Optimizing, Efficiency and Impact in the African Clinical Trial Ecosystem | Cape Town, South Africa, 16-18 May 2023
African Union/ Africa CDC, AUDA NEPAD, EDCTP and the Bill & Melinda Gates Foundation organised a three-day meeting themed ‘Optimizing, Efficiency and Impact in the African Clinical Trial Ecosystem’. The meeting took place in Cape Town, South Africa from 16-18 May 2023. It aimed to discuss the current state of the Africa clinical research ecosystem and develop a collective vison for strengthening it in order to drive its impact. The COVID-19 pandemic exposed both obvious and previously invisible gaps between the different players and components of the ecosystem such as clinical trials design, capacity development, ethico-regulatory oversight, map of networks, digitalisation, community engagement and financing.
The meeting built on a discussion convened in 2022 on the heels of the Grand Challenges Annual Meeting in Brussels, and a 2019 Pan African Clinical Trials Alliance (PACTA) meeting organised by EDCTP and hosted by AUDA-NEPAD. Both meetings acknowledged the importance of strengthening the clinical trial ecosystem within low- and middle-income countries, including through approaches such as better visibility of research capabilities in Africa and enhanced clinical trials registration. Therefore, the meeting in Cape Town was also an opportunity to identify priority funding, areas of harmonisation in policy and practices to strengthening the ecosystem.
The Director General of Africa CDC, Dr Jean Kaseya, opened the meeting, which was later jointly closed by officials from both Africa CDC and AUDA-NEPAD. It was noted that over the last decades, less than 3% of all trials conducted globally have taken place in Africa – the majority being conducted in South Africa or Egypt. While this proportion continues to grow, rising to nearly 4% in 2021, this vastly underrepresents the population of Africa relative to other regions. Investments in research don’t always sustain the essential capabilities that they build, and a lack of coordination across the ecosystem means that critical talent is not always well-nurtured or retained on the continent. Research is often heavily concentrated at relatively few research centres, which can leave these centres and their sites chronically overburdened, while other research centres falter or struggle to retain their experts. Available expertise and resources are usually poorly coordinated, while essential components like ethics oversight, regulations and community engagement remains relatively weak. Financial resources are not adequate to cover all clinical research areas, yet funders and donors are not aligned by one African research agenda, such as one under development through the leadership of the Africa CDC.
The meeting concluded with a panel discussion on a new approach to financing clinical trials in Africa. Innovative and collaborative funding approaches, including mobilising African capital are critical elements to be explored for driving the clinical trial ecosystem forward.