Ethics guidance on issues raised by the novel coronavirus disease (COVID-19) pandemic

What this guideline says

GMJ summary

This PAHO guidance, developed by the Regional Program on Bioethics, addresses ethical issues in public health surveillance, research and communication during the COVID-19 pandemic. It distinguishes public health surveillance (which does not require informed consent but must protect privacy) from research (which requires ethics review and informed consent). The document emphasises that emergencies demand higher, not lower, ethical safeguards.

Key ethical principles include equity (ensuring disadvantaged populations are not disproportionately burdened), transparency (honest communication about uncertainty and priority-setting criteria), solidarity (rapid data sharing across borders), and responsibility (building capacity for future emergencies). Health authorities must provide accurate, comprehensible information to the public, explain uncertainty honestly, and justify resource allocation decisions publicly when systems are overwhelmed.

For research, the guidance requires rigorous but fast-tracked ethics review, informed consent (with exceptions only when unfeasible and risks are minimal), broad consent for future sample use, and immediate open-access sharing of results. Community consultation before research initiation is strongly encouraged to build trust and ensure studies address local needs.

Key points

For clinicians — doses and thresholds as stated in the guideline

1. Public health surveillance during COVID-19 does not require informed consent but must safeguard privacy, maintain confidentiality, collect data respectfully, and provide transparent information about data collection purposes
2. All human subjects research during emergencies requires prior ethics review committee approval; ethics review must be fast-tracked but rigorous, not relaxed
3. Informed consent is required for all emergency research unless ethics committees waive it when: (a) obtaining consent is not feasible, (b) studies have important social value, and (c) studies pose only minimal risks
4. Broad consent for future research use of samples and data should be strongly encouraged to facilitate pandemic research; future studies using these samples still require ethics approval
5. When health systems are overwhelmed and cannot provide care to all (e.g. ventilators, ICU beds), health authorities have an ethical obligation to provide public justification of priority-setting criteria
6. Research results, protocols, instruments, data and samples must be shared promptly through open-access channels without delay to inform public health responses
7. Health authorities must communicate uncertainty honestly, avoid false certainty, explain that recommendations may change as knowledge increases, and provide the most accurate and complete available information
8. Community consultations prior to research initiation are strongly encouraged to ensure studies address local needs, designs are acceptable to populations, and trust is built

From the guideline

Verbatim

“Human subjects research conducted during emergencies must be subject to higher, not lower, ethical safeguards.”

Editor’s perspective

Why this matters for Georgia and the region

Applicability

Georgia and the South Caucasus

Questions this guideline answers

Quick answers

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