Ethics, pandemic and environment; looking at the future of low middle income countries

Tanveer, Faouzia; Khalil, Ali Talha; Ali, Muhammad

doi:10.1186/s12939-020-01296-z

Cited by 25 publications

(23 citation statements)

References 44 publications

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“…The WHO guidelines emphasises the importance of building public confidence and trust in the local capacity of research institutions to implement research quickly and efficiently 12 . In the new era of rapidly shared information on social media platforms, delays in trial approval could be interpreted as an unsafe trial, which may affect trial participation or vaccine and therapeutic drug uptake once approved 40,41 .…”

Section: Discussionmentioning

confidence: 99%

Pandemic preparedness and responsiveness of research review committees: lessons from review of COVID-19 protocols at KEMRI Wellcome Trust Research Programme in Kenya

et al. 2022

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Background: The scale of the COVID-19 pandemic and novelty of SARS-CoV-2 presented unprecedented challenges in the review of COVID-19 protocols. We investigated how research at the Kenya Medical Research Institute - Wellcome Trust Research Programme (KWTRP) was reviewed, including by institutional and national level committees. Methods: A document review and in-depth interviews with researchers, regulators and research reviewers were conducted. Documents reviewed included research logs of all protocols submitted between April-1-2020 and March-31-2021, feedback letters from review committees for 10 new COVID-19 protocols (n=42), and minutes from 35 COVID-19 research review meetings. Fifteen in-depth interviews were conducted with respondents purposively selected because of their experience of developing or reviewing COVID-19 protocols at the institution level (n=9 researchers, engagement officers and regulators) or their experience in reviewing proposals at a national-level (n=6 committee members). Data were managed and analyzed using MS Excel and NVivo12. Results: Between April-1-2020 and March-31-2021, 30 COVID-19-related submissions by KWTRP researchers were approved. Changes to the review system included strengthening the online system for protocol submission and review, recruiting more reviewers, and trialing a joint review process. The turnaround time from submission to national approval/rejection over this period was faster than pre-pandemic, but slower than the national committee’s target. COVID-19-specific ethics questions centred on: virtual informed consent and data collection; COVID-19 prevention, screening and testing procedures; and the challenges of study design and community engagement during the pandemic. Conclusions: The unprecedented challenges of the pandemic and added bureaucratic requirements created a more complex review process and delayed final approval of research protocols. The feasibility of conducting joint review of research during public health emergencies in Kenya needs further investigation. Consideration of the unique COVID-19 ethics issues raised in this paper might aid expedience in current and future reviews.

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Section: Discussionmentioning

confidence: 99%

Pandemic preparedness and responsiveness of research review committees: lessons from review of COVID-19 protocols at KEMRI Wellcome Trust Research Programme in Kenya

et al. 2022

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“…Health emergencies such as the COVID-19 pandemic emphasize the importance of clinical ethics which values the greater good of the whole society rather than individual demands and rights (24)(25)(26)(27). The COVID-19 pandemic has raised various ethical concerns, especially in the low to middleincome countries (LMICs).…”

Section: Discussionmentioning

confidence: 99%

Participatory Approach to Develop Evidence-Based Clinical Ethics Guidelines for the Care of COVID-19 Patients: A Mixed Method Study From Nepal

Bhattarai¹,

Adhikari²,

Rayamajhee³

et al. 2022

Front. Public Health

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During health emergencies such as the COVID-19 pandemic, healthcare workers face numerous ethical challenges while catering to the needs of patients in healthcare settings. Although the data recapitulating high-income countries ethics frameworks are available, the challenges faced by clinicians in resource-limited settings of low- and middle-income countries are not discussed widely due to a lack of baseline data or evidence. The Nepali healthcare system, which is chronically understaffed and underequipped, was severely affected by the COVID-19 pandemic in its capacity to manage health services and resources for needy patients, leading to ethical dilemmas and challenges during clinical practice. This study aimed to develop a standard guideline that would address syndemic ethical dilemmas during clinical care of COVID-19 patients who are unable to afford standard-of-care. A mixed method study was conducted between February and June of 2021 in 12 government designated COVID-19 treatment hospitals in central Nepal. The draft guideline was discussed among the key stakeholders in the pandemic response in Nepal. The major ethical dilemmas confronted by the study participants (50 healthcare professionals providing patient care at COVID-19 treatment hospitals) could be grouped into five major pillars of ethical clinical practice: rational allocation of medical resources, updated treatment protocols that guide clinical decisions, standard-of-care regardless of patient's economic status, effective communication among stakeholders for prompt patient care, and external factors such as political and bureaucratic interference affecting ethical practice. This living clinical ethics guideline, which has been developed based on the local evidence and case stories of frontline responders, is expected to inform the policymakers as well as the decision-makers positioned at the concerned government units. These ethics guidelines could be endorsed with revisions by the concerned regulatory authorities for the use during consequent waves of COVID-19 and other epidemics that may occur in the future. Other countries affected by the pandemic could conduct similar studies to explore ethical practices in the local clinical and public health context.

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“…In the current crisis, sharing of scientific knowledge and technology has an important role to play. In addition, emergency preparedness is a shared responsibility of all countries with a moral obligation to support each other [3]. The ongoing pandemic has led to a situation in which the scale of emergency is similar to WW-II, requiring decisiveness and commitment.…”

Section: The Sars-cov-2 Infection and Covid-19 Pandemicmentioning

confidence: 99%

"Compromised Health and Constrained Human Life in COVID-19 Pandemic, and Concurrent Healthcare Transformation"

Nikhra

2021

BJSTR

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Ethics, pandemic and environment; looking at the future of low middle income countries

Cited by 25 publications

References 44 publications

Pandemic preparedness and responsiveness of research review committees: lessons from review of COVID-19 protocols at KEMRI Wellcome Trust Research Programme in Kenya

Pandemic preparedness and responsiveness of research review committees: lessons from review of COVID-19 protocols at KEMRI Wellcome Trust Research Programme in Kenya

Participatory Approach to Develop Evidence-Based Clinical Ethics Guidelines for the Care of COVID-19 Patients: A Mixed Method Study From Nepal

"Compromised Health and Constrained Human Life in COVID-19 Pandemic, and Concurrent Healthcare Transformation"

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