethical issues for review and oversight of COVID-19 research. RESULTS 10 out of 19 LA countries have some policy to streamline ethics review of COVID-19 research. Of these countries only 6 issued comprehensive documents following international guidance that contemplate strategies with recommendations for concrete actions for a timely and rigorous review. CONCLUSION LA countries adopted partial strategies and operational guidance that may demonstrate a lack of a comprehensive view of research ethics for the review and oversight of COVID-19 research. Continuing efforts should be directed to strengthen LA countries' research capacity to respond timely and ethically to future health emergencies. Past lessons and the ones from this pandemic should be the basis to develop international standards and operational guidelines for ethics review and oversight of any research for public health emergencies.
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Affiliation(s)
- Ana Palmero
- Directorate of Research for Health, Ministry of Health, 1925 9 de Julio Av, 1091, Buenos Aires, Argentina.
| | | | - Noelia Cabrera
- Center for the Study of State and Society, Buenos Aires, Argentina
| | - Alahí Bianchini
- School of Law, University of Buenos Aires, Buenos Aires, Argentina
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Fenton E, Chillag K. Conditions of Global Health Crisis Decision-Making-An Ethical Analysis. JOURNAL OF BIOETHICAL INQUIRY 2021; 18:395-402. [PMID: 33860895 PMCID: PMC8050628 DOI: 10.1007/s11673-021-10100-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 03/10/2021] [Indexed: 06/12/2023]
Abstract
The circumstances of a public health emergency (PHE) shape reasoning and decision-making in ways that deviate from routine circumstances, where adherence to established values, principles, and methodologies is expected. Understanding what drives these deviations is critical to assessing their ethical consequences. In this paper we describe four conditions that influence decision-making during PHEs, in particular regarding the deployment and conduct of research on experimental or novel biomedical interventions. These four conditions are politicization, urgency, uncertainty, and fear. We argue that taken together these four conditions create pressure to address the most visible targets of immediate crisis events, driving emphasis on research and development of biomedical interventions. However, this emphasis raises ethical concerns regarding the extent to which attention to and investment in the underlying causes of PHEs, particularly impoverished global public health infrastructure, is diminished as a result.
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Affiliation(s)
- Elizabeth Fenton
- Bioethics Centre, University of Otago, 71 Frederick Street, Dunedin, New Zealand.
| | - Kata Chillag
- Department of Public Health, Davidson College, Davidson, NC, USA
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Ethical review of COVID-19 research in the Netherlands; a mixed-method evaluation among medical research ethics committees and investigators. PLoS One 2021; 16:e0255040. [PMID: 34297752 PMCID: PMC8301608 DOI: 10.1371/journal.pone.0255040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/09/2021] [Indexed: 11/19/2022] Open
Abstract
Background During the beginning of the COVID-19 pandemic there was an urgent need for accelerated review of COVID-19 research by Medical Research Ethics Committees (MRECs). In the Netherlands this led to the implementation of so-called ‘fast-track-review-procedures’ (FTRPs) to enable a swift start of urgent and relevant research. The objective of this study is to evaluate FTRPs of MRECs in the Netherlands during the COVID-19 pandemic and to compare them with the regular review procedures (RRPs). Methods and findings An explanatory sequential mixed method study was conducted. Online questionnaires and four group interviews were conducted among MREC representatives and investigators of COVID-19 research. In addition, data from a national research registration system was requested. Main outcome measures are differences in timelines, quality of the review and satisfaction between FTRPs and RRPs. The total number of review days was shorter in FTRP (median 10.5) compared to RRPs (median 98.0). Review days attributable to the MRECs also declined in FTRPs (median 8.0 versus 50.0). This shortening can be explained by installing ad hoc (sub)committees, full priority given to COVID-19 research, regular research put on hold, online review meetings and administrative leniency. The shorter timelines did not affect the perceived quality of the review and ethical and legal aspects were not weighted differently. Both MREC representatives and investigators were generally satisfied with the review of COVID-19 research. Weaknesses identified were the lack of overview of COVID-19 research and central collaboration and coordination, the delay of review of regular research, and limited reachability of secretariats. Conclusions This study shows that accelerated review is feasible during emergency situations. We did not find evidence that review quality was compromised and both investigators and MRECs were content with the FTRP. To improve future medical ethical review during pandemic situations and beyond, distinguishing main and side issues, working digitally, and (inter)national collaboration and coordination are important.
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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.
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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.
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11
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Hashemi A, Bahmani F, Saeedi Tehrani S, Forouzandeh M, Koohpayehzadeh J, Ashrafi M, Khalajzadeh MR, Motevalian SA. Ethical considerations and interdisciplinary approach to research on COVID-19 pandemic: The response of Iran University of Medical Sciences. Med J Islam Repub Iran 2020; 34:87. [PMID: 33306052 PMCID: PMC7711043 DOI: 10.34171/mjiri.34.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Indexed: 11/05/2022] Open
Abstract
Background: Research ethics committees are comprised of policymakers, supervisors, and decision-makers and aim at increasing adherence to professional ethics standards in conducting health-related research. The existential philosophy of these committees is to preserve the patients’ health, maintain and promote public trust in health care providers, protect the rights of both patients and health care providers, and promote organizational ethics. However, this task can be complex and challenging during a public health emergency. Research ethics committees set the standard of research in the emergency situations through defining which research has the potential to promote the quality of response to a public health emergency.
Methods: This study aims at collecting and classifying the valuable experiences of the research ethics committee members and reviewers during the early days of the COVID-19 epidemic in Iran University of Medical Sciences, one of the major universities in Tehran. It provides a basic understanding of the key concepts and challenges in reviewing and approving research by research ethics committees and the recommendations to overcome these challenging issues.
