1. World Health Organization
13 September, 2018
WHO Training Manual
Ethics in epidemics, emergencies and disasters: Research, surveillance and patient care
Learning Objective 7.3
Explain the potential conflicts of interest of health care workers participating in emergency research activities
L.O. XX Title

2. Outline Key definitions and concepts
Problem solving tools and the model for the ethical management of conflicts
Case study
Discussion
Wrap up
Suggested time
0-15
(15 min)
16-25
(10 min)
26-55
(30 min)
56-85
86-90
(5 min)
Activity
Introduction
Presentation problem-solving tools
Case study and discussion, phase 1
Case study and discussion, phases 2 and 3
Summary and conclusion
L.O. XX Title

3. Definition: Conflict of Interest
A situation in which a person has a private or personal interest sufficient to appear to influence the objective exercise of his or her official duties as, say, a public official, an employee, or a professional.
(MacDonald, McDonald and Norman 2002)
Any factor that might tend to undermine a competent researcher’s ability to make scientifically reliable judgments concerning research strategy, evidence or conclusions.
(Davis 1999)
A set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest.
(Institute of Medicine 2009)
There are many definitions of COI used in the academic literature and which can apply to a diversity of professional or institutional contexts. For example, in a business or public sector context, a COI can be defined as “a situation in which a person has a private or personal interest sufficient to appear to influence the objective exercise of his or her official duties as, say, a public official, an employee, or a professional” (MacDonald, McDonald and Norman 2002). While this definition is clear, it does not give details that would be of specific use to researchers or healthcare workers in public health settings. Also, it does not speak to the risk involved in the COI situation, which can include bias in research methods, harm to participants, or threat to the reputation of an organisation, institution or to the research enterprise as a whole. A definition more directly applicable to the research context is “any factor that might tend to undermine a competent researcher’s ability to make scientifically reliable judgments concerning research strategy, evidence or conclusions.” (Davis 1999) Finally, to bring in the professional component of judgment, COI can be defined as “a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest.” (Institute of Medicine 2009)

4. Financial Interests
Recruiting patients
Stock options
Research grants

5. Non-financial Interests
“If there’s no money, there’s no conflict…”
Tendency to focus on what’s measurable ($$$)
Non-financial interests often ignored completely
Given much less attention in policies
Not considered very harmful
Less problematic than financial interests
Recognizing these threatens professional identity
Objectivity, neutrality, independence
Non-financial interests can be especially problematic, because they are less recognized and less understood.

6. Determining the workforce costs of the AIDS epidemic
Case Study
Determining the workforce costs of the AIDS epidemic
Hint: Use the facilitator’s discussion guide to lead the discussion

7. Managing COI in Practice
Being in a COI is not unethical …the issue is how to handle it.
Guidance:
Identify COI, avoid when possible
Discuss with all concerned
Remove person from sensitive decisions
Sometimes 1 and 3 are impossible. So 2 (transparency & dialogue) becomes crucial.

8. A Model for Ethical COI Management in Public Health
Identifying the actors
Where in the world are the COI? They’re “in the researcher” and “in the research setting”
Phase 1
The Context
What is and What if?
Phase 2
Take Home Messages
What can we do better in the future?
Phase 3

9. A Model for Ethical COI Management in Public Health
Educational
PHASE
Know what a COI is and appropriate policies
Financial or non-financial?
What policies are you subject to?
PHASE 1
Know yourself, the actors and evaluate the risk
Where in the world are the COI? They’re “in the researcher” and “in the research setting”
Who’s involved, what are their/your interests?
Is there a problematic COI situation (actual/potential; financial/non-financial)?
PHASE 2
Know the context and how to manage it
What is? and What if?
What are the benefits/risks of different resolution strategies?
Identification
What is a COI?
Is there a COI, and if so, what sort? Financial or non-financial?
Evaluation
Who’s involved in the situation?
What are the risks of the COI, and for whom?
Management
What are the possible management strategies, and who should be involved?
What are the risks and benefits of different resolution mechanisms?
Reflection
What can we learn from this experience: what worked and what did not?
What policies or procedures could be implemented or enhanced to avoid or manage similar situations in the future?
How can the situation contribute to enriching a COI definition in the context of emergency research and education?
PHASE 3
“Take Home Messages”
What can we do better in the future:
As a team - for future education and practice
In terms of practice - to inform policy makers.

10. Summary Beyond a pejorative view of “conflict of interest”
Attention to non-financial and institutional COI
Recognise some COI are endemic, unavoidable
Be proactive and systematic: “Better prevent than cure”
Use & limits of policies, procedures, guidelines
Self-awareness, humility
Discuss integrity & ethical conduct

11. Sources
MacDonald, C.; McDonald, M.; Norman, W “Charitable Conflicts of Interest” Journal of Business Ethics 39(1):
Davis, M Ethics and the University (London, UK: Routledge)
Institute of Medicine. Conflict of Interest in Medical Research, Education, and Practice. Edited by B. Lo and M.J. Field, Washington, D.C.: Institute of Medicine Committee on Conflict of Interest in Medical Research, Education, and Practice, National Academies Press,

12. Chapter authors Acknowledgements
Potvin, Marie-Josée, Reproductive Ethics Research Group, School of Public Health, Université de Montréal, Montréal, Québec, Canada
Williams-Jones, Bryn, Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Québec, Canada
L.O. XX Title