Pan American Health Organization · 2020
Procedural guidance for health authorities and ethics review committees on rapid, rigorous ethical oversight of COVID-19 research during pandemic emergencies.
- Issuer
- Pan American Health Organization
- Edition
- 2020
- Audience
- Health authorities, ethics review committees, researchers
- Evidence
- Expert consensus
- Reviewed
- 20 Oct 2026 · GMJ
What this guideline says
GMJ summary
This document provides health authorities and ethics review committees with strategies to implement rapid yet rigorous ethics review and oversight processes for COVID-19-related human subjects research. It addresses the moral imperative to conduct ethical research during the pandemic while adapting existing ethics review procedures to reduce obstacles and avoid delays.
The guidance presents five organizational alternatives for ethics review during emergencies: ad hoc committees, national-level committees, (sub)regional extra-territorial committees, provincial/sub-national committees, and institutional-level committees. Each model aims to avoid duplication of efforts and committee overload whilst maintaining ethical standards. Key operational strategies include digital communications, virtual meetings, reduced quorum, tight deadlines, and flexibility in documentation requirements.
The document emphasises that ethics review committees must balance speed with rigour, maintaining international ethical standards whilst adapting to emergency contexts. For example, informed consent processes may need modification to use video or telephone calls to avoid contagion risks. Committees should set tight deadlines: protocol distribution within 24 hours of receipt, member review within 72 hours, and researcher responses within 48 hours.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Research protocol must be sent to committee members for review within 24 hours of receipt
- Reviewing committee members should complete protocol review within 72 hours
- Researchers should respond to committee observations within 48 hours
- Ethics committees should include diverse gender representation, health professionals with COVID-19 knowledge, methodologists, ethicists, and community representatives
- Virtual meetings through video or telephone should be used to facilitate deliberations during the pandemic without unnecessary risk to members
- Alternative informed consent mechanisms may be used, including video or phone calls with audiovisual registry of consent to avoid contagion risks
- Ethics monitoring can be carried out remotely through reports submitted at established deadlines or deferred contact with participants
- Coordination mechanisms between ethics review committees and regulatory authorities should ensure simultaneous rather than sequential review processes
Organizational alternatives for ethics review and oversight during COVID-19 pandemic
Table extracted from the guideline
| Model | Description | Scope |
|---|---|---|
| Ad hoc committee | Authority creates committee to review COVID-19 research for emergency duration | All COVID-19 research or identified subset (clinical/multicentre) |
| National-level committee | Authority designates national government entity committee for COVID-19 research oversight | All COVID-19 research or identified subset (clinical/multicentre) |
| (Sub)regional extra-territorial committee | Authorities of several states establish joint committee for cross-border research | All COVID-19 research or identified subset (clinical/multicentre) |
| Provincial/sub-national committee | Sub-national jurisdiction establishes or delegates committee based on governmental organisation | All COVID-19 research or identified subset (clinical/multicentre) |
| Institutional-level committees | Authority designates one or several institutional committees based on experience, capacity, or other criteria | All COVID-19 research or continues existing normal processes |
Source: Pan American Health Organization, Guidance and strategies to streamline ethics review and oversight of COVID-19-related research. Reproduced in summary form.
From the guideline
Verbatim
“The moral imperative to catalyze COVID-19-related ethical research requires that ethics review and oversight processes be rapid, rigorous, and adapted to the emergency context.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As someone who has worked extensively with WHO on health systems strengthening in Georgia, I recognise that this guidance addresses a critical gap we experienced during the COVID-19 pandemic: the tension between conducting urgent research and maintaining ethical rigour. For Georgian institutions, I would particularly stress the 24-72-48 hour timeline for protocol distribution, review, and researcher response, which represents a practical target that respects both speed and thoroughness. The guidance on remote informed consent procedures is especially relevant given Georgia's digital health infrastructure development. However, one realistic caveat for implementation in our region is that smaller countries may lack sufficient committee members with both COVID-19 expertise and availability during an active pandemic response, making the pre-identification of independent consultants and possible cross-border collaboration with Armenian and Azerbaijani colleagues particularly important for future preparedness.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 20 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus region, this guidance provides a framework for establishing rapid ethics review systems during health emergencies whilst maintaining international standards. Georgia’s existing institutional ethics review committees and the Public Health Institute could implement these streamlined procedures for future pandemic preparedness. The guidance is particularly relevant for countries with developing research ethics infrastructure, as it offers flexible models adaptable to national capacity and governmental structure. National programmes would need to consider establishing digital submission systems, training committee members on emergency research ethics, pre-identifying expert consultants, and creating coordination mechanisms between ethics committees and regulatory authorities such as the Georgian Ministry of Health. The regional model could facilitate coordinated ethics review for multicentre studies across Armenia, Azerbaijan, and Georgia.
Questions this guideline answers
Quick answers
What is the fastest timeline for ethics review of COVID-19 research protocols?
Protocols should be distributed to members within 24 hours of receipt, members should complete review within 72 hours, meetings should occur as soon as review is complete, and researchers should respond to queries within 48 hours. Communication to researchers should occur as soon as possible after the committee meeting.
Can informed consent be obtained remotely during the pandemic?
Yes, committees should consider alternative mechanisms such as video or phone calls with audiovisual registry of consent to avoid contagion risks whilst protecting participant autonomy. For participants unable to provide consent, phone or instant messaging can be used to contact relatives for support or consent.
How should multicentre COVID-19 studies be reviewed to avoid duplication?
Committees should agree on a single committee whose review and decision on each research protocol will be binding for the others involved in the ethics review process. This requires effective coordination and communication mechanisms between committees and health authorities to avoid duplication of efforts or loss of valuable time.
Can committee quorum be reduced during emergencies?
Given the exceptional nature of the emergency, a lower than normal quorum may be allowed, taking into account the number of committee members and their experience and knowledge relevant to the research review. Members unable to participate in virtual meetings may send comments, questions, and reviews electronically to be counted for quorum.
Related on GMJ
Interconnected resources
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GMJ News coverage
Quality & accreditation
Other guidelines on this topic
- Summary on Advances in the Development of Vaccines against COVID-19, 3 April 2020
- A Checklist for COVID-19 Pandemic Risk and Impact Management
- Recommendations for the Preparation of Disinfectant Solutions
- COVID-19: Chloroquine and hydroxychloroquine research
- Promoting health equity, gender and ethnic equality, and human rights in COVID-19 responses: Key considerations
- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Status
- Current
- Published
- 2020-01-01
- Scope
- Ethics review and oversight procedures for COVID-19-related research with human subjects during pandemic emergencies
- Audience
- Health authorities, ethics review committees, researchers
- Licence
- CC BY-NC-SA 3.0 IGO
- Evidence
- Expert consensus
- Record history
- Created 20 Oct 2026 · updated 20 Oct 2026 · next check Apr 2027
Pan American Health Organization. Guidance and strategies to streamline ethics review and oversight of COVID-19-related research, 7 April 2020. Washington, D.C.: PAHO; 2020. (PAHO/HSS/BIO/Covid-19/20-0004).GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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