WHO Report Exposes Inequities in Global Cancer Clinical Trials

Cancer clinical trials are expanding worldwide, yet access and participation remain strikingly unequal, according to the World Health Organization’s (WHO) latest comprehensive review of 89,069 trials registered between 1999 and 2022.

The analysis, published in Nature Medicine, highlights that while oncology research is growing, it remains heavily concentrated in high-income countries (HICs), with low- and lower-middle-income countries (LMICs) largely excluded.

WHO’s findings reveal stark imbalances in research allocation relative to disease burden. About 70% of global trials are hosted in HICs, with low-income countries (LICs) conducting fewer than 1% of studies. When adjusted for cancer mortality, trial density in HICs exceeds that of LICs by nearly 80-fold. Certain high-burden cancers, including liver, stomach, pancreas, and cervical cancers — particularly prevalent in Africa and Southeast Asia — remain critically underrepresented. Phase 2 trials dominate the landscape, while larger, confirmatory phase 3 studies account for just 13% of entries. Pediatric and geriatric populations are also underrepresented, with only 3.3% of trials enrolling participants under 14 years and just 28% explicitly targeting adults over 60.

Sponsorship patterns further highlight the inequities. While academic and research institutions account for over half of all trial sponsorships, industry-funded studies have grown in influence, often favoring commercially attractive interventions over high-mortality cancers in underserved regions. Multinational collaboration is limited: only 15% of all trials are conducted across multiple countries, and just 3% of recruiting trials involve high-income and lower-resource country partnerships. WHO warns that these imbalances undermine the external validity of trial results and perpetuate inequities in access to potentially life-saving innovations.

Innovation Clusters as Illustrative Solutions

WHO’s analysis provides not only a snapshot of global disparities but also a roadmap for action. According to Pascaline Leon, Head of the Healthcare Department, Business France México, initiatives like the Paris-Saclay cancer research cluster in France illustrate how concentrated innovation hubs can help address such inequities. By fostering collaboration among academic institutions, hospitals, and biotechnology companies, Paris-Saclay aims to showcase how regional ecosystems can accelerate cancer research efficiency and attract investment in underrepresented areas.

On the other hand, AI technologies can enable more efficient trial design, patient recruitment, and data analysis. AI-driven platforms can optimize trial matching for rare or high-mortality cancers and facilitate collaboration across borders, offering a potential model for equitable research partnerships that align with local health priorities. 

Aligning Research Investment with Global Need

The WHO review underscores urgent priorities for policymakers, funders, and the private sector. It urges them to expand clinical trial capacity in LICs and LMICs, particularly for high-mortality cancers; increase multinational collaboration that genuinely involves local stakeholders in research design and implementation; diversify research beyond pharmacological interventions to include prevention, diagnostics, surgery, and radiotherapy; and ensure trials are inclusive of pediatric and geriatric populations to better reflect patient demographics.

By aligning investment with disease burden and strengthening local research ecosystems, the global oncology community can ensure that clinical trials produce practice-changing, context-relevant evidence for all populations. WHO emphasizes that transformative impact requires sustained political commitment, coordinated multi sectoral governance, and integration of cancer trials within broader health system reforms.