This open letter synthesizes the 2024 Wellcome Major International Programmes meeting, which brought together research-institution representatives from Africa, Asia, and the United Kingdom. Participants identified limited clinical-trial literacy, unstable funding, workforce recruitment and retention, inequitable partnerships, ethics and regulatory bottlenecks, operational inefficiencies, and barriers in remote settings. Proposed responses included locally led agendas, diversified funding, workforce development, stronger community and regulator engagement, platform, adaptive and decentralized trials, shared monitoring, and interoperable data systems. The meeting agreed to explore a formal MIPs alliance, but the paper does not show that the alliance has yet delivered operational or health outcomes.
Key findings
- Participants identified recurring constraints in trial literacy, funding, workforce, equity and local autonomy, regulation and ethics, trial efficiency, data systems, and remote-site operations.
- Suggested responses included locally led priority setting, diversified funding, career pathways and staff exchange, early regulatory engagement, platform, factorial, adaptive and decentralized designs, and shared monitoring and data infrastructure.
- The meeting agreed to pursue a formal MIPs alliance for infrastructure, training, advocacy, and multicentre delivery; the paper reports subsequent development toward the Africa Asia Alliance for Clinical Trials, planned for launch in November 2026.
Why this matters globally
The proposal matters for global research equity because it shifts LMIC institutions from recruitment sites toward local leadership, infrastructure, workforce, and agenda-setting authority. If implemented and evaluated, a cross-regional network could reduce duplicated effort, share standards and data infrastructure, and accelerate locally relevant trials. The paper does not quantify cost, timelines, trial quality, product access, or health outcomes, so it should be treated as a strategic agenda requiring prospective implementation metrics.
Thai researcher contribution
Nicholas P J Day and Nicholas J White are affiliated with the Mahidol Oxford Tropical Medicine Research Unit in Bangkok and contributed to the manuscript's conceptual review. MORU is one of the established Wellcome MIP trial units represented in the workshop. Thailand's contribution is therefore institutional experience in multicountry tropical-medicine trials and the Mahidol–Oxford research partnership, not clinical outcome data from Thai participants.
Limitations to consider
This is an expert-meeting open letter, not a trial, representative survey, or policy evaluation. Individual participant numbers and characteristics are not reported in the abstract, and a Wellcome MIP network may overrepresent comparatively established research institutions. Full transcripts require data-access approval, limiting independent coding checks. The proposed alliance, funding mechanisms, and technologies have not yet been evaluated for effectiveness or cost, and version 1 was awaiting peer review when checked.