A scoping review of the landscape of ethics review processes during public health emergencies in sub-Saharan Africa

Abstract

Abstract Background: The COVID-19 pandemic forced governments, multilateral public health organisations and (academic) research institutions to undertake research quickly to inform their responses to the pandemic. Most COVID-19-related studies required swift ethical approval, creating ethical and practical challenges for both regulatory authorities and researchers. In this paper, we look at the landscape of ethics review processes in Africa during the public health emergencies (PHEs). Methods: We searched four electronic databases (Web of Science, PUBMED, MEDLINE Complete, and CINAHL) to identify articles describing ethics review processes during public health emergencies and/or pandemics. We reviewed the retrieved articles, excluding articles that were not focused on Africa. We charted the data from the retrieved articles including the authors and year of publication, title, country and disease(s) reference, broad areas of (ethical) consideration, paper type, and approach. Results: Of an initial 4536 entries, we screened the titles and abstracts of 1491 articles, and identified 72 articles for full review. Nine articles were selected for inclusion. Of these nine articles, five referenced West African countries such as Liberia, Guinea and Sierra Leone and experiences linked to the Ebola virus disease. Two articles were centred on South Africa and Kenya, while the other two articles referenced Africa within more general discussions on experiences and pitfalls of ethics review during PHEs. We found that very few articles captured, or reported on, ethics review processes in Africa (including before the emergence of COVID-19). Guidelines on protocol review and approval processes for PHE were more frequently discussed after the 2014 Ebola outbreak, but these did not focus on Africa specifically. Conclusions: There is a gap in the literature about ethics review processes and preparedness within Africa during PHEs. This paper underscores the importance of these processes to inform practices that facilitate timely, context-relevant research that adequately recognises and reinforces human dignity within the quest to advance scientific knowledge about diseases.