The Cyclical Pattern of Boom and Bust in Research Has Left Africa Unprepared for Emergencies Such as Ebola

Abstract

Having observed several Ebola outbreaks since 1976, the distribution of clinical trials indicates patterns that jeopardise Africa's future epidemic responses ¹. The cross-sectional audit evaluated 23,873 sub-Saharan Africa (SSA) and 190,644 United States international trials registered with https://clinicaltrials.gov/data-api/about-api through April 2026.  Investigators computed an interrupted time-series slope change as the primary estimate, using registry metadata from each nation, including SSA.  Despite experiencing the harshest Ebola outbreaks in SSA countries, including Uganda and the Democratic Republic of Congo, they did not register efficacy trials, unlike the US, which conducted 127 trials ^{1 2}.  Temporal analysis showed a 17.1-fold increase in SSA trial-registrations from 2000-2005 to 2021-2025, yet persistent gaps existed in high-income regions.

Uganda managed the 2025 Sudan virus outbreak using experience; however, the lack of pre-funded research hinders sustained preparedness and calls for emergency responses ³. Therefore, the lack of subnational data and interpretational Ebola studies may lead to an underestimation of the true research scope in SSA.

Keywords: Ebola preparedness, clinical trials, Africa, Uganda, research gap.