Many of the world’s largest medical research funders still fail to ensure that clinical trial results are made public, new data show. Their lack of safeguards raises concerns that public money is being wasted while patients suffer harms due to systematic distortions in the medical evidence base.
Only one funder worldwide, the UK’s National Institute of Health Research, has adopted all 11 research waste safeguards recommended by the World Health Organisation. Several funders, including the U.S. Centers for Disease Control, the Italian Ministry of Health, and Spain’s Instituto de Salud Carlos III, neither require their grantees to make all trial results public nor monitor whether they do so.
Even some funders that have formally committed to implementing all WHO safeguards, notably Gates Foundation and the Netherlands’ ZonMw, have so far failed to deliver on their promises.
What are the 11 WHO safeguards?
Clinical trials only benefit the public if and when their results are made publicly available.
Unreported trial results are not only a waste of public money, but also leave gaps in the medical evidence base that can endanger patients and undermine public health. In addition, many results are currently only made public after a delay of several years.
The World Health Organisation's Joint Statement sets out 11 safeguards that all medical research funders worldwide should adopt to prevent research waste and maximise the value of funds invested in medical research:
TranspariMED's assessment found a very wide range of performance among American funders.
For example, the U.S. National Institutes of Health have already adopted 10 out of 11 WHO safeguards (and have recently started chasing up missing results), while other funders including the Centers for Disease Control appear to still be handing out public money without checking whether researchers actually deliver the promised results.
In mainland Europe, the picture is also very mixed.
While no European funder has adopted all WHO-recommended safeguards, several European funders now have strong policies in place, including public funders in Sweden, Norway, and Belgium. However, public funders in Austria, Denmark, Germany, Italy, the Netherlands and Spain continue to disappoint.
Note: Several of the funders listed above significantly strengthened their policies during 2021-2022. For funder-by-funder data on improvements, please see this preprint.
The UK’s National Institute of Health Research is the only major funder worldwide to have adopted all 11 WHO-recommended research waste safeguards. The country’s other major public funder, the Medical Research Council, also performs very strongly, as does the philanthropic giant, the Wellcome Trust.
Oceania and South Asia
Funders in these regions still have large gaps in their research waste safeguards.
However, funders in Oceania seem likely to improve soon. New Zealand’s funder recently completed an extensive audit of its trial portfolio, and Australia’s funder is reportedly discussing the issue internally.
Mapping safeguards across all 39 funders
The chart below shows how widespread the 11 WHO-recommended research waste safeguards currently are.
WHO recommends that all funders should require trial results to be made public on a registry within one year. However, only 18 out of 39 funders have adopted that requirement so far. Ten funders do not even require their grantees to register trials before they begin, even though this is a long-standing global ethics requirement.
On the positive side, a significant (and rapidly growing) minority of funders now actively monitor whether trials are registered and reported.
Note: The colour coding in the chart indicates whether the safeguard is related to registries (GREEN), journals (GREY), monitoring (YELLOW) or sanctioning (RED).
What can funders do?
TranspariMED’s report includes a simple checklist and text templates that funders can use to strengthen their policies and systems.
Please download the report here:
What comes next?
TranspariMED will re-assess all 39 funders in early 2024 to track their progress.
We need your support to keep up the pressure and end the scandal of unreported clinical trials. TranspariMED operates on a shoestring and does not accept industry funding.
Please make a small donation to enable us to continue the good fight.
A big thank you to our volunteers
They were supported in their work by the following volunteers:
Netzahualpilli Delgado Figueroa
Alan Rossi Silva
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