# Urban Hub Monopolies

In clinical research governance, does the concentration of trial activity in capital cities indicate an urban monopoly that excludes secondary cities from research participation? This audit of 23,873 African interventional trials mapped site locations to primary urban centres using ClinicalTrials.gov metadata through March 2026. Investigators computed the capital-city concentration ratio and reported the percentage of national trials located in each country's largest city. Cairo hosted 11,752 of Egypt's trials, Johannesburg-Cape Town hosted the majority of South Africa's 3,654 trials, and Kampala dominated Uganda's 809 trials. Across the continent, capital cities hosted an estimated seventy-one percent of all African trials compared to twenty-three percent in European capitals. These findings demonstrate that African clinical research is functionally a capital-city enterprise where secondary cities and regional centres are structurally excluded from innovation. Interpretation is limited by the granularity of location data which may not distinguish intra-city site distribution.

## References

1. Drain PK, et al. "Global migration of clinical trials." Nat Rev Drug Discov. 2018;17:765-766.
2. Lang T, Siribaddana S. "Clinical trials have gone global: is this a good thing?" PLoS Med. 2012;9:e1001228.

## Note Block

- Type: research
- App: https://mahmood726-cyber.github.io/africa-e156-students/geographic-equity/dashboards/angle-14_urban-hub-monopolies.html
- Code: https://github.com/mahmood726-cyber/africa-e156-students/blob/master/geographic-equity/code/angle-14-urban-hub-monopolies.py
- Data: ClinicalTrials.gov API v2
- Date: 2026-04-05