The expansion of collaborative and data-intensive multicentre international research has intensified the need to reassess current national ethics review systems to ensure they both protect research participants and facilitate ethical research. Regarding the latter aim, this means ensuring that systems do not create unnecessary review barriers that may delay or even prevent important, ethical research. Australia and other jurisdictions recently have been revising their ethics review procedures and guidelines. However, many Australian Human Research Ethics Committees (HRECs) continue to undertake a full review of each research project undertaken at their home institution, irrespective of whether the project is stand-alone or multicentre. Australia has been addressing duplication in ethics review, but this remains a work-in-progress. Structural barriers created by state-based approaches to legislation and ethics review exacerbate the problem in the Australian context. Harmonisation of ethical review has not enjoyed sufficient resourcing or political support and moves ahead at a glacial pace. International cooperation and harmonisation of protocols through initiatives like the Global Alliance for Genomics and Health (GA4GH) provide a clear impetus to accelerate ethics review reform that aims to reduce duplicated review and recognise the equivalency of review of multi-centre research projects by another research ethics committee.