1
|
Staunton C, Shabani M, Mascalzoni D, Mežinska S, Slokenberga S. Ethical and social reflections on the proposed European Health Data Space. Eur J Hum Genet 2024; 32:498-505. [PMID: 38355959 PMCID: PMC11061131 DOI: 10.1038/s41431-024-01543-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 11/08/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
The COVID-19 pandemic demonstrated the benefits of international data sharing. Data sharing enabled the health care policy makers to make decisions based on real-time data, it enabled the tracking of the virus, and importantly it enabled the development of vaccines that were crucial to mitigating the impact of the virus. This data sharing is not the norm as data sharing needs to navigate complex ethical and legal rules, and in particular, the fragmented application of the General Data Protection Regulation (GDPR). The introduction of the draft regulation for a European Health Data Space (EHDS) in May 2022 seeks to address some of these legal issues. If passed, it will create an obligation to share electronic health data for certain secondary purposes. While there is a clear need to address the legal complexities involved with data sharing, it is critical that any proposed reforms are in line with ethical principles and the expectations of the data subjects. In this paper we offer a critique of the EHDS and offer some recommendations for this evolving regulatory space.
Collapse
Affiliation(s)
- Ciara Staunton
- Institute for Biomedicine, Eurac Research, Bolzano, Italy.
- School of Law, University of Kwazulunatal, Durban, South Africa.
| | - Mahsa Shabani
- Faculty of Law and Criminology, Ghent University, Gent, Belgium
| | - Deborah Mascalzoni
- Institute for Biomedicine, Eurac Research, Bolzano, Italy
- Department of Public Health and Caring Science, Uppsala University, CRB, P.O. Box 256, 751 05, Uppsala, Sweden
| | - Signe Mežinska
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
| | | |
Collapse
|
2
|
Ibrahim ME, Adarmouch L, Elgamri A, Abd ElHafeez S, Mohammed Z, Abdelgawad F, Elsebaie EH, Abdelhafiz AS, Gamel E, El Rhazi K, Abdelnaby A, Ahram M, Silverman H. Researchers' Perspectives Regarding Ethical Issues of Biobank Research in the Arab Region. Biopreserv Biobank 2024; 22:98-109. [PMID: 36951637 PMCID: PMC11044858 DOI: 10.1089/bio.2022.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
Background: The recent expansion of genomic biobank research in the Arab region in the Middle East North Africa has raised complex ethical and regulatory issues. However, there is a lack of studies regarding the views of Arab researchers involved in such research. We aimed to assess the perceptions and attitudes of Arab researchers regarding these issues in biobank research. Methods: We developed a questionnaire to assess the perceptions and attitudes regarding genetic research of researchers from Egypt, Sudan, Morocco, and Jordan. The questionnaire requested demographic data, perceptions, and attitudes regarding the collection, storage, and use of biospecimens and data, the use of broad consent, data security, data sharing, and community engagement. We used multiple linear regressions to identify predictors of perceptions and attitudes. Results: We recruited 383 researchers. Researchers favored equally the use of broad and tiered consent (44.1% and 39.1%, respectively). Most respondents agreed with the importance of confidentiality protections to ensure data security (91.8%). However, lower percentages were seen regarding the importance of community engagement (64.5%), data sharing with national colleagues and international partners (60.9% and 41.1%, respectively), and biospecimen sharing with national colleagues and international partners (59.9% and 36.2%, respectively). Investigators were evenly split on whether the return of individual research results should depend on the availability or not of a medical intervention that can be offered to address the genetic anomaly (47.5% and 46.4%, respectively). Predictors of attitudes toward biospecimen research included serving on Research Ethics Committees, prior research ethics training, and affiliation with nonacademic institutions. Conclusions: We recommend further exploratory research with researchers regarding the importance of community engagement and to address their concerns about data sharing, with researchers within and outside their countries.
Collapse
Affiliation(s)
- Maha E. Ibrahim
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Latifa Adarmouch
- Department of Community Medicine, Public Health and Epidemiology, Faculty of Medicine, Cadi Ayyad University, Marrakesh, Morocco
| | - Alya Elgamri
- Department of Orthodontics, Pediatric Dentistry and Preventive Dentistry, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan
| | - Samar Abd ElHafeez
- Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Zeinab Mohammed
- Department of Public Health and Community Medicine, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Fatma Abdelgawad
- Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Eman H. Elsebaie
- Department of Public Health, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Samir Abdelhafiz
- Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ehsan Gamel
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan
| | - Karima El Rhazi
- Department of Epidemiology and Public Health, Faculty of Medicine, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Asmaa Abdelnaby
- Department of Public Health, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mamoun Ahram
- Department of Physiology and Biochemistry, School of Medicine, The University of Jordan, Amman, Jordan
| | - Henry Silverman
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
3
|
Dicko B, Kodio S, Samoura H, Traoré F, Sykes N, Drabo M, Thizy D, Coche I, Robinson B, Sanogo K, Yagouré B, Diop S, Coulibaly MB. Stakeholder engagement in the development of genetically modified mosquitoes for malaria control in West Africa: lessons learned from 10 years of Target Malaria's work in Mali. Front Bioeng Biotechnol 2024; 11:1286694. [PMID: 38249804 PMCID: PMC10797414 DOI: 10.3389/fbioe.2023.1286694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/05/2023] [Indexed: 01/23/2024] Open
Abstract
From 2012 to 2023, the Malaria Research and Training Center (MRTC), based out of the University of Sciences, Techniques and Technologies of Bamako (USTTB), was part of the Target Malaria research consortium working towards developing novel gene drive-based tools for controlling populations of malaria vector mosquitoes. As part of this work, Target Malaria Mali has undertaken a range of in-depth engagement activities with the communities where their research is conducted and with other stakeholders nationally. These activities were meant to ensure that the project's activities took place with the agreement of those communities, and that those communities were able to play a role in shaping the project's approach to ensure that its eventual outcomes were in line with their needs and concerns. This paper aims to conduct a critical assessment of those 10 years of stakeholder engagement in order to identify good practices which can inform future engagement work on gene drive research in West Africa. It sets out a range of approaches and practices that enabled the Target Malaria Mali team to engage a variety of stakeholders, to share information, collect feedback, and determine community agreement, in a manner that was inclusive, effective, and culturally appropriate. These can be useful tools for those working on gene drive research and other area-wide vector control methods in West African contexts to ensure that their research is aligned with the interests of the communities who are intended to be its ultimate beneficiaries, and to allow those communities to play a meaningful role in the research process.
Collapse
Affiliation(s)
- Bakara Dicko
- Malaria Research and Training Center at the University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Souleymane Kodio
- Malaria Research and Training Center at the University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Hatouma Samoura
- Malaria Research and Training Center at the University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Fatoumata Traoré
- Malaria Research and Training Center at the University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Naima Sykes
- Imperial College London, London, United Kingdom
| | | | | | | | | | - Kadiatou Sanogo
- Malaria Research and Training Center at the University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Bilkissou Yagouré
- Malaria Research and Training Center at the University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Samba Diop
- Malaria Research and Training Center at the University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Mamadou B. Coulibaly
- Malaria Research and Training Center at the University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| |
Collapse
|
4
|
Amoakoh-Coleman M, Vieira D, Abugri J. Ethical considerations for biobanking and use of genomics data in Africa: a narrative review. BMC Med Ethics 2023; 24:108. [PMID: 38053109 PMCID: PMC10699036 DOI: 10.1186/s12910-023-00985-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Biobanking and genomic research requires collection and storage of human tissue from study participants. From participants' perspectives within the African context, this can be associated with fears and misgivings due to a myriad of factors including myths and mistrust of researchers. From the researchers angle ethical dilemmas may arise especially with consenting and sample reuse during storage. The aim of this paper was to explore these ethical considerations in the establishment and conduct of biobanking and genomic studies in Africa. METHODS We conducted a narrative synthesis following a comprehensive search of nine (9) databases and grey literature. All primary research study designs were eligible for inclusion as well as both quantitative and qualitative evidence from peer reviewed journals, spanning a maximum of 20 years (2000-2020). It focused on research work conducted in Africa, even if data was stored or analysed outside the region. RESULTS Of 2,663 title and abstracts screened, 94 full texts were retrieved and reviewed for eligibility. We included 12 studies (7 qualitative; 4 quantitative and one mixed methods). Ethical issues described in these papers related to community knowledge and understanding of biobanking and genomic research, regulation, and governance of same by research ethics committees, enrolment of participants, types of informed consents, data collection, storage, usage and sharing as well as material transfer, returning results and benefit sharing. ca. Biospecimen collection and storage is given in trust and participants expect confidentially of data and results generated. Most participants are comfortable with broad consent due to trust in researchers, though a few would like to be contacted for reconsenting in future studies, and this would depend on whether the new research is for good cause. Sharing data with external partners is welcome in some contexts but some research participants did not trust foreign researchers. CONCLUSION Biobanking and genomic studies are a real need in Africa. Linked to this are ethical considerations related to setting up and participation in biobanks as well as data storage, export, use and sharing. There is emerging or pre-existing consensus around the acceptability of broad consent as a suitable model of consent, the need for Africans to take the lead in international collaborative studies, with deliberate efforts to build capacity in local storage and analysis of samples and employ processes of sample collection and use that build trust of communities and potential study participants. Research ethics committees, researchers and communities need to work together to work together to adapt and use clearly defined ethical frameworks, guidelines, and policy documents to harmonize the establishment and running of biobanking and genomic research in Africa.
