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• Posted November 18, 2025

Drugs Rarely Become Available In Lower-Income Countries Where They're Tested, Study Says

Pharmaceutical companies are using the citizens of lower-income countries as guinea pigs to test cutting-edge drugs headed mainly for the United States and other well-off nations, a new study says.

Only a quarter of medicines tested in other countries wound up available to the citizens there within five years of the drugs’ approval by the U.S. Food and Drug Administration (FDA), researchers reported Nov. 17 in JAMA Internal Medicine.

The United States, Western Europe and Canada had the greatest access to the drugs tested within their borders, researchers found.

On the other hand, African, Latin American, Asian, Eastern European and Middle Eastern countries frequently host clinical trials for drugs that never reach their shores as approved and marketed products, results show.

“This gap raises concerns,” senior researcher Jennifer Miller, co-director of the Program for Biomedical Ethics at Yale School of Medicine in New Haven, Connecticut, said in a news release. “According to ethical guidance, if you enroll a population in clinical research, they must stand to benefit from it.” 

For the new study, researchers tracked 172 medicines approved by the U.S. Food and Drug Administration that were tested in nearly 90 countries between 2015 and 2018. About 45% of the countries were low- or middle-income nations.

Only 24% of the drugs were available to patients in the countries outside the United States where they were tested in clinical trials for FDA approval, results show.

High-income countries were more likely to gain access to drugs tested there, while middle- and low-income countries could wait for years without a medicine tested there actually becoming available to patients, researchers said.

People in other countries likely enroll in clinical trials for many reasons, including the opportunity to contribute to scientific progress, said researcher Dr. Cary Gross, a professor at Yale School of Medicine, said in a news release.

“But there is also a frequently-unstated part of this ‘bargain’: that if the new treatment works, then presumably people in your community — or country — will be able to access it,” Gross said in a news release.

Miller’s team now is looking into what she calls “bright spots” — countries like Ethiopia and Uganda that managed to secure full access to drugs they helped test.

She plans to figure out what those nations did to gain access, and share those lessons with other countries.

“Pharma companies have to change, countries need to be empowered, and the media, non-government organizations and patient organizations have to stay engaged,” Miller says. “We need all hands on deck.”

More information

The National Institutes of Health has more on how clinical trials work.

SOURCE: Yale School of Medicine, news release, Nov. 14, 2025