Table 2 Four priorities to take forward a more ethically-prepared ethical review system

1. Action by governments and national ethics bodies, supported by WHO, to translate existing ethical guidance into practice: through consolidating guidance from diverse sources; sharing good practice and tools effectively; and ensuring that systems and structures are in place to enable guidance to be implemented

2. Critical (internal) scrutiny by the ethics community of what the ethical review system offers, and how it fulfils its remit: through reviewing processes from the perspective of researchers; contributing to ethics education and awareness; making the case for the value that good review adds; exploring the development of quality indicators to support accountability; and using action research and evaluation to tackle longstanding issues in review processes

3. Increased support for the capacity, skills and confidence of research ethics committee members and staff, particularly with reference to novel trial designs: including through effective networking and the development of systems of mutual learning and support at both local and international level

4. Adequate funding of ethical review infrastructure: through ensuring that research ethics committees receive a set percentage of research funding upfront so that they operate their functions effectively and contribute to the shared aim of facilitating ethically-conducted research