Results: To accelerate the review process of COVID-19 research proposals, the scientific, methodological and ethical review panel was integrated as a large committee called ‘IUMS Corona Research Team’. The first meeting was held on March 7, two weeks after the official announcement of the first case of the disease and is continued once a week. A total of 130 projects have been discussed and evaluated in this committee, among which 83 proposals were approved after modification.
Conclusion: An interdisciplinary approach supports a flexible and effective scientific and ethical review of research leading to more protection of research subjects as well as promotion in the treatment and management of the pandemic ahead.
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Affiliation(s)
- Akram Hashemi
- Department of Medical Ethics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Bahmani
- Department of Medical Ethics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saeedeh Saeedi Tehrani
- Department of Medical Ethics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mina Forouzandeh
- Department of Medical Ethics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Jalil Koohpayehzadeh
- Community Medicine Department, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mortaza Ashrafi
- Department of Medical Ethics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Reza Khalajzadeh
- Department of Medical Ethics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Abbas Motevalian
- Research Center for Addiction and Risky Behaviors (ReCARB), Psychosocial Health Research Institute (PHRI), Iran University of Medical Sciences, Tehran, Iran
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12
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Zeidan AM, Boddu PC, Patnaik MM, Bewersdorf JP, Stahl M, Rampal RK, Shallis R, Steensma DP, Savona MR, Sekeres MA, Roboz GJ, DeAngelo DJ, Schuh AC, Padron E, Zeidner JF, Walter RB, Onida F, Fathi A, DeZern A, Hobbs G, Stein EM, Vyas P, Wei AH, Bowen DT, Montesinos P, Griffiths EA, Verma AK, Keyzner A, Bar-Natan M, Navada SC, Kremyanskaya M, Goldberg AD, Al-Kali A, Heaney ML, Nazha A, Salman H, Luger S, Pratz KW, Konig H, Komrokji R, Deininger M, Cirici BX, Bhatt VR, Silverman LR, Erba HP, Fenaux P, Platzbecker U, Santini V, Wang ES, Tallman MS, Stone RM, Mascarenhas J. Special considerations in the management of adult patients with acute leukaemias and myeloid neoplasms in the COVID-19 era: recommendations from a panel of international experts. Lancet Haematol 2020; 7:e601-e612. [PMID: 32563283 PMCID: PMC7302757 DOI: 10.1016/s2352-3026(20)30205-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 01/28/2023]
Abstract
The ongoing COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 is a global public health crisis. Multiple observations indicate poorer post-infection outcomes for patients with cancer than for the general population. Herein, we highlight the challenges in caring for patients with acute leukaemias and myeloid neoplasms amid the COVID-19 pandemic. We summarise key changes related to service allocation, clinical and supportive care, clinical trial participation, and ethical considerations regarding the use of lifesaving measures for these patients. We recognise that these recommendations might be more applicable to high-income countries and might not be generalisable because of regional differences in health-care infrastructure, individual circumstances, and a complex and highly fluid health-care environment. Despite these limitations, we aim to provide a general framework for the care of patients with acute leukaemias and myeloid neoplasms during the COVID-19 pandemic on the basis of recommendations from international experts.
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Affiliation(s)
- Amer M Zeidan
- Section of Hematology, Yale School of Medicine, Yale University, New Haven, CT, USA; Yale Comprehensive Cancer Center, Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Prajwal C Boddu
- Section of Hematology, Yale School of Medicine, Yale University, New Haven, CT, USA; Yale Comprehensive Cancer Center, Yale School of Medicine, Yale University, New Haven, CT, USA
| | | | - Jan Philipp Bewersdorf
- Section of Hematology, Yale School of Medicine, Yale University, New Haven, CT, USA; Yale Comprehensive Cancer Center, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Maximilian Stahl
- Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raajit K Rampal
- Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rory Shallis
- Section of Hematology, Yale School of Medicine, Yale University, New Haven, CT, USA; Yale Comprehensive Cancer Center, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - David P Steensma
- Department of Hematology, Division of Leukemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Michael R Savona
- Department of Hematology, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Mikkael A Sekeres
- Leukemia Program, Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Gail J Roboz
- Department of Hematology and Oncology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Daniel J DeAngelo
- Department of Hematology, Division of Leukemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Andre C Schuh
- Division of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada
| | - Eric Padron
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - Joshua F Zeidner
- Division of Hematology and Oncology, Lineberger Comprehensive Care Center, University of North Carolina, Chapel Hill, NC, USA
| | - Roland B Walter
- Division of Hematology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Francesco Onida
- Department of Hematology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Amir Fathi
- Department of Hematology, Centre for Leukemia, Massachusetts General Hospital, Boston, MA, USA
| | - Amy DeZern
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Gabriela Hobbs
- Department of Hematology, Centre for Leukemia, Massachusetts General Hospital, Boston, MA, USA
| | - Eytan M Stein
- Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paresh Vyas
- MRC Molecular Haematology Unit, BRC Oxford Department of Haematology, University of Oxford, Oxford, UK
| | - Andrew H Wei
- Department of Clinical Haematology, Alfred Hospital, Melbourne, VIC, Australia
| | - David T Bowen
- Department of Haematology, Leeds Teaching Hospitals National Health Service Trust, Leeds, UK
| | - Pau Montesinos
- Department of Haematology, Hospital Universitario y Politecnico La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, University of Valencia, Madrid, Spain
| | - Elizabeth A Griffiths
- Leukemia Service, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Amit K Verma
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Alla Keyzner
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michal Bar-Natan
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shyamala C Navada
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marina Kremyanskaya
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aaron D Goldberg
- Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aref Al-Kali
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Mark L Heaney
- Department of Hematology, Herbert Irving Comprehensive Care Centre, Columbia University, New York, NY, USA
| | - Aziz Nazha
- Department of Hematology, Cleveland Clinic-Taussig Cancer Institute, Cleveland, OH, USA
| | - Huda Salman
- Department of Internal Medicine, Stony Brook University Cancer Center, Stony Brook, NY, USA
| | - Selina Luger
- Department of Medicine, Hematology and Oncology Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Keith W Pratz
- Department of Medicine, Hematology and Oncology Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Heiko Konig
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Division of Hematology and Oncology, Indiana University, Indianapolis, IN, USA
| | - Rami Komrokji
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - Michael Deininger
- Huntsman Cancer Institute, Department of Medicine, Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City, UT, USA
| | - Blanca Xicoy Cirici
- Clinical Haematology Department, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vijaya Raj Bhatt
- Fred and Pamela Buffett Cancer Center, Department of Oncology and Hematology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lewis R Silverman
