Strengthening global health ethics through collaboration

Members of the Ethics and Justice TWG, Dorcas Kamuya and Dinnah Rippon, share their reflections on meeting with colleagues at the Oswaldo Cruz Foundation (Fiocruz), Brazil's leading public health research institution, and one of the most significant biomedical science organisations in the Global South.

The purpose of the meeting with Fiocruz, held in May, was to share information on topics like research integrity and genomics ethics, feminist perspectives on health, indigenous knowledge systems, pandemic governance, and the ethics of AI. While these discussions were rooted in bioethics, they quickly revealed their direct relevance to health systems research. Questions of who defines research priorities, whose knowledge counts, how communities participate, and how emerging technologies shape health systems are central to building equitable, responsive, and just health systems. Together, we explored not only the challenges facing contemporary bioethics but also the ethical foundations needed to strengthen health systems research and practice. 

Conversations that matter

A set of overarching themes quickly emerged: the unequal distribution of power in the production of knowledge; the difference between genuine inclusion and performed participation; the colonial structures embedded in academia and science; the growing risks posed by AI and genomic technologies to already-marginalised populations; and how to make progress despite disagreements. These pose fundamental questions for health systems research and how health systems can better serve diverse populations in fair and accountable ways. It is clear that we need to collaborate to solve the world’s complex problems, but how do we make progress when value systems are fundamentally different?

A substantial portion of the discussions focused on social participation in research - what it actually means, how it can go wrong, and what honest engagement requires. Participants interrogated the gap between the language of participation and its reality: when the research agenda is already set, the funding already secured, and the consent form already drafted in a foreign language, what exactly is being offered to communities? These discussions naturally led to questions of power: who produces knowledge, who sets the agenda, and who benefits - and toward the practical demands of rebuilding trust with communities that have been historically harmed by research. Such questions are central to producing health systems research that is relevant, legitimate, and capable of informing equitable policy and practice.

The meeting also explored the future of bioethics as a field, including whether, and how bioethicists from low- and middle-income contexts should engage with emerging technology agendas currently being set elsewhere, rather than arriving to find those agendas already determined. Participants reflected on the importance of shaping these debates early, ensuring that ethical considerations are informed by the realities of diverse health systems rather than responding to decisions that have already been made.

Looking ahead

The meeting highlighted numerous opportunities for future collaboration with Fiocruz, at the intersection of ethics, justice, and health policy systems research. Shared areas of interest include shared interest: social participation as an ethical issue in its own right, indigenous approaches to bioethics, racism and structural inequality in global health, ethics, AI and the problem of "digital misthanasia" (i.e., preventable deaths resulting from biased or incomplete data), and the epistemological questions raised by cognitive justice and non-western knowledge systems. These themes underscore the importance of embedding ethics and justice throughout the design, conduct, and use of health policy and systems research.

What struck us most was the spirit of intellectual generosity that characterised the discussions. There was a willingness to be honest about the limits of our own work and perspectives, a genuine curiosity and openness to learn about each other's contexts. Fiocruz brings a distinctive tradition of bioethics rooted in collective health, social justice, and critical engagement with inequality. This tradition enriches the ethics perspectives developed across institutions in Africa and Asia. We left Rio with new colleagues, new questions to explore, and a renewed vision for the future.

This visit was organised by the Global Health Bioethics Network (GHBN). 

A recording of the public lecture hosted during the visit, can be found here.