Collapse
Affiliation(s)
- Mary Amoakoh-Coleman
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana.
| | - Dorice Vieira
- 2Health Sciences Library, Grossman School of Medicine, New York University, New York, USA
| | - James Abugri
- School of Chemical and Biochemical Sciences, C.K. Tedam University. of Technology & Applied Sciences, Navrongo, Ghana
| |
Collapse
|
5
|
Iwai Y, Toumbou K, Zuze T, Morgan JS, Simwinga L, Wright ST, Fedoriw Y, Oladeru OT, Balogun OD, Roberson ML, Olopade OI, Tomoka T, Elmore SN. Breast Cancer Germline Genetic Counseling and Testing for Populations of African Heritage Globally: A Scoping Review on Research, Practice, and Bioethical Considerations. JCO Glob Oncol 2023; 9:e2300154. [PMID: 37944088 PMCID: PMC10645409 DOI: 10.1200/go.23.00154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/05/2023] [Accepted: 09/05/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE Despite the disproportionately high risk of breast cancer among women of African heritage, little is known about the facilitators and barriers to implementing germline genetic testing and counseling (GT/C). METHODS This scoping review followed guidelines recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Published manuscripts from database inception through 2021 were sourced from PubMed, Cumulative Index to Nursing and Allied Health Literature via EBSCO, Embase, Cochrane Library, and Scopus. Search terms were used to retrieve articles addressing (1) African heritage, (2) breast cancer, and (3) GT or GC. The screening involved abstract and title review and full-text review. Data were extracted for all articles meeting the inclusion criteria. RESULTS A total of 154 studies were included. Most studies that took place were conducted in the United States (71.4%), and most first authors (76.9%) were from the United States. GT was conducted in 73 (49.7%) studies. BRCA1/BRCA2 were the most commonly studied genes for germline mutations. GC was conducted in 49 studies (33.3%), and perspectives on GC were evaluated in 43 (29.3%). The use of racial/ethnic categories varied broadly, although African American was most common (40.1%). Racism was mentioned in three studies (2.0%). CONCLUSION There is a growing body of literature on GT/C for breast cancer in women of African heritage. Future studies on GT/C of African populations should consider increased clarity around racial/ethnic categorizations, continued community engagement, and intentional processes for informed consent.
Collapse
Affiliation(s)
- Yoshiko Iwai
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | - Jenny S. Morgan
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
- Department of Clinical Medicine, Indiana University School of Medicine, Indianapolis, IN
- Department of Global Health, Indiana University School of Medicine, Indianapolis, IN
| | | | - Sarah T. Wright
- UNC Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yuri Fedoriw
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Oluwadamilola T. Oladeru
- Department of Radiation Oncology, University of Florida, Gainesville, FL
- Department of Radiation Oncology, Mayo Clinic in Florida, Jacksonville, FL
| | | | - Mya L. Roberson
- Department of Health Policy, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | | | | | - Shekinah N.C. Elmore
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| |
Collapse
|
6
|
Amoakoh-Coleman M, Vieira D, Abugri J. Ethical considerations for Biobanking and Use of Genomics Data in Africa: A narrative review. RESEARCH SQUARE 2023:rs.3.rs-3173909. [PMID: 37546977 PMCID: PMC10402194 DOI: 10.21203/rs.3.rs-3173909/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Background Biobanking and genomic research requires collection and storage of human tissue from study participants. From participants' perspectives within the African context, this can be associated with fears and misgivings due to a myriad of factors including myths and mistrust of researchers. From the researchers angle ethical dilemmas may arise especially with consenting and sample reuse during storage. The aim of this paper was to explore these ethical considerations in the establishment and conduct of biobanking and biogenomic studies in Africa. Methods We conducted a narrative synthesis following a comprehensive search of nine (9) databases and grey literature. Ethical issues studied related to community knowledge and understanding of biobanking and genomic research, regulation, and governance of same by research ethics committees, enrolment of participants, types of informed consents, data collection, storage, usage and sharing as well as material transfer, returning results and benefit sharing. Results Of 2,663 title and abstracts screened, 94 full texts were retrieved and reviewed for eligibility. We included 12 studies (7 qualitative; 4 quantitative and one mixed methods). More education of study participants is needed, as well as appropriate community engagement processes that allow community confidence in enrolment into such studies. Competence of review and ethics committees (RECs) should be enhanced to adequately review and govern biobanking and genomic research in Africa. Biospecimen collection and storage is given in trust and participants expect confidentially of data and results generated. Most participants are comfortable with broad consent due to trust in researchers, though a few would like to be contacted for reconsenting in future studies, and this would depend on whether the new research is for good cause. Sharing data with external partners is welcome in some contexts but some research participants did not trust foreign researchers. Conclusion With these varying ethical considerations, we recommend that stakeholders, including research ethics committees, work together to adapt and use clearly defined ethical frameworks, guidelines, and policy documents to harmonize the establishment and running of biobanking and genomic research in Africa.
Collapse
Affiliation(s)
| | - Dorice Vieira
- Health Sciences Library, Grossman School of Medicine, New York University
| | - James Abugri
- School of Chemical and Biochemical Sciences, C.K. Tedam University. of Technology & Applied Sciences
| |
Collapse
|
7
|
Borthwick J, Evertsz N, Pratt B. How should communities be meaningfully engaged (if at all) when setting priorities for biomedical research? Perspectives from the biomedical research community. BMC Med Ethics 2023; 24:6. [PMID: 36747191 PMCID: PMC9900561 DOI: 10.1186/s12910-022-00879-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/19/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is now rising consensus that community engagement is ethically and scientifically essential for all types of health research. Yet debate continues about the moral aims, methods and appropriate timing in the research cycle for community engagement to occur, and whether the answer should vary between different types of health research. Co-design and collaborative partnership approaches that involve engagement during priority-setting, for example, are common in many forms of applied health research but are not regular practice in biomedical research. In this study, we empirically examine the normative question: should communities be engaged when setting priorities for biomedical research projects, and, if so, how and for what purpose? METHODS We conducted in-depth interviews with 31 members of the biomedical research community from the UK, Australia, and African countries who had engaged communities in their work. Interview data were thematically analysed. RESULTS Our study shows that biomedical researchers and community engagement experts strongly support engagement in biomedical research priority-setting, except under certain circumstances where it may be harmful to communities. However, they gave two distinct responses on what ethical purpose it should serve-either empowerment or instrumental goals-and their perspectives on how it should achieve those goals also varied. Three engagement approaches were suggested: community-initiated, synergistic, and consultative. Pre-engagement essentials and barriers to meaningful engagement in biomedical research priority-setting are also reported. CONCLUSIONS This study offers initial evidence that meaningful engagement in priority-setting should potentially be defined slightly differently for biomedical research relative to certain types of applied health research and that engagement practice in biomedical research should not be dominated by instrumental goals and approaches, as is presently the case.
Collapse
Affiliation(s)
- Josephine Borthwick
- grid.454047.60000 0004 0584 7841Royal Australian College of General Practitioners, Melbourne, Australia ,grid.411958.00000 0001 2194 1270Queensland Bioethics Centre, Australian Catholic University, 1100 Nudgee Rd., Brisbane, Australia
| | - Natalia Evertsz
- grid.416153.40000 0004 0624 1200Royal Melbourne Hospital, Melbourne, Australia
| | - 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.
| |
Collapse
|
8
|
Singh S, Cadigan RJ, Moodley K. Research-Related Stakeholders' Perspectives on Sociocultural Considerations in Biobanking Practice in South Africa. Biopreserv Biobank 2023; 21:81-89. [PMID: 35759422 PMCID: PMC9963473 DOI: 10.1089/bio.2021.0149] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Biobanking practice continues to proliferate in South Africa, yet little is known about how stakeholders engage with social, cultural, and religious considerations in this area of research. This study was undertaken to establish the perspectives of South African stakeholders (researchers, biobankers, clinicians, and research committee members) on sociocultural considerations in biobanking research. Methods: This in-depth exploratory study used semistructured face-to-face or Skype interviews with 25 purposively selected stakeholders involved in the biobanking-related practice. The study sample comprised biobankers, clinicians, researchers, postgraduate students in biobanking research, and research ethics committee members in South Africa. The interview focused on social and cultural challenges facing the biobanking practice in the country. Further probes included stakeholder perspectives on ownership and custodianship of stored biosamples. Thematic analysis was used to analyze the collected data. Results and Discussion: Several themes arose from the data analysis. These included respondents' perceptions of poor understanding of biobanking among research participants and communities; inconsistency in defining ownership and custodianship of biosamples; variability in respondents' understanding of cultural, religious, and social implications of biobanking; the notion of distrust; and building trust in biobanking. There were also inconsistencies in respondents' recognition of social, cultural, and/or religious influences on participant decision-making in biobanking research. Respondents highlighted that a general climate of distrust existed in the biobanking practice in South Africa. Conclusion: There is a need for greater stakeholder awareness of sociocultural considerations in biobanking practice in South Africa. One possible way to achieve this could be through the availability of training programs aimed at improving stakeholder understanding of the sociocultural context for biobanking practice in addition to greater efforts at community engagement with respect to all biobanking activities and research.
