Considering Risks to Researchers and Staff in Low-Resource Settings during Public Health Crises: A Proposed Conceptual Model

Abstract

Human subjects research protections have historically focused on mitigating risk of harm and promoting benefits for research participants. In many low-resource settings (LRS), complex and often severe challenges in daily living, poverty, geopolitical uprisings, sociopolitical, economic, and climate crises increase the burdens of even minimal risk research. While there has been important work to explore the scope of ethical responsibilities of researchers and research teams to respond to these wider challenges and hidden burdens in global health research, less attention has been given to the ethical dilemmas and risk experienced by frontline researcher staff as they perform research-related activities in LRS. Risks such as job insecurity, moral distress, infection, or physical harm can be exacerbated during public health crises, as recently highlighted by the COVID-19 pandemic. We highlight the layers of risk research staff face in LRS and present a conceptual model to characterize drivers of this risk, with particular attention to public health crises. A framework by which funders, institutions, principal investigators, and/or research team leaders can systematically consider these additional layers of risk to researchers and frontline staff is an important and needed addition to routine research proposals and protocol review.

Keywords: global health ethics; public health crises; risks to researchers.

Figure 1

Conceptual model of contributors and potential modifiers to researchers and research staff risk. Beginning from the left of the figure, the yellow boxes are categories of baseline risk that are represented as individual threads that form a rope. Various threats (and protections) to the rope are encountered that translate to risk for a research team. “Risk” in this model is depicted as a weight suspended over the research team by the metaphorical rope. Beyond the strength of the rope derived from the thickness or thinness of its individual threads, the integrity of the rope may be compromised by “cuts” occurring in the setting of public health crises depicted in the green horizontal boxes, which lead to additional layers of risk described within the row of blue boxes and are represented as scissors. Just as these additional layers of risk threaten to cut the rope, protective factors—represented by a sheath—safeguard the rope from being cut. Examples of such risk modifiers are listed within the orange box.