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.
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.
Timely public health action depends on the prompt beginning of high-quality epidemic research. However, traditional ethics review schedules, which are often measured in weeks, might delay the initiation of a study and diminish the impact of an intervention. The recent Uganda Ebola Sudan outbreak exemplifies how accelerated review is feasible. The World Health Organization (WHO) reported that Uganda’s vaccine trial began ‘with record speed, only 3 days since the outbreak was declared, while ensuring full compliance with international and national regulatory and ethical requirements’.
Accelerated ethical review during outbreaks is critical for timely research when data are most relevant. Fast-tracking approvals enable rapid development of diagnostics, treatments, and vaccines, and supports real-time epidemiological studies that inform policy and containment strategies. It minimises bureaucratic delays, prevents duplication, and ensures evidence-based resource allocation, particularly in low-resource settings. Harmonised ethical standards also foster international collaboration. While essential, expedited review must balance speed with scientific, ethical, regulatory, and operational rigour.
A key enabler of rapid response has been proactive preparedness. In Uganda’s case, thousands of vaccine doses and trial protocols were pre-positioned in advance of the outbreak, allowing immediate trial activation.
In Uganda, Rwanda, and Sierra Leone, expedited procedures and pre-existing infrastructure allowed for quick ethics clearance during outbreaks.
During its 2024 outbreak, Rwanda initiated exploratory Marburg vaccine trials, and the ethics committee quickly approved Phase 2 procedures.
In 2024, Africa CDC declared its first Public Health Emergency of Continental Security (PHECS) in response to a surge in mpox cases across 20 Member States, highlighting the urgent need for coordinated and intensified response efforts.
Ethical approval submission date and approval processes timeline in nine countries involved in the Africa centres for disease control and prevention mpox socio-behavioural study in Africa.
| № | Country | Research Ethical Committee (REC) authority & process | Payment required | Submission date | Second submission date | Approval date | Duration from submission to approval (days) | Remarks |
|---|---|---|---|---|---|---|---|---|
| 1 | DRC | Institute of Public Health (INSP); ethical approval followed by INSP registration | Yes | 15 September 2024 | Not applicable | 25 October 2024 | 40 | Approval and registration required payment |
| 2 | Congo | National ethics authority | Yes | 24 October 2024 | Not applicable | 14 November 2024 | 21 | Standard ethical review process |
| 3 | Kenya | National ethics committee | Yes | 04 December 2024 | Not applicable | 30 January 2025 | 57 | Separate research permit required |
| 4 | Rwanda | Rwanda National Ethics Committee (RNEC) | Yes | 27 November 2024 | 25 January 2025 | 11 February 2025 | 76 | Initial feedback within 2 weeks; presentation held 07 December 2024 |
| 5 | Burundi | National ethics committee | Yes | 19 January 2025 | Not applicable | 14 February 2025 | 26 | Study could not commence until statistical visa obtained |
| 6 | Uganda | MUREC → Uganda Council of Science and Technology (UCST) | Yes | 09 January 2025 | 17 February 2025 | 25 February 2025 | 47 | UCST provides final approval; PI creates online account |
| 7 | Nigeria | National Health Research Ethics Committee (NHREC) | No | 27 January 2025 | Not applicable | 28 February 2025 | 32 | Initial email unacknowledged; expedited approval later confirmed |
| 8 | Côte d’Ivoire | National ethics committee | Yes | 28 February 2025 | Not applicable | 04 April 2025 | 35 | Standard review process |
| 9 | Central African Republic (CAR) | National ethics committee | Yes | 18 February 2025 | Not applicable | 14 April 2025 | 55 | Verbal consent allowed training of field team before approval |
| 10 | Sierra Leone | National ethics committee | Yes | 09 June 2025 | Not applicable | 03 July 2025 | 24 | Review on expedited basis |
PI, Principal investigator; MUREC, Makerere University Research Ethics Committee; DRC, Democratic Republic of the Congo; CDC, Centres for Disease Control and Prevention.
This article followed all ethical standards for research without direct contact with human or animal subjects.
Within a month of IMST’s inauguration, a master protocol and 10 country-specific protocols were finalised, led by Africa CDC’s Directorate of Science and Innovation in collaboration with national public health institutes and academic experts. The approval processes took from 3 weeks – 11 weeks, with most countries completing review within 4 weeks – 8 weeks. The experiences of the countries involved are summarised in
Several countries required multiple layers of approval, further extending timelines. For example, in Uganda, approval involved both Makerere University Research Ethics Committee (MUREC) and the Uganda Council of Science and Technology (UCST), while in the DRC, ethical approval had to be followed by registration with the Institute of Public Health. Rwanda required a second submission and an in-person presentation, although it demonstrated relatively strong procedural efficiency by providing initial feedback within 2 weeks. At the time of writing, most participating countries have successfully completed data collection for the multicountry mpox socio-behavioural study coordinated by the Africa CDC. Despite variations in ethical approval timelines and procedural requirements across countries, all study activities were conducted in full compliance with national and institutional ethical standards. Importantly, there were no reported ethical compromises throughout the implementation of the study. Quick adaptation to the outbreak scenario while maintaining ethical standards was made possible by pre-approved adaptive protocols.
