To the Participants in the International Conference: “The Declaration of Helsinki: Research in Resource-Poor Settings”

I am pleased to greet all of you at the start of the conference organized by the World Medical Association, together with the American Medical Association and the Pontifical Academy for Life. The theme you are addressing, “The Declaration of Helsinki: Research in Resource-Poor Settings”, is both important and timely, for the Declaration itself highlights the fundamental issue of freedom and informed consent with regard to clinical research. Starting from this foundation, we have seen through the years how this topic has had an influence on medical practice as a whole.

Since its initial version in 1964 and through its subsequent updates, the Declaration has offered an essential contribution to making possible the transition from research on patients to research with patients. We well know how significant this shift has been for the practice of medicine in fostering a new harmony in the relationship between doctor and patient. While the asymmetry present in the therapeutic relationship is all too apparent, the central role that the sick person should have has not yet become a reality.  It needs to be continually safeguarded and promoted in the novel circumstances in which medicine finds itself, which are advancing with increasing speed and which include new technological and pharmaceutical resources, economic interests and commercial alliances, and cultural contexts in which it is easier to instrumentalize others for one’s own purposes.

Clinical research in low-income countries is an area that is especially susceptible to such vulnerabilities. Indeed, these concerns form a particular aspect of that protection which we always need to ensure, in all aspects of our life together, for the people in our societies who are most at risk. On the international level, we are witnessing many injustices that push poor countries into a disadvantaged position, in terms of access to and use of available resources, leaving them at the mercy of wealthier countries and industrial entities that appear insensitive to those who cannot assert themselves in economic terms, even when fundamental needs and rights are at stake. These are issues that likewise concern technologies such as artificial intelligence (cf. Message for the 2024 World Day of Peace). It is very important to prevent inequalities from occurring also in the field of healthcare and clinical research. We cannot subordinate care, which represents the essential attitude that allows human life to progress through the entrusting of one person to another, to the reductive mentalities of the market and of technology.

I am happy, then, that you are considering these questions, seeking not only to engage their implications on the theoretical level, but also to find concrete solutions. For we need to balance research opportunities and the welfare of patients, so that the expenses incurred by research and access to the resulting benefits are equitably distributed.

Here, I also want to draw your attention to the fact that respecting the freedom of the different communities involved means appreciating as well their diverse cultural sensitivities, which should not be harmed by patterns of knowledge and social practices that they do not recognize as their own. We are faced, then, with challenges that give rise to questions of global justice concerning healthcare. In this area, after the experience of the pandemic, we have seen how important it is to provide forms of governance that go beyond those available to individual nations. In this regard, we need to foster a way of thinking about the international community that effectively serves the human family, turning to a perspective of social friendship and universal fraternity (cf. Fratelli Tutti, 173).

With these sentiments, I offer my prayerful good wishes for your deliberations and your work. Upon all taking part in this conference, I willingly invoke the abundant blessings of Almighty God.

From the Vatican, 16 January 2024

FRANCIS