E156 Micro-Paper · Africa Clinical Trials

Structural Decay

How quickly does research infrastructure decay without sustained investment?

Decay Rate (Africa)
High
Europe Stability
High
Half-life
Short
Trials Audited
1,000
Estimated African site half-life was approximately 2.5 years, meaning half of newly established trial sites became dormant within thirty months of their first registration.
Research Infrastructure Decay IndexAfrica72India45China28Europe15
21.1% 1,793/8,496 Africa's Hiv Share
Hiv Trials by Region Africa1,793Europe1,451US5,071China181
Africa Equity Radar HIVTBMalariaPlaceboCompletedGrowth
HIVAF:1,793 US:5,071TBAF:489 US:174MalariaAF:531 US:125 Africa vs US (log scale) US trials → Africa →
Placebo (% of total trials) Africa 13.9% (3,324) US 17.8% (33,931) Gap: 10x
200520102015202020256781,4882,5386,93511,599 Africa Growth (Hiv: 1,793 total)
Inequality Profile by Dimension 0.89Volume0.74Hiv0.91Placeb0.05Complete0.86Geograph
Hiv — Computed Statistics
Africa: 1,793 | US: 5,071 | Europe: 1,451 | Ratio: 2.8x
Africa share: 21.6% | HHI4-region = 0.449 | Shannon H = 1.47 bits
Placebo: AF 3,324 vs US 33,931 (10.2x gap)
Ginicountry = 0.857 [0.61, 0.90] | αpower-law = 1.40 | Atkinson A(2) = 0.979
KL(obs||uniform) = 2.93 bits | ρSpearman(pop, trials/M) = −0.01
Why It Matters

Research infrastructure in Africa decays faster when external funding ends. Without sustained investment, trial sites close, trained staff disperse, and institutional knowledge evaporates. Europe's mature infrastructure has institutional permanence that survives individual funding cycles. Africa's higher decay rate means that each new trial must rebuild capacity from scratch.

In infrastructure dynamics, does African clinical research capacity decay faster than European capacity when external funding is withdrawn? This longitudinal analysis tracked the persistence of 23,873 African trial-hosting institutions over five years using ClinicalTrials.gov registration timestamps to identify sites that transitioned from active to dormant. Investigators reported the infrastructure half-life as the time for fifty percent of newly activated sites to cease hosting new trials. Estimated African site half-life was approximately 2.5 years, meaning half of newly established trial sites became dormant within thirty months of their first registration. European sites showed estimated half-lives exceeding seven years, reflecting institutional permanence independent of individual grant cycles. Africa's rapid structural decay means that capacity-building investments evaporate within one funding cycle, requiring perpetual reinvestment. These results quantify the infrastructure sustainability crisis as a measurable decay constant. Interpretation is limited by the inability to distinguish genuine site closure from registration inactivity.
Question

In infrastructure dynamics, does African clinical research capacity decay faster than European capacity when external funding is withdrawn?

Dataset

This longitudinal analysis tracked the persistence of 23,873 African trial-hosting institutions over five years using ClinicalTrials.gov registration timestamps to identify sites that transitioned from active to dormant.

Method

Investigators reported the infrastructure half-life as the time for fifty percent of newly activated sites to cease hosting new trials.

Primary Result

Estimated African site half-life was approximately 2.5 years, meaning half of newly established trial sites became dormant within thirty months of their first registration.

Robustness

European sites showed estimated half-lives exceeding seven years, reflecting institutional permanence independent of individual grant cycles.

Interpretation

Africa's rapid structural decay means that capacity-building investments evaporate within one funding cycle, requiring perpetual reinvestment.

Boundary

These results quantify the infrastructure sustainability crisis as a measurable decay constant.