Promoting health research governance in the Eastern Mediterranean Region

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Commentary

Arshad Altaf¹, Aamir Jafarey², Ahmed Mandil³ and Arash Rashidian¹

¹Science, Information and Dissemination Department, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (Correspondence to Arshad Altaf: This email address is being protected from spambots. You need JavaScript enabled to view it.). ²Centre for Biomedical Ethics and Culture, Sindh Institute of Urology and Transplantation, Karachi, Pakistan. ³Department of Epidemiology, High Institute of Public Health, University of Alexandria, Egypt.

Citation: Altaf A, Jafarey A, Mandil A, Rashidian A. Promoting health research governance in the Eastern Mediterranean Region. East Mediterr Health J. 2024;30(6):397–398. https://doi.org/10.26719/2024.30.6.397.

Copyright © Authors 2024; Licensee: World Health Organization. EMHJ is an open access journal. This paper is available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

The WHO Eastern Mediterranean Region (EMR) has 22 countries and territories with an estimated population of 700 million (1). The region faces health and humanitarian emergencies of unprecedented scale that include armed conflicts and devastating impact of climate change, which make more than 40% of the population to require humanitarian assistance (2). The EMR also comprises 64% of the world’s refugees (3).

The WHO Regional Office for the Eastern Mediterranean (WHO/EMRO) published 2 linked studies in 2022 (4), which reviewed and mapped existing health research and health research institutions, and conducted a bibliometric analysis of health research production in the 22 countries and territories in the region. Out of 575 institutions contacted, 223 (38.3%) responded, and 57% of the respondents reported providing research-related capacity-building. More than half of the institutions reported having an ethics board in the areas of medicine, public health, health systems, and allied health sciences. Lack of awareness among policymakers of the importance of research governance was reported as a key challenge in conducting sound research (4). Other challenges were limited external and internal funding for research, lack of a sustainable research grants management system and mismatch between funding opportunities and priorities (4).

Although all the EMR countries and territories reported conducting human subject research, none of them had national ethics guidelines for biomedical research. They probably relied, for guidance, on the standard international guidance documents such as the International Ethical Guidelines for Health-related Research Involving Humans by the Council for International Organizations of Medical Sciences (5), the World Medical Association (Declaration of Helsinki) Ethical Principles for Medical Research Involving Human Subjects (6), or the WHO Code of Conduct for Responsible Research (7). This lack of specific national ethics guidelines could cause disparities in ethics practices, and this is a significant concern.

Health research governance plays a pivotal role in ensuring that the best ethical practices are applied during biomedical research to safeguard the rights of research participants and ensure that the research output is of high quality and relevant to the community's needs. 

In a situation analysis of research ethics governance in Pakistan, Jafaery et al (8) reported that there was no accurate information regarding the existence of ethics review committees in Pakistan and no national registry or accreditation process. The analysis identified the need for national guidelines for ethics governance in Pakistan and recommended a process for accreditation of ethics review committees to ensure and maintain the integrity of the ethics governance structure. The analysis further recommended an assessment of ethics governance in other EMR countries to provide an authentic overview of the health research structures in the region (8).

Another aspect that requires urgent action in the EMR is increasing general awareness of bioethics, with emphasis on research and public health ethics. We cannot ensure human subject protection without raising awareness among researchers, policymakers and governance stakeholders of the rights of research participants. They need to know how to ensure the integrity of their research and research agenda and this is only possible through contextual education in various aspects of bioethics.

The EMR currently hosts 3 of the WHO bioethics collaborating centres: Centre for Biomedical Ethics and Culture at the Sindh Institute of Urology and Transplantation in Karachi, Pakistan; Medical Ethics and History of Medicine Research Centre at Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran; and Salim El-Hoss Bioethics and Professionalism Program at the American University of Beirut and Medical Centre, Beirut, Lebanon (9,10). Although each of these centres primarily offers educational opportunities in bioethics, there is a need to make such training opportunities available across the region to enhance bioethics education. 

References

1. World Health Organization. WHO's Eastern Mediterranean Region comprises 21 Member States and the Occupied Palestinian Territory (including East Jersalem), with a population of nearly 679 million people. Cairo: WHO Regional Office for the Eastern Mediterranean, n.d. https://www.emro.who.int/countries.html.
2. United Nations Office for the Coordination of Humanitarian Affairs. Global Humanitarian Overview 2022. Geneva: OCHA, 2022. https://2022.gho.unocha.org/.
3. Office of the United Nations High Commissioner for Refugees. Data and statistics global trends. Geneva: UNHCR, 2023. https://www.unhcr.org/global-trends#:~:text=The%20increase%20to%20117.3%20million,population%2C%20is%20now%20forcibly%20displaced.
4. World Health Organization. Health research in the Eastern Mediterranean Region: current status and challenges. Cairo: WHO Regional Office for the Eastern Mediterranean, 2022. https://applications.emro.who.int/docs/9789292740528-eng.pdf?ua=1.
5. Council for International Organizations of Medical Sciences. 2016 International ethical guidelines for health-related research involving humans. Geneva: CHIOMS, 2016. https://cioms.ch/working_groups/bioethics/.
6. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013;310(20):2191-2194. doi: 10.1001/jama.2013.281053.
7. World Health Organization. Code of conduct for responsible research. Geneva: World Health Organization, 2017. https://cdn.who.int/media/docs/default-source/wpro---documents/regional-committee/nomination-regional-director/code-of-conduct/ccrr.pdf?sfvrsn=b2cb450_2&ua=1.
8. Jafarey A, Shekhani S, Raza F, Naz S. Situation analysis of research ethics governance in Pakistan. East Mediterr Health J. 2023;29(7):500-507. doi: 10.26719/emhj.23.069.
9. Centre of Biomedical Ethics and Culture. Centre of Biomedical Ethics and Culture, Siut
10. Sindh Institute of Medical Sciences. Karachi. CBEC, n.d. https://siut.org/bioethics/.
11. American University of Beirut Medical Center. Salim El-Hoss Bioethics and Professionalism Program. Beirut: AUBMCACC, n.d. https://sites.aub.edu.lb/aubmcacc/services/shbpp/.