Fig. 1

Ethics application process in NAPKON. *Germany has 17 medical state associations with specific regulations for the ethical consultation of physicians. Some ethics committees perform an in-depth review of each new study, while others accept the ethical approval of the primary ethics committee [23]. Bavaria is the only one not to require further ethics applications after the primary vote [24] 1 with own university ethics committee; 2 without own university ethics committee; SUEP = Cross-Sectoral Platform; HAP = High-Resolution Platform. Created with BioRender.com