Clinical trials: surely not just for some?
Ian D. Davis
Professor of Medicine, Monash University and Eastern Health
There is an overrepresentation in clinical trials in Australia of white, English-speaking, younger and middle-class people - despite the fact that 37 per cent of people aged 65 and older (the largest cohort of Australians accessing medicines) were born overseas.
Drug companies recognise the importance of this problem. The pharmaceutical company, Moderna, in the middle of a race to develop a COVID-19 vaccine in 2021, deliberately slowed down enrolment for its clinical trials to ensure participants reflected the whole community, because of concerns that the patients included in the trial might not reflect the diversity of the wider population.
This push to make clinical trials more representative of the global population was raised in Australia in November 2022, when the National Health and Medical Research Council held a symposium targeting increased diversity in the translation of research. The discussion specifically included the need to provide access to clinical trials to people of different cultures, ethnic groups, socio-economic groups, abilities, or ages.
It isn’t just about fairness in numbers. It is also important to include a diversity of people in clinical trials because we know, for instance, that people from culturally and linguistically different groups, or those whose English is not their first language, or those who live remote from a hospital, or those with fewer financial resources, often have poorer health than others in the community. These people cannot benefit from clinical trials if they cannot participate in them, and the community as a whole cannot benefit if the evidence from a clinical trial only applies to a fraction of the people in the community, meaning loss of benefits for our broader healthcare system and our ability to manufacture essential medicines and medical devices onshore.
Eastern Health services a large community that is recognised as one of the fastest-growing regions in Victoria outside Melbourne’s CBD. Its catchment covers a diverse population: over 20 per cent more people in the over-80 age group live here compared to other areas of metropolitan Melbourne; 5.5 per cent of Victoria’s Aboriginal population in eastern Melbourne is located within the catchment; and one in four patients admitted to our hospitals come from a country where English is not the predominant language, with the top five contributing countries including China, Greece, India, Italy, and the Netherlands. Eastern Health is also a critical catchment area for outer Melbourne, large parts of Victoria, and even interstate patients, all of whom are currently disadvantaged in access to clinical trials.
I lead a team of clinician-researchers at Monash University and Eastern Health, supporting access through clinical trials to life-saving medicines and medical devices to improve healthcare in the community. We perform large numbers of clinical trials and have won awards for this work, but we struggle to meet our current commitments and are concerned we might not be able to meet projected needs, for one simple reason - there is no space for us to grow our trial activity, to accommodate our staff and to treat our patients on trials.
Box Hill, the home of the largest hospital of Eastern Health, is near the geographic heart of Melbourne's population and we serve one of the largest populations in Victoria - with distinct healthcare needs. Despite the clear need, and the express wishes of our community that they receive treatment close to where we live, the space we currently have to run clinical trials at Eastern Health is about 1-2 per cent of what is available at other health services.
Our patients commonly have to decide between travelling to distant healthcare services to access potentially life-altering treatment, or miss out on the opportunity. Travel might not be feasible, due to cost, or the time required, or lack of transport options, and care can be disrupted when moving between health services. It is critical that people in the community be able to access the treatments they need in the region in which they live.
The problem is easily solvable. A new, dedicated, clinical trials and research building based at Eastern Health’s Box Hill campus will allow delivery of world-quality care and research right where it is needed. This building has been planned and costed, and could be fully funded with relatively small investments from both State and Federal governments.
The community needs this and wants this. We owe it to them to get it done.
About Monash University
Monash University is Australia’s largest university with more than 80,000 students. In the 60 years since its foundation, it has developed a reputation for world-leading high-impact research, quality teaching, and inspiring innovation.
With four campuses in Australia and a presence in Malaysia, China, India, Indonesia and Italy, it is one of the most internationalised Australian universities.
As a leading international medical research university with the largest medical faculty in Australia and integration with leading Australian teaching hospitals, we consistently rank in the top 50 universities worldwide for clinical, pre-clinical and health sciences.