Ethical approval processes for research during public health emergencies in Africa: Experiences from a multicountry mpox study

Abstract

Timely initiation of outbreak research is essential for timely public health action. Yet conventional ethics review timelines, often measured in weeks, can delay study start-up and blunt the impact of interventions. During epidemics, routine review timelines of 2 weeks – 9 weeks delay research and weaken public health responses. Fast-tracking ethical review allows researchers to initiate studies at the height of an outbreak, when data are most relevant and informative. A spike in mpox cases across 20 Member States in 2024 prompted the Africa Centres for Disease Control and Prevention (Africa CDC) to declare its first Public Health Emergency of Continental Security. To expedite therapeutic trials, develop supporting policies, and mobilise resources for research and response, the Africa CDC and the World Health Organization (WHO) developed the Research and Innovation pillar within the Continental Incident Management Support Team (IMST). Among key research initiatives was a multicountry social and behavioural study led by Africa CDC. This article includes a synthesis based on implementation experiences from a multicountry mpox socio-behavioural study coordinated by the Africa CDC across 10 African countries. Within a month of IMST’s inauguration, a master protocol and 10 country-specific protocols were finalised, led by Africa CDC in collaboration with national public health institutes and academic experts. Approval processes took 3 weeks – 11 weeks, with most countries completing review within 4 weeks – 8 weeks. This underscores the need to further streamline the ethical review process during emergencies and to improve efficiency.
Contribution: As the global research landscape continues to evolve, there is an urgent need for a unified continental ethical oversight framework to address the historical delays caused by multiple and overlapping requirements.