1
|
Berner-Rodoreda A, McMahon S, Eyal N, Hossain P, Rabbani A, Barua M, Sarker M, Metta E, Mmbaga E, Leshabari M, Wikler D, Bärnighausen T. Consent Requirements for Testing Health Policies: An Intercontinental Comparison of Expert Opinions. J Empir Res Hum Res Ethics 2022; 17:346-361. [PMID: 35617114 PMCID: PMC9136368 DOI: 10.1177/15562646221076764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Individual informed consent is a central requirement for clinical research on
human subjects, yet whether and how consent requirements should apply to health
policy experiments (HPEs) remains unclear. HPEs test and evaluate public health
policies prior to implementation. We interviewed 58 health experts in Tanzania,
Bangladesh and Germany on informed consent requirements for HPEs. Health experts
across all countries favored a strong evidence base, prior information to the
affected populations, and individual consent for ‘risky’ HPEs. Differences
pertained to individual risk perception, how and when consent by group
representatives should be obtained and whether HPEs could be treated as health
policies. The study adds to representative consent options for HPEs, yet shows
that more research is needed in this field – particularly in the present
Covid-19 pandemic which has highlighted the need for HPEs nationally and
globally.
Collapse
Affiliation(s)
| | - Shannon McMahon
- Heidelberg Institute of Global Health, Heidelberg University, Germany
- Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Nir Eyal
- Department of Health, Behavior, Society and Policy, Rutgers University, Piscataway, USA
- Center for Population-Level Bioethics, New Brunswick, USA
| | - Puspita Hossain
- McMaster University, Hamilton, Canada
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Atonu Rabbani
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Department of Economics, University of Dhaka, Dhaka, Bangladesh
| | - Mrittika Barua
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Radboud Universiteit, Nijmegen, Netherlands
| | - Malabika Sarker
- Heidelberg Institute of Global Health, Heidelberg University, Germany
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Emmy Metta
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Elia Mmbaga
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Melkizedeck Leshabari
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Daniel Wikler
- Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, USA
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Germany
- Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, USA
| |
Collapse
|
2
|
Abstract
BACKGROUND Rapid data sharing can maximize the utility of data. In epidemics and pandemics like Zika, Ebola, and COVID-19, the case for such practices seems especially urgent and warranted. Yet rapidly sharing data widely has previously generated significant concerns related to equity. The continued lack of understanding and guidance on equitable data sharing raises the following questions: Should data sharing in epidemics and pandemics primarily advance utility, or should it advance equity as well? If so, what norms comprise equitable data sharing in epidemics and pandemics? Do these norms address the equity-related concerns raised by researchers, data providers, and other stakeholders? What tensions must be balanced between equity and other values? METHODS To explore these questions, we undertook a systematic scoping review of the literature on data sharing in epidemics and pandemics and thematically analyzed identified literature for its discussion of ethical values, norms, concerns, and tensions, with a particular (but not exclusive) emphasis on equity. We wanted to both understand how equity in data sharing is being conceptualized and draw out other important values and norms for data sharing in epidemics and pandemics. RESULTS We found that values of utility, equity, solidarity, and reciprocity were described, and we report their associated norms, including researcher recognition; rapid, real-time sharing; capacity development; and fair benefits to data generators, data providers, and source countries. The value of utility and its associated norms were discussed substantially more than others. Tensions between utility norms (e.g., rapid, real-time sharing) and equity norms (e.g., researcher recognition, equitable access) were raised. CONCLUSIONS This study found support for equity being advanced by data sharing in epidemics and pandemics. However, norms for equitable data sharing in epidemics and pandemics require further development, particularly in relation to power sharing and participatory approaches prioritizing inclusion. Addressing structural inequities in the wider global health landscape is also needed to achieve equitable data sharing in epidemics and pandemics.
Collapse
Affiliation(s)
- Bridget Pratt
- Queensland Bioethics Centre, Australian Catholic University, 1100 Nudgee Rd., Brisbane, Australia.