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Harry P Erba
- Duke Cancer Institute, Department of Medicine, Division of Hematologic Malignancies and Cellular Therapies, Durham, NC, USA
| | - Pierre Fenaux
- Department of Hematology, Hôpital St Louis, Assistance Publique-Hôpitaux de Paris, Paris, France; Department of Haematology, Paris University, Paris, France
| | - Uwe Platzbecker
- Department of Medicine, Division of Translational Hematology, Leipzig University Hospital, Leipzig, Germany
| | - Valeria Santini
- Department of Medicine, University of Florence Medical School, Florence, Italy
| | - Eunice S Wang
- Leukemia Service, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Martin S Tallman
- Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard M Stone
- Department of Hematology, Division of Leukemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - John Mascarenhas
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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13
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Sigfrid L, Maskell K, Bannister PG, Ismail SA, Collinson S, Regmi S, Blackmore C, Harriss E, Longuere KS, Gobat N, Horby P, Clarke M, Carson G. Addressing challenges for clinical research responses to emerging epidemics and pandemics: a scoping review. BMC Med 2020; 18:190. [PMID: 32586391 PMCID: PMC7315698 DOI: 10.1186/s12916-020-01624-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/07/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Major infectious disease outbreaks are a constant threat to human health. Clinical research responses to outbreaks generate evidence to improve outcomes and outbreak control. Experiences from previous epidemics have identified multiple challenges to undertaking timely clinical research responses. This scoping review is a systematic appraisal of political, economic, administrative, regulatory, logistical, ethical and social (PEARLES) challenges to clinical research responses to emergency epidemics and solutions identified to address these. METHODS A scoping review. We searched six databases (MEDLINE, Embase, Global Health, PsycINFO, Scopus and Epistemonikos) for articles published from 2008 to July 2018. We included publications reporting PEARLES challenges to clinical research responses to emerging epidemics and pandemics and solutions identified to address these. Two reviewers screened articles for inclusion, extracted and analysed the data. RESULTS Of 2678 articles screened, 76 were included. Most presented data relating to the 2014-2016 Ebola virus outbreak or the H1N1 outbreak in 2009. The articles related to clinical research responses in Africa (n = 37), Europe (n = 8), North America (n = 5), Latin America and the Caribbean (n = 3) and Asia (n = 1) and/or globally (n = 22). A wide range of solutions to PEARLES challenges was presented, including a need to strengthen global collaborations and coordination at all levels and develop pre-approved protocols and equitable frameworks, protocols and standards for emergencies. Clinical trial networks and expedited funding and approvals were some solutions implemented. National ownership and community engagement from the outset were a key enabler for delivery. Despite the wide range of recommended solutions, none had been formally evaluated. CONCLUSIONS To strengthen global preparedness and response to the COVID-19 pandemic and future epidemics, identified solutions for rapid clinical research deployment, delivery, and dissemination must be implemented. Improvements are urgently needed to strengthen collaborations, funding mechanisms, global and national research capacity and capability, targeting regions vulnerable to epidemics and pandemics. Solutions need to be flexible to allow timely adaptations to context, and research led by governments of affected regions. Research communities globally need to evaluate their activities and incorporate lessons learnt to refine and rehearse collaborative outbreak response plans in between epidemics.
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Affiliation(s)
- Louise Sigfrid
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Oxford, OX3 7LG, UK.
| | - Katherine Maskell
- Deparment for Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Peter G Bannister
- Deparment for Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Sharif A Ismail
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Shelui Collinson
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Sadie Regmi
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Claire Blackmore
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Kajsa-Stina Longuere
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Oxford, OX3 7LG, UK
| | - Nina Gobat
- Nuffield Dep of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter Horby
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Oxford, OX3 7LG, UK
| | - Mike Clarke
- Evidence Aid, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Gail Carson
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Oxford, OX3 7LG, UK
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14
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Caplan AL, Upshur R. Panic prescribing has become omnipresent during the COVID-19 pandemic. J Clin Invest 2020; 130:2752-2753. [PMID: 32330122 DOI: 10.1172/jci139562] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Arthur L Caplan
- Division of Medical Ethics, New York University Grossman School of Medicine, New York, New York, USA
| | - Ross Upshur
- Department of Family and Community Medicine and.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, USA.,Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
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15
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Bruno W, Haar RJ. A systematic literature review of the ethics of conducting research in the humanitarian setting. Confl Health 2020; 14:27. [PMID: 32489418 PMCID: PMC7245798 DOI: 10.1186/s13031-020-00282-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 05/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background Research around humanitarian crises, aid delivery, and the impact of these crises on health and well-being has expanded dramatically. Ethical issues around these topics have recently received more attention. We conducted a systematic literature review to synthesize the lessons learned regarding the ethics of research in humanitarian crises. Methods We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines to identify articles regarding the ethics of research in humanitarian contexts between January 1, 1997 and September 1, 2019. We analyzed the articles to extract key themes and develop an agenda for future research. Results We identified 52 articles that matched our inclusion criteria. We categorized the article data into five categories of analysis: 32 were expert statements, 18 were case studies, 11 contained original research, eight were literature reviews and three were book chapters. All included articles were published in English. Using a step-wise qualitative analysis, we identified 10 major themes that encompassed these concepts and points. These major themes were: ethics review process (21 articles, [40.38%]); community engagement (15 articles [28.85%]); the dual imperative, or necessity that research be both academically sound and policy driven, clinical trials in the humanitarian setting (13 articles for each, [25.0%)]; informed consent (10 articles [19.23%]); cultural considerations (6 articles, [11.54%]); risks to researchers (5 articles, [9.62%]); child participation (4 articles [7.69%]); and finally mental health, and data ownership (2 articles for each [3.85%]). Conclusions Interest in the ethics of studying humanitarian crises has been dramatically increasing in recent years. While key concepts within all research settings such as beneficence, justice and respect for persons are crucially relevant, there are considerations unique to the humanitarian context. The particular vulnerabilities of conflict-affected populations, the contextual challenges of working in humanitarian settings, and the need for ensuring strong community engagement at all levels make this area of research particularly challenging. Humanitarian crises are prevalent throughout the globe, and studying them with the utmost ethical forethought is critical to maintaining sound research principles and ethical standards.
