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Despite the tremendous improvement that has been made in the past decade on funding research into diseases that are highly prevalent in developing countries, there remains a lot to be done. Currently less than 10% of the world’s biomedical research is dedicated to medical problems that account for 90% of the global burden of disease1–3. Several initiatives have began to tackle these problems but they have had varying degrees of success4, 5. These initiatives include the Roll Back Malaria project (RBM), President’s Emergency Plan for AIDS Relief (PEPFAR), Global Fund to fight AIDS, Tuberculosis and Malaria and the William J. Clinton Presidential Foundation. The focus and funding on research and services for diseases like HIV/AIDS and malaria that are highly prevalent in developing countries has therefore increased tremendously. For example, the UNAIDS reports that while there was about US$330 million available for HIV/AIDS initiative in 1996, this has grown to $4.7 billion in 2003, even though some of these programs have fallen short of their funding goals4. In addition to funding shortfall, programs have also been beset with problems associated with limited personnel and health care infrastructure in developing countries with which to meet stated goals. Historical weaknesses in the health care system of developing countries have contributed to bottlenecks in distribution and utilization of funds6. While limitations in clinical and laboratory practices have received significant attention6, the impact of limited bioethics expertise is no less significant.
In the past few years also, several well developed and carefully implemented programs have ran aground on account of ethical problems that were either not foreseen or were not handled with the requisite skills and sensitivity when they occurred7–10. Programs are threatened as much by ethical problems at the program preparation and implementation level as by program delivery and access. In the Tenofovir trials in Thailand, it has been argued that lack of communication between activists, participants and researchers, inadequate involvement of stakeholders in decision making and trial planning, and lack of preventative diplomacy were factors that led to the crisis7. In Nigeria, the Tenofovir ran aground for different but arguably ethical reasons7. Other ethical problems abound within the context of other research programs in health and biotechnology in developing countries. These problems illustrate the need for bioethics services, research and training and it is increasingly realized that a sound bioethics component is necessary in research proposals much the same way as statistical analysis sections are now required. Therefore a rapid up-scaling of available bioethics expertise is urgently needed to meet both current and projected needs. These needs are likely to be tremendous given the current state of affairs and the rapid development and deployment of new biotechnologies.
Another trend in global health is the exportation of clinical trials to developing countries. Often these involve trials of therapies for conditions that rate lower on the health burden of the nation where the studies are conducted and involve exploitation of weak regulatory environments and lower costs. These practices have generated many papers, reports and regulations from developed countries but the little that has been heard from ethicists in developing countries are often negative and critical11–16. Yet there is little doubt that these studies will continue to be conducted for much the same reason that manufacturing is outsourced to several developing countries. It is therefore important to increase the pool of bioethicists that can respond to the challenge of developing appropriate ethical guidelines, monitor and advise on the implementation of the projects17.
It is also recognized that the myriad of health and social problems as well as the growing influx of research dollars notwithstanding, programs to effectively protect research participants in Africa are either nonexistent in many areas or are weak and nonfunctional in others18. Most research publications from African biomedical researchers are self financed and are often not submitted for IRB evaluations (personal observation). This is particularly common in the clinical and laboratory sciences where protocols are often not written out for peer review and research proceeds as catch as catch can. The incidence of research ethics violation at this level is likely to be more widespread than 33% prevalence of at least one serious misdemeanor in the 3 years preceding that was described in a recent study of NIH funded researchers19, where despite the risk and potential for serious career and financial jeopardy, ethics violations were still rather common. It was suggested that these widespread mundane “regular” abuses are more damaging to science on the long run than the big ethics scandals19. The report concludes that efforts to foster integrity among scientists should go beyond teaching about falsification, fabrication and plagiarism to consideration of methods of fostering an ethical scientific working environment19.
Because of the “Out of Africa” theory of human evolution20, Africa holds particular interest for genetic studies and the creation of databases for the study of population history and gene-disease association. This has encouraged genetic epidemiological studies of many African populations21–24 yet such studies have raised significant ethical questions particularly about ability of the participants to understand consent documents related to such sophisticated studies, risk of exploitation and relevance of such studies to the health burden of the population within the context of diseases of poverty, infections and lack of healthcare infrastructure25. Yet given the promise of pharmacogenomics26, these studies are likely to increase in the future. In addition, pharmacogenomics, nanotechnology and other emerging technologies do hold a promise of improving public health in developing countries26–30. The role of public education in enlightening and reducing ethical conflicts in the implementation of these new technologies has been highlighted31.
Given this background and the various guidelines and protocols on ethical conduct of research, it is clear that even if there is the will to provide and fully equip IRBs in West Africa, it is doubtful that they alone will be able to fulfill the mission of improving the ethical standard of research in West Africa32. A multi pronged approach is therefore necessary. Efforts to train and develop IRBs in West Africa must be complemented with efforts that train biomedical researchers in ethical conduct of research and create ethical working environments for scientists.
It is this realization that motivates the mission of the West African Bioethics Training Program. West Africa with a population of about 300 million is the largest subregion in Africa. Its unique characteristics including association with slave trade, hence it is the population of origin of the world’s largest recent Diaspora. It also boasts triple religious heritage of Islam, Christianity and Animism; its colonial history also left it with a triple heritage (English, French and Indigenous languages), of languages, culture, administration, philosophy and social norms that present a rich source of ethical reflection and interpretation. A training program in research ethics in this environment can therefore take advantage of these attributes to train biomedical researchers in ethical reflection, contribute to global ethics discourse and research the impact of and the varieties of ethical traditions and interpretations in this subregion. Among the expected impact of this training program is an increase in the contribution of researchers from developing countries to the global discourse on Bioethics. This is currently low and has not shown a significant upward trend in the past decade33, though this is not peculiar to bioethics34.
We have therefore designed our program in a way that allows joint participation by bioethics experts and researchers throughout West Africa in the training and conducting research into Bioethics in the subregion. We believe that this approach will help students identify relevant bioethics issues for research while helping the subregional bioethicists to enhance their research endeavors with the ultimate aim of contributing to the literature. Global bioethics discourse will benefit from the contributions of developing countries bioethicists, particularly females, Muslims and animists from the third world.
The West African Bioethics Training Program (WAB) was set up with funds received from the Fogarty International Center of the US NIH in 2004. Since then the WAB has been able to lay the foundation for the establishment of graduate programs in Bioethics at the University of Ibadan by developing a curriculum for Masters’ Degree in Bioethics. The WAB has also conducted short term training in Bioethics for over 1000 medical, dental and nursing students, postgraduate students, medical laboratory scientists, biomedical researchers and members of faculties of several medical schools in Nigeria. Presentations and public lectures by members of faculty of WAB have also been used to increase awareness of bioethics in general and the programs of the WAB in particular. These have been achieved through the annual meetings of the West African Postgraduate Colleges, Global Forum on Bioethics, Premières Journées de Bioéthique pour l’Afrique de l’Ouest et du Centre among others. These meetings have also been useful in identifying collaborators and potential mentors for trainees in the West African subregion.
The WAB has collaborated with other Fogarty training programs in identifying candidates for their training programs from Nigeria and other West African countries. We have also begun the preliminary investment in information technology (See http://www.westafricanbioethics.net/new/eng?pg=home) We intend to use this web presence to offer online training in Bioethics and Informed Consent (Already we have partnered with the Collaborative IRB Training Initiative (CITI) founded in March 2000 as a collaboration between the University of Miami and the Fred Hutchinson Cancer Research Center to provide their training programs to Universities in Nigeria). We are sure that these efforts will contribute substantially to the growth of bioethics in West Africa in the nearest future.
Conflict of Interest: None