Moving from clinical to pragmatic equipoise in health policy and systems research

Health policy and systems research refers to the research conducted on the formulation, impact, organisation and functioning of health policies, and how to optimise the functioning of health systems and policies towards achieving health for all. There is emerging scholarship on the ethics of conducting such health policy and systems research. Ethics of health policy and systems research, though similar to the ethics of traditional clinical research in many ways, has several important distinctions. In traditional clinical research on human participants, where two treatments or interventions are compared, clinical equipoise is an important ethical consideration. This refers to the genuine uncertainty among professional peers on whether one of the interventions is better than the other. This uncertainty is in the biomedical efficacy of the intervention. Unless such equipoise exists, clinical research is said to be unethical from the benefit-risk balance and justice perspectives. In health policy and systems research, the question of clinical equipoise is often not relevant. This article will describe the condition of clinical equipoise in health policy and systems research, its applications and challenges.