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Susan Bull
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| |
Collapse
|
3
|
Sheehy A, Ralph James J, Horgan M. Implementing a National Approach to Research Ethics Review during a Pandemic - the Irish Experience. HRB Open Res 2020; 3:63. [PMID: 33490861 PMCID: PMC7797935 DOI: 10.12688/hrbopenres.13146.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 11/20/2022] Open
Abstract
The surge of coronavirus disease 2019 (COVID-19) research studies involving human participants in response to the pandemic has meant that research ethics committees across the world have been challenged to adapt their processes to meet demand while retaining high standards of review. Ethics review during this pandemic remains essential to ensure the safety, dignity and well-being of research participants, however research ethics committees are now faced with new, and often complex, ethics considerations and logistical challenges. This Open Letter looks specifically at the Irish experience of establishing a national approach to research ethics review amidst a global pandemic. This represents Ireland’s first National Research Ethics Committee, which provided the research community with an expedited and ‘single national opinion’ for ethics review for COVID-related research. The insights gleaned and lessons learned from the Irish experience may inform emergency responses to future pandemics or public health emergencies.
Collapse
Affiliation(s)
- Aileen Sheehy
- National Office for Research Ethics Committees, Dublin, Ireland
| | | | - Mary Horgan
- Royal College of Physicians of Ireland, Dublin, Ireland.,School of Medicine, University College Cork, Cork, Ireland
| |
Collapse
|
4
|
Sheehy A, Ralph James J, Horgan M. Implementing a National Approach to Research Ethics Review during a Pandemic – the Irish Experience. HRB Open Res 2020; 3:63. [DOI: 10.12688/hrbopenres.13146.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 11/20/2022] Open
Abstract
The surge of coronavirus disease 2019 (COVID-19) research studies involving human participants in response to the pandemic has meant that research ethics committees across the world have been challenged to adapt their processes to meet demand while retaining high standards of review. Ethics review during this pandemic remains essential to ensure the safety, dignity and well-being of research participants, however research ethics committees are now faced with new, and often complex, ethics considerations and logistical challenges. This Open Letter looks specifically at the Irish experience of establishing a national approach to research ethics review amidst a global pandemic. This represents Ireland’s first National Research Ethics Committee, which provided the research community with an expedited and ‘single national opinion’ for ethics review for COVID-related research. The insights gleaned and lessons learned from the Irish experience may inform emergency responses to future pandemics or public health emergencies.
Collapse
|
5
|
Choudhury S, Ghosh A. Ethical Considerations of Mental Health Research Amidst COVID-19 Pandemic: Mitigating the Challenges. Indian J Psychol Med 2020; 42:379-381. [PMID: 33402798 PMCID: PMC7746900 DOI: 10.1177/0253717620929097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Abhishek Ghosh
- (Addiction Psychiatry), Postgraduate Institute of Medical Education & Research, Chandigarh, India
| |
Collapse
|
6
|
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: 25] [Impact Index Per Article: 6.3] [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.
Collapse
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
| |
Collapse
|
7
|
Bar M, Fish E, Mendlovic S. Mental-health care under threat: a pragmatic approach for ethical decision-making for practitioners in COVID-19. COUNSELLING PSYCHOLOGY QUARTERLY 2020. [DOI: 10.1080/09515070.2020.1777939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- M. Bar
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Psychiatric Division, Sheba Medical Center, Ramat-Gan, Israel
| | - E. Fish
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S. Mendlovic
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Director, the Shalvata Mental Health Center, Shalvata Mental Health Center, Hod Hasharon, Israel
- Psychotherapy Program, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
8
|
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] [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.
Collapse
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.
| |
Collapse
|
9
|
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.
Collapse
Affiliation(s)
- Nayha Sethi
- Liminal Spaces, Mason Institute, University of Edinburgh
| |
Collapse
|
10
|
Amzat J, Razum O. Healthcare Emergencies in Africa: The Case of Ebola in Nigeria. TOWARDS A SOCIOLOGY OF HEALTH DISCOURSE IN AFRICA 2018. [PMCID: PMC7120945 DOI: 10.1007/978-3-319-61672-8_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The Ebola crisis in Africa presented a case study in both hope and despair. There were severe casualties in the weak and unprepared system of Liberia and Sierra Leone, but hope for a developing system in Nigeria, which managed to prevent a mass outbreak. This chapter takes a closer look at the Ebola crisis of 2014 in Africa and examines Nigeria as a model of political will and voluntary preparedness to tackle this national and continental health emergency. This chapter looks at risk and crisis communication in particular, and explores the concepts of ethics in the case of the Ebola outbreak.
Collapse
Affiliation(s)
- Jimoh Amzat
- Department of Sociology, Usmanu Danfodiyo University Department of Sociology, Sokoto, Nigeria
| | - Oliver Razum
- Fak. Gesundheitswissenschaften, Universität Bielefeld Fak. Gesundheitswissenschaften, Bielefeld, Germany
| |
Collapse
|
11
|
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: 40] [Impact Index Per Article: 5.7] [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.
