This document discusses ethics review preparedness during the COVID-19 pandemic in Pakistan. It notes that Pakistan's health system is fragmented due to underinvestment, and that ethics and regulatory systems have struggled to keep up with research challenges from the novel disease. While the National Bioethics Committee provides guidance, local institutional review boards operate independently with varying processes and timelines. The document calls for developing national standard operating procedures to guide coordinated ethics review during health emergencies and between crises, in order to improve research quality and efficiency. It argues that capacity building is urgently needed for Pakistan's decentralized ethics review system.