Improving diversity in clinical trials is both an equity issue and a scientific necessity

Brian Duggan reflects on the need for more inclusive research, following his appearance at an All-Party Parliamentary Group (APPG) on Black Health event on improving diversity in clinical trials. 

This week, I had the pleasure of speaking in Parliament at the APPG on Black Health's event on improving diversity in clinical trials, hosted by the Caribbean and African Health Network. I began by thanking the APPG for Black Health for their continued leadership on this agenda and for keeping the spotlight firmly on health inequalities and the action needed to address them.

I've worked on these issues both in NHS England and now at the Association of the British Pharmaceutical Industry (ABPI). At the ABPI, our role is to help ensure the UK is the best place in the world to research, develop and access new medicines and vaccines, working in partnership with the NHS, academia and patient organisations. Improving diversity and participation in clinical research is central to that mission.

The challenge we face

Currently, participation in clinical research is not representative of the population our NHS serves. This has real consequences for all of us. Research from Ipsos shows that while three-fifths (58%) of UK adults say they would be willing to join a clinical trial, this falls to two-fifths (41%) among people from ethnic minority backgrounds. Among those invited to take part, just a third (36%) of ethnic minority adults go on to participate, compared with well over two-fifths (44%) of White adults. [1]

These disparities matter. Inclusive trials are essential to ensuring medicines and vaccines work safely and effectively across the whole population, particularly when only around one in ten (11%) medicines entering clinical trials progress to Phase III (the latter stages of clinical trials, when there is a chance that a medicine may eventually reach patients). Improving diversity in clinical research is therefore both an equity issue and a scientific necessity.

Alongside this, the UK is facing a sustained decline in recruitment into commercial clinical trials in the NHS. Overall recruitment has now fallen for the fourth consecutive year, reaching just over 19,000 patients. This is the lowest level since 2017/18. In England in 2024/25, only 3.4% of all trial participants were recruited into industry trials in the NHS, and the proportion of Phase III oncology trials with UK sites has also declined. [2]

Together, this presents a double challenge: participation is falling overall, and those who do take part are not fully representative of our population. Without inclusive and representative research, we risk both worsening health inequalities and weakening the UK's position as a global destination for research investment.

Turning to solutions - and accountability

Almost a year ago, the ABPI and the Association of Medical Research Charities brought together industry, charities, regulators, government and the NHS to identify shared actions to improve inclusivity in clinical research – this was the first time that all the relevant agencies were brought together in a long time. We agreed on the need for a UK-wide strategy and roadmap, better sharing of best practice, and a robust national approach to measuring and reporting trial diversity. You can read our report here.

Encouragingly, progress is being made. The Health Research Authority is developing a UK-wide strategy, with support from the UK Clinical Inclusion Research Group. The ABPI's People-Centred Research Hub shares real-world examples of inclusive research in practice. And the Department of Health and Social Care has committed to publishing national metrics on research inclusivity this year - a significant step forward in transparency. [3]

During the Q&A, there was a particularly rich discussion about accountability. Measuring diversity is essential, but we also need to be clear where responsibility sits in a changing health system. Is it nationally, regionally, with Integrated Care Boards and/or NHS regions, or locally with trusts and research teams on the ground? There is no single answer, but it is clear that accountability must be shared, explicit and embedded across the system if progress is to be sustained.

Why inclusion matters and what comes next

Contributions from across the panel reinforced why inclusivity matters. Dr Veline L'Esperance highlighted how genetic differences in some Black men can affect the accuracy of diabetes testing, leading to delayed diagnosis and worse outcomes for people affected.

Dr Bola Owolabi reminded us that during the COVID pandemic, pulse oximeters, which were widely used at home and in hospitals during the COVID-19 pandemic, were less accurate for people with darker skin, including Black men, often overestimating oxygen saturation levels. This inaccuracy meant that some patients had dangerously low oxygen levels that the devices did not detect, resulting in delayed care and costing lives.

Both examples were powerful reminders that without inclusive research, and putting the learnings from that research into action, inequalities persist in diagnosis, treatment and outcomes.

Government commitments to improve trial set-up times and invest in research infrastructure are welcome. But speed and scale alone will not solve the participation challenge. Inclusive trial design, meaningful community engagement and collaboration across the system must remain central.

The message from the event was clear: we all need to do more, and the enthusiasm in the room for doing just that was great to hear. Supporting inclusive research is a responsibility shared by government, the NHS, researchers, communities and industry. Pharmaceutical companies take this responsibility seriously, and the ABPI and our members will continue to work in partnership to turn commitments into measurable impact.

Because a research system that works for everyone is not only fairer - it is also scientifically stronger, more trusted, and ultimately delivers better health outcomes for all.

Find out more about the APPG for Black Health: https://www.linkedin.com/company/appgblackhealth/

Follow the Caribbean and African Health Network: https://www.cahn.org.uk/ or https://www.linkedin.com/company/caribbean-and-african-health-network-cahn/

References

[1] ABPI/AMRC, Achieving inclusivity in clinical research, June 2025

[2] ABPI, UK industry clinical trials: Translating actions into impact, Dec 2025

[3] DHSC, Transforming the UK clinical research system, August 2025 update