Global RCT Equity: Africa vs. Europe

Abstract

In global health research, does the geographic distribution of interventional trials reveal a fundamental equity gap between Africa and Europe? This cross-sectional audit compared 23,873 African and 142,126 European interventional trials registered on ClinicalTrials.gov API v2 through March 2026. Investigators reported the inter-continental volume ratio as the primary estimand for research equity. Europe hosted 6.0 times more trials than Africa despite having less than half the population, yielding a per-capita disparity exceeding ten-fold. Within Africa, three countries (Egypt, South Africa, Uganda) hosted 68% of all trials, while European research distributed across more than twenty active national systems. Africa’s growth from 678 trials in 2000–2005 to 11,599 in 2021–2025 demonstrated 17-fold expansion but failed to narrow the proportional gap. These findings confirm that Africa functions as a validation ground rather than a discovery hub for new medicines; interpretation is limited by reliance on public registrations which may underreport locally funded trials.