Collapse
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
| |
Collapse
|
12
|
Schopper D, Ravinetto R, Schwartz L, Kamaara E, Sheel S, Segelid MJ, Ahmad A, Dawson A, Singh J, Jesani A, Upshur R. Research Ethics Governance in Times of Ebola. Public Health Ethics 2016; 10:49-61. [PMID: 28567113 PMCID: PMC5444563 DOI: 10.1093/phe/phw039] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Médecins Sans Frontières (MSF) ethics review board (ERB) has been solicited in an unprecedented way to provide advice and review research protocols in an ‘emergency’ mode during the recent Ebola epidemic. Twenty-seven Ebola-related study protocols were reviewed between March 2014 and August 2015, ranging from epidemiological research, to behavioural research, infectivity studies and clinical trials with investigational products at (very) early development stages. This article examines the MSF ERB’s experience addressing issues related to both the process of review and substantive ethical issues in this context. These topics include lack of policies regarding blood sample collection and use, and engaging communities regarding their storage and future use; exclusion of pregnant women from clinical and vaccine trials; and the difficulty of implementing timely and high-quality qualitative/anthropological research to consider potential upfront harms. Having noticed different standards across ethics committees (ECs), we propose that when multiple ethics reviews of clinical and vaccine trials are carried out during a public health emergency they should be accompanied by transparent communication between the ECs involved. The MSF ERB experience should trigger a broader discussion on the ‘optimal’ ethics review in an emergency outbreak and what enduring structural changes are needed to improve the ethics review process.
Collapse
Affiliation(s)
- Doris Schopper
- Medical Faculty, University of Geneva, Center for Education and Research in Humanitarian Action (CERAH)
| | - Raffaella Ravinetto
- Department of Clinical Sciences, Institute of Tropical Medicine, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven
| | | | - Eunice Kamaara
- Department of Philosophy, Religion and Theology, Moi University
| | - Sunita Sheel
- Independent Researcher in Global Health and Bioethics,Pune
| | | | - Aasim Ahmad
- The Kidney Centre, Pakistan, Aga Khan University
| | - Angus Dawson
- Centre for Values, Ethics & the Law in Medicine, School of Public Health, University of Sydney
| | - Jerome Singh
- Centre for the AIDS Programme of Research in South Africa (CAPRISA)
| | | | - Ross Upshur
- Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto
| |
Collapse
|
13
|
Affiliation(s)
- Bridget G Haire
- Bridget G. Haire is with the Kirby Institute for Infection and Immunity in Society, University of New South Wales Australia, Sydney, Australia. Morenike O. Folayan is with the Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Morenike O Folayan
- Bridget G. Haire is with the Kirby Institute for Infection and Immunity in Society, University of New South Wales Australia, Sydney, Australia. Morenike O. Folayan is with the Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| |
Collapse
|
14
|
Gallagher B, Berman AH, Bieganski J, Jones AD, Foca L, Raikes B, Schiratzki J, Urban M, Ullman S. National Human Research Ethics: A Preliminary Comparative Case Study of Germany, Great Britain, Romania, and Sweden. ETHICS & BEHAVIOR 2015; 26:586-606. [PMID: 27746664 PMCID: PMC5044765 DOI: 10.1080/10508422.2015.1096207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although international research is increasing in volume and importance, there remains a dearth of knowledge on similarities and differences in “national human research ethics” (NHREs), that is, national ethical guidelines (NEGs), Institutional Review Boards (IRBs), and research stakeholder’ ethical attitudes and behaviors (EABs). We begin to address this situation by reporting upon our experiences in conducting a multinational study into the mental health of children who had a parent/carer in prison. The study was conducted in 4 countries: Germany, Great Britain, Romania, and Sweden. Data on NHREs were gathered via a questionnaire survey, two ethics-related seminars, and ongoing contact between members of the research consortium. There was correspondence but even more so divergence between countries in the availability of NEGs and IRBs and in researcher’ EABs. Differences in NHREs have implications particularly in terms of harmonization but also for ethical philosophy and practice and for research integrity.
