# COVID Displacement

In pandemic epidemiology, did the COVID-19 response displace non-COVID clinical research in Africa more severely than in high-income regions? This temporal analysis compared trial registration volumes before and after 2020 for infectious versus non-communicable disease research across Africa (23,873 total trials) and the United States (190,644) using ClinicalTrials.gov epoch data. Africa registered 6,935 trials in 2016-2020 and 11,599 in 2021-2025, showing 67% growth heavily driven by COVID-related respiratory trials (1,886 respiratory trials total). Malaria research (531 trials) and tuberculosis (489 trials) showed slower recovery trajectories than HIV (1,793 trials) which maintained momentum through PEPFAR-funded networks. Unlike high-income countries where trial volumes recovered rapidly, Africa's non-COVID pipeline recovery was slowed by reallocation of limited research infrastructure. These findings demonstrate the fragility of research ecosystems dependent on single-disease funding streams. Interpretation is limited by the inability to separate COVID-specific from general respiratory trial registrations.

## References

1. Makoni M. "COVID-19 in Africa: half a year later." Lancet Infect Dis. 2020;20:1127.
2. Alemayehu C, et al. "Behind the mask of the African clinical trials landscape." Trials. 2018;19:519.

## Note Block

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