Collapse
Affiliation(s)
- Shenuka Singh
- Department of Medicine, Centre for Medical Ethics and Law, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Rosemary Jean Cadigan
- Department of Social Medicine, Center for Bioethics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Keymanthri Moodley
- Department of Medicine, Centre for Medical Ethics and Law, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| |
Collapse
|
9
|
No person left behind: Mapping the health policy landscape for genomics research in the Caribbean. LANCET REGIONAL HEALTH. AMERICAS 2022; 15:100367. [PMID: 36778076 PMCID: PMC9904062 DOI: 10.1016/j.lana.2022.100367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The Caribbean has long been an under-represented geographical region in the field of genomics research. Such under-representation may result in Caribbean people being underserved by precision medicine and other public health benefits of genomics. A collaboration among regional and international researchers aims to address this issue through the H3ECaribbean project (Human Heredity, Environment, and Health in the Caribbean), which builds on the lessons and success of H3Africa. The Caribbean project aims to target issues of social justice by encouraging the inclusion of diverse Caribbean communities in genomics research. This paper explores a framework for the ethical and socially acceptable conduct of genomics research in the Caribbean, taking account of the cultural peculiarities of the region. This is done in part by exploring research ethics issues identified in indigenous communities in North America, Small Island Developing States, and similar endeavours from the African continent. The framework provides guidance for interacting with local community leaders, as well as detailing steps for obtaining informed consent of all participants. Specifically, the authors outline the methods to ensure effective interaction and enforce full transparency with study participants to combat historical neglect when working with under-represented communities in the Caribbean.
Collapse
|
10
|
Luthuli M, Ngwenya N, Gumede D, Gunda R, Gareta D, Koole O, Siedner MJ, Wong EB, Seeley J. Participant recall and understandings of information on biobanking and future genomic research: experiences from a multi-disease community-based health screening and biobank platform in rural South Africa. BMC Med Ethics 2022; 23:43. [PMID: 35436913 PMCID: PMC9014601 DOI: 10.1186/s12910-022-00782-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 04/11/2022] [Indexed: 11/11/2022] Open
Abstract
Background Limited research has been conducted on explanations and understandings of biobanking for future genomic research in African contexts with low literacy and limited healthcare access. We report on the findings of a sub-study on participant understanding embedded in a multi-disease community health screening and biobank platform study known as ‘Vukuzazi’ in rural KwaZulu-Natal, South Africa. Methods Semi-structured interviews were conducted with research participants who had been invited to take part in the Vukuzazi study, including both participants and non-participants, and research staff that worked on the study. The interviews were transcribed, and themes were identified from the interview transcripts, manually coded, and thematically analysed. Results Thirty-nine individuals were interviewed. We found that the research team explained biobanking and future genomic research by describing how hereditary characteristics create similarities among individuals. However, recollection and understanding of this explanation seven months after participation was variable. The large volume of information about the Vukuzazi study objectives and procedures presented a challenge to participant recall. By the time of interviews, some participants recalled rudimentary facts about the genetic aspects of the study, but many expressed little to no interest in genetics and biobanking. Conclusion Participant’s understanding of information related to genetics and biobanking provided during the consent process is affected by the volume of information as well as participant’s interest (or lack thereof) in the subject matter being discussed. We recommend that future studies undertaking biobanking and genomic research treat explanations of this kind of research to participants as an on-going process of communication between researchers, participants and the community and that explanatory imagery and video graphic storytelling should be incorporated into theses explanations as these have previously been found to facilitate understanding among those with low literacy levels. Studies should also avoid having broader research objectives as this can divert participant’s interest and therefore understanding of why their samples are being collected. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-022-00782-z.
Collapse
Affiliation(s)
- Manono Luthuli
- Africa Health Research Institute, KwaZulu-Natal, South Africa.
| | - Nothando Ngwenya
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Division of Infection and Immunity, University College London, London, UK.,School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Dumsani Gumede
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Resign Gunda
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Division of Infection and Immunity, University College London, London, UK.,School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Olivier Koole
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Global Health and Development Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Mark J Siedner
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Emily B Wong
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.,Global Health and Development Department, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
11
|
Data protection, data management, and data sharing: Stakeholder perspectives on the protection of personal health information in South Africa. PLoS One 2021; 16:e0260341. [PMID: 34928950 PMCID: PMC8687565 DOI: 10.1371/journal.pone.0260341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022] Open
Abstract
The Protection of Personal Information Act (POPIA) 2013 came into force in South Africa on 1 July 2020. It seeks to strengthen the processing of personal information, including health information. While POPIA is to be welcomed, there are concerns about the impact it will have on the processing of health information. To ensure that the National Health Laboratory Service [NHLS] is compliant with these new strict processing requirements and that compliance does not negatively impact upon its current screening, treatment, surveillance and research mandate, it was decided to consider the development of a NHLS POPIA Code of Conduct for Personal Health. As part of the process of developing such a Code and better understand the challenges faced in the processing of personal health information in South Africa, 19 semi-structured interviews with stakeholders were conducted between June and September 2020. Overall, respondents welcomed the introduction of POPIA. However, they felt that there are tensions between the strengthening of data protection and the use of personal information for individual patient care, treatment programmes, and research. Respondents reported a need to rethink the management of personal health information in South Africa and identified 5 issues needing to be addressed at a national and an institutional level: an understanding of the importance of personal information; an understanding of POPIA and data protection; improve data quality; improve transparency in data use; and improve accountability in data use. The application of POPIA to the processing of personal health information is challenging, complex, and likely costly. However, personal health information must be appropriately managed to ensure the privacy of the data subject is protected, but equally that it is used as a resource in the individual's and wider public interest.
Collapse
|
12
|
Evaluating Community Engagement Strategies to Manage Stigma in Two African Genomics Studies Involving People Living with Schizophrenia or Rheumatic Heart Disease. GLOBAL HEALTH EPIDEMIOLOGY AND GENOMICS 2021; 2021:9926495. [PMID: 34527261 PMCID: PMC8415068 DOI: 10.1155/2021/9926495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022]
Abstract
In global health research and genomics research specifically, community engagement has gained prominence in enhancing ethical conduct, particularly in managing the risk of stigmatization, but there is minimal scientific evidence on how to do this effectively. This article reports on community engagement evaluation strategies in two African genomics studies: the Stigma in African Genomics Research study and the Genomics of Schizophrenia in South African Xhosa People (SAX) study. Within the Stigma in African Genomics Research study, a self-report rating scale and open-ended questions were used to track participant responses to an experiential theatre workshop. The workshop focused on participant experiences of living with schizophrenia or rheumatic heart disease (RHD). While the schizophrenia group reported more alienation and less stigma resistance than the RHD group, both groups demonstrated increased stigma resistance over time, after participating in the workshops. Hearing from others living with and managing the same illness normalised participants' own experiences and encouraged them. Within the SAX study, a short rating scale and qualitative feedback methods were used to evaluate a Mental Health Literacy Day targeting mental health stigma. Information talks about (i) the symptoms of schizophrenia and treatment options and (ii) the illness experiences of a patient in recovery were rated as the most helpful on the day. Audience members reported that these talks challenged negative perceptions about severe mental illness. Three important learnings emerged from these evaluations: firstly, integration of evaluation strategies at the research study planning phase is likely to promote more effective community engagement. Secondly, a combination of quantitative and qualitative methods that draw on simple descriptive statistics and thematic analysis can provide nuanced perspectives about the value of community engagement. Thirdly, such evidence is necessary in establishing and promoting the science of community engagement in genomics research and health research more broadly.
Collapse
|
13
|
de Graeff N, Jongsma KR, Lunshof JE, Bredenoord AL. Governing Gene Drive Technologies: A Qualitative Interview Study. AJOB Empir Bioeth 2021; 13:107-124. [PMID: 34219621 DOI: 10.1080/23294515.2021.1941417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Gene drive technologies (GDTs) bias the inheritance of a genetic element within a population of non-human organisms, promoting its progressive spread across this population. If successful, GDTs may be used to counter intractable problems such as vector-borne diseases. A key issue in the debate on GDTs relates to what governance is appropriate for these technologies. While governance mechanisms for GDTs are to a significant extent proposed and shaped by professional experts, the perspectives of these experts have not been explored in depth. METHODS A total of 33 GDT experts from different professional disciplines were interviewed to identify, better understand, and juxtapose their perspectives on GDT governance. The pseudonymized transcripts were analyzed thematically. RESULTS Three main themes were identified: (1) engagement of communities, stakeholders, and publics; (2) power dynamics, and (3) decision-making. There was broad consensus amongst respondents that it is important to engage communities, stakeholders, and publics. Nonetheless, respondents had diverging views on the reasons for doing so and the timing and design of engagement. Respondents also outlined complexities and challenges related to engagement. Moreover, they brought up the power dynamics that are present in GDT research. Respondents stressed the importance of preventing the recurrence of historical injustices and reflected on dilemmas regarding whether and to what extent (foreign) researchers can legitimately make demands regarding local governance. Finally, respondents had diverging views on whether decisions about GDTs should be made in the same way as decisions about other environmental interventions, and on the decision-making model that should be used to decide about GDT deployment. CONCLUSIONS The insights obtained in this interview study give rise to recommendations for the design and evaluation of GDT governance. Moreover, these insights point to unresolved normative questions that need to be addressed to move from general commitments to concrete obligations.
