The global burden of cancer is estimated with more than 20 million cases by 2030, most of them occur in low- and middle-income countries (LMICs). LMICs account for 64% of global cancer deaths and 80% of life-years lost because of disability. In spite of this, only 5% of the global cancer resources are spent in LMICs causing a high mortality-to-income ratio. Despite the burgeoning number of clinical trials in the HICs, there are several reasons to conduct clinical trials in LMICs.
Strengths
- Large sample of patients with diverse genetic pool
- Trained manpower
- Large market share for the pharmaceutical industry
- Increase in insurance coverage in both public and privates sectors
- FDA approved WHO GMP facilities
- Information technology support
- Engagement of DCGI/SEC/CDSCO with stakeholders
Weaknesses
- Lack of more centers of excellence
- Lack of transparency
- Lack of accountability
Opportunities
- Strengthen current academic institutions and empower academic researches
- Establish a central body like NIHR in UK for oversea of trial approval and research funding
- From central ethics committee to provide oversight
- Healthy Public-Private partnership
Threats
- Lack of funding
- Cultural view on clinical trials
- Overzealous media
- Delayed approvals
- Cumbersome paperwork
To ensure true progress in clinical trial landscape in the LMICs, regionally sensitive policy making is a necessity. Efficiency in government, academia, and pharmaceutical industry; with improved funding opportunities and incentives for healthcare providers will play a pivotal role in development. Scientific education for the lay public and media, while simultaneously bolstering the research training among LMICs can prove beneficial in long term. Lastly, increased partnership not only among experts but with patients-empowering them as vital stakeholders will be essential for progress in LMICs.
Sources: Aakash Desai, Bhawna Sirohi & Aju Mathew (2021) Clinical Trial Access in Low- and Middle-Income Countries: A Case Study on India, Cancer Investigation, 39:9, 685-689