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Affiliation(s)
- William Bruno
- Department of Emergency Medicine, University of Southern California, Keck School of Medicine, Los Angeles, USA
| | - Rohini J Haar
- Division of Epidemiology and Biostatistics, School of Public Health, Research Fellow, Human Rights Center, School of Law, University of California at Berkeley, Berkeley, USA
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Eccleston-Turner M, Brassington I. Restricting Access to Pathogen Samples and Epidemiological Data: A Not-So-Brief History of “Viral Sovereignty” and the Mark It Left on the World. INFECTIOUS DISEASES IN THE NEW MILLENNIUM 2020; 82. [PMCID: PMC7226898 DOI: 10.1007/978-3-030-39819-4_8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
In 2007 the Indonesian government claimed sovereignty over the H5N1 influenza virus samples isolated within Indonesia’s territories, refusing to share those samples with the World Health Organisation. Indonesia’s sovereignty claims conflicted with the decades-long practice of sharing influenza samples with the WHO, and was seen as an affront to scientific norms of cooperation and openness. The conflict was ostensibly resolved in 2011 with the introduction of the WHO’s Pandemic Influenza Preparedness Framework (PIP Framework), which was intended to secure access to influenza viruses from around the world and effect a fairer distribution of vaccines and other benefits associated with the use of pandemic influenza samples. The problem is, the PIP Framework did not resolve the issues created with the concept of viral sovereignty. In fact, by recognising the sovereign rights of states over this subset of pathogens, the PIP Framework legitimised viral sovereignty as a broader legal norm. Instead of resisting this concept, the WHO quietly acceded to it and reinforced a set of perverse incentives for countries to restrict access to pathogens precisely when those pathogens embody the greatest value: during a public health emergency. This chapter demonstrates that the concept of viral sovereignty did not begin with Indonesia in 2007, and more importantly, it did not end with the PIP Framework in 2011. Despite the term “viral sovereignty” fading into relative obscurity, the concept itself is now an established legal norm that could delay efforts to save lives during epidemics and pandemics.
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17
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Zhang H, Shao F, Gu J, Li L, Wang Y. Ethics Committee Reviews of Applications for Research Studies at 1 Hospital in China During the 2019 Novel Coronavirus Epidemic. JAMA 2020; 323:1844-1846. [PMID: 32202608 PMCID: PMC7091374 DOI: 10.1001/jama.2020.4362] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This study reviews research ethics committee applications for COVID-19–related research at a Chinese hospital in February 2020 to characterize study type, approval rate and review time, reason for revision or denial, and issues with informed consent.
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Affiliation(s)
- Hui Zhang
- Department of Scientific Research and Discipline Construction, Henan Provincial People’s Hospital and the People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Fengmin Shao
- Department of Nephrology, Henan Provincial People’s Hospital and the People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianqin Gu
- Department of General Medicine, Henan Provincial People’s Hospital and the People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Li Li
- Department of Scientific Research and Discipline Construction, Henan Provincial People’s Hospital and the People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuming Wang
- Clinical Research Guidance Center, Henan Provincial People’s Hospital and the People’s Hospital of Zhengzhou University, Zhengzhou, China
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18
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Bajrovic I, Schafer SC, Romanovicz DK, Croyle MA. Novel technology for storage and distribution of live vaccines and other biological medicines at ambient temperature. SCIENCE ADVANCES 2020; 6:eaau4819. [PMID: 32181330 PMCID: PMC7056310 DOI: 10.1126/sciadv.aau4819] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 12/11/2019] [Indexed: 05/10/2023]
Abstract
A novel, thin-film platform that preserves live viruses, bacteria, antibodies, and enzymes without refrigeration for extended periods of time is described. Studies with recombinant adenovirus in an optimized formulation that supports recovery of live virus through 16 freeze-thaw cycles revealed that production of an amorphous solid with a glass transition above room temperature and nitrogen-hydrogen bonding between virus and film components are critical determinants of stability. Administration of live influenza virus in the optimized film by the sublingual and buccal routes induced antibody-mediated immune responses as good as or better than those achieved by intramuscular injection. This work introduces the possibility of improving global access to a variety of medicines by offering a technology capable of reducing costs of production, distribution, and supply chain maintenance.
