New Survey Highlights the Need for More Ethics Training in Field Epidemiology Training Programs (FETPs)

Emma Cooke, Angela Hilmers, David Addiss, Tina Rezvani, Hayat Adem

In February 2019, TEPHINET partnered with the Focus Area for Compassion and Ethics (FACE) of The Task Force for Global Health to conduct a survey targeting alumni of Field Epidemiology Training Programs (FETPs) worldwide. The purpose of the survey was to better understand the ethical challenges faced by practicing field epidemiologists, and to use this information to inform the development of new training modules on ethics for FETPs. Although much attention is given to ethical issues in medical settings and in biomedical research, little is known about ethical challenges faced by epidemiologists in field settings, where the complexity of interests, influences, and pressures are considerably greater. TEPHINET distributed the survey via TEPHIConnect, its online FETP alumni network.

A total of 149 respondents, who live across 54 countries*, participated. The most common ethics-related issues included problems with informed consent (51 percent), inequitable allocation of public health resources (40 percent), conflicts of interest (36 percent), corruption (24 percent), lack of autonomy among community members or “beneficiaries” of programs (21 percent), and inadequate access to essential drugs and services (20 percent). Respondents indicated a strong desire for training to address these ethical challenges, particularly for informed consent and unfair allocation of resources.

Of the 149 respondents, 128 responded to a question about moral distress in the workplace (i.e., situations in which they knew what the morally correct thing to do was, but were unable to do it because of circumstances or competing claims on their loyalty). Twenty-six percent of respondents indicated that they experience moral distress frequently or “almost all the time” and another 64 percent experience moral distress “sometimes.” These findings indicate an unexpectedly large, unmet need for support and training in moral resiliency among field epidemiologists.

FACE and TEPHINET will display a poster summarizing the results of this survey at the 10th TEPHINET Global Scientific Conference in Atlanta this October. In addition, a half-day ethics workshop is planned for the conference on Monday, October 28.

The first new ethics module, developed for training frontline veterinary public health officers, is now available here.

*Respondents lived in the following countries: Afghanistan, Australia, Bangladesh, Belgium, Belize, Brazil, Burkina Faso, Cameroon, Canada, Central African Republic, Colombia, Democratic Republic of Congo, Dominican Republic, Egypt, El Salvador, Ethiopia, France, the Gambia, Ghana, Guatemala, Guinea, Haiti, India, Indonesia, Italy, Japan, Kenya, Laos, Liberia, Malawi, Malaysia, Mali, Mexico, Morocco, Myanmar, Namibia, the Netherlands, Niger, Nigeria, Pakistan, Papua New Guinea, the Philippines, Rwanda, Saudi Arabia, South Africa, Tajikistan, Tanzania, Togo, Turkey, Uganda, the United Kingdom, the United States, Zambia, Zimbabwe