How COVID-19 changes trial processes and costs: fewer barriers or just different ones?

Clinical Trials Pre-Pandemic 

The COVID-19 pandemic dramatically reshaped healthcare forever. Not only did healthcare worker burnout increase, but other systems that were previously in place were put to the limit exposing many of their drawbacks. An example of this was within clinical research. Clinical research was put to the test during the pandemic to develop a safe and effective vaccine for COVID-19.

Prior to the pandemic, clinical trials were typically expensive, slow and complex. Most of the trials used centralized clinical sites, in-person visits, and paper-based documentation. Recruiting participants, monitoring outcomes and data collection could take years and exceed costs of $2.6 billion. It often took 10-15 years to go from drug discovery to FDA approval due to all the protocols and regulatory requirements in place. 

Multiple systemic barriers of clinical trials led to low participant enrollment rates, high dropout rates, excessive paperwork, and lack of diversity in the study population. Only a fraction of trials ever met their enrollment goal, and participants were predominantly white, urban, and well-insured. This not only skewed the results but limited their generalizability. Additionally, the administrative burden and transportation limitations excluded many underserved or rural communities. As a result of these inefficiencies, many potential life-saving therapies were delayed. 

Transformation From the Pandemic 

When the pandemic started in 2020, the healthcare industry was