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MESH Headings
- Adenoviridae/genetics
- Adenoviridae/immunology
- Administration, Buccal
- Administration, Sublingual
- Animals
- Antibodies, Neutralizing/biosynthesis
- Antibodies, Viral/biosynthesis
- HEK293 Cells
- Humans
- Immunization/methods
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza A Virus, H1N1 Subtype/pathogenicity
- Injections, Intramuscular
- Male
- Membranes, Artificial
- Mice
- Mice, Inbred BALB C
- Orthomyxoviridae Infections/immunology
- Orthomyxoviridae Infections/prevention & control
- Orthomyxoviridae Infections/virology
- Preservation, Biological/methods
- Temperature
- Vaccine Potency
- Vaccines, Attenuated/biosynthesis
- Vaccines, Attenuated/pharmacology
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Affiliation(s)
- Irnela Bajrovic
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA
| | - Stephen C. Schafer
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA
| | - Dwight K. Romanovicz
- Institute for Cellular and Molecular Biology, College of Natural Sciences, The University of Texas at Austin, Austin, TX 78712, USA
| | - Maria A. Croyle
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA
- LaMontagne Center for Infectious Disease, The University of Texas at Austin, Austin, TX 78712, USA
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Krubiner CB, Schwartz DA. Viral Hemorrhagic Fevers in Pregnant Women and the Vaccine Landscape: Comparisons Between Yellow Fever, Ebola, and Lassa Fever. CURRENT TROPICAL MEDICINE REPORTS 2019. [DOI: 10.1007/s40475-019-00194-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Oza S, Wing K, Sesay AA, Boufkhed S, Houlihan C, Vandi L, Sebba SC, McGowan CR, Cummings R, Checchi F. Improving health information systems during an emergency: lessons and recommendations from an Ebola treatment centre in Sierra Leone. BMC Med Inform Decis Mak 2019; 19:100. [PMID: 31133075 PMCID: PMC6537453 DOI: 10.1186/s12911-019-0817-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 04/16/2019] [Indexed: 11/11/2022] Open
Abstract
Background The 2014–2016 West Africa Ebola epidemic highlighted the difficulty of collecting patient information during emergencies, especially in highly infectious environments. Health information systems (HISs) appropriate for such settings were lacking prior to this outbreak. Here we describe our development and implementation of paper and electronic HISs at the Sierra Leone Kerry Town Ebola treatment centre (ETC) from 2014 to 2015. We share our approach, experiences, and recommendations for future health emergencies. Methods We developed eight fact-finding questions about data-related needs, priorities, and restrictions at the ETC (“inputs”) to inform eight structural decisions (“outputs”) across six core HIS components. Semi-structured interviews about the “inputs” were then conducted with HIS stakeholders, chosen based on their teams’ involvement in ETC HIS-related activities. Their responses were used to formulate the “output” results to guide the HIS design. We implemented the HIS using an Agile approach, monitored system usage, and developed a structured questionnaire on user experiences and opinions. Results Some key “input” responses were: 1) data needs for priorities (patient care, mandatory reporting); 2) challenges around infection control, limited equipment, and staff clinical/language proficiencies; 3) patient/clinical flows; and 4) weak points from staff turnover, infection control, and changing protocols. Key outputs included: 1) determining essential data, 2) data tool design decisions (e.g. large font sizes, checkboxes/buttons), 3) data communication methods (e.g. radio, “collective memory”), 4) error reduction methods (e.g. check digits, pre-written wristbands), and 5) data storage options (e.g. encrypted files, accessible folders). Implementation involved building data collection tools (e.g. 13 forms), preparing the systems (e.g. supplies), training staff, and maintenance (e.g. removing old forms). Most patients had basic (100%, n = 456/456), drug (96.9%, n = 442/456), and additional clinical/epidemiological (98.9%, n = 451/456) data stored. The questionnaire responses highlighted the importance of usability and simplicity in the HIS. Conclusions HISs during emergencies are often ad-hoc and disjointed, but systematic design and implementation can lead to high-quality systems focused on efficiency and ease of use. Many of the processes used and lessons learned from our work are generalizable to other health emergencies. Improvements should be started now to have rapidly adaptable and deployable HISs ready for the next health emergency. Electronic supplementary material The online version of this article (10.1186/s12911-019-0817-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shefali Oza
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. .,Save the Children International, Kerry Town, Rural District, Western Area, Sierra Leone.
