Meeting Report: Optimizing Efficiency and Impact in the African Clinical Trials Ecosystem

Executive Summary

In May 2023, Africa CDC and AUDA-NEPAD convened sixty experts from across the continent and the globe to discuss concrete solutions for strengthening the impact and efficiency of the African clinical trials ecosystem, with the goal of speeding access to new lifesaving technologies in line with public health priorities. This meeting—rooted in aspirations of Africa’s Agenda 2063 and informed by the World Health Assembly clinical trials resolution—built upon discussions forged at the 2019 Pan African Clinical Trials Alliance meeting and in the sidelines of the 2022 Grand Challenges Annual Meeting. It was designed to:
• Diagnose and develop a collective vision for strengthening the African clinical trial ecosystem to drive more impact.
• Co-design a roadmap to drive efficiency and optimal impact for clinical trial pipelines in line with global initiatives on clinical trials.
• Identify priority funding, areas of harmonization in policy and practices, and opportunities for meeting participants to contribute to strengthening the ecosystem.

Participants agreed that despite the strengths and assets within the current clinical trial ecosystem, it is not equipped to effectively manage a global health product pipeline that is expected to grow in both complexity and size. A lack of overall coordination and ecosystem-wide weaknesses mean that individual investments in areas such as capacity strengthening and retention, digital infrastructure, trial design, and network strengthening have often yielded transactional gains that cannot be sustained over time.
Over three days, meeting participants examined all aspects of the clinical trial ecosystem and proposed concrete solutions, ultimately agreeing that there is an urgent need to reconfigure how coordination happens and how information, data, processes, and tools are shared and reported. They examined the opportunity to improve coordination across the continent to build more predictability for researchers, clinical trial funders, and sponsors; a stronger clinical trials workforce; more streamlined and efficient systems for collaboration; harmonized ethics and regulatory reviews; and better responsiveness to the needs of African research centers.

Participants together developed a shared vision for the African clinical trial ecosystem and developed several priority solutions that would enable this vision. They ultimately agreed that a coordination mechanism was needed to enable increased efficiency and impact and recommended that this mechanism be housed at Africa CDC and managed in partnership with AUDA-NEPAD, WHO AFRO, and AVAREF.
This mechanism should foster collaboration across funders and research sponsors, research networks and centers, industry partners, and community representatives, and that its mandate should include evaluation of the pipeline of clinical trials in line with African public health and research priorities, aligning on financing needs and mechanisms, building cohesive capacity strengthening partnerships, and driving evaluation of the impact of these changes on the clinical trial ecosystem. Participants prioritized a set of solutions that should be coordinated through this mechanism, including those that would strengthen clinical trial networks, advance innovative clinical trial design, harness digital innovations and efficiencies,
ensure sufficient capacity and capacity strengthening across the ecosystem, standardize policies and practices, and ensure effective engagement of communities and the public.
In the coming months, Africa CDC and AUDA-NEPAD will continue to engage with the African clinical research ecosystem and African Member States to shape and refine this coordination role, including through the evolution of a ten-year execution roadmap.