Collapse
Affiliation(s)
| | - Anne H Berman
- Department of Clinical Neurosciences, Karolinska Institutet
| | | | - Adele D Jones
- School of Human and Health Sciences, University of Huddersfield
| | - Liliana Foca
- Department of Psychology, Asociația Alternative Sociale
| | - Ben Raikes
- Division of Social Work, University of Huddersfield
| | | | - Mirjam Urban
- Department of Medicine, Technische Universitaet Dresden
| | - Sara Ullman
- Department of Investigation, The Swedish Police
| |
Collapse
|
15
|
Maduka O, Odia O. Ethical challenges of containing Ebola: the Nigerian experience. JOURNAL OF MEDICAL ETHICS 2015; 41:917-919. [PMID: 26091816 DOI: 10.1136/medethics-2014-102561] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 06/02/2015] [Indexed: 06/04/2023]
Abstract
Responding effectively to an outbreak of disease often requires routine processes to be set aside in favour of unconventional approaches. Consequently, an emergency response situation usually generates ethical dilemmas. The emergence of the Ebola virus in the densely populated cities of Lagos and Port Harcourt in Nigeria brought bleak warnings of a rapidly expanding epidemic. However, these fears never materialised largely due to the swift reaction of emergency response and incident management organisations, and the WHO has now declared Nigeria free of Ebola. However, numerous ethical issues arose in relation to the response to the outbreak. This paper discusses some of these ethical challenges and the vital lessons learned. Ethical challenges relating to confidentiality, the dignity of persons, non-maleficence, stigma and the ethical obligations of health workers are examined. Interventions implemented to ensure that confidentiality and the dignity of persons improved and stigma was reduced, included community meetings, knowledge communication and the training of media personnel in the ethical reporting of Ebola issues. In addition, training in infection prevention and control helped to allay the fears of health workers. A potential disaster was also averted when the use of an experimental medicine was reconsidered. Other countries currently battling the epidemic can learn a lot from the Nigerian experience.
Collapse
Affiliation(s)
- Omosivie Maduka
- Department of Preventive and Social Medicine, University of Port Harcourt, Port Harcourt, Rivers, Nigeria
| | - Osaretin Odia
- Department of Medicine, University of Port Harcourt, Port Harcourt, Rivers, Nigeria
| |
Collapse
|
16
|
Smith MJ. Ebola and Learning Lessons from Moral Failures: Who Cares about Ethics? Public Health Ethics 2015; 8:305-318. [PMID: 32288786 PMCID: PMC7107108 DOI: 10.1093/phe/phv028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The exercise of identifying lessons in the aftermath of a major public health emergency is of immense importance for the improvement of global public health emergency preparedness and response. Despite the persistence of the Ebola Virus Disease (EVD) outbreak in West Africa, it seems that the Ebola 'lessons learned' exercise is now in full swing. On our assessment, a significant shortcoming plagues recent articulations of lessons learned, particularly among those emerging from organizational reflections. In this article we argue that, despite not being recognized as such, the vast majority of lessons proffered in this literature should be understood as ethical lessons stemming from moral failures, and that any improvements in future global public health emergency preparedness and response are in large part dependent on acknowledging this fact and adjusting priorities, policies and practices accordingly such that they align with values that better ensure these moral failures are not repeated and that new moral failures do not arise. We cannot continue to fiddle at the margins without critically reflecting on our repeated moral failings and committing ourselves to a set of values that engenders an approach to global public health emergencies that embodies a sense of solidarity and global justice.
Collapse
|
17
|
Schopper D, Dawson A, Upshur R, Ahmad A, Jesani A, Ravinetto R, Segelid MJ, Sheel S, Singh J. Innovations in research ethics governance in humanitarian settings. BMC Med Ethics 2015; 16:10. [PMID: 25890281 PMCID: PMC4351683 DOI: 10.1186/s12910-015-0002-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Médecins Sans Frontières (MSF) is one of the world's leading humanitarian medical organizations. The increased emphasis in MSF on research led to the creation of an ethics review board (ERB) in 2001. The ERB has encouraged innovation in the review of proposals and the interaction between the ERB and the organization. This has led to some of the advances in ethics governance described in this paper. DISCUSSION We first update our previous work from 2009 describing ERB performance and then highlight five innovative practices: • A new framework to guide ethics review • The introduction of a policy exempting a posteriori analysis of routinely collected data • The preapproval of "emergency" protocols • General ethical approval of "routine surveys" • Evaluating the impact of approved studies. The new framework encourages a conversation about ethical issues, rather than imposing quasi-legalistic rules, is more engaged with the specific MSF research context and gives greater prominence to certain values and principles. Some of the innovations implemented by the ERB, such as review exemption or approval of generic protocols, may run counter to many standard operating procedures. We argue that much standard practice in research ethics review ought to be open to challenge and revision. Continued interaction between MSF researchers and independent ERB members has allowed for progressive innovations based on a trustful and respectful partnership between the ERB and the researchers. In the future, three areas merit particular attention. First, the impact of the new framework should be assessed. Second, the impact of research needs to be defined more precisely as a first step towards being meaningfully assessed, including changes of impact over time. Finally, the dialogue between the MSF ERB and the ethics committees in the study countries should be enhanced. SUMMARY We hope that the innovations in research ethics governance described may be relevant for other organisations carrying out research in fragile contexts and for ethics committees reviewing such research.
