Why Africa Is Being Left Out of Life-Saving Clinical Trials — And Why It Could Kill Millions

Africa clinical trials medical research bias is costing lives across the continent — and a landmark new study has put hard numbers to a crisis that has long been acknowledged but rarely quantified with such devastating clarity.

Despite carrying approximately 25% of the global disease burden and being home to 19% of the world’s population, African people are almost entirely absent from the clinical trials that shape modern medicine. A major study analysing 2,472 randomised controlled trials published globally between 2019 and 2024 found that only 3.9% of trials featured in the world’s most prestigious medical journals were conducted exclusively in Africa.

In cardiovascular research the figures are even more alarming. Of all major trials published in leading cardiology journals during the same period, just two studies — representing a mere 0.6% of the total — were conducted solely on African soil.

The study examined publications across some of the world’s most influential medical journals including the New England Journal of Medicine, The Lancet, the Journal of the American Medical Association, Nature Medicine, the British Medical Journal, Circulation, the European Heart Journal and the Journal of the American College of Cardiology.

A Crisis of Scientific Accuracy

The lead researcher, a physician-scientist working at the intersection of cardiometabolic epidemiology and biomedical data science, described the findings as a crisis of scientific accuracy rather than merely a problem of representation.

When clinical trials exclude African populations, they produce results that lack what researchers call external validity — the ability to apply findings reliably across different populations, environments and real-world conditions. Without that validity, doctors treating African patients are effectively applying evidence generated from entirely different populations, with no guarantee the results will translate safely or effectively.

This is not a theoretical concern. Emerging research shows that genetics, diet and environment can significantly alter how the human body responds to medication. Certain common blood pressure treatments such as ACE inhibitors carry a three to four times higher risk of severe, life-threatening side effects in people of African descent compared to other populations. Similar differences have been documented in the treatment of diabetes and gout.

When trials exclude entire populations, doctors are forced to extrapolate findings from one group and apply them to another — a practice that in any other scientific context would be considered unacceptable.

The Wrong Diseases Being Studied

Compounding the problem is a dangerous mismatch between where African trial funding is directed and where the actual health burden lies. The study found that nearly 76% of trials conducted exclusively in Africa focused on infectious diseases — yet the continent is undergoing a profound epidemiological shift.

Non-communicable diseases including heart disease, stroke and diabetes now account for approximately 38% of all deaths across many African nations. Africa’s middle class has tripled from around 100 million people in the early 2000s to 300 million today, bringing with it longer lifespans and lifestyle-related chronic conditions that demand long-term treatment and management. Yet cardiovascular trials on the continent remain extremely rare.

Deep Inequalities Within the Continent

Even within Africa itself, the data reveals stark disparities. South Africa alone accounted for more than 62% of all trials conducted on the continent, reflecting decades of investment in academic institutions, research governance and established relationships with international sponsors.

By contrast, Central Africa — a region home to more than 180 million people — contributed less than 3% of the continent’s already limited trial output, making it virtually invisible in the global research record.

The inequality extends into the scientific hierarchy itself. Even when African research sites are included in large multinational trials, they are typically used as recruitment hubs rather than genuine scientific partners. The study found that African scientists led only 3.6% of multicontinental trials that included an African site — a finding that exposes a deeply entrenched power imbalance in global medical research.

The Path Forward

The study’s authors argue that Africa must stop being treated as a location where research is conducted and start being recognised as a place where it is conceived, designed, led and interpreted.

The current model — in which international institutions control the funding, the data and the conclusions — leaves African research systems dependent, fragile and unable to translate scientific evidence into national health policy.

Recommended solutions include dedicated ring-fenced funding for African-led research, the creation of regional clinical trial networks across the continent, and a formal requirement for medical journals to report on the demographic diversity of trial populations before publication.

Organisations such as the Alliance for Medical Research in Africa are already working to build the next generation of African research leaders. But the pace of change must accelerate. Modern medicine cannot credibly claim to be a universal science while an entire continent remains absent from the evidence that drives it.