Abstract
The recent Ebola and Zika virus epidemics in some parts of Africa and Asia have showcased the porosity in disaster preparedness and response, not only in the affected countries, but on a global scale. For the Ebola epidemic, scientifically robust research was started late during the course of the epidemic, with waste of resources and lost research opportunities. Research Ethics Committees have a significant role to play with regards to epidemic response for the future. This paper presents key challenges and opportunities for ethics review during emergencies, specifically for low and middle income countries. There is no better moment to test the efficacy and safety of drugs or vaccines for infected, or at risk populations than during the disaster itself. The main mantras that form the back bone of research ethics review (Helsinki Declaration, the CIOMS International Ethical Guidelines for Biomedical Research Involving Human Subjects, WHO and the ICH guidelines for Good Clinical Practice) are increasingly showing their limitations. Most protocols are generally from developed countries where the funding originates. Not only is the direct transposition to Low and Middle Income Country (LMIC) settings inappropriate on its own, also, using such guidelines in times of public health disasters might be time consuming, and might also lead to wastage of research opportunities, especially when sociocultural peculiarities, and anthropological research arms are completely excluded or avoided within the care and research packages. Governments should include RECs as key members during the elaboration, and daily functioning of their national public emergency response packages. Developing simple research ethics review guidelines, involvement of health care staff in ethics training, community mobilization, and incorporation of anthropological research during the medical response, research and communication phases, are imperatives in epidemic response.
Highlights
The recent Ebola and Zika virus epidemics in some parts of Africa and Asia have showcased the porosity in disaster preparedness and response, in the affected countries, but on a global scale [1, 2]
The response of the international community, especially the World Health Organization, humanitarian organizations like Medecins Sans Frontiers (Doctors Without Borders (MSF) and other research partners has been described as late and exemplified by huge collaboration and coordination loopholes. It took the WHO over 8 months to declare the Ebola epidemic as a global public health concern [2], and well scientifically robust clinical trials came into the scene at the end of the crisis
In the case of the recent Ebola epidemic, over nine clinical trials were carried out when the epidemic had almost disappeared
Summary
The recent Ebola and Zika virus epidemics in some parts of Africa and Asia have showcased the porosity in disaster preparedness and response, in the affected countries, but on a global scale [1, 2]. The response of the international community, especially the World Health Organization, humanitarian organizations like Medecins Sans Frontiers (Doctors Without Borders (MSF) and other research partners has been described as late and exemplified by huge collaboration and coordination loopholes It took the WHO over 8 months to declare the Ebola epidemic as a global public health concern [2], and well scientifically robust clinical trials came into the scene at the end of the crisis. Transdisciplinary research teams, though difficult to constitute and coordinate, remain useful in properly handling public health emergency responses, from acute case identification and management, to research and proper anthropological appraisal of specificities of the affected regions. How can LMICs be prepared to accelerate ethics review in public health emergencies while upholding high ethical standards, is the central question that we attempt to answer in this essay
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