More and more research funded by high-income countries (HICs, e.g. the US) is taking place in low- and middle-income countries (LMICs). For example, colleagues at my institution have received grants of over $64 million to do research in Ghana. A search of ClinicalTrials.gov shows that 20 of 29 open studies in Ghana involve women, children, and persons with HIV—all considered vulnerable populations. The obvious concern is how to protect human subjects of research from exploitation. For example, the pregnant woman with HIV who is approached by a US-funded researcher who offers to pay for all her prenatal care if she agrees to be randomized into a trial. How can she best be protected from coercion?
Therefore, HICs are now taking the responsibility of exporting research ethics to LMICs. The question then comes up: Whose ethics? A cynical view is to look at the effort to teach research ethics in LMICs as a form of missionary work: to proselytize those who haven’t heard the good news of the Georgetown mantra and to help them build research ethics committees that can function like a Western IRB. Certainly many of these countries have been colonized by Western countries and have seen missionary work in their borders. Is this just adding insult to injury as rich countries continue another form of imperialism in South America, Africa, the Middle East and Asian sub-continent? Many authors think so, or at least warn against this approach.
But even if we all agree that exporting a Western IRB framework is the ideal, implementation still has a long way to go. A recent survey of research ethics committees in LMICs (that will be published next month in the Journal of Medical Ethics) showed that only 40% of these committees had a budget and only 50% included women on the committee—certainly a few stumbling blocks to effective research regulation.
An ideal model would be to facilitate the articulation of ethical guidelines for research in LMICs that are based on local interpretations of the concept of respect for human dignity. What that looks like and how to sustain protections of human subjects of research in LMICs is still a work in progress.