Why is there a paucity of clinical trials in Africa?

Abstract

Summary Disproportionately few clinical trials are undertaken on the African continent, in part due to lingering neocolonial attitudes in the Global North which keep research activity primarily in developing countries, while being skeptical of the abilities of those in the Global South to undertake organized clinical studies. In the era of the COVID-19 pandemic, applicable research and clinical trials should be undertaken in relevant populations in order to extrapolate to a population level. This is all the more important in Africa, which has a rich genetic diversity. We suggest that a lack of organized research ethics committees across the continent and a deficiency of appropriate training are responsible in part for the reluctance of clinical trial organizers in the developed countries of the Global North to engage with medical leadership in Africa. We consider ways of alleviating this problem, including suggesting a pan-continental surveillance of ethics committee agendas and of training, either through the auspices of the African Union or the World Health Organization. In addition, medical leadership in African nations must be encouraged to take ownership of their medical ethics agendas to facilitate decent international clinical trial participation for the good of the continent as a whole.

Experience of Research Ethics Committees in Africa during the COVID-19 Pandemic

“…The most common type of protocols reviewed were public health intervention for COVID-19 and community engagement. As previous reports showed (19,20), there are few clinical trials in Africa which is also re ected in this study. Due to the poorly characterized nature of the coronavirus, case de nition, prevention, and diagnostic tools and variant nature resulted in continuous changes in protocols designs and guidelines (21,22).…”

Promoting Best Practice in Cancer Care in Sub Saharan Africa

“…Of the 2.7 million clinical trials conducted internationally, less than a fraction of 1% are conducted in the African continent with participation of African subjects ( 35 ). This disparity was further unmasked during the Covid-19 pandemic when <2% of the clinical trials linked to the pandemic were conducted in the African continent ( 36 ) and African patients had limited access to novel treatment approaches such as Tocilizumab, Remdesivir or participation in convalescent plasma studies. Within Africa itself, nearly 2/3 of the clinical trials are conducted either in Egypt or South Africa with marginal presence in the remaining 44 countries within the continent ( 35 ).…”

Ethical Considerations for Engaging Children and Adolescents Living with HIV in Research in African Countries: A Systematic Review

“…(Crane, 2013; Newman et al, 2011; Saethre & Stadler, 2013) For example, human research practices in African countries have too often neglected adequate consent, (Afolabi et al, 2014; Krosin et al, 2006) withheld information on potential risks and benefits, (Appiah-Poku et al, 2011; Rennie et al, 2017; Vreeman et al, 2012), and disproportionately put the burdens of research on populations that are prevented from benefiting from its’ findings. (Strüver et al, 2022; Taylor-Robinson et al, 2021) All of these concerns mandate a very close examination of the strategies to maximize the ethical conduct of research involving vulnerable populations in these settings.…”