| | - Kevin Wing
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Save the Children International, Kerry Town, Rural District, Western Area, Sierra Leone
| | - Alieu Amara Sesay
- Save the Children International, Kerry Town, Rural District, Western Area, Sierra Leone
| | - Sabah Boufkhed
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Save the Children International, Kerry Town, Rural District, Western Area, Sierra Leone
| | - Catherine Houlihan
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Save the Children International, Kerry Town, Rural District, Western Area, Sierra Leone.,University College London, Gower Street, London, WC1E 6BT, UK
| | - Lahai Vandi
- Save the Children International, Kerry Town, Rural District, Western Area, Sierra Leone
| | - Sahr Charles Sebba
- Save the Children International, Kerry Town, Rural District, Western Area, Sierra Leone
| | - Catherine R McGowan
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Save the Children International, Kerry Town, Rural District, Western Area, Sierra Leone.,Save the Children UK, London, 1 St John's Lane, London, EC1M 4AR, UK
| | - Rachael Cummings
- Save the Children International, Kerry Town, Rural District, Western Area, Sierra Leone.,Save the Children UK, London, 1 St John's Lane, London, EC1M 4AR, UK
| | - Francesco Checchi
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Save the Children International, Kerry Town, Rural District, Western Area, Sierra Leone.,Save the Children UK, London, 1 St John's Lane, London, EC1M 4AR, UK
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21
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Saxena A, Horby P, Amuasi J, Aagaard N, Köhler J, Gooshki ES, Denis E, Reis AA, Ravinetto R. Ethics preparedness: facilitating ethics review during outbreaks - recommendations from an expert panel. BMC Med Ethics 2019; 20:29. [PMID: 31060618 PMCID: PMC6501283 DOI: 10.1186/s12910-019-0366-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 04/17/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Ensuring that countries have adequate research capacities is essential for an effective and efficient response to infectious disease outbreaks. The need for ethical principles and values embodied in international research ethics guidelines to be upheld during public health emergencies is widely recognized. Public health officials, researchers and other concerned stakeholders also have to carefully balance time and resources allocated to immediate treatment and control activities, with an approach that integrates research as part of the outbreak response. Under such circumstances, research "ethics preparedness" constitutes an important foundation for an effective response to infectious disease outbreaks and other health emergencies. MAIN TEXT A two-day workshop was convened in March 2018 by the World Health Organisation Global Health Ethics Team and the African coaLition for Epidemic Research, Response and Training, with representatives of National Ethics Committees, to identify practical processes and procedures related to ethics review preparedness. The workshop considered five areas where work might be undertaken to facilitate rapid and sound ethics review: preparing national ethics committees for outbreak response; pre-review of protocols; multi-country review; coordination between national ethics committees and other key stakeholders; data and benefit sharing; and export of samples to third countries. In this paper, we present the recommendations that resulted from the workshop. In particular, the participants recommended that Ethics Committees would develop a formal national standard operating procedure for emergency response ethical review; that there is a need to clarify the terminology and expectations of pre-review of generic protocols and agree upon specific terminology; that there is a need to explore mechanisms for multi-country emergency ethical consultation, and to establish procedures for communication between national ethics committees and other oversight bodies and public health authorities. In addition, it was suggested that ethics committees should request from researchers, at a minimum, a preliminary data sharing and sample sharing plan that outlines the benefit to the population from which data and samples are to be drawn. This should be followed in due time by a full plan. CONCLUSION It is hoped that the national ethics committees, supported by the WHO, relevant collaborative research consortia and external funding agencies, will work towards bringing these recommendations into practice, for supporting the conduct of effective research during outbreaks.
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Affiliation(s)
- Abha Saxena
- Global Health Ethics Team, World Health Organization, Geneva, Switzerland
- University of Geneva, Geneva, Switzerland
| | - Peter Horby
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - John Amuasi
- Kumasi Center for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Nic Aagaard
- Ethics Committees, Ministry of Health, Wellington, New Zealand
| | - Johannes Köhler
- Global Health Ethics Team, World Health Organization, Geneva, Switzerland
| | - Ehsan Shamsi Gooshki
- Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Emmanuelle Denis
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Andreas A Reis
- Global Health Ethics Team, World Health Organization, Geneva, Switzerland
| | - Raffaella Ravinetto
- Institutional Review Board, Institute of Tropical Medicine, Antwerp, Belgium.
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Sethi N. Research and Global Health Emergencies: On the Essential Role of Best Practice. Public Health Ethics 2018; 11:237-250. [PMID: 30429871 PMCID: PMC6225813 DOI: 10.1093/phe/phy014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This article addresses an important, overlooked regulatory challenge during global health emergencies (GHEs). It provides novel insights into how, and why, best practice can support decision makers in interpreting and implementing key guidance on conducting research during GHEs. The ability to conduct research before, during and after such events is crucial. The recent West-African Ebola outbreaks and the Zika virus have highlighted considerable room for improvement in meeting the imperative to research and rapidly develop effective therapies. A means of effectively capturing these experiences and folding them into future decision-making is lacking; the need for effective practical translational measures remains. The challenge for the research community lies in extracting meaningful action-guiding content from pre-existing guidelines-which draw upon practical examples of guidelines 'in action'-that assist in determining how to act in a particular (future) situation. Insights are provided into the role of best practice as a means to do so; such examples can provide invaluable support to decision makers in interpreting high-level guidance; overarching guidelines retain their necessary level of generality and flexibility, whilst corresponding best practice examples-which incorporate important lessons learned-illustrate how such guidelines can be interpreted at a practical level.
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Affiliation(s)
- Nayha Sethi
- Liminal Spaces, Mason Institute, University of Edinburgh
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23
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Ward CL, Shaw D, Sprumont D, Sankoh O, Tanner M, Elger B. Good collaborative practice: reforming capacity building governance of international health research partnerships. Global Health 2018; 14:1. [PMID: 29310698 PMCID: PMC5759302 DOI: 10.1186/s12992-017-0319-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 12/29/2017] [Indexed: 02/01/2023] Open
Abstract
In line with the policy objectives of the United Nations Sustainable Development Goals, this commentary seeks to examine the extent to which provisions of international health research guidance promote capacity building and equitable partnerships in global health research. Our evaluation finds that governance of collaborative research partnerships, and in particular capacity building, in resource-constrained settings is limited but has improved with the implementation guidance of the International Ethical Guidelines for Health-related Research Involving Humans by The Council for International Organizations of Medical Sciences (CIOMS) (2016). However, more clarity is needed in national legislation, industry and ethics guidelines, and regulatory provisions to address the structural inequities and power imbalances inherent in international health research partnerships. Most notably, ethical partnership governance is not supported by the principal industry ethics guidelines - the International Conference on Harmonization Technical Requirements for Registration of Pharmaceutical for Human Use (ICH) Good Clinical Practice (ICH-GCP). Given the strategic value of ICH-GCP guidelines in defining the role and responsibility of global health research partners, we conclude that such governance should stipulate the minimal requirements for creating an equitable environment of inclusion, mutual learning, transparency and accountability. Procedurally, this can be supported by i) shared research agenda setting with local leadership, ii) capacity assessments, and iii) construction of a memorandum of understanding (MoU). Moreover, the requirement of capacity building needs to be coordinated amongst partners to support good collaborative practice and deliver on the public health goals of the research enterprise; improving local conditions of health and reducing global health inequality. In this respect, and in order to develop consistency between sources of research governance, ICH-GCP should reference CIOMS ethical guidelines as the established standard for collaborative partnership. Moreover, greater commitment and support should be given to co-ordinate, strengthen and enforce local laws requiring equitable research partnerships and health system strengthening.
