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South African research ethics committees (RECs) faced significant challenges during the COVID-19 pandemic. Research ethics committees needed to find a balance between careful consideration of scientific validity and ethical merit of protocols, and review with the urgency normally associated with public health emergency research. We aimed to explore the views of South African RECs on their pandemic preparedness and response during COVID-19. We conducted in-depth interviews with 21 participants from RECs that were actively involved in the review of COVID-19 related research, at seven academic institutions across South Africa. Interviews were conducted remotely using an in-depth interview guide that included questions regarding REC preparedness and response to COVID-19. Interviews were conducted until data saturation, and audio-recordings were transcribed verbatim and coded. An inductive approach to thematic analysis was used to organise data into themes and sub-themes. This study focused on three main themes: coping during COVID-19, building REC capacity during pandemic times and a consistently cautious approach to mutual recognition of REC reviews. Despite an initial sense of unpreparedness, RECs were able to adapt and maintain careful ethical oversight of both COVID and non-COVID research, and the rigour of REC reviews. Several important lessons for preparedness and response to future pandemics were identified, including heightened awareness of publication, funding and political pressures, the importance of regular training for RECs and researchers, and strategies to enhance moral resilience of REC members. Incremental steps are needed to build trust and authentic partnerships among RECs in inter-pandemic times, to facilitate collaboration during future public health emergencies. [ABSTRACT FROM AUTHOR]

Antiretroviral therapy is not curative. Given the challenges in providing lifelong therapy to a global population of more than 35 million people living with HIV, there is intense interest in developing a cure for HIV infection. The International AIDS Society convened a group of international experts to develop a scientific strategy for research towards an HIV cure. This Perspective summarizes the group's strategy.

Humanitarian emergencies result in a breakdown of critical health-care services and often make vulnerable communities dependent on external agencies for care. In resource-constrained settings, this may occur against a backdrop of extreme poverty, malnutrition, insecurity, low literacy and poor infrastructure. Under these circumstances, providing food, water and shelter and limiting communicable disease outbreaks become primary concerns. Where effective and safe vaccines are available to mitigate the risk of disease outbreaks, their potential deployment is a key consideration in meeting emergency health needs. Ethical considerations are crucial when deciding on vaccine deployment. Allocation of vaccines in short supply, target groups, delivery strategies, surveillance and research during acute humanitarian emergencies all involve ethical considerations that often arise from the tension between individual and common good. The authors lay out the ethical issues that policy-makers need to bear in mind when considering the deployment of mass vaccination during humanitarian emergencies, including beneficence (duty of care and the rule of rescue), non-maleficence, autonomy and consent, and distributive and procedural justice. Les urgences humanitaires entrainent une rupture des services de soins de sante essentiels et elles rendent souvent les communautes vulnerables dependantes des organismes externes pour leurs soins. Dans les milieux ou les ressources sont comptees, cela peut se produire sur fond d'extreme pauvrete, de malnutrition, d'insecurite, de faible niveau d'alphabetisation et d'infrastructures insuffisantes. Dans ces circonstances, fournir nourriture, eau et abri, tout en limitant les epidemies de maladies transmissibles, devient une preoccupation centrale. Lorsqu'il existe des vaccins surs et efficaces pour limiter les risques d'epidemies, leur eventuel deploiement est un facteur cle pour satisfaire les besoins sanitaires d'urgence. Les considerations ethiques sont essentielles pour se prononcer sur le deploiement de la vaccination. La distribution de vaccins en quantites limitees, les groupes cibles, les strategies de vaccination, la surveillance et la recherche lors de situations d'urgence humanitaire graves impliquent tous des considerations ethiques souvent nees de la tension entre le bien individuel et le bien commun. Les auteurs exposent les questions ethiques que les decideurs doivent garder a l'esprit lorsqu'ils envisagent le deploiement d'une vaccination de masse pendant les urgences humanitaires, notamment la beneficience (devoir de diligence et devoir d'assistance), la non-maleficience, l'autonomie et le consentement, ainsi que la justice de repartition et l'equite procedurale. Las emergencias humanitarias causan el desplome de los servicios de atencion de salud esenciales y, a menudo, provocan que la atencion sanitaria de las comunidades vulnerables pase a depender de organismos externos. En entornos con recursos limitados esto puede darse en un contexto de pobreza extrema, desnutricion, inseguridad, bajos niveles de alfabetizacion e infraestructuras deficientes. Bajo estas circunstancias, suministrar alimentos, agua y refugio, asi como limitar la aparicion de brotes de enfermedades transmisibles representan las principales preocupaciones. Cuando se dispone de vacunas eficaces y seguras para reducir el riesgo de aparicion de brotes de enfermedades, la distribucion potencial de las mismas constituye un factor clave en las situaciones de emergencia sanitaria. Las consideraciones eticas son fundamentales a la hora de decidir sobre la distribucion de las vacunas. La asignacion de vacunas con suministro limitado, los grupos destinatarios de las mismas, las estrategias de entrega, asi como la monitorizacion y los estudios durante las emergencias humanitarias graves implican consideraciones eticas que, a menudo, derivan de un enfrentamiento entre el beneficio individualyel bien comun. Los autores exponen los problemas eticos que los responsables politicos deben tener en cuenta a la hora de considerar como distribuir la vacunacion masiva durante las emergencias humanitarias, lo cual incluye principios como la beneficencia (el deber de atencion y la regla del rescate), la no maleficencia, la autonomia y el consentimiento, asi como la justicia distributiva y procesal., Introduction Acute humanitarian crises pose complex ethical dilemmas for policy-makers, particularly in settings with inadequate health-care services, which often become dependent on external agencies for urgently needed care. (1) These [...]