The absence of harmonised standards, clear expedited pathways, and coordinated multicountry review mechanisms contributes to delays that could undermine timely evidence generation during outbreaks. This underscores the need for further streamlining of the ethical review process during emergencies and for efficiency improvements.
The experience of non-uniform submission and delay in receiving ethical approval during public health emergencies poses unique ethical dilemmas that require urgent attention and a robust ethical review framework that minimises delays while ethical standards are not compromised. Ethical frameworks must be adaptive to address emergent issues effectively, yet the current literature reveals a significant gap in understanding the ethics review processes specific to African contexts during public health emergencies. Obtaining ethical approval for multicountry studies during emergencies in Africa remains a major challenge.
Several challenges have been raised regarding delayed approval processes. High workloads and inadequate compensation discourage member participation, ultimately affecting the quality of ethical reviews. Many research ethical committee (REC) members report difficulties, including insufficient administrative support, limited knowledge of research ethics, and a lack of resources to adequately review complex research proposals, particularly those involving coronavirus disease 2019 (COVID-19) studies.
This brief report focuses on a single multicountry mpox research initiative coordinated by the Africa CDC, which can be a limitation. While this provides valuable real-world insights, the findings may not be fully generalisable to other disease contexts, regions, or types of studies, particularly those with different regulatory or operational complexities. Descriptive synthesis was used in this report with no comparative or statistical methods. Therefore, no inferential conclusions can be drawn from the findings.
Development of national SOPs for emergency ethics reviews has been recommended as a way forward to address these issues.
The establishment of a Continental Health Research Ethics Committee (CH-REC) in Africa has emerged as a pivotal response to the unique ethical challenges faced by the continent in research practices. An Africa-centric framework for ethical research practices that ensures optimal protection of participants in complex and diverse cultural and socioeconomic settings of Africa has been proposed.
Getting ethical approval for multicountry studies during public health emergencies in Africa has been a major challenge. As the global research landscape continues to evolve, particularly in the wake of public health emergencies such as the COVID-19 pandemic and the mpox pandemic. Experiences from Africa CDC’s multicountry mpox research can be used as a reference when conducting research during outbreaks, and it underscores the need for further streamlining of the ethical review process during emergencies. As Africa strives to enhance its research capabilities and collaborate with international partners, the establishment of a CH-REC represents a significant step towards ensuring ethical integrity and promoting equitable research practices that reflect the continent’s unique values and needs.
The authors acknowledge the contributions of the national public health institutes, ethics review committees, country research teams and field data collectors across the participating countries for their support in facilitating the multicountry mpox socio-behavioural study. The authors also acknowledge the support of the Africa CDC Incident Management Support Team (IMST), the Research and Innovation Pillar, and collaborating academic and technical partners who contributed to protocol development, coordination and implementation of the study activities.
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article. Nebiyu Dereje is the Editor-in-Chief, Olayinka S. Ilesanmi, Yap Boum and Ngashi Ngongo are members of the editorial board of the
Mosoka P. Fallah: Conceptualisation, Investigation, Methodology, Project administration, Supervision, Writing – review & editing. Olayinka S. Ilesanmi: Conceptualisation, Data curation, Formal analysis, Investigation, Methodology, Supervision, Writing – original draft, Writing – review & editing. Nebiyu Dereje: Conceptualisation, Investigation, Methodology, Writing – original draft, Writing – review & editing. Oluwatoyosi Olawande: Conceptualisation, Data curation, Methodology, Project administration, Supervision, Writing – original draft, Writing – review & editing. Elvis TemFack: Conceptualisation, Data curation, Visualisation, Writing – original draft, Writing – review & editing. Tamrat Shaweno: Conceptualisation, Data curation, Methodology, Project administration, Supervision, Writing – original draft, Writing – review & editing. Abigael A. Mesfin: Conceptualisation, Data curation, Formal analysis, Investigation, Supervision, Writing – original draft, Writing – review & editing. Cathy A. Tabaro: Conceptualisation, Data curation, Formal analysis, Visualisation, Writing – original draft, Writing – review & editing. Shahd O.S. Osman: Conceptualisation, Data curation, Formal analysis, Writing – original draft, Writing – review & editing. Yap Boum: Conceptualisation, Data curation, Formal analysis, Methodology, Project administration, Supervision, Writing – original draft, Writing – review & editing. Raji Tajudeen: Conceptualisation, Data curation, Funding acquisition, Project administration, Supervision, Writing – review & editing. Ngashi Ngongo: Conceptualisation, Funding acquisition, Investigation, Methodology, Supervision, Writing – review & editing. Jean Kaseya: Conceptualisation, Funding acquisition, Methodology, Project administration, Supervision, Writing – review & editing. All authors reviewed the article, contributed to the discussion of results, approved the final version for submission and publication, and take responsibility for the integrity of its findings.
Data sharing is not applicable to this article, as no new data were created or analysed in this study.
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