National research ecosystems: protecting populations and building health security worldwide

The global clinical research enterprise remains fundamentally misaligned with worldwide disease burden and public health needs, despite corrective efforts in recent years. Although clinical trials deliver important medical advances that benefit populations globally, research capabilities and trials are concentrated in high-income countries, which means that populations with the heaviest disease burdens (often in low-income and middle-income countries) participate in relatively few trials addressing their needs—infectious and non-communicable diseases alike. This imbalance leaves knowledge gaps in treating the most prevalent diseases and leaves the world dangerously unprepared for emerging threats. In this Viewpoint, we advance a vision of strong national research ecosystems that prioritise national and regional health needs, are integrated into health systems for rapid incorporation of research results into health care, and are prepared to pivot to emergency research when needed. This vision and the investment it requires—both domestic and international—are essential to improving and protecting population health.