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Affiliation(s)
- Claire Leonie Ward
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
| | - David Shaw
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Dominique Sprumont
- Institut de Droit de la Santé, University of Neuchâtel, Neuchâtel, Switzerland
| | | | - Marcel Tanner
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Bernice Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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Gomes MF, de la Fuente-Núñez V, Saxena A, Kuesel AC. Protected to death: systematic exclusion of pregnant women from Ebola virus disease trials. Reprod Health 2017; 14:172. [PMID: 29297366 PMCID: PMC5751665 DOI: 10.1186/s12978-017-0430-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For 30 years, women have sought equal opportunity to be included in trials so that drugs are equitably studied in women as well as men; regulatory guidelines have changed accordingly. Pregnant women, however, continue to be excluded from trials for non-obstetric conditions, though they have been included for trials of life-threatening diseases because prospects for maternal survival outweighed potential fetal risks. Ebola virus disease is a life-threatening infection without approved treatments or vaccines. Previous Ebola virus (EBOV) outbreak data showed 89-93% maternal and 100% fetal/neonatal mortality. Early in the 2013-2016 EBOV epidemic, an expert panel pointed to these high mortality rates and the need to prioritize and preferentially allocate unregistered interventions in favor of pregnant women (and children). Despite these recommendations and multiple ethics committee requests for their inclusion on grounds of justice, equity, and medical need, pregnant women were excluded from all drug and vaccine trials in the affected countries, either without justification or on grounds of potential fetal harm. An opportunity to offer pregnant women the same access to potentially life-saving interventions as others, and to obtain data to inform their future use, was lost. Once again, pregnant women were denied autonomy and their right to decide. CONCLUSION We recommend that, without clear justification for exclusion, pregnant women are included in clinical trials for EBOV and other life-threatening conditions, with lay language on risks and benefits in information documents, so that pregnant women can make their own decision to participate. Their automatic exclusion from trials for other conditions should be questioned.
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Affiliation(s)
| | | | - Abha Saxena
- Department for Information Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Annette C. Kuesel
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
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Yeh KB, Monagin C, Fletcher J. Promoting Scientific Transparency to Facilitate the Safe and Open International Exchange of Biological Materials and Electronic Data. Trop Med Infect Dis 2017; 2:E57. [PMID: 30270914 PMCID: PMC6082060 DOI: 10.3390/tropicalmed2040057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/20/2017] [Accepted: 10/23/2017] [Indexed: 11/11/2022] Open
Abstract
Scientific communication, collaboration and progress are enhanced through the exchange of data, materials and ideas. Recent advances in technology, commercial proprietary discovery and current local and global events (e.g., emerging human, animal and plant disease outbreaks) have increased the demand, and shortened optimal timelines for material and data exchange, both domestically and internationally. Specific circumstances in each case, such as the type of material being transferred (i.e., select agent, disease-causing agent and assessed biosafety risk level) and current events, dictate the level of agreements and requirements. Recent lessons learned from emerging disease issues and emergencies have demonstrated that human engagement and increased science diplomacy are needed to reinforce and sustain biosafety and biosecurity practices and processes, for better scientific transparency. A reasonable and accepted framework of guidance for open sharing of data and materials is needed that can be applied on multiple cooperative levels, including global and national. Although numerous agreement variations already exist for the exchange of materials and data, regulations to guide the development of both the language and implementation of such agreements are limited. Without such regulations, scientific exchange is often restricted, limiting opportunities for international capacity building, collaboration and cooperation. In this article, we present and discuss several international case histories that illustrate the complex nature of scientific exchange. Recommendations are made for a dual bottom-up and top-down approach that includes all stakeholders from beginning negotiation stages to emphasize trust and cooperation. The broader aim of this approach is to increase international scientific transparency and trust in a safe and open manner, supporting increased global one health security.
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Affiliation(s)
| | - Corina Monagin
- One Health Institute, School of Veterinary Medicine, University of California, Davis, CA 95616, USA.
| | - Jacqueline Fletcher
- National Institute for Microbial Forensics & Food and Agricultural Biosecurity, Oklahoma State University, Stillwater, OK 74078, USA.
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Familiar ethical issues amplified: how members of research ethics committees describe ethical distinctions between disaster and non-disaster research. BMC Med Ethics 2017; 18:44. [PMID: 28659166 PMCID: PMC5490228 DOI: 10.1186/s12910-017-0203-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 06/19/2017] [Indexed: 11/10/2022] Open
Abstract
Background The conduct of research in settings affected by disasters such as hurricanes, floods and earthquakes is challenging, particularly when infrastructures and resources were already limited pre-disaster. However, since post-disaster research is essential to the improvement of the humanitarian response, it is important that adequate research ethics oversight be available. Methods We aim to answer the following questions: 1) what do research ethics committee (REC) members who have reviewed research protocols to be conducted following disasters in low- and middle-income countries (LMICs) perceive as the key ethical concerns associated with disaster research?, and 2) in what ways do REC members understand these concerns to be distinct from those arising in research conducted in non-crisis situations? This qualitative study was developed using interpretative description methodology; 15 interviews were conducted with REC members. Results Four key ethical issues were identified as presenting distinctive considerations for disaster research to be implemented in LMICs, and were described by participants as familiar research ethics issues that were amplified in these contexts. First, REC members viewed disaster research as having strong social value due to its potential for improving disaster response, but also as requiring a higher level of justification compared to other research settings. Second, they identified vulnerability as an overarching concern for disaster research ethics, and a feature that required careful and critical appraisal when assessing protocols. They noted that research participants’ vulnerabilities frequently change in the aftermath of a disaster and often in unpredictable ways. Third, they identified concerns related to promoting and maintaining safety, confidentiality and data security in insecure or austere environments. Lastly, though REC members endorsed the need and usefulness of community engagement, they noted that there are significant challenges in a disaster setting over and above those typically encountered in global health research to achieve meaningful community engagement. Conclusion Disaster research presents distinctive ethical considerations that require attention to ensure that participants are protected. As RECs review disaster research protocols, they should address these concerns and consider how justification, vulnerability, security and confidentially, and community engagement are shaped by the realities of conducting research in a disaster.