Collapse
Affiliation(s)
- N de Graeff
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karin R Jongsma
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jeantine E Lunshof
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts, USA.,Department of Global Health and Social Medicine, Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA.,European Research Institute for the Biology of Ageing (ERIBA), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Annelien L Bredenoord
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
14
|
Singh S, Moodley K. Stakeholder perspectives on the ethico-legal dimensions of biobanking in South Africa. BMC Med Ethics 2021; 22:84. [PMID: 34210291 PMCID: PMC8247071 DOI: 10.1186/s12910-021-00645-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 06/09/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Biobanking provides exciting opportunities for research on stored biospecimens. However, these opportunities to advance medical science are fraught with challenges including ethical and legal dilemmas. This study was undertaken to establish perspectives of South African stakeholders on the ethico-legal dimensions of biobanking. METHODS An in-depth exploratory study was conducted with 25 purposively selected biobankers, clinicians, researchers, postgraduate students in biobanking research, and research ethics committee (REC) members in South Africa. Potential study participants were recruited through known hubs for biobanking in the country, online searches and the snowball sampling technique. A semi-structured face-to-face or Skype interview was arranged. Data was analysed using thematic analysis. RESULTS The emergent themes included: inconsistency in understanding consent models, disconnect between biobank researchers and biosample donors, inadequate processes to support re-consenting minors, inconsistent governance processes for biobanking research; challenges with sample and data sharing, and suboptimal strategies for benefit sharing and return of results. Biobanking practice in general appeared to be inconsistent and fragmented. While the need for consent in research is explicitly outlined in legislative documents, some respondents were unclear on the type of consent model to apply in biosample collection. They also reported inconsistencies in research participants' understanding of consent. Furthermore, these respondents' own understanding of consent and consent models were dependent on where they were positioned in biobanking practice (roles occupied). Respondents were unsure about the process to follow to re-consent child participants once the age of majority (≥ 18 years) was reached. It was not surprising that consent was identified as one of the major ethical challenges in biobanking practice. In certain settings, some respondents reported suboptimal governance processes for sample collection. Participants were generally unsure about how to operationalise benefit sharing and how to approach the idea of returning results to research participants and biobank donors. CONCLUSION The study findings indicated inconsistencies in stakeholder understanding of ethico-legal considerations related to biobanking in South Africa. A need for ongoing ethics capacity development among stakeholders was identified. Improving understanding of the ethics of biobanking could be facilitated by acknowledging the disconnect created by biosamples in the relationship between biobank researchers and donors.
Collapse
Affiliation(s)
- Shenuka Singh
- Centre for Medical Ethics and Law, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Keymanthri Moodley
- Centre for Medical Ethics and Law, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa
| |
Collapse
|
15
|
Peu MD, Mulaudzi FM, Rikhotso SR, Ngunyulu RN, Rasweswe MM. Reflections on accessing indigenous research settings: Encounters with traditional health practitioners and leaders in Vhembe district, South Africa. CULTURE & PSYCHOLOGY 2021. [DOI: 10.1177/1354067x20971249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Conducting research in indigenous settings in rural villages, where traditional leaders are the custodians of communities remains a challenge. Traditional health practitioners have to adapt their protocols to the needs of the cultural setting. When gaining access to a setting, researchers have to follow a process that respects the autonomy of individuals, thus adhering to one of the ethical principles of research with human participants. In this paper, the researchers reflect on gaining access to conduct research with traditional health practitioners and traditional leaders in Vhembe district, South Africa. Researchers participated in sharing circles, and identified five reflective themes. The themes included initiating agreement and rapport, continuous negotiation and compromise, Them and Us, adhering to local dress code and ritual performance. Researchers planning to conduct research with traditional health practitioners and traditional leaders should consider these themes in the preparation phase.
Collapse
Affiliation(s)
- MD Peu
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - FM Mulaudzi
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - SR Rikhotso
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - RN Ngunyulu
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - MM Rasweswe
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
16
|
Matshabane OP, Campbell MM, Faure MC, Appelbaum PS, Marshall PA, Stein DJ, de Vries J. The role of causal knowledge in stigma considerations in African genomics research: Views of South African Xhosa people. Soc Sci Med 2021; 277:113902. [PMID: 33865094 DOI: 10.1016/j.socscimed.2021.113902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/16/2021] [Accepted: 03/31/2021] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Advances in genomics research have raised several ethical concerns. One concern is the potential impact of genomics research on stigma experienced by people affected by a disease. Studies have found that the type of illness as well as disease causal beliefs impact on the relation between genetic attribution and stigma. This study explored the potential impact of genetic attribution of disease on stigma among Xhosa people with Rheumatic Heart Disease (RHD). METHODS Study participants were 46 Xhosa people with RHD living in the Western Cape Province of South Africa. Using video vignettes in 7 focus group discussions we explored whether and how genetic attribution may impact on disease-stigma. Vignettes introduced participants to non-genetic and genetic causal explanations and were followed-up with a series of open-ended questions eliciting their perceptions of non-genetic disease causes as well as genetic causation and its impact on internalised stigma. RESULTS This study found that Xhosa people with RHD have a general understanding of genetics and genetic attribution for disease. Additionally, and not withstanding their genetic knowledge, these participants hold multiple disease causal beliefs including genetic, infectious disease, psychosocial, behavioural and cultural explanations. While there was evidence of internalised stigma experiences among participants, these appeared not to be related to a genetic attribution to the disease. DISCUSSION The findings of this study provide clues as to why it is unlikely that a genetic conceptualisation of disease impacts internalised stigma experiences of Xhosa people. The causal explanations provided by participants reflect their cultural understandings and their context, namely, living in low-income and poverty-stricken environments. Divergence in these findings from much of the evidence from high-income countries emphasises that context matters when considering the impact of genetic attribution on stigma and caution against generalising findings from one part of the globe to another.
Collapse
Affiliation(s)
- Olivia P Matshabane
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Megan M Campbell
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Department of Psychology, Rhodes University, Grahamstown, South Africa.
| | - Marlyn C Faure
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University, Irving Medical Center, New York, United States; New York State Psychiatric Institute, New York, United States.
| | - Patricia A Marshall
- Department of Anthropology, Case Western Reserve University, Cleveland, United States.
| | - Dan J Stein
- Department of Psychiatry & Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; SA MRC Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa.
| | - Jantina de Vries
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| |
Collapse
|
17
|
Mwaka ES, Sebatta DE, Ochieng J, Munabi IG, Bagenda G, Ainembabazi D, Kaawa-Mafigiri D. Researchers' perspectives on return of individual genetics results to research participants: a qualitative study. Glob Bioeth 2021; 32:15-33. [PMID: 33762814 PMCID: PMC7952062 DOI: 10.1080/11287462.2021.1896453] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 02/24/2021] [Indexed: 11/19/2022] Open
Abstract
Genetic results are usually not returned to research participants in Uganda despite their increased demand. We report on researchers' perceptions and experiences of return of individual genetic research results. The study involved 15 in-depth interviews of investigators involved in genetics and/or genomic research. A thematic approach was used to interpret the results. The four themes that emerged from the data were the need for return of individual results including incidental findings, community engagement and the consenting process, implications and challenges to return of individual results. While researchers are willing to return clinically significant genetic results to research participants, they remain unsure of how this should be implemented. Suggestions to aid implementation of return of results included reconsenting of participants before receiving individual genetic results and increasing access to genetic counseling services. Community engagement to determine community perceptions and individual preferences for the return of results, and also prepare participants to safely receive results emerged as another way to support return of results. Researchers have a positive attitude toward the return of clinically significant genetic results to research participants. There is need to develop national guidance on genetic research and also build capacity for clinical genetics and genetic counseling.
Collapse
Affiliation(s)
| | | | - Joseph Ochieng
- College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Godfrey Bagenda
- College of Health Sciences, Makerere University, Kampala, Uganda
| | | | | |
Collapse
|
18
|
Warrier P, Ho CWL, Bull S, Vaz M, Vaz M. Engaging publics in biobanking and genetic research governance - a literature review towards informing practice in India. Wellcome Open Res 2021; 6:5. [PMID: 38645686 PMCID: PMC11026954 DOI: 10.12688/wellcomeopenres.16558.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 04/23/2024] Open
Abstract
Background: There is growing interest in advancing biobanking and genetic research in many countries, including India. Concurrently, more importance is being placed on participatory approaches involving the public and other stakeholders in addressing ethical issues and policymaking as part of a broader governance approach. We analyse the tools, purposes, outcomes and limitations of engaging people towards biobanking and genetic research governance that have been undertaken worldwide, and explore their relevance to India. Methods: Papers to be reviewed were identified through a targeted literature search carried out using ProQuest and PubMed. Retrieved papers were analysed with the Rpackage for Qualitative Data Analysis using inductive coding and thematic analysis, guided by the Framework Method. Results: Empirical studies on public and community engagement in the context of biobanking and or genetic research show a predominance towards the end of the last decade, spanning 2007 to 2019. Numerous strategies-including public meetings, community durbars, focus group discussions, interviews, deliberations, citizen-expert panels and community advisory boards-have been used to facilitate communication, consultation and collaboration with people, at the level of general and specific publics. Engagement allowed researchers to understand how people's values, opinions and experiences related to the research process; and enabled participants to become partners within the conduct of research. Conclusions: Constructs such as 'co-production', 'engagement of knowledges', 'rules of engagement' and 'stewardship' emerge as significant mechanisms that can address the ethical challenges and the governance of biobanking and genetic research in India. Given the inherent diversity of the Indian population and its varying cultural values and beliefs, there is a need to invest time and research funds for engagement as a continuum of participatory activity, involving communication, consultation and collaboration in relation to biobanking and genetic research. Further research into these findings is required to explore their effective employment within India.
