The Integrative Expert: Moral, Epistemic, and Poietic Virtues in Transformation Research

Over the past 50 years, policy makers have sought to shape new and emerging technologies in light of societal risks, public values, and ethical concerns. While much of this work has taken place during “upstream” research prioritization and “downstream” technology regulation, the actual “midstream” work of engineers and other technical experts has increasingly been seen as a site for governing technology in society. This trend towards “socio-technical integration” is reflected in various governance frameworks such as Sustainable Development (SD), Technology Assessment (TA), and Responsible Innovation (RI) that are at the center of transformation research. Discussions around SD, TA, and RI often focus on meso- and macro-level processes and dynamics, with less attention paid to the qualities of individuals that are needed to support transformation processes. We seek to highlight the importance of micro-level practices by drawing attention to the virtues of technical experts. Drawing on empirical study results from embedding philosophical-reflective dialogues within science and engineering laboratories, we claim that poietic, as well as moral and epistemic, virtues belong to those required of technical experts who foster integrative practices in transformation research.

Research priority-setting for human, plant, and animal virology: an online experience for the Virology Institute of the Philippines

Background Viral pandemics have had catastrophic consequences on population health and economies. The Philippine government intends to establish the Virology Institute of the Philippines, one of the key areas of which will be virology research. This project aimed to develop the institute’s research agenda across the fields of human, plant, and animal virology. Methodology Key considerations for the prioritization methodology were (1) the imminent establishment of the Virology Institute of the Philippines, (2) mobility restrictions caused by the coronavirus disease 2019 (COVID-19) pandemic, (3) the timeline to develop the research agenda, and (4) the need to separate the research agenda for the three fields of human, plant, and animal virology. The process was fully conducted online in four steps: stakeholder identification, soliciting research priorities, generating initial research priorities, and final prioritization consultations conducted on Zoom Pro. Results Twenty-eight participants attended three online consultations between 21 and 27 July 2020 through Zoom Pro. Participants selected the research prioritization criteria and its weights, and used these to evaluate the research priorities. The final research agenda covers topics in epidemiology, diagnostics, surveillance, biosafety, and genomics. Conclusion This initiative resulted in the first research agenda for the Virology Institute of the Philippines across the three fields of human, plant, and animal virology. An expert-driven process which places a premium on consensus-building facilitated through online platforms was the most feasible approach to develop the research agenda. This process resulted in an agenda aligned with the mandates of national research councils but leaves gaps on areas such as emerging infectious diseases. Pre-COVID-19 literature expressed apprehensions on the online medium that weakens social ties necessary for consensus. Our experience with changing the mode of consensus-building shows that users will continually adapt to technology. Online tools are currently able to address the limitations of the virtual space.

Research priorities in maternal and neonatal health in Africa: results using the Child Health and Nutrition Research Initiative method involving over 900 experts across the continent

Background: Africa will miss the maternal and neonatal health (MNH) Sustainable Development Goals (SDGs) targets if the current trajectory is followed. The African Academy of Sciences has formed an expert maternal and newborn health group to discuss actions to improve MNH SDG targets. The team, among other recommendations, chose to implement an MNH research prioritization exercise for Africa covering four grand challenge areas. Methods: The team used the Child Health and Nutrition Research Initiative (CHNRI) research prioritization method to identify research priorities in maternal and newborn health in Africa. From 609 research options, a ranking of the top 46 research questions was achieved. Research priority scores and agreement statistics were calculated, with sub-analysis possible for the regions of East Africa, West Africa and those living out of the continent. Results: The top research priorities generally fell into (i) improving identification of high-risk mothers and newborns, or diagnosis of high-risk conditions in mothers and newborns to improve health outcomes; (ii) improving access to treatment through improving incentives to attract and retain skilled health workers in remote, rural areas, improving emergency transport, and assessing health systems' readiness; and (iii) improving uptake of proven existing interventions such as Kangaroo Mother Care. Conclusions: The research priorities emphasized building interventions that improved access to quality healthcare in the lowest possible units of the provision of MNH interventions. The lists prioritized participation of communities in delivering MNH interventions. The current burden of disease from MNCH in Africa aligns well with the list of priorities listed from this exercise but provides extra insights into current needs by African practitioners. The MNCH Africa expert group believes that the recommendations from this work should be implemented by multisectoral teams as soon as possible to provide adequate lead time for results of the succeeding programmes to be seen before 2030.

