Refocusing research ethics paradigms post Ebola: a narrative synthesis

Abstract

Abstract Background The 2014–15 west Africa outbreak presented a number of challenges in terms of conducting research while managing the outbreak. As virus disease (EVD) rapidly spread throughout west African countries, intense bioethical debate centred around the of using experimental treatments and how best to allocate these resources. We aimed to identify further and practical challenges. Methods We did a narrative synthesis of scholarly literature emerging from research conducted during the west Africa outbreak. Articles from Jan 1, 2014, to Jan 1, 2017, were retrieved via MeSH and keyword searches of five indexes (Embase, JSTOR, PubMed, Philosopher's Index, and CINAHL). Keywords included Ebola with trial or trials or ethics or ethical or study or studies. An initial 2062 articles were reduced to 427 articles after title and abstract screening. After full text screening, 145 articles were uploaded to Nvivo 11 for coding. Eligible articles were analysed inductively and deductively using a team-centred codebook and discussion. Findings Alongside the central dilemmas that emerged from bioethicist commentaries, a separate discussion could be heard: authors argued that the intense focus on short-term, individual bioethical dilemmas during the EVD outbreak detracted from big-picture inequalities: lack of health system and health capacity in Ebola-affected countries. These authors insisted on the moral imperative to rebalance unequal transnational power relations when doing research in the global South. More needed to be done to prevent exploitative research, differing standards of care, and false notions of minimal expertise in African researchers. They also highlighted the need to acknowledge the root historical and political causes of Ebola, such as neoliberal economic policies imposed on west African health infrastructure. In short, it was felt that to talk about and without focusing on structural inequalities and neocolonial policies at the root of this public health disaster would be unethical. Interpretation During an outbreak of incredible proportion, the need to debate short-term, individual-focused bioethical dilemmas must be balanced with a long-term focus at the community and health-system level. Debates in global bioethics have a responsibility to keep uppermost in their analyses local bioethical paradigms and incorporate an understanding of global economic consequences on health infrastructure and trust building. To move forward, global health needs to prioritise building trustworthy systems that embody solidarity and global justice. Funding R2HC: an ELRHA (Wellcome Trust/DFID/Save the Children) programme.