A clinical trial conducted in Africa may recruit African participants, rely on African investigators and address a pressing African health need, yet still route its funding, protocol design, data governance and publication decisions through institutions thousands of kilometres away.
This model has enabled important research and remains valuable. But when it becomes the default rather than one option among many, it limits who sets priorities, controls resources and retains institutional knowledge.
South-South collaboration offers a necessary second axis: direct relationships among African, Latin American and Asian research institutions. Its value is not based on geography alone, nor on the assumption that institutions across the Global South are equal or interchangeable. It lies in the opportunity to compare solutions developed under related constraints and to build partnerships in which authority does not automatically sit elsewhere.
Shared constraints can produce transferable insight
Brazil, India, Thailand and many African countries work within very different political, economic and health systems. Yet they face overlapping research challenges: constrained public budgets, uneven infrastructure, shortages of specialised personnel, complex disease burdens and the need to connect research more closely to public health delivery.
These conditions create knowledge that is operational, not merely theoretical.
India’s experience is instructive. Following serious concerns about participant protection and trial oversight, reforms introduced from 2013 strengthened ethics committee registration, compensation requirements and regulatory scrutiny. The New Drugs and Clinical Trials Rules of 2019 subsequently consolidated the framework governing clinical trials and ethics committees (1). African regulators should not copy this pathway wholesale, but they can examine how India balanced participant protection, regulatory certainty and the need to sustain a viable research environment.
Brazil offers a different lesson. Through the Oswaldo Cruz Foundation, known as Fiocruz, the country has linked public health research with surveillance, training and the production of medicines and vaccines. Its experience shows that research, regulation and manufacturing are more useful when treated as connected parts of a health system rather than as separate sectors.
Thailand’s HIV Netherlands Australia Thailand Research Collaboration, established in 1996, demonstrates the value of sustained institutional focus. Based within the Thai Red Cross AIDS and Infectious Diseases Research Centre, HIV-NAT has coordinated multicentre trials and contributed evidence relevant to Thai and international HIV treatment guidance (2). The lesson is not simply to create more networks. It is to maintain them long enough to accumulate scientific credibility, operational memory and trusted relationships.
Africa brings equally valuable expertise to this exchange. African institutions have conducted complex trials across dispersed populations, developed approaches to community engagement in settings where trust cannot be assumed, and integrated research into health systems operating under significant resource pressure. Experience in outbreak research, genomic surveillance, HIV, tuberculosis, malaria and other diseases has generated capabilities that partners elsewhere can adapt.
South-South collaboration should therefore not be framed as Africa seeking instruction from more advanced peers. It is an exchange among institutions with different strengths and unfinished agendas.
The strongest collaborations solve a defined problem
The most convincing examples begin with a practical need rather than the language of solidarity.
The Tuberculosis Genomic Surveillance Network, or REVIGET, connects expertise from Brazil and South Africa to strengthen genomic surveillance in northern and northeastern Brazil. The initiative has adapted infrastructure developed for COVID-19 surveillance to tuberculosis and included hands-on genomics and bioinformatics training delivered through Brazilian public laboratories. South African and Indian expertise contributed to the programme, while implementation remained embedded in Brazil’s public health context (3).
Critical care provides another model. The Collaboration for Research, Implementation and Training in Critical Care in Asia and Africa supports partners across nine Asian and nine African countries (4). Its shared data platform enables clinical registries, quality improvement and multicentre research, while data coordination is managed by a Sri Lanka-based research unit (5). This matters because ownership of research infrastructure, not participation alone, determines whether a collaboration leaves lasting institutional capability.
Africa CDC and Fiocruz have also established a cooperation framework covering research, disease surveillance, workforce development, health systems and local production of health products (6). The breadth of this agenda reflects an important principle: meaningful research collaboration cannot be separated from the systems that regulate, finance, manufacture and use the resulting interventions.
These examples are still exceptions. They show what is possible, but they should not be mistaken for evidence that a mature South-South clinical research architecture already exists.
Why the usual routes persist
The central barrier is not a lack of interest. It is the way research is financed and organised.
African medical research remains heavily dependent on external funding. An analysis published in Research Policy found that public non-African and philanthropic institutions were major sources of funding across African regions, while domestic funding remained limited outside a small number of countries (7). Other studies of global health partnerships have documented how funding eligibility, grant-management requirements and institutional track records can place northern organisations in the lead even when research is conducted elsewhere.
Direct collaboration between southern institutions must then compete with established routes that already have funders, contracting systems, publication relationships and administrative support.
Regulatory differences create another obstacle. International standards provide an essential baseline for participant protection and data quality, but their implementation varies between jurisdictions. A trial spanning Africa, Latin America and South Asia may face multiple ethics reviews, import processes, contracting requirements and interpretations of the same technical standard.