An ethics framework for consolidating and prioritizing COVID-19 clinical trials

Given the dearth of established safe and effective interventions to respond to COVID-19, there is an urgent ethical imperative to conduct meaningful clinical research. The good news is that interventions to be tested are not in short supply. Unfortunately, the human and material resources needed to conduct these trials are finite. It is essential that trials be robust and meet enrollment targets and that lower-quality studies not be permitted to displace higher-quality studies, delaying answers to critical questions. Yet, with few exceptions, existing research review bodies and processes are not designed to ensure these conditions are satisfied. To meet this challenge, we offer guidance for research institutions about how to ethically consolidate and prioritize COVID-19 clinical trials, while recognizing that consolidation and prioritization should also take place upstream (among manufacturers and funders) and at a higher level (e.g. nationally). In our proposed three-stage process, trials must first meet threshold criteria. Those that do are evaluated in a second stage to determine whether the institution has sufficient capacity to support all proposed trials. If it does not, the third stage entails evaluating studies against two additional sets of comparative prioritization criteria: those specific to the study and those that aim to advance diversification of an institution’s research portfolio. To implement these criteria fairly, we propose that research institutions form COVID-19 research prioritization committees. We briefly discuss some important attributes of these committees, drawing on the authors’ experiences at our respective institutions. Although we focus on clinical trials of COVID-19 therapeutics, our guidance should prove useful for other kinds of COVID-19 research, as well as non-pandemic research, which can raise similar challenges due to the scarcity of research resources.

Setting the Health Research Priority Agenda for the Ministry of Health (MoH), Kingdom of Saudi Arabia 2020-2025 Project

BackgroundThe Saudi Vision 2030 project recognized the integral role of health research in transforming, modernizing and governing the healthcare system, as well as improving health. The nature of health research prioritization is context-specific, and there is an obligation to effectively allocate resources to initiatives that will achieve the greatest impact, which is discussed in this paper.MethodsThe best practice for health research prioritization depends on the existing needs and context. The e-Delphi technique was conducted via an online self-administered questionnaire that covered health research topics, topics related to Vision 2030, as well as collaborative research. Criteria used for scoring the selected topics were: appropriateness, relevance, feasibility, urgency, collaboration and impact of research outcome. Research domains were prioritized by ranking the weighted mean aggregate score and all topics of the top five ranked domains, along with the aggregate scores of the answers of those in leadership positions were pooled together, validated, verified, summarized, refined and then classified into themes. ResultsThe participants included those from a full range of health specialties and subspecialties (46.5% physicians, 39% health specialists, 10% pharmacists and 3.6% dentists), and the study achieved balanced regional participation and covered a wide spectrum of qualification and professional levels. In total there were 2252 participants and 98% belonged to MoH. Of those from the MoH, 134 were leaders (85 Headquarters policy makers and 49 regional decision makers), while the rest were made up from individuals from 16 Health Affairs Directorates spanning 75 hospitals and specialized health centers, 24 primary health care centers , 2 healthcare clusters, in addition to five medical cities. Community involvement was represented by 26 organizations. Approximately half of stakeholders contributed to scientific research, while 24% had previous publications, and only 6% had a direct influence in health policymaking. The study deliverables were listed into three agendas:1. Health System Research Priority Themes: Service Delivery, Workforce, Information Systems, Access to Essential Medicines, Financing, Governance & Leadership and Disaster Response. 2. Diseases and Health Problems Themes: Non-Communicable and Communicable Diseases, Trauma, Public Health, Dental Health, Environmental Health, Pilgrims’ Health, Women’s Health, Child & Geriatric Health, Biomedical Technology, Radiology and Physical Technology.3. National and International Collaborative Research Themes: Major research areas impacted by COVID-19, Public Health, ‎ Healthcare Access, Medical Care & Universal Health Coverage, Value-based Healthcare, Health System Financing and Economics, Health Information and Communication Technology, Health System Governance, Health Workforce Development and Health System Preparedness and Response to Emergency.Conclusion Adequate description of the stakeholders and the methodology can strengthen legitimacy, credibility and maximize the impact of the priority setting process. Involvement of policymakers, researchers and funding organizations increases the opportunity of translation into actual research, supports redesigning the research landscape and ensures uptake of results and integration.

Correction: Pharmacogenomic associations of adverse drug reactions in asthma: systematic review and research prioritization

An amendment to this paper has been published and can be accessed via a link at the top of the paper.