White Paper

The MENA Region: A Growing Sprout in the Map of Rare Disease Research


The tides of clinical research have significantly turned throughout the last 30 years. In general, less than 15% of clinical trials were conducted outside the United States (US). This share has almost doubled in 2013, where almost one third (31%) of all global studies were found to be conducted outside the US. As of August 2020, almost 20 thousand clinical trials are either ongoing or completed in the Middle East and Africa, including Israel and Turkey. This accounts for almost 7.3% of all global studies putting this region in the fourth position after North America, Europe, and East Asia; including China.

Many of these countries are low- or middle-income countries who are racing to reserve a seat as important players in the global map of clinical research. Several theories have evolved explaining this undeniable increase in number of trials, enrolled patients, and disease areas involved. Scientific factors related to the diversity of involved patient populations, disease prevalence, environmental and cultural differences; had the main say in the participation of patients from the Middle East and North Africa (MENA) region in global studies.

Other factors have attracted global studies to include the MENA region in their agenda including; decreased trials costs, facilitated regulatory procedures, easy access to different diseases. This globalization of clinical trials will continue to rise after the COVID-19 pandemic with the increased global awareness of the importance of clinical research on both national and international levels.

However, we did not include Israel or Turkey in our analysis due to their well established and expanding clinical trial portfolios.



Despite the political instability in some MENA countries, the overall number of clinical trials in this region is increasing (3). Religion, social, and cultural influence does not only impact clinical research but also shape the political and regulatory perspectives of any country or region.

Saudi Arabia is considered one of the region's most prolific nation in scientific research output, aiming to increase the GDP spend on research projects from 0.8% in 2017 to 2.5% of GDP in 2020. The UAE proved to have advanced as a political and economic leader in the region with a rapidly developing pace for medical education and biomedical research.

Over the past decade, hospitals in the UAE have aimed to include academic objectives in most of their clinical institutions. UAE hospitals sought the ACGME-International (ACGME-I) accreditation in their teaching hospitals and residency programs (6). Public investment in research and development (R&D) has increased significantly in other MENA countries such as Qatar (projected to be 2.8% in 2012) and Tunisia (1.25%, compared with 0.03% in 1996).

The productivity of researchers in Arab countries has increased 3-fold between 2007 and 2016.

Between 2007 and 2016, a total of 76,978 papers were published by research groups in Arab countries ranking among the top 25 countries conducting research worldwide and representing 1.6% of the global share of clinical research (Figure 1).

Figure (1). Number of publications in medical research in the Arab countries as a whole vs the world per year between 2007 and 2016.

Research groups in Arab countries published 189 papers per one million people as compared to 695 papers per one million by researchers worldwide.


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