# Modality Symmetry & Innovation Gaps

In health technology assessment, does the distribution of intervention types in African trials show a modality imbalance compared to global portfolios? This audit classified 23,873 African trials by intervention modality using ClinicalTrials.gov keyword analysis for drugs, devices, diagnostics, digital health, and behavioural interventions through March 2026. Investigators reported the modality concentration index as the primary estimand for innovation diversity. Drug trials dominated Africa's portfolio, while device trials represented under five percent and digital health interventions numbered only 268 compared to 4,540 in the United States (17x gap). Immunotherapy trials were virtually absent in Africa (92) compared to 3,803 in the United States, a 41x disparity. Africa receives pharmaceutical validation but is excluded from the device, diagnostic, and digital health revolutions transforming high-income healthcare. These findings reveal a structural modality asymmetry that limits the type of health innovations accessible to African populations. Interpretation is limited by keyword-based classification of intervention modalities.

## References

1. Lang T, Siribaddana S. "Clinical trials have gone global: is this a good thing?" PLoS Med. 2012;9:e1001228.
2. ClinicalTrials.gov API v2 Documentation. U.S. National Library of Medicine.

## Note Block

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