Ethical review of research in Africa: sobering reading

There have been a number of initiatives in the past to -- as the jargon goes -- strengthen capacity in the ethical review of research in Africa. This blog is sponsored by one such initiative by the Fogarty International Center. A recent article in BMC Medical Ethics by Kirigia et. al. ('Status of national research bioethics committees in the WHO African region') shows that there is still a long way to go. The study arose from a suspicion, expressed by WHO's Regional Committee for Africa back in 2001, that some health-related studies in the region were not subjected to ethical review at all. If The Constant Gardener is anything to go by, the suspicion is alive and well.

One of the startling features of the Kirigia study is the terrible response rate: the researchers sent a questionaire concerning the existence and nature of ethical research committees to 46 countries, and only 28 bothered to reply. Of those that bothered, only 64% confirmed the existence of an ethical review committee, while at the same time 85% acknowledged that reviewing scientific research involving human subjects is, um, required. Which means that 15% of the respondent countries did not think that ethical review of protocols was necessary at all, though fortunately Kirigia et. al. had the wisdom not to disclose the names of those countries to the pharmaceutical world.

Let's look on the bright side. The study focuses on the existence of national research ethics committees, and seemed to consider regional or local review as something less than the real thing. But this can't be right. The DR Congo is noted as having a national research ethics committee, but this hardly inspires confidence, because few know whether the committee actually reviews protocols (or its inner workings in general). And Malawi is recorded as not having a research ethics committee, but the College of Medicine in Blantyre has a very capable ethics review board.

While I'm at it, I should mention the existence of a new, European initiative to reinforce the ethical review of research in Africa. The European and Developing Countries Clinical Trials Partnership (or EDCTP) is a European Union project to support biomedical research on neglected diseases in Africa, and part of the funding goes to the strengthening of ethics review in the countries of interest. They have put out calls for proposals, so African bioethicists and research institutions -- particularly those with European partners -- should take note.