Collapse
Affiliation(s)
- Doris Schopper
- Medical Faculty, University of Geneva, Geneva, Switzerland.
- Centre for Education and Research in Humanitarian Action (CERAH), Geneva, Switzerland.
| | - Angus Dawson
- Centre for Biomedical Ethics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
| | - Ross Upshur
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
| | - Aasim Ahmad
- The Kidney Centre, Karachi, Pakistan.
- Aga Khan University, Karachi, Pakistan.
| | | | - Raffaella Ravinetto
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
- Department of Pharmaceutical and Pharmacological Sciences, Leuven, KU, Belgium.
| | | | - Sunita Sheel
- Independent researcher in global health and bioethics, Pune, India.
| | - Jerome Singh
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.
| |
Collapse
|
18
|
Chiappelli F, Bakhordarian A, Thames AD, Du AM, Jan AL, Nahcivan M, Nguyen MT, Sama N, Manfrini E, Piva F, Rocha RM, Maida CA. Ebola: translational science considerations. J Transl Med 2015; 13:11. [PMID: 25592846 PMCID: PMC4320629 DOI: 10.1186/s12967-014-0362-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 12/11/2014] [Indexed: 12/13/2022] Open
Abstract
We are currently in the midst of the most aggressive and fulminating outbreak of Ebola-related disease, commonly referred to as "Ebola", ever recorded. In less than a year, the Ebola virus (EBOV, Zaire ebolavirus species) has infected over 10,000 people, indiscriminately of gender or age, with a fatality rate of about 50%. Whereas at its onset this Ebola outbreak was limited to three countries in West Africa (Guinea, where it was first reported in late March 2014, Liberia, where it has been most rampant in its capital city, Monrovia and other metropolitan cities, and Sierra Leone), cases were later reported in Nigeria, Mali and Senegal, as well as in Western Europe (i.e., Madrid, Spain) and the US (i.e., Dallas, Texas; New York City) by late October 2014. World and US health agencies declared that the current Ebola virus disease (EVD) outbreak has a strong likelihood of growing exponentially across the world before an effective vaccine, treatment or cure can be developed, tested, validated and distributed widely. In the meantime, the spread of the disease may rapidly evolve from an epidemics to a full-blown pandemic. The scientific and healthcare communities actively research and define an emerging kaleidoscope of knowledge about critical translational research parameters, including the virology of EBOV, the molecular biomarkers of the pathological manifestations of EVD, putative central nervous system involvement in EVD, and the cellular immune surveillance to EBOV, patient-centered anthropological and societal parameters of EVD, as well as translational effectiveness about novel putative patient-targeted vaccine and pharmaceutical interventions, which hold strong promise, if not hope, to curb this and future Ebola outbreaks. This work reviews and discusses the principal known facts about EBOV and EVD, and certain among the most interesting ongoing or future avenues of research in the field, including vaccination programs for the wild animal vectors of the virus and the disease from global translational science perspective.
Collapse
Affiliation(s)
- Francesco Chiappelli
- UCLA School of Dentistry (Oral Biology & Medicine), Los Angeles, USA.
- Evidence-Based Decision Practice-Based Research Network, Los Angeles, USA.
- UCLA Center for the Health Sciences 63-090, 10833 Le Conte Avenue, Los Angeles, CA, 90095-1668, USA.
| | - Andre Bakhordarian
- UCLA School of Dentistry (Oral Biology & Medicine), Los Angeles, USA.