Collapse
Affiliation(s)
- Prasanna Warrier
- Health and Humanities, St John's Research Institute, Bengaluru, Karnataka, 560034, India
| | - Calvin Wai-Loon Ho
- Faculty of Law and Centre for Medical Ethics and Law, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Susan Bull
- Ethox Centre and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, OX3 7LF, UK
| | - Mario Vaz
- Health and Humanities, St John's Research Institute, Bengaluru, Karnataka, 560034, India
| | - Manjulika Vaz
- Health and Humanities, St John's Research Institute, Bengaluru, Karnataka, 560034, India
| |
Collapse
|
19
|
Conradie EH, Malherbe H, Hendriksz CJ, Dercksen M, Vorster BC. An Overview of Benefits and Challenges of Rare Disease Biobanking in Africa, Focusing on South Africa. Biopreserv Biobank 2021; 19:143-150. [PMID: 33567219 DOI: 10.1089/bio.2020.0108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The North-West University's Centre for Human Metabolomics (CHM) is in the process of establishing the first rare disease (RD) biobank in South Africa and Africa. The CHM Biobank's main focus is on the collection of samples and information for rare congenital disorders. Approximately 72% of all RDs have a genetic origin, of which 70% have an exclusive pediatric onset. The need for such a biobank was identified by the CHM diagnostic laboratory. Feedback toward this initiative was overwhelmingly positive at the first stakeholder meeting in August 2019. However, gaining support from the public sector and recruiting of participants have proven to be challenging. Problems experienced to date include lack of support from government and clinicians; lack of knowledge on RDs (patients and clinicians); public health care focus not directed toward RDs; patients not returning for follow-up visits; and unwillingness to participate due to fear of exploitation. The CHM Biobank's vision and goals are aligned to address a national and international research need: it will provide a valuable resource for scientists to improve what is known about these diseases; to better understand the natural history and pathophysiology; to optimize diagnostic methods; and to potentially develop treatments. The genetic variability of the South African population provides added value to the RD biobank. This review provides a brief overview of the literature on the challenges and benefits of an RD biobank and how this relates to low- and middle-income countries (LMIC) like South Africa. The aim of the review is to draw attention to the potential benefits of such an undertaking and to create awareness, at both local and global level, toward some of the unique collective considerations that an RD biobank in LMIC (also unique South African challenges) faces on an operational, collaborate, and sustainability level.
Collapse
Affiliation(s)
- Engela H Conradie
- North-West University, Human Metabolomics, Potchefstroom, South Africa
| | - Helen Malherbe
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Rare Diseases South Africa NPC, Sunninghill, South Africa
| | | | - Marli Dercksen
- North-West University, Human Metabolomics, Potchefstroom, South Africa
| | - Barend C Vorster
- North-West University, Human Metabolomics, Potchefstroom, South Africa
| |
Collapse
|
20
|
Chemonges Wanyama E, Dicko B, Pare Toe L, Coulibaly MB, Barry N, Bayala Traore K, Diabate A, Drabo M, Kayondo JK, Kekele S, Kodio S, Ky AD, Linga RR, Magala E, Meda WI, Mukwaya S, Namukwaya A, Robinson B, Samoura H, Sanogo K, Thizy D, Traoré F. Co-developing a common glossary with stakeholders for engagement on new genetic approaches for malaria control in a local African setting. Malar J 2021; 20:53. [PMID: 33478519 PMCID: PMC7818942 DOI: 10.1186/s12936-020-03577-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/31/2020] [Indexed: 11/19/2022] Open
Abstract
Stakeholder engagement is an essential pillar for the development of innovative public health interventions, including genetic approaches for malaria vector control. Scientific terminologies are mainly lacking in local languages, yet when research activities involve international partnership, the question of technical jargon and its translation is crucial for effective and meaningful communication with stakeholders. Target Malaria, a not-for-profit research consortium developing innovative genetic approaches to malaria vector control, carried out a linguistic exercise in Mali, Burkina Faso and Uganda to establish the appropriate translation of its key terminology to local languages of sites where the teams operate. While reviewing the literature, there was no commonly agreed approach to establish such glossary of technical terms in local languages of the field sites where Target Malaria operates. Because of its commitment to the value of co-development, Target Malaria decided to apply this principle for the linguistic work and to take the opportunity of this process to empower communities to take part in the dialogue on innovative vector control. The project worked with linguists from other institutions (whether public research ones or private language centre) who developed a first potential glossary in the local language after better understanding the project scientific approach. This initial glossary was then tested during focus groups with community members, which significantly improved the proposed translations by making them more appropriate to the local context and cultural understanding. The stepwise process revealed the complexity and importance of elaborating a common language with communities as well as the imbrication of language with cultural aspects. This exercise demonstrated the strength of a co-development approach with communities and language experts as a way to develop knowledge together and to tailor communication to the audience even in the language used.
Collapse
Affiliation(s)
| | - Bakara Dicko
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Lea Pare Toe
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Mamadou B Coulibaly
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Nourou Barry
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | | | - Abdoulaye Diabate
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Mouhamed Drabo
- Department of Life Sciences, Imperial College London, London, UK
| | - Jonathan K Kayondo
- Department of Entomology, Uganda Virus Research Institute, Entebbe, Uganda
| | - Souleymane Kekele
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Souleymane Kodio
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Anselme Dinyiri Ky
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | | | - Emmanuel Magala
- Department of Entomology, Uganda Virus Research Institute, Entebbe, Uganda
| | | | - Solome Mukwaya
- Department of Entomology, Uganda Virus Research Institute, Entebbe, Uganda
| | - Annet Namukwaya
- Department of Entomology, Uganda Virus Research Institute, Entebbe, Uganda
| | | | - Hatouma Samoura
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Kadiatou Sanogo
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Delphine Thizy
- Department of Life Sciences, Imperial College London, London, UK.
| | - Fatoumata Traoré
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| |
Collapse
|
21
|
Warrier P, Ho CWL, Bull S, Vaz M, Vaz M. Engaging publics in biobanking and genetic research governance - a literature review towards informing practice in India. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16558.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: There is growing interest in advancing biobanking and genetic research in many countries, including India. Concurrently, more importance is being placed on participatory approaches involving the public and other stakeholders in addressing ethical issues and policymaking as part of a broader governance approach. We analyse the tools, purposes, outcomes and limitations of engaging people towards biobanking and genetic research governance that have been undertaken worldwide, and explore their relevance to India. Methods: Papers to be reviewed were identified through a targeted literature search carried out using ProQuest and PubMed. Retrieved papers were analysed with the R package for Qualitative Data Analysis using inductive coding and thematic analysis, guided by the Framework Method. Results: Empirical studies on public and community engagement in the context of biobanking and or genetic research show a predominance towards the end of the last decade, spanning 2007 to 2019. Numerous strategies—including public meetings, community durbars, focus group discussions, interviews, deliberations, citizen-expert panels and community advisory boards—have been used to facilitate communication, consultation and collaboration with people, at the level of general and specific publics. Engagement allowed researchers to understand how people’s values, opinions and experiences related to the research process; and enabled participants to become partners within the conduct of research. Conclusions: Constructs such as ‘co-production’, ‘engagement of knowledges’, ‘rules of engagement’ and ‘stewardship’ emerge as significant mechanisms that can address the ethical challenges and the governance of biobanking and genetic research in India. Given the inherent diversity of the Indian population and its varying cultural values and beliefs, there is a need to invest time and research funds for engagement as a continuum of participatory activity, involving communication, consultation and collaboration in relation to biobanking and genetic research. Further research into these findings is required to explore their effective employment within India
Collapse
|
22
|
Transitioning Toward a Circular Economy: The Impact of Stakeholder Engagement on Sustainability Culture. SUSTAINABILITY 2020. [DOI: 10.3390/su12208641] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The circular economy transition increasingly points to the need for a change in corporate culture, namely toward sustainability. This change can be supported by improving relations with relevant stakeholders, engaging comprehensively with them, and creating strong awareness about issues such as ecosystem protection, health-related safeguards, and the careful use of resources. In this regard, through stakeholder engagement and a review of traditional business models, the circular economy can contribute to transforming the corporate culture to ensure the concurrent enhancement of economic, social, and environmental dimensions. This study verified the role of stakeholder engagement in establishing and strengthening the sustainability culture in a company transitioning toward a circular economy. The case study research methodology was applied, referencing a single firm—operating in the oil and energy industry—representing one of the best practices in the international context, even if some efforts are still required to reduce downstream emissions. The findings underline the contributing role played by stakeholder engagement in establishing values and principles compliant with environmental protection and community wellbeing. Thus, this study contributes to the existing stakeholder engagement literature and sheds light on the practical implications and emerging issues.
