Reframing Clinical Research in Latin America: Implications of Underrepresentation for Health Systems and Global Evidence.

Although Latin America represents a substantial share of the global population and bears a significant and growing disease burden, the region remains underrepresented in global clinical research relative to its scale. This imbalance is associated with limited generation of locally relevant evidence and may influence the pace of evidence uptake, health system learning, and patient access to innovative medicines, devices, and technologies. Available analyses suggest that barriers to research participation in the region are predominantly structural, including chronic underinvestment, regulatory fragmentation, misaligned incentives, institutional constraints, and limitations related to health system scale, rather than intrinsic deficiencies in clinical or scientific capacity. Comparative regional evidence indicates that research activity varies according to governance models, regulatory alignment, and system organization, supporting the view that underrepresentation reflects modifiable system-level factors. Framing clinical research as a core health system function may strengthen healthcare performance in Latin America while enhancing the relevance, diversity, and equity of the global biomedical evidence base.