- Evidence-Based Decision Practice-Based Research Network, Los Angeles, USA.
| | - April D Thames
- UCLA David Geffen School of Medicine (Psychiatry), Los Angeles, USA.
| | - Angela M Du
- UCLA School of Dentistry (Oral Biology & Medicine), Los Angeles, USA.
| | - Allison L Jan
- UCLA School of Dentistry (Oral Biology & Medicine), Los Angeles, USA.
| | - Melissa Nahcivan
- UCLA School of Dentistry (Oral Biology & Medicine), Los Angeles, USA.
| | - Mia T Nguyen
- UCLA School of Dentistry (Oral Biology & Medicine), Los Angeles, USA.
| | - Nateli Sama
- UCLA School of Dentistry (Oral Biology & Medicine), Los Angeles, USA.
| | | | - Francesco Piva
- Polytechnic University of the Marche Region (Odontostomatological Sciences), Ancona, Italy.
| | | | - Carl A Maida
- UCLA School of Dentistry (Oral Biology & Medicine), Los Angeles, USA.
- UCLA School of Dentistry (Public Health Dentistry), UCLA Institute of the Environment and Sustainability, UCLA Center for Tropical Research, Los Angeles, USA.
| |
Collapse
|
19
|
Affiliation(s)
- Annette Rid
- Department of Social Science, Health & Medicine, King's College London, London, UK.
| | - Ezekiel J Emanuel
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
20
|
A call to action to enhance filovirus disease outbreak preparedness and response. Viruses 2014; 6:3699-718. [PMID: 25271875 PMCID: PMC4213557 DOI: 10.3390/v6103699] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 09/23/2014] [Accepted: 09/23/2014] [Indexed: 01/16/2023] Open
Abstract
The frequency and magnitude of recognized and declared filovirus-disease outbreaks have increased in recent years, while pathogenic filoviruses are potentially ubiquitous throughout sub-Saharan Africa. Meanwhile, the efficiency and effectiveness of filovirus-disease outbreak preparedness and response efforts are currently limited by inherent challenges and persistent shortcomings. This paper delineates some of these challenges and shortcomings and provides a proposal for enhancing future filovirus-disease outbreak preparedness and response. The proposal serves as a call for prompt action by the organizations that comprise filovirus-disease outbreak response teams, namely, Ministries of Health of outbreak-prone countries, the World Health Organization, Médecins Sans Frontières, the Centers for Disease Control and Prevention—Atlanta, and others.
Collapse
|
21
|
Leach M, Tadros M. Epidemics and the Politics of Knowledge: Contested Narratives in Egypt’s H1N1 Response. Med Anthropol 2014; 33:240-54. [DOI: 10.1080/01459740.2013.842565] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
22
|
Leach M, Scoones I. The social and political lives of zoonotic disease models: narratives, science and policy. Soc Sci Med 2013; 88:10-7. [PMID: 23702205 DOI: 10.1016/j.socscimed.2013.03.017] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 03/13/2013] [Accepted: 03/14/2013] [Indexed: 10/27/2022]
Abstract
Zoonotic diseases currently pose both major health threats and complex scientific and policy challenges, to which modelling is increasingly called to respond. In this article we argue that the challenges are best met by combining multiple models and modelling approaches that elucidate the various epidemiological, ecological and social processes at work. These models should not be understood as neutral science informing policy in a linear manner, but as having social and political lives: social, cultural and political norms and values that shape their development and which they carry and project. We develop and illustrate this argument in relation to the cases of H5N1 avian influenza and Ebola, exploring for each the range of modelling approaches deployed and the ways they have been co-constructed with a particular politics of policy. Addressing the complex, uncertain dynamics of zoonotic disease requires such social and political lives to be made explicit in approaches that aim at triangulation rather than integration, and plural and conditional rather than singular forms of policy advice.
Collapse
Affiliation(s)
- Melissa Leach
- STEPS Centre, Institute of Development Studies, University of Sussex, Falmer, Brighton BN1 9RE, UK.
| | | |
Collapse
|
23
|
Edwards SJL. Ethics of clinical science in a public health emergency: drug discovery at the bedside. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2013; 13:3-14. [PMID: 23952822 PMCID: PMC4151792 DOI: 10.1080/15265161.2013.813597] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Clinical research under the usual regulatory constraints may be difficult or even impossible in a public health emergency. Regulators must seek to strike a good balance in granting as wide therapeutic access to new drugs as possible at the same time as gathering sound evidence of safety and effectiveness. To inform current policy, I reexamine the philosophical rationale for restricting new medicines to clinical trials, at any stage and for any population of patients (which resides in the precautionary principle), to show that its objective to protect public health, now or in the future, could soon be defeated in a pandemic. Providing wider therapeutic access and coordinating observations and natural experiments, including service delivery by cluster (wedged cluster trials), may provide such a balance. However, there are important questions of fairness to resolve before any such research can proceed.
Collapse
|