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, some of the world¡¯s largest funders of medical research signed a??aimed at improving the way clinical trial systems are run globally, to better serve patients and communities.

The statement, whose signatories include Australia¡¯s National Health and Medical Research Council (NHMRC), recognises the importance of embedding the clinical trials within national health and research infrastructure and aligning them with local priorities.

This is in line with a global trend to move medical research away from being funded and coordinated from a largely Caucasian male perspective, with an emphasis on ensuring trials include diverse participants. In 2023, joined other prestigious journals such as in declaring a clampdown on ¡°helicopter research¡± ¨C when researchers from high-income countries conduct studies in lower-income settings or with groups that are historically marginalised, with little or no involvement from either those communities or local researchers in the conceptualisation, design, conduct or publication of the research.

The WHO¡¯s statement, making it clear that broadening the participant bases in trials is critical to better health outcomes, is probably a response to the widespread defunding in the US of clinical trials linked to diversity, equality and inclusion (DEI), as well as childhood immunisation, pandemic influenza vaccines and mRNA vaccines, to name just a few. As of May, nearly 800 projects had had their National Institutes of Health funding cancelled, 29 per cent of which are associated with HIV/Aids; an April??in Nature speculated that this may have to do with Trump¡¯s executive order targeting trans people and healthcare, since HIV/Aids disproportionately affects sexual and gender minorities.?

Trump from the WHO in January because of, among other things, ¡°the organization¡¯s mishandling of the Covid-19 pandemic that arose out of Wuhan, China¡±.

But if the US is shrinking the scale and narrowing the scope of clinical trials, others can and must step in. And Australia is well placed to do so.

Australia has a reputation for conducting world-class clinical trials. Our strong research base, robust patent and regulatory laws, attractive tax incentives and strong relationships between universities and hospitals mean that clinical trials conducted here are efficient and cost-effective.

In 2023, researchers from the University of Sydney published a looking at 15 years of clinical trial data.?They found that, compared with other OECD countries, Australia¡¯s clinical trials space is ¡°healthy¡± but has room for improvement, including in the diversity of trial participants.

Recently, the? undertook an honest ¡°warts-and-all¡± analysis of its own trials. Under Monash University professor Ian Davis, they found low representation of patients from culturally and linguistically diverse backgrounds, including Aboriginal and Torres Strait Islander people.

But there are moves to address this. Davis, for instance, also runs Monash¡¯s Eastern Health Clinical School (EHCS), which serves an area where?, and more than 30,000 speak a language other than English. Importantly, more than 40 per cent of EHCS¡¯s trials are ¡°investigator-initiated¡±, meaning its clinician-researchers have identified a health issue in the community and are testing out new treatments or models of care.

In essence, they are doing exactly what the WHO is calling for ¨C to determine the health needs of a diverse community and design clinical trials to test treatments that are specific for that community.

Australia also has excellent facilities. Moderna, which developed one of the mRNA Covid vaccines, has a manufacturing facility in Melbourne, making Australia one of very few countries in the world ¨C and the only one in the Southern Hemisphere ¨C with pandemic-scale end-to-end mRNA manufacturing capability. Moderna¡¯s US government funding for the development of pandemic influenza vaccines has been cut. Australia is the obvious alternative location to continue this work.

Meanwhile, in August, Monash University, Nvidia, Dell Technologies and CDC Data Centres announced that they were building MAVERIC, Australia¡¯s first higher education AI supercomputer, at a cost of A$60 million. This technology will assist Australia¡¯s largest clinical trials network, consisting of more than 7,000 beds and 3.5 million people from very diverse backgrounds.

As US medical research gets mired in politics, the need for the research continues, of course ¨C as does the need for clinical trials to test these potentially lucrative treatments. And that need will be met. That research and those trials will simply continue outside the US.

Australia has a strong investigator-initiated funding base ¨C with government-allocated money from the NHMRC and the Medical Research Future Fund. And while the pharmaceutical industry can still self-fund its trials in the US, the Trump administration¡¯s scrapping of every equalisation measure relating to health makes the atmosphere there a hostile one, particularly for any trials that want to step beyond Anglo-American participants to include culturally and linguistically diverse groups.

Taking trials offshore from the US isn¡¯t just a decision based in equality. It¡¯s a financial one that recognises the fact that markets for treatments and medicines are diverse and must be catered for. Countries such as Australia are very happy to step in.

is foundation dean of the Sub-Faculty of Translational Medicine and Public Health at Monash University, Melbourne.