Language also shapes opportunity. Research networks tend to follow existing linguistic and diplomatic connections. Links between Brazil and Portuguese-speaking African countries demonstrate what shared language can enable, but they also reveal how easily potentially valuable relationships remain unexplored when researchers lack translation resources or trusted intermediaries.
None of these barriers will be solved by signing more memoranda of understanding. Collaboration becomes real only when institutions can move money, people, data, samples and decisions across borders responsibly.
Build the operating system before pursuing the flagship trial
The instinct may be to begin with a large, highly visible multicountry trial. That is usually the wrong starting point. Institutions should first build the mechanisms that make joint research repeatable.
Four priorities stand out.
First, establish direct funding routes. African, Asian and Latin American funders should create joint calls that permit institutions in participating regions to serve as lead applicants and direct recipients. Funding should cover grant management, translation, contracting and data infrastructure, not only scientific activities.
Second, create regulator-to-regulator relationships. Structured exchanges among African regulators, Brazil’s Anvisa, India’s Central Drugs Standard Control Organisation and relevant Asian authorities could focus on practical questions such as reliance pathways, safety reporting, inspection approaches and oversight of decentralised trials. The African Medicines Agency, which began operations in 2025, provides a continental platform from which such relationships could develop (8).
Third, agree on ownership before recruitment begins. Every collaboration should define governance, budget authority, authorship, access to data and samples, intellectual property, technology transfer and post-trial responsibilities at the outset. South-South partnerships are not automatically equitable. Differences in institutional resources and political influence can reproduce the same hierarchies they are intended to avoid.
Fourth, organise collaboration around shared problems. Tuberculosis, antimicrobial resistance, maternal health, climate-sensitive diseases and critical care offer strong starting points because they require evidence across varied health systems. Joint work should extend from observational studies and shared registries to interventional trials only when the scientific question and operating capacity justify that progression.
Manufacturing should be considered early, not appended after a successful trial. If an intervention may eventually require regional production, research agreements should address process development, regulatory strategy and technology transfer from the beginning. Brazil’s long-running cooperation with Mozambique on public pharmaceutical production illustrates both the potential and the complexity of connecting technical exchange to institutional ownership.
Diversification, not disengagement
South-South collaboration should not become a rhetorical rejection of Europe or North America. Northern partners remain important sources of scientific expertise, finance and technology, and many have supported valuable African-led work.
The strategic objective is diversification.
A resilient research ecosystem should be able to work north-south, south-south and, where useful, through triangular partnerships. No single route should determine which questions can be asked or who is permitted to lead.
For ACRN, this means supporting relationships in which African institutions participate from priority-setting through implementation, analysis and translation into policy or practice. It also means approaching Latin American and Asian partners with a clear account of what African networks contribute, not only what they need.
The next phase of African clinical research will not be defined by the number of partnerships it can announce. It will be defined by whether those partnerships create durable routes for African institutions to commission research, coordinate trials, govern data and translate evidence without always passing decision-making authority through the Global North.
South-South collaboration is not valuable because southern institutions share an identity. It is valuable when they share responsibility, risk, knowledge and control. That is the standard that will turn geographic connection into genuine research capability.
References
- Central Drugs Standard Control Organization. The New Drugs and Clinical Trials Rules, 2019. New Delhi, India: Ministry of Health and Family Welfare, Government of India; 2019. Report No.: G.S.R. 227(E).
- HIVNAT. About us: HIV Netherlands Australia Thailand Research Collaboration; Available from: https://www.hivnat.org/en/about-us/
- Sciences SUDoB. Stellenbosch University strengthens bilateral collaboration in the Global South for capacity building in tuberculosis genomics 2025 Available from: https://blogs.sun.ac.za/mbhgblog/2025/01/19/reviget/
- MORU Tropical Health Network. Critical illness: Mahidol Oxford Tropical Medicine Research Unit; Available from: https://www.tropmed.ac/units/moru-bangkok/malaria/studies-study-sites/critical-illness
- Beane A, De Silva AP, Athapattu PL, Jayasinghe S, Abayadeera AU, Wijerathne M, et al. Addressing the information deficit in global health: lessons from a digital acute care platform in Sri Lanka. BMJ Global Health. 2019;4(1):e001134.
- Africa Centres for Disease Control and Prevention. Africa CDC and Fiocruz Partner to Strengthen Health Systems: Africa Centres for Disease Control and Prevention; Available from: https://africacdc.org/news-item/africa-cdc-and-fiocruz-partner-to-strengthen-health-systems/
- Confraria H, Wang L. Medical research versus disease burden in Africa. Research Policy. 2020;49(3):103916.
- African Medicines Agency. Overview: African Medicines Agency; Available from: https://au-ama.africa/about-overview/