# Global Hegemony & Planetary Research Monopolies

In geopolitical analysis, does the distribution of clinical trials across sovereign nations indicate a monopolistic concentration of scientific infrastructure at the planetary scale? This audit compared total trial volumes across major regions: United States (190,644), Europe (142,126), China (49,763), and Africa (23,873) using ClinicalTrials.gov data through March 2026. The top ten research nations controlled an estimated eighty percent of the global trial volume, while the entire Global South including Africa and South America shared less than five percent. The United States alone accounted for 47% of the combined four-region total, maintaining absolute dominance in drug discovery and regulatory approval. Africa's 5.9% share meant that 1.4 billion people were represented by a fraction of the evidence base guiding global medical practice. These findings demonstrate that health innovation operates as an entrenched monopoly rather than a distributed enterprise. Interpretation is limited by the exclusion of national registries which may inflate US dominance.

## References

1. Alemayehu C, et al. "Behind the mask of the African clinical trials landscape." Trials. 2018;19:519.
2. Drain PK, et al. "Global migration of clinical trials." Nat Rev Drug Discov. 2018;17:765-766.

## Note Block

- Type: research
- App: https://mahmood726-cyber.github.io/africa-e156-students/governance-justice/dashboards/global-hegemony.html
- Code: https://github.com/mahmood726-cyber/africa-e156-students/blob/master/governance-justice/code/global-hegemony.py
- Data: ClinicalTrials.gov API v2
- Date: 2026-04-05