For decades, discussions about equity in global clinical research have often focused on the terms of partnership, who owns the data, who leads publications, who holds intellectual property, and who captures the economic value created by research. These are important questions. But they are also downstream questions.
The more fundamental question is this: what creates negotiating power in the first place?
Negotiating power is rarely won at the contract table. By the time a clinical trial agreement is being negotiated, much of the leverage has already been established, or lost, through years of institutional investment, scientific credibility, operational performance, and strategic positioning.
This distinction matters because it changes where African institutions should focus their efforts. Sustainable negotiating power is not built through grievance or rhetoric. It is built through capability.
Negotiating power is an outcome—not a strategy
Strong institutions consistently negotiate better partnerships because they possess assets that others value and cannot easily replace. In global clinical research, negotiating power rests on five interconnected foundations.
- Execution credibility
The first and most important source of leverage is execution.
Institutions that consistently deliver studies on time, maintain high participant retention, produce reliable data, perform well during audits and inspections, and meet Good Clinical Practice (GCP) standards become trusted partners. Sponsors return because delivery reduces scientific, operational, and regulatory risk.
Negotiating strength begins long before a contract is signed. It begins with a reputation for delivering high-quality research repeatedly and predictably.
- Scientifically valuable data
Africa contributes scientific value that extends well beyond participant recruitment.
The continent possesses the greatest human genetic diversity globally, making African populations indispensable for improving the understanding of disease biology, treatment response, and precision medicine (1,2). Yet despite this importance, African populations remain substantially underrepresented in genomic research, limiting both scientific discovery and equitable translation of research into health benefits (2,3).
As regulators and sponsors increasingly recognize the importance of representative clinical evidence, institutions capable of generating high-quality data from diverse populations become more strategically valuable. Recent guidance from the U.S. Food and Drug Administration (FDA) on Diversity Action Plans reflects this broader shift toward more representative clinical evidence generation (4).
Scientific value creates negotiating opportunities—but only when institutions have the systems to protect and steward that value.
- Institutional infrastructure
Strong science alone is insufficient.
Negotiating power depends equally on institutional systems that support research excellence, including research administration, legal expertise, financial management, quality assurance, regulatory compliance, contract review, and data governance.
These functions are often invisible to external audiences, yet they determine whether an institution can negotiate confidently and protect its long-term interests.
Indirect cost recovery illustrates this clearly. Universities and research institutions incur substantial costs beyond the direct conduct of research, including facilities, administration, information technology, finance, ethics oversight, and regulatory support. These costs are routinely recognized within research funding systems in high-income countries (5). However, institutions in many low- and middle-income countries continue to recover only a fraction of these costs, weakening their ability to build sustainable research systems (6).
Negotiating fair indirect cost recovery is therefore not simply a financial issue—it is an investment in future research capacity.
- Legal and contracting maturity
Many important research partnerships succeed or fail long before the first participant is enrolled.
Contracts determine ownership of data, publication rights, intellectual property, access to biological samples, dispute resolution, confidentiality, and long-term use of research outputs.
Historically, many African institutions have had limited access to specialist legal expertise focused on clinical research contracting. As a result, agreements have often reflected established sponsor templates rather than genuinely negotiated partnerships (7).
Building institutional legal capacity is therefore an essential component of scientific capacity.
- Institutional confidence
Perhaps the least discussed component of negotiating power is confidence.
Institutional confidence is not confrontation. Nor is it ideological.
It is the confidence to ask difficult questions, propose alternative contractual arrangements, negotiate respectfully, and, where necessary, decline partnerships that do not align with institutional priorities or long-term sustainability.
Confidence is earned through experience. Institutions that consistently deliver high-quality research understand the value they bring and negotiate accordingly.
From transactional partnerships to strategic partnerships
Many discussions about equitable research partnerships focus on correcting historical imbalances. While history provides important context, the future will be shaped less by historical grievance than by institutional excellence.
Sponsors increasingly seek partners capable of delivering complex, multinational clinical research efficiently, ethically, and at global standards. Those partners are distinguished not simply by geography, but by capability.
The strongest partnerships therefore move beyond transactional service delivery.
They recognize African institutions as scientific collaborators that contribute operational expertise, contextual knowledge, participant trust, data stewardship, and increasingly, scientific leadership.
This has practical implications.
Contracts should address data governance transparently.
Publication practices should reflect genuine scientific contribution.
Intellectual property arrangements should appropriately recognize contributions from African researchers, institutions, data, and biological samples.
Long-term capacity strengthening should be integrated into partnerships rather than treated as a discretionary addition.
These principles are neither novel nor exceptional. They represent standard institutional practice among many mature research organisations globally.
The next frontier for African clinical research
Perhaps the greatest misconception is that negotiating power begins during negotiation.
It does not.
Negotiating power begins years earlier—with investment in people, systems, governance, financial sustainability, regulatory maturity, data infrastructure, and scientific quality.
Every successfully completed trial strengthens institutional credibility.
Every clean audit builds trust.
Every well-governed dataset increases scientific value.
Every experienced study coordinator, pharmacist, laboratory scientist, data manager, research administrator, and investigator contributes to an institution’s reputation.
Over time, these assets compound.
The institutions that consistently invest in them become increasingly difficult to replace—not because they demand influence, but because they have earned it.
What ACRN is building
This understanding shapes ACRN’s approach.
Our ambition is not simply to coordinate clinical research across Africa. It is to strengthen the institutional foundations that enable African organizations to become long-term strategic partners within the global clinical research ecosystem.
That includes investing in operational excellence, high-quality data systems, contracting capability, workforce development, research management, and collaborative networks that improve delivery across the continent.
Ultimately, the future of African clinical research will not be determined by whether global partners become more generous.
It will be determined by whether African institutions become consistently excellent.
Negotiating power is not something institutions request.
It is something they earn.
References
- Choudhury A, Aron S, Botigué LR, Sengupta D, Botha G, Bensellak T, et al. High-depth African genomes inform human migration and health. Nature. 2020 Oct;586(7831):741–8. doi:10.1038/s41586-020-2859-7
- Adepoju P. Tackling Africa’s underrepresentation in genomics studies. Nat Afr. 2022 Apr 5. doi:10.1038/d44148-022-00051-6
- Fatumo S, Chikowore T, Choudhury A, Ayub M, Martin AR, Kuchenbaecker K. A roadmap to increase diversity in genomic studies. Nat Med. 2022 Feb;28(2):243–50. doi:10.1038/s41591-021-01672-4
- Diversity Action Plans to Improve Enrollment of Participants from Underrepresented Populations in Clinical Studies | FDA [Internet]. [cited 2026 Jun 30]. Available from: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/diversity-action-plans-improve-enrollment-participants-underrepresented-populations-clinical-studies
- 7.4 Reimbursement of Indirect Costs [Internet]. [cited 2026 Jul 2]. Available from: https://grants.nih.gov/grants/policy/nihgps/HTML5/section_7/7.4_reimbursement_of_indirect_costs.htm
- TDR [Internet]. [cited 2026 Jul 2]. Five keys to improving research costing and pricing in low- and middle-income countries. Available from: https://tdr.who.int/publications/m/item/2020-09-29-five-keys-to-improving-research-costing-and-pricing-in-low-and-middle-income-countries
- Council on Health Research for Development (COHRED). Where There Is No Lawyer: Guidance for Fairer Contract Negotiation in Collaborative Research Partnerships. Available from: https://www.cohred.org/wp-content/uploads/2012/04/COHRED-guidancebookletv-web-ISBN.pdf