Collapse
|
23
|
Griesemer I, Staley BS, Lightfoot AF, Bain L, Byrd D, Conway C, Grant TL, Leach B, Milko L, Mollison L, Porter N, Reid S, Smith G, Waltz M, Berg JS, Rini C, O'Daniel JM. Engaging community stakeholders in research on best practices for clinical genomic sequencing. Per Med 2020; 17:435-444. [PMID: 33026293 PMCID: PMC7938705 DOI: 10.2217/pme-2020-0074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aim: Maximizing the utility and equity of genomic sequencing integration in clinical care requires engaging patients, their families, and communities. The NCGENES 2 study explores the impact of engagement between clinicians and caregivers of children with undiagnosed conditions in the context of a diagnostic genomic sequencing study. Methods: A Community Consult Team (CCT) of diverse parents and advocates for children with genetic and/or neurodevelopmental conditions was formed. Results: Early and consistent engagement with the CCT resulted in adaptations to study protocol and materials relevant to this unique study population. Discussion: This study demonstrates valuable contributions of community stakeholders to inform the implementation of translational genomics research for diverse participants.
Collapse
Affiliation(s)
- Ida Griesemer
- Department of Health Behavior, UNC Chapel Hill, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, UNC Chapel Hill, Chapel Hill NC, USA
| | - Brooke S Staley
- Department of Epidemiology, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Alexandra F Lightfoot
- Department of Health Behavior, UNC Chapel Hill, Chapel Hill, NC, USA.,Center for Health Promotion & Disease Prevention, UNC Chapel Hill, Chapel Hill, NC, USA
| | | | - Derrick Byrd
- Parent/Advocate, Family Resource Center South Atlantic, Raleigh, NC, USA
| | - Carol Conway
- Parent/Advocate, Parent Advocates for Adult Children with Intellectual &/or Developmental Disabilities in NC, Chapel Hill, NC, USA
| | - Tracey L Grant
- Department of Genetics, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Barbara Leach
- Parent/Advocate, Family Support Program, School of Social Work, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Laura Milko
- Department of Genetics, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Lonna Mollison
- Department of Genetics, UNC Chapel Hill, Chapel Hill, NC, USA
| | | | - Sharron Reid
- Parent/Advocate, Wake County Sickle Cell Support Group, Raleigh, NC, USA
| | | | - Margaret Waltz
- Department of Social Medicine, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Jonathan S Berg
- Department of Genetics, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Christine Rini
- Department of Medical Social Sciences, Feinberg School of Medicine & Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | | |
Collapse
|
24
|
Spence A, Love P, Byrne R, Wakem A, Matwiejczyk L, Devine A, Golley R, Sambell R. Childcare Food Provision Recommendations Vary across Australia: Jurisdictional Comparison and Nutrition Expert Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186793. [PMID: 32957687 PMCID: PMC7558074 DOI: 10.3390/ijerph17186793] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 12/14/2022]
Abstract
Early childhood is a critical stage for nutrition promotion, and childcare settings have the potential for wide-reaching impact on food intake. There are currently no Australian national guidelines for childcare food provision, and the comparability of existing guidelines across jurisdictions is unknown. This project aimed to map and compare childcare food provision guidelines and to explore perspectives amongst early childhood nutrition experts for alignment of jurisdictional childcare food provision guidelines with the Australian Dietary Guidelines (ADG). A desktop review was conducted and formed the basis of an online survey. A national convenience sample of childhood nutrition experts was surveyed. Existing guideline recommendations for food group serving quantities were similar across jurisdictions but contained many minor differences. Of the 49 survey respondents, most (84-100%) agreed with aligning food group provision recommendations to provide at least 50% of the recommended ADG serves for children. Most (94%) agreed that discretionary foods should be offered less than once per month or never. Jurisdictional childcare food provision guidelines do not currently align, raising challenges for national accreditation and the provision of support and resources for services across jurisdictions. Childhood nutrition experts support national alignment of food provision guidelines with the ADG.
Collapse
Affiliation(s)
- Alison Spence
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3216, Australia;
- Correspondence: ; Tel.: +61-3-9244-5481
| | - Penelope Love
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3216, Australia;
| | - Rebecca Byrne
- Institute of Health and Biomedical Innovation, Centre for Children’s Health Research, Queensland University of Technology, Brisbane, QLD 4000, Australia;
| | - Amy Wakem
- Nutrition Australia Vic, Carlton, VIC 3053, Australia;
| | - Louisa Matwiejczyk
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5001, Australia;
| | - Amanda Devine
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia; (A.D.); (R.S.)
| | - Rebecca Golley
- Caring Futures Institute, Flinders University, Adelaide, SA 5001, Australia;
| | - Ros Sambell
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia; (A.D.); (R.S.)
| |
Collapse
|
25
|
Kintossou AK, N'dri MK, Money M, Cissé S, Doumbia S, Soumahoro MK, Coulibaly AF, Djaman JA, Dosso M. Study of laboratory staff' knowledge of biobanking in Côte d'Ivoire. BMC Med Ethics 2020; 21:88. [PMID: 32917182 PMCID: PMC7488401 DOI: 10.1186/s12910-020-00533-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 09/06/2020] [Indexed: 12/23/2022] Open
Abstract
Background A biobank is a structure which collects and manages biological samples and their associated data. The collected samples will then be made available for various uses. The sharing of those samples raised ethical questions which have been answered through specific rules. Thus, a Biobank functioning under tight ethical rules would be immensely valuable from a scientific and an economic view point. In 2009, Côte d’Ivoire established a biobank, which has been chosen to house the regional biobank of Economic Community of West African States (ECOWAS) countries in 2018. To ensure optimal and efficient use of this biobank, the scientific community must be aware of its existence and its role. It was therefore necessary to evaluate the knowledge of laboratories staff on the role and activities of a biobank. Methods This descriptive study was done by questioning staff from laboratories working on human’s health, animals or plants. The laboratories were located in southern Côte d’Ivoire. Results A total of 205 people completed the questionnaire. Of these 205 people, 34.63% were biologists, 7.32% engineers, 48.78% technicians and 9.27% PhD students. The average length of work experience was 10.11 ± 7.83 years. In this study, 43.41% of the participants had never heard of biobanking. Only 48.78% of participants had a good understanding of the role of a biobank. Technicians and PhD students were less educated on the notion of biobank (p < 0.000001). Although biologists were more educated on this issue, 21.13% of them had a misconception of biobank. Good knowledge of the role of a biobank was not significantly related to the work experience’s length (p > 0.88). Conclusion The level of knowledge of laboratory staff about biobanking needs to be improved. Training on the role, activities and interests of the biobank is important.
Collapse
Affiliation(s)
- Ambroise Kouamé Kintossou
- Biobank, Pasteur Institute of Côte d'Ivoire, 01 BP 490, Abidjan, Côte d'Ivoire. .,Training and Research Unit of Biosciences, Felix Houphouët Boigny University, Abidjan, Côte d'Ivoire.
| | - Mathias Kouamé N'dri
- Department of Epidemiology and Clinical Research, Pasteur Institute of Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Marcelle Money
- Biobank, Pasteur Institute of Côte d'Ivoire, 01 BP 490, Abidjan, Côte d'Ivoire
| | - Souleymane Cissé
- Biobank, Pasteur Institute of Côte d'Ivoire, 01 BP 490, Abidjan, Côte d'Ivoire
| | - Simini Doumbia
- Biobank, Pasteur Institute of Côte d'Ivoire, 01 BP 490, Abidjan, Côte d'Ivoire
| | - Man-Koumba Soumahoro
- Department of Epidemiology and Clinical Research, Pasteur Institute of Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | | | - Joseph Allico Djaman
- Training and Research Unit of Biosciences, Felix Houphouët Boigny University, Abidjan, Côte d'Ivoire
| | - Mireille Dosso
- Biobank, Pasteur Institute of Côte d'Ivoire, 01 BP 490, Abidjan, Côte d'Ivoire.,Department of Epidemiology and Clinical Research, Pasteur Institute of Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Training and Research Unit of Medical Sciences, Felix Houphouët Boigny University, Abidjan, Côte d'Ivoire
| |
Collapse
|
26
|
Thaldar DW, Botes M, Nienaber A. South Africa's new standard material transfer agreement: proposals for improvement and pointers for implementation. BMC Med Ethics 2020; 21:85. [PMID: 32883298 PMCID: PMC7469330 DOI: 10.1186/s12910-020-00526-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 08/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background Whenever South African (SA) research institutions share human biological material and associated data for health research or clinical trials they are legally compelled to have a material transfer agreement (MTA) in place that uses as framework the standard MTA newly gazetted by the South African Minister of Health (SA MTA). Main body The article offers a legal analysis of the SA MTA and focuses on its substantive fit with the broader legal environment in South Africa, and the clarity and practicality of its terms. The following problematic aspects of the SA MTA are highlighted: (a) Where only data and no human biological material are transferred, the SA MTA does not apply, leaving a lacuna; (b) Health Research Ethics Committees are required to be parties to a MTA despite it being outside their legal mandate and undermining their oversight function; (c) the SA MTA’s consent provisions are not aligned with extant law; and, similarly, (d) its provision on donor ownership is misaligned with extant law; (e) its creation of fictitious performance can only cause frustration on the part of an injured party; (f) its benefit-sharing provision is vague and will have little practical effect; (g) its dispute-resolution provisions fail to adequately protect South African research institutions and research participants; (h) it fails to provide substantive guidance regarding intellectual property as its provisions relating to intellectual property may cause practical problems; and, finally, (i) its data privacy provision is insufficiently specific, is overbroad, and fails to provide terms that in general would facilitate the international sharing of human biological material and associated data in terms of existing privacy law. Conclusions While some of the problematic aspects of the SA MTA are intricate and require consultative processes with stakeholders and others, to develop comprehensive solutions, most of the problematic aspects can be resolved immediately through amendments by the South African Minister of Health. The formulation of such amendments is proposed and, where possible, interim measures are suggested that may ameliorate the problems presented by the SA MTA.
