Building Infrastructure through Training: Best Practices from Latin America

1. Plenary Panel: “Building an Infrastructure through Training: Best Practices and Lessons Learned from Africa, Asia, Central-Eastern Europe and Latin America” A Perspective from Latin AmericaMayra AchíoUniversidad de Costa Rica

2. Some guiding ideas • Education and training in research bioethics in our countries became a relevant concern as a result of the increase of international biomedical studies and clinical trials • Requirement to meet international standards

3. Most training comes and is sponsored by developed countries, especially US. • Participation and collaboration between academics from developing countries and developed countries is necessary to create a sustainable and proactive bioethics community • Despite efforts, education and training remain a challenge in our countries

4. Major research ethics development took place in developed countries • In LA, implementation of ethical regulations is still weak • Concern for education and training in research ethics is relatively recent in LA • 1990’s in response to new standards in international research sponsored by pharmaceutical industry and research institutions in developed countries • establishment of national/local research ethics committees and protocol review

5. Initially, international organizations and public/private institutions in developed countries offered and sponsored training programs • Development of education and training in research ethics for ethicists and researchers soon followed • At present, a substantial academic community throughout LA offers educational/training options (Argentina, Brazil, Chile, Colombia, Costa Rica) • Accessibility: main problem

6. The Costa Rican Experience • Similar to most of LA • Costa Rica is known as a success story • Main reason: a health care system and health indicators comparable with those of USA, Canada, and European countries.

7. Some indicators: • Population: 4.401.894 • Infant mortality rate: 9.70/1000 • Life expectancy: • 76.97 men, • 81.35 women

8. Growing number of biomedical research projects in universities and teaching hospitals funded by pharmaceutical corporations, NIH and Fogarty International Center • This growth has lead to ethical regulations and research ethics review to meet international standards • Need for education in bioethics became critical as regulations were approved and RECs began to be accredited

9. Costa Rican MS program in Research Ethics • Until recently: no formal in-depth education program in CR universities • 2005: alliance between two main public universities resulted in the Master Degree Program in Bioethics

10. Costa Rican MS Program in Research Ethics • 2-year program • National and regional project with no international funding/collaboration • 12 current students from different health institutions • Hopefully will impact other Central American countries as well

11. Other Training Program in Research Ethics 1. TRAINING PROGRAM IN RESEARCH ETHICS • Co-Directors: Ruth Macklin, Florencia Luna • Sponsor: Fogarty International Center, NIH • Jointly planned and executed with faculty from US and LA • Four trainees recruited from all over La; award covered all expenses • One-year non-degree program with two 6-month locations: New York and Buenos Aires

12. 1. TRAINING PROGRAM IN RESEARCH ETHICS - Main achievements • Learning from two viewpoints: US and LA • Possibility of application of ethical principles in societies with different cultures and socioeconomic conditions • Contrasting different North-South perspectives and experiences

13. 2. Creating Collaborative Research Ethics Education with Costa Rica (CREE-CR) • Recent program with Vanderbilt University, sponsored by Fogarty International Center • A collaborative effort between Vanderbilt University Medical Center, Vanderbilt Children’s Hospital, Costa Rica’s Children’s Hospital, the Costa Rican Social Security System and the Ministry of Health

14. 2. Creating Collaborative Research Ethics Education with Costa Rica (CREE-CR) • Components: • MS program in clinical and public health science and mentored research in research ethics at Vanderbilt • 5-week practicum in research ethics at Vanderbilt • 4-day course for REC members in Costa Rica • 4-day course for research educators in Costa Rica • Creation and distribution of curricular materials in Spanish tailored to the Central American context, web-based, professional publications and presentations

15. Key aspects in both cases • Fully collaborative programs and equal partnership between academic institutions, North and South • Solidarity and financial support from industrialized country • Coordination of academic in-depth degree programs with short term courses and practical training • Respect for specific needs of developing countries

16. Recommendations • Sustainability of training programs is more likely if sponsoring institutions works with universities instead of government officials, who are more vulnerable to policy changes • Regional networks and meetings should be encouraged to discuss and learn from experiences

17. Thank you!