WHO guidance, issued in 2016 on managing ethical issues in infectious disease outbreaks, provides detailed advice on the rights and obligations of front-line response workers, which could be applied by analogy also to front-line research workers. Given the risks that front-line workers may run in order to meet the expectations placed upon them, it is suggested that governments and others owe them reciprocal obligations to:
- minimise the risk of possible infection, through the provision of appropriate training, tools and resources;
- provide access to the ‘highest level of care reasonably available’ should staff or their immediate family members become ill (including consideration of priority access to vaccines and other treatments as they become available);
- ensure fair remuneration, including financial support during illness associated with their role;
- provide support for reintegration, recognising the risks of stigmatisation and discrimination that may be associated with their role (which governments should also make efforts to reduce); and
- give assistance to family members, where this is necessary because of the nature of the front-line staff member’s role.
Where such front-line workers are deployed from abroad, the guidance further emphasises the responsibilities of the foreign governments and humanitarian aid organisations responsible for their deployment. These include: clarity about the terms and conditions of their deployment, including what healthcare will be available if they fall ill; action to ensure their security and safety; and provision of necessary training and resources.
In the context of a wider range of humanitarian crises, including natural and manmade disasters, guidance issued by the UN’s Inter-Agency Standing Committee on the conduct of ethical mental health and psychosocial research in such settings similarly emphasises the potential safety risks to researchers, including the presence of armed actors, unpredictable events and engaging with communities that have been displaced. The IASC emphasises the importance of “having safeguards, security measures and exit strategies” as part of ethical research practice; and the associated need for coordinating closely with agencies managing the emergency response, monitoring and responding to changing security contexts.
While the WHO and others clearly spell out responsibilities of both governments and employing organisations to those working on the front-line, in practice, direct lines of accountability may be less than clear, particularly where research activity crosses organisational boundaries and involves complex collaborations (see also section 7). Thus, the responsibilities of those with ‘hidden power’, such as those funding research, and the home research institutions of expatriate principal investigators, may be less well recognised than those with direct employment and line management relationships with front-line staff. However, in practice the decisions and priorities of such organisations may have a strong bearing on what happens on the ground.
There also remain a number of ethically-challenging issues with respect to the role of front-line workers, on which there is as yet little consensus. These include:
- How to determine the appropriate level of healthcare, where this is required. If expatriate staff have access to the best available care (including standards of care that cannot feasibly be provided more widely) on the basis that their work is exposing them to dangers that they would otherwise not face, does this justification also apply to local staff? Wherever distinctions are drawn (for example, between front-line staff and local populations, between expatriate and local workers, or between expatriate staff from different continents) difficult questions of fairness arise.
- The availability of timely ethics training, support and advice for those on the front line of research: recognising that ethical challenges are not simply ‘dealt with’ at the ethical review stage, but may emerge at any point during the study.
Finally, those working on the front-line of research do themselves owe obligations consistent with their role, both to research participants and to the wider community. As noted earlier, WHO advises that these obligations include participating in public health efforts through appropriate data sharing, and promoting responsible communication with local communities. These responsibilities highlight the role of character, virtue and personal conduct, for example in how individuals interpret these responsibilities, and in how they handle difficult situations that may not be clearly envisaged by guidelines or in the ethical review process. These concerns arise in reverse in the context of the risks of abusive behaviour by those on the front line.
 WHO (2016) Guidance for managing ethical issues in infectious disease outbreaks, available at: http://apps.who.int/iris/bitstream/10665/250580/1/9789241549837-eng.pdf, pp43-6.
 Such support may be regarded as a necessary component of any duty to run personal risks as a healthcare professional in such cases: see, for example, Kpanake L, Tonguino TK, Sorum PC et al. (2018) Duty to provide care to Ebola patients: the perspectives of Guinean lay people and healthcare providers Journal of Medical Ethics: published first online: 21 May.
 WHO (2016) Guidance for managing ethical issues in infectious disease outbreaks, available at: http://apps.who.int/iris/bitstream/10665/250580/1/9789241549837-eng.pdf, pp47-9.
 IASC (2014) Recommendations for conducting ethical mental health and psychosocial research in emergency settings, available at: https://interagencystandingcommittee.org/system/files/1._iasc_recommendations_for_ethical_mhpss_research_in_emergency_settings_0.pdf, at page 44.
 See, for example, the discussion in Draper H, and Jenkins S (2017) Ethical challenges experienced by UK military medical personnel deployed to Sierra Leone (operation GRITROCK) during the 2014-2015 Ebola outbreak: a qualitative study BMC Medical Ethics 18(77).
 See, for example, Arie S (2018) Global medical aid charities and allegations of sexual misconduct and crime BMJ 361; CONCORD (9 May 2018) Safeguards against sexual exploitation and abuse in development and humanitarian action – European NGOs action points, available at: https://concordeurope.org/2018/05/09/safeguarding-development-seamus-jeffreson/.
- Call for evidence
- Response form and questions
- 1. What constitutes a global health emergency?
- 2. Undertaking research in a global health emergency: whose voices should be heard?
- 3. Study design and review
- 4. Making decisions about participation in research
- 5. Duties at the interface of research, treatment, and public health
- 7. What are the challenges of effective collaboration in global health emergencies?
- 8. Other issues / considerations