Collapse
Affiliation(s)
- Donrich W Thaldar
- School of Law, University of KwaZulu-Natal, Durban, South Africa. .,African Health Research Flagship, University of KwaZulu-Natal, Durban, South Africa.
| | - Marietjie Botes
- School of Law, University of KwaZulu-Natal, Durban, South Africa.,African Health Research Flagship, University of KwaZulu-Natal, Durban, South Africa
| | - Annelize Nienaber
- Faculty of Law, University of Pretoria, Pretoria, South Africa.,Centre for Ethics and Philosophy of Health Sciences, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Division of Law, Abertay University, Dundee, Scotland, UK
| |
Collapse
|
27
|
Mashinya F, Alberts M, Mashaba RG, Tindana PO. Community engagement in Genomics research; Challenges and lessons learnt in the AWI-Gen study at Dikgale Health and Demographic Surveillance System (HDSS) Site, South Africa. AAS Open Res 2020. [DOI: 10.12688/aasopenres.13076.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
As health research often requires consent from participants and permission from community gate keepers, community engagement is considered an integral process of health research. Community engagement is also important in building trust between the research team and participants, gathering information on the needs and expectations of the community with respect to the project and present the community with an opportunity to gain more information on the goals of the research. Although there are published guidelines on how to conduct community engagement activities, the concept itself and the way in which it is put into practice is highly contextual. In this paper we reflect on the community engagement strategy used in the AWI-Gen Phase 1 study at the Dikgale Health and Demographic Surveillance System (Dikgale HDSS) site, the challenges encountered throughout the research process and the lessons learnt. Lastly, we highlight possible improvements to the CE strategic framework for AWI-Gen Phase 2 in Dikgale HDSS that may enhance the participation of the community.
Collapse
|
28
|
Matimba A, Chimatira A, Kuguyo O, January J, Mupambireyi Z, Marimbe-Dube B, Chikwasha V, Nyati-Jokomo Z, Muteti S, Mangezvo P, Kangwende A, Chingono A, Chidzonga M, Gandari J, Hakim J, Nathoo K, Samkange C, Mangezi W, Lee S, Gwanzura L, Cho M, Ndebele P. Understanding Ethical, Legal and Societal Issues (ELSIs) in Human Biobanking and Genomics for Research and Healthcare in Zimbabwe: The Genomics Inheritance Law Ethics and Society (GILES) initiative. AAS Open Res 2020; 2:1. [PMID: 32382699 PMCID: PMC7194152 DOI: 10.12688/aasopenres.12917.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2019] [Indexed: 11/20/2022] Open
Abstract
Biobanks and human genomics applications are key for understanding health, disease and heredity in Africa and globally. Growing interest in these technologies calls for strengthening relevant legal, ethical and policy systems to address knowledge disparities and ensure protection of society, while supporting advancement of science. In Zimbabwe there is limited understanding of ethical, legal, and societal issues (ELSI) for biobanking and genomics. The Genomics Inheritance Law Ethics and Society (GILES) initiative was established in 2015 to explore the current status and gaps in the ethical and legal frameworks, knowledge among various stakeholders, and to establish capacity for addressing ELSI of biobanking and genomics as applied in biomedical and population research, and healthcare. The project was conducted over a countrywide geographical region and established one of the most comprehensive studies for ELSI of human biobanking and genomics in Africa. This paper outlines the strategy undertaken during the implementation of the GILES initiative and discusses the importance of such an initiative for characterisation of ELSI of human biobanking and genomics in Zimbabwe and Africa.
Collapse
Affiliation(s)
- Alice Matimba
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Andrew Chimatira
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Oppah Kuguyo
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - James January
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Zivayi Mupambireyi
- Centre for Sexual Health and HIV Research Zimbabwe (CeSHHAR Zimbabwe), Harare, Zimbabwe
| | | | - Vasco Chikwasha
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Shamiso Muteti
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | | | - Alfred Chingono
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Midion Chidzonga
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Jonathan Gandari
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - James Hakim
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Kusum Nathoo
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Walter Mangezi
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Sandra Lee
- Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA
| | - Lovemore Gwanzura
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Mildred Cho
- Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA
| | - Paul Ndebele
- Medical Research Council of Zimbabwe, Harare, Zimbabwe.,Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| |
Collapse
|
29
|
Moodley K, Beyer C. Tygerberg Research Ubuntu-Inspired Community Engagement Model: Integrating Community Engagement into Genomic Biobanking. Biopreserv Biobank 2019; 17:613-624. [PMID: 31603696 PMCID: PMC6921246 DOI: 10.1089/bio.2018.0136] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Introduction: Community engagement (CE) is an ethical imperative in research, but the knowledge base for what constitutes effective and ethically sound CE is limited. Ubuntu, as a component of responsive communitarianism where communal welfare is valued together with individual autonomy, is useful in furthering our understanding of effective CE and how it could best be achieved. Similarly, a relative solidarity model serves as a compromise between extreme individualism and extreme communalism and is more appropriate in a heterogenous African context. Approaching CE from an Ubuntu philosophical perspective in southern Africa is particularly important in genomic biobanking, given the implications for individuals, families, and communities. Discussion: CE is often implemented in a tokenistic manner as an ancillary component of research. Understanding consent information is challenging where genomic biobanking is concerned due to scientific complexity. We started a process of CE around genomic biobanking and conducted empirical research in an attempt to develop a model to promote effective and ethically sound CE, using relative solidarity to create a nuanced application of Ubuntu. The TRUCE model is an eight-step model that uses social mapping to identify potential communities, establishes the scope of CE, and requires that communities are approached early. Co-creation strategies for CE are encouraged and co-ownership of knowledge production is emphasized. Recruiting and engaging communities at each stage of research is necessary. Evaluation and adaptation of CE strategies are included. Discussion and dissemination of results after the research is completed are encouraged. Conclusions: There is a significant gap between the theory of CE and its authentic application to research in Africa. This Ubuntu-inspired model facilitates bridging that gap and is particularly suited to genomic biobanking. The CE model enhances and complements the consent process and should be integrated into research as a funding and regulatory requirement where applicable.
Collapse
Affiliation(s)
- Keymanthri Moodley
- Department of Medicine, Faculty of Medicine and Health Sciences, Centre for Medical Ethics & Law, Stellenbosch University, Cape Town, South Africa
- Address correspondence to: Keymanthri Moodley, MBChB, MFamMed, MPhil, FCFP (SA), Executive MBA, DPhil, Department of Medicine, Faculty of Medicine and Health Sciences, Centre for Medical Ethics & Law, Stellenbosch University, P.O. Box 241, Cape Town 7505, South Africa
| | - Chad Beyer
- Department of Medicine, Faculty of Medicine and Health Sciences, Centre for Medical Ethics & Law, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
30
|
Staunton C, Abayomi A, Bassa F, Moodley K. Negotiating Requests for Reimbursement for Community Engagement: Challenges in Developing an Educational Video for Genomic Biobanking Research in South Africa. J Empir Res Hum Res Ethics 2019; 14:501-503. [PMID: 31230513 DOI: 10.1177/1556264619856223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Genomic research and the biobanking capacity it requires are experiencing considerable growth on the continent of Africa. However genomic research and biobanking raise a range of legal, ethical, social, and cultural issues, including concerns about broad consent, confidentiality, community stigmatization, discrimination, indefinite storage, and long-term use. There is a need to establish governance frameworks that address these issues, and many international health research ethics and biobanking guidelines now recommend that the best way to do so is by involving potential research participants and key community stakeholders in the research development and the process of acquiring samples and data through active community engagement (CE). This article describes the experience and challenges in developing an educational tool as part of a CE initiative in South Africa and the commentaries reflect on how this process may be improved going forward.
