title: Ethical issues in public health surveillance: a systematic qualitative review.
abstract: Public health surveillance is not ethically neutral and yet, ethics guidance and training for surveillance programmes is sparse. Development of ethics guidance should be based on comprehensive and transparently derived overviews of ethical issues and arguments. However, existing overviews on surveillance ethics are limited in scope and in how transparently they derived their results. Our objective was accordingly to provide an overview of ethical issues in public health surveillance; in addition, to list the arguments put forward with regards to arguably the most contested issue in surveillance, that is whether to obtain informed consent.
  
  
  
  Ethical issues were defined based on principlism. We assumed an ethical issue to arise in surveillance when a relevant normative principle is not adequately considered or two principles come into conflict. We searched Pubmed and Google Books for relevant publications. We analysed and synthesized the data using qualitative content analysis.
  
  
  
  Our search strategy retrieved 525 references of which 83 were included in the analysis. We identified 86 distinct ethical issues arising in the different phases of the surveillance life-cycle. We further identified 20 distinct conditions that make it more or less justifiable to forego informed consent procedures.
  
  
  
  This is the first systematic qualitative review of ethical issues in public health surveillance resulting in a comprehensive ethics matrix that can inform guidelines, reports, strategy papers, and educational material and raise awareness among practitioners.
authors.affiliation: Institute of Ethics, History and Theory of Medicine at LMU Munich, Lessingstr. 2, 80336, Munich, Germany. corinna.klingler@med.uni-muenchen.de.
authors.forename: Corinna
authors.identifier: 0000-0002-8148-5999
authors.initials: C
authors.lastname: Klingler
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11008, 8888 University Drive, Burnaby, B.C, V5A 1S6, Canada.|Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Diego Steven
authors.initials: DS
authors.lastname: Silva
authors.affiliation: Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Schuermann
authors.affiliation: Global Health Ethics Unit, World Health Organization, Avenue Appia 20, Geneva, GE, 1211, Switzerland.
authors.forename: Andreas Alois
authors.initials: AA
authors.lastname: Reis
authors.affiliation: Global Health Ethics Unit, World Health Organization, Avenue Appia 20, Geneva, GE, 1211, Switzerland.
authors.forename: Abha
authors.initials: A
authors.lastname: Saxena
authors.affiliation: Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Strech
mesh_terms: D032984:Ethics, Research; D006801:Humans; D062486:Public Health Surveillance
keywords: Ethics; Informed consent; Public health surveillance; Qualitative evidence synthesis; Systematic review