How scaling up clinical research in Africa can benefit society and the economy

• Africa is the world's fastest-growing region, and the population could double by 2050, putting further strain on healthcare systems.
• The continent has made progress in controlling infectious diseases but faces the growing challenge of non-communicable conditions.
• Only 4% of clinical trials globally were hosted in African countries – this needs to change if the continent is to thrive.

Demographic trends define Africa as the world’s fastest-growing region, with its population potentially doubling by 2050. As the continent achieves significant progress in the control of infectious diseases, the rise of non-communicable conditions, in parallel with the possibility of emerging pandemic pathogens, is adding more pressure to already strained healthcare systems and posing challenges to continental development ambitions.

According to IQVIA, out of the 20,825 trials that started globally in 2023, only 819 – or 4% of the total – were hosted by African countries, which resulted in the continent providing less than 2% of genetic data analyzed in genomics research. Most of these trials were not only focused on infectious diseases but also restricted to phases III and IV (or phases focused on comparisons to current treatment standards and long-term effects), remaining consistent with clinical research trends over the last 15 years.

Figure 1 (below) illustrates these dynamics and the scenarios that Africa’s ambition could aspire to.

What if 10% of global clinical trials included African patients? Is this a possibility based on industry growth prospects, especially from the emerging biopharma sector, and what would the benefits be to patients, healthcare systems, and economies?

While issues of genomic representation and pandemic preparedness are certainly critical for discoveries, why should we continue insisting on the need to increase investment in African clinical development?

The case for investing in clinical research in Africa

Clinical development has an overwhelmingly positive impact on patient populations in Africa, providing early access to cutting-edge treatments and immunization tools.

Similarly, producing therapies and vaccines that respond better to the genetic and phenotypic specificities of African populations can contribute to improved health outcomes for those living on the continent and the African diaspora migrating to other regions. Clinical trials are also a fundamental resource for global health security, assisting the swift development of vaccines in response to disease outbreaks.

Clinical research can develop or reinforce the medical infrastructure of host countries by increasing access to more global standards of care and directing clinical trial-related fees to hospitals and other sites. This attracts and retains researchers and sets the foundations for future studies. Increasing local research and home-grown innovation also gives way to cost-effective approaches to managing public health priorities, as domestic experiences can guide more targeted interventions.

The uses of trial-generated data can equally strengthen and harmonize regulatory frameworks, persuading life sciences companies to partake in regionalized manufacturing. If increased production can improve the availability of medicines and vaccines and make them more affordable, then additional investments in clinical research in Africa are pivotal to advance equity in access, create economies of scale, and support the inclusion of much-needed therapies in national health insurance schemes.

Studies show that every dollar invested in clinical research has a return of $405 in wider societal and economic gains, with product development in Africa, based on local trials, averting nearly 600 million disability-adjusted life years (DALY) between 2000 and 2022. For example, clinical studies to assess the treatment of schizophrenia with paliperidone palmitate in Rwanda were pivotal to catalysing research and development in other mental health areas, empowering local talent, strengthening local health systems, and adequately engaging patient communities.

Finally, life science companies and other private sector actors can benefit from low competition and costs in key African markets and drive clinical research agendas that shape the therapeutic landscape and establish local expertise networks. Playing responsibly in areas with great unmet needs also shows commitment from the private sector to environmental, sustainability and governance standards, contributing to social progress and reinforcing the trust of shareholders and constituents.

Attracting investment for clinical research in Africa requires an ‘all-hands-on-deck’ approach

With these benefits in mind, making the continent more attractive for clinical research requires a broad and integrated effort. Firstly, it demands additional regulatory streamlining to encourage investments from the private sector, allow local innovation to flourish, and facilitate the discovery of and access to safe therapies and vaccines. With 30 countries as members, the creation of the African Medicines Agency (AMA) in 2018 represents a major step forward in revamping regional harmonization systems and optimizing access to high-quality and effective medical products.

Secondly, attracting more investments into the continent requires African governments to consider:

• Overhauling the national health infrastructure, with a focus on data systems and more resilient supply chains.
• Ramping up the allocation of domestic resources to clinical research and providing incentives for private sector participation.
• Generating clearer and stronger clinical guidelines.
• Leading partnerships with key stakeholders to build trust and accelerate research.

Thirdly, the private sector, particularly the pharmaceutical industry, has a critical role in conducting the pre-scoping of sites, understanding epidemiological needs, attracting patients, and growing or expanding country-specific trial infrastructure. While countries or regions have the desire to do this themselves, knowledge shared through public-private partnerships could make a substantial difference in research success and sustainability. Investing in community engagement and collaboration arrangements with various stakeholders, including patient advocacy organizations, can ultimately augment trial participation and improve adherence.

Clinical research in Africa is growing but more needs to be done

The number of clinical trials is growing broadly across the continent. Figure 2 shows that while trials for interventional phases I to III occurring in northern African countries have decreased since 2019, the opposite is true for the sub-Saharan region. Approximately 70% of the research in Africa is in Egypt, South Africa, and Nigeria.

Separate from the number of trials, site expansion responds to increases in healthcare workers, researchers, and ongoing investments in medical infrastructure. For example, IQVIA, a leading clinical research organization, is currently partnering with over 5,000 investigators in Africa across 3,630 sites, and the number continues to grow. Investigators in many African countries are exceptionally trained and eager to participate in clinical development.

Investing in the future

Scaling up trials in Africa is a public health priority that will strengthen healthcare interventions, improve access to lifesaving medicines and vaccines both for routine healthcare and pandemic times and boost research capacity.

Pivotal continental institutions such as the Africa Centres for Disease Control and Prevention (Africa CDC), in collaboration with the African Union Development Agency (AUDA-NEPAD), the AMA and the African Continental Free Trade Area (AfCFTA), recognize the multi-pronged value of promoting the clinical research as a pathway to achieving Agenda 2063. Bringing together the right expertise, political will, and resources is crucial to realizing this ambition and building a safer, healthier, and more prosperous continent.

The authors acknowledge the valuable contributions and research support provided by Briana Deahl, Intern, EMEA Precision Medicine and Genomics.