Collapse
Affiliation(s)
- Ciara Staunton
- Division of Haematology, Faculty of Health and Medical Science, Stellenbosch University, South Africa
| | - Akin Abayomi
- Division of Haematology, Faculty of Health and Medical Science, Stellenbosch University, South Africa.,Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Fatima Bassa
- Division of Haematology, Faculty of Health and Medical Science, Stellenbosch University, South Africa
| | - Keymanthri Moodley
- Division of Haematology, Faculty of Health and Medical Science, Stellenbosch University, South Africa
| |
Collapse
|
31
|
Middleton A, Milne R, Thorogood A, Kleiderman E, Niemiec E, Prainsack B, Farley L, Bevan P, Steed C, Smith J, Vears D, Atutornu J, Howard HC, Morley KI. Attitudes of publics who are unwilling to donate DNA data for research. Eur J Med Genet 2019; 62:316-323. [PMID: 30476628 PMCID: PMC6582635 DOI: 10.1016/j.ejmg.2018.11.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 12/17/2022]
Abstract
With the use of genetic technology, researchers have the potential to inform medical diagnoses and treatment in actionable ways. Accurate variant interpretation is a necessary condition for the utility of genetic technology to unfold. This relies on the ability to access large genomic datasets so that comparisons can be made between variants of interest. This can only be successful if DNA and medical data are donated by large numbers of people to 'research', including clinical, non-profit and for-profit research initiatives, in order to be accessed by scientists and clinicians worldwide. The objective of the 'Your DNA, Your Say' global survey is to explore public attitudes, values and opinions towards willingness to donate and concerns regarding the donation of one's personal data for use by others. Using a representative sample of 8967 English-speaking publics from the UK, the USA, Canada and Australia, we explore the characteristics of people who are unwilling (n = 1426) to donate their DNA and medical information, together with an exploration of their reasons. Understanding this perspective is important for making sense of the interaction between science and society. It also helps to focus engagement initiatives on the issues of concern to some publics.
Collapse
Affiliation(s)
- Anna Middleton
- Society and Ethics Research, Connecting Science, Wellcome Genome Campus, Cambridge, UK; Faculty of Education, University of Cambridge, Cambridge, UK.
| | - Richard Milne
- Society and Ethics Research, Connecting Science, Wellcome Genome Campus, Cambridge, UK; Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Adrian Thorogood
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
| | - Erika Kleiderman
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
| | - Emilia Niemiec
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
| | - Barbara Prainsack
- Department of Political Science, University of Vienna, Austria; Department of Global Health & Social Medicine, King's College London, UK
| | - Lauren Farley
- Society and Ethics Research, Connecting Science, Wellcome Genome Campus, Cambridge, UK
| | - Paul Bevan
- Web Team, Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | - Claire Steed
- Web Team, Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | - James Smith
- Web Team, Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | - Danya Vears
- Center for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Melbourne Law School, The University of Melbourne, Melbourne, Australia; Biomedical Ethics Research Group, Murdoch Children's Research Institute, Parkville, Australia
| | - Jerome Atutornu
- Society and Ethics Research, Connecting Science, Wellcome Genome Campus, Cambridge, UK; Faculty of Education, University of Cambridge, Cambridge, UK; School of Health Sciences, University of Suffolk, Ipswich, UK
| | - Heidi C Howard
- Society and Ethics Research, Connecting Science, Wellcome Genome Campus, Cambridge, UK; Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
| | - Katherine I Morley
- Society and Ethics Research, Connecting Science, Wellcome Genome Campus, Cambridge, UK; Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; Centre for Epidemiology and Biostatistics, Melbourne School of Global and Population Health, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
32
|
Bentley AR, Callier S, Rotimi C. The Emergence of Genomic Research in Africa and New Frameworks for Equity in Biomedical Research. Ethn Dis 2019; 29:179-186. [PMID: 30906167 DOI: 10.18865/ed.29.s1.179] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Individuals with African ancestry have the greatest genomic diversity in the world, yet they have been underrepresented in genomic research. To advance our understanding of human biology and our ability to trace human history, we must include more samples from Africans in genomic research. Additionally, inclusion of more samples from participants of recent African descent is imperative to provide equitable health care as genomics is increasingly used for diagnosis, treatment, and to understand disease risk. The Human Heredity and Health in Africa initiative (H3Africa) seeks to expand the number of Africans included in genomic research and to do so by expanding the research capacity on the continent. In this article, we discuss how H3Africa is endeavoring to achieve these goals while promoting equitable research collaborations.
Collapse
Affiliation(s)
- Amy R Bentley
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Shawneequa Callier
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD.,Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Charles Rotimi
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| |
Collapse
|
33
|
Matimba A, Chimatira A, Kuguyo O, January J, Mupambireyi Z, Marimbe-Dube B, Chikwasha V, Nyati-Jokomo Z, Muteti S, Mangezvo P, Kangwende A, Chingono A, Chidzonga M, Gandari J, Hakim J, Nathoo K, Samkange C, Mangezi W, Lee S, Gwanzura L, Cho M, Ndebele P. Understanding Ethical, Legal and Societal Issues (ELSIs) in Human Biobanking and Genomics for Research and Healthcare in Zimbabwe: The Genomics Inheritance Law Ethics and Society GILES initiative. AAS Open Res 2019; 2:1. [DOI: 10.12688/aasopenres.12917.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2018] [Indexed: 11/20/2022] Open
Abstract
Biobanks and human genomics applications are key for understanding health, disease and heredity in Africa and globally. Growing interest in these technologies calls for strengthening relevant legal, ethical and policy systems to address knowledge disparities and ensure protection of society, while supporting advancement of science. In Zimbabwe there is limited understanding of ethical, legal, and societal issues (ELSI) for biobanking and genomics. The Genomics Inheritance Law Ethics and Society (GILES) initiative was established in 2015 to explore the current status and gaps in the ethical and legal frameworks, knowledge among various stakeholders, and to establish capacity for addressing ELSI of biobanking and genomics as applied in biomedical and population research, and healthcare. A multi-methods approach was applied including document reviews, focus group discussions and in-depth interviews among health and research professionals, and community members in six provinces comprising urban, peri-urban and rural areas. Emerging findings indicates a need for updating guidelines and policies for addressing ELSI in biobanking and genomics research in Zimbabwe. Emerging terminologies such as biobanking and genomics lack clarity suggesting a need for increased awareness and educational tools for health professionals, research scientists and community members. Common concerns relating to consent processes, sample and data use and sharing, particularly where there is trans-national flow of biospecimens and data, call for nationally tailored ELSI frameworks aligned to regional and international initiatives. This paper describes the strategy undertaken for the development and implementation of the GILES project and discusses the importance of such an initiative for characterisation of ELSI of human biobanking and genomics in Zimbabwe and Africa. Conducting this explorative study among a wide range of stakeholders over a countrywide geographical regions, established one of the most comprehensive studies for ELSI of human biobanking and genomics in Africa.
Collapse
|
34
|
Amendola LM, Berg JS, Horowitz CR, Angelo F, Bensen JT, Biesecker BB, Biesecker LG, Cooper GM, East K, Filipski K, Fullerton SM, Gelb BD, Goddard KA, Hailu B, Hart R, Hassmiller-Lich K, Joseph G, Kenny EE, Koenig BA, Knight S, Kwok PY, Lewis KL, McGuire AL, Norton ME, Ou J, Parsons DW, Powell BC, Risch N, Robinson M, Rini C, Scollon S, Slavotinek AM, Veenstra DL, Wasserstein MP, Wilfond BS, Hindorff LA, Plon SE, Jarvik GP, Jarvik GP. The Clinical Sequencing Evidence-Generating Research Consortium: Integrating Genomic Sequencing in Diverse and Medically Underserved Populations. Am J Hum Genet 2018; 103:319-327. [PMID: 30193136 DOI: 10.1016/j.ajhg.2018.08.007] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/15/2018] [Indexed: 01/26/2023] Open
Abstract
The Clinical Sequencing Evidence-Generating Research (CSER) consortium, now in its second funding cycle, is investigating the effectiveness of integrating genomic (exome or genome) sequencing into the clinical care of diverse and medically underserved individuals in a variety of healthcare settings and disease states. The consortium comprises a coordinating center, six funded extramural clinical projects, and an ongoing National Human Genome Research Institute (NHGRI) intramural project. Collectively, these projects aim to enroll and sequence over 6,100 participants in four years. At least 60% of participants will be of non-European ancestry or from underserved settings, with the goal of diversifying the populations that are providing an evidence base for genomic medicine. Five of the six clinical projects are enrolling pediatric patients with various phenotypes. One of these five projects is also enrolling couples whose fetus has a structural anomaly, and the sixth project is enrolling adults at risk for hereditary cancer. The ongoing NHGRI intramural project has enrolled primarily healthy adults. Goals of the consortium include assessing the clinical utility of genomic sequencing, exploring medical follow up and cascade testing of relatives, and evaluating patient-provider-laboratory level interactions that influence the use of this technology. The findings from the CSER consortium will offer patients, healthcare systems, and policymakers a clearer understanding of the opportunities and challenges of providing genomic medicine in diverse populations and settings, and contribute evidence toward developing best practices for the delivery of clinically useful and cost-effective genomic sequencing in diverse healthcare settings.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gail P Jarvik
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA 98195, USA; Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA.
| |
Collapse
|