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Alirol E, Kuesel AC, Guraiib MM, dela Fuente-Núñez V, Saxena A, Gomes MF. Ethics review of studies during public health emergencies - the experience of the WHO ethics review committee during the Ebola virus disease epidemic. BMC Med Ethics 2017; 18:43. [PMID: 28651650 PMCID: PMC5485606 DOI: 10.1186/s12910-017-0201-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 06/08/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Between 2013 and 2016, West Africa experienced the largest ever outbreak of Ebola Virus Disease. In the absence of registered treatments or vaccines to control this lethal disease, the World Health Organization coordinated and supported research to expedite identification of interventions that could control the outbreak and improve future control efforts. Consequently, the World Health Organization Research Ethics Review Committee (WHO-ERC) was heavily involved in reviews and ethics discussions. It reviewed 24 new and 22 amended protocols for research studies including interventional (drug, vaccine) and observational studies. WHO-ERC REVIEWS WHO-ERC provided the reviews within on average 6 working days. The WHO-ERC often could not provide immediate approval of protocols for reasons which were not Ebola Virus Disease specific but related to protocol inconsistencies, missing information and complex informed consents. WHO-ERC considerations on Ebola Virus Disease specific issues (benefit-risk assessment, study design, exclusion of pregnant women and children from interventional studies, data and sample sharing, collaborative partnerships including international and local researchers and communities, community engagement and participant information) are presented. CONCLUSIONS To accelerate study approval in future public health emergencies, we recommend: (1) internally consistent and complete submissions with information documents in language participants are likely to understand, (2) close collaboration between local and international researchers from research inception, (3) generation of template agreements for data and sample sharing and use during the ongoing global consultations on bio-banks, (4) formation of Joint Scientific Advisory and Data Safety Review Committees for all studies linked to a particular intervention or group of interventions, (5) formation of a Joint Ethics Review Committee with representatives of the Ethics Committees of all institutions and countries involved to strengthen reviews through the different perspectives provided without the 'opportunity costs' for time to final approval of multiple, independent reviews, (6) direct information exchange between the chairs of advisory, safety review and ethics committees, (7) more Ethics Committee support for investigators than is standard and (8) a global consultation on criteria for inclusion of pregnant women and children in interventional studies for conditions which put them at particularly high risk of mortality or other irreversible adverse outcomes under standard-of-care.
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Affiliation(s)
- Emilie Alirol
- Global Antibiotics Research and Development Partnership (GARDP), Drugs for Neglected Diseases initiative (DNDi), 15 chemin Louis Dunant, 1202 Geneva, Switzerland
| | - Annette C. Kuesel
- World Health Organization, UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, 20 Avenue Appia, 1211, 27 Geneva, Switzerland
| | - Maria Magdalena Guraiib
- World Health Organization, Department for Information Evidence and Research, 20 Avenue Appia, 1211, 27 Geneva, Switzerland
| | - Vânia dela Fuente-Núñez
- World Health Organization, Department for Information Evidence and Research, 20 Avenue Appia, 1211, 27 Geneva, Switzerland
| | - Abha Saxena
- World Health Organization, Department for Information Evidence and Research, 20 Avenue Appia, 1211, 27 Geneva, Switzerland
| | - Melba F. Gomes
- World Health Organization, 20 Avenue Appia, 1211, 27 Geneva, Switzerland
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Luyckx VA, Biller-Andorno N, Saxena A, Tran NT. Health policy and systems research: towards a better understanding and review of ethical issues. BMJ Glob Health 2017; 2:e000314. [PMID: 29225934 PMCID: PMC5717951 DOI: 10.1136/bmjgh-2017-000314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/01/2017] [Accepted: 04/04/2017] [Indexed: 11/04/2022] Open
Abstract
Given the focus on health systems in the post-millennium development goal era and moving towards the sustainable development goals, there is a compelling need for a common framework for health policy and systems research ethics to guide researchers and facilitate review by research ethics committees. A consultation of global health policy and systems research and ethics experts was convened to identify ethical considerations relevant to health policy and systems research based on existing knowledge and to identify knowledge gaps through a scoping review and further expert deliberation. Health policy and systems research is highly complex and, in the absence of guidance documents, there is significant variability in ethics review. Although fundamental ethical principles pertain to both traditional clinical research and health policy and systems research, the application of these principles requires a comprehensive understanding of the nature of health policy and systems research with its distinct challenges. Such awareness must be raised among researchers and research ethics committees. Current research ethics committees lack familiarity with health policy and systems research and because health policy and systems research is conducted in real-world contexts, committees often have difficulties in determining whether a project is indeed research and/or requires ethical review. Given the strong current focus on health policy and systems research to rapidly improve health and health systems functioning globally, greater engagement and dialogue around the ethical concerns is required to optimise research review and research conduct in this rapidly evolving field.
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Affiliation(s)
- Valerie Ann Luyckx
- Institute of Biomedical Ethics and History of Medicine, Universität Zürich, Zürich, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, Universität Zürich, Zürich, Switzerland
| | - Abha Saxena
- Global Health Ethics Unit, World Health Organization, Geneva, Switzerland
| | - Nhan T Tran
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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