How clinical development can tackle Africa's unique health needs

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​From This article is part of: World Economic Forum Annual Meeting

• Commercially-led clinical development activity has been vastly neglected in Africa, a situation that must change considering the changing demographics and health profile of the continent.
• Clinical trials in Africa carry huge benefits including innovation in medicinal development, improved healthcare and patient outcomes, and subsequent benefits for Africa's development as a whole.
• Better regulation of medicines in Africa will improve medicinal quality and manufacturing capacity.

While the second most populous continent with over 1.2 billion people, Africa has vast unmet patient needs. By 2050, the United Nations projects that 25% of all humanity will be African and that population will be older and more concentrated within urban settings. Although infectious diseases exact a terrible toll across many African countries, non-communicable illnesses are poised to become the leading causes of death in sub-Saharan Africa by 2030, diversifying Africa’s disease burden.

The continent also has greater human genetic diversity than any other region globally, which means that the aetiology and epidemiology of Africa’s health challenge present significant unknowns that can only be addressed through African population research and African clinical development.
Clinical development far-reaching benefitsClinical development for diseases plays a direct role in improving treatment. For example, the benefits to patients of conducting clinical trials for sickle cell anaemia (SCA) in sub-Saharan Africa (SSA) extend beyond access to novel medications.
Over 1 million children are affected by SCA in this region and an estimated 60,000 children have ischemic strokes, a known complication. Over the last two decades and in many parts of the world, it has been standard practice to screen children for stroke risk each year. An ultrasound technique known as transcranial Doppler ultrasound (TCD) is used to treat children with elevated risk to prevent stroke more aggressively, greatly reducing morbidity in children with SCA.
This life-changing TCD screening was not available in the region until clinical research in SCA. As part of both academic- and industry-sponsored trials, TCD equipment and training allow TCD screening on a much wider scale than ever before. The technology and expertise for TCD screening are now finding their way into the standard of care in some countries in the region to the benefit of many children and families.
Although clinical research can improve treatment practices, in 2020/21, the proportion of clinical trials starting in Africa, out of the worldwide total, was a mere 3.9%, according to IQVIA analysis of the Citeline TrialTrove database. This percentage represents a doubling of African trial starts in the last decade but is still a small proportion of the global trial landscape and under-represents the potential for 16% of humanity, effectively ignoring many of the major unmet health burden challenges of the 21st century. So, what must change?

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