Refocusing research ethics paradigms post Ebola: a narrative synthesis

• Main Authors: Nicola Gailits, Elysée Nouvet
• Format: Article
• Language: English
• Published: Elsevier 2018-03-01
• Series: The Lancet Global Health
• Online Access: http://www.sciencedirect.com/science/article/pii/S2214109X18301487

Background: The 2014–15 west Africa Ebola outbreak presented a number of ethical challenges in terms of conducting research while managing the outbreak. As Ebola virus disease (EVD) rapidly spread throughout west African countries, intense bioethical debate centred around the ethics of using experimental treatments and how best to allocate these resources. We aimed to identify further ethical and practical challenges. Methods: We did a narrative synthesis of scholarly literature emerging from research conducted during the west Africa Ebola 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 ethical 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 ethics and Ebola 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 ethics needs to prioritise building trustworthy systems that embody solidarity and global justice. Funding: R2HC: an ELRHA (Wellcome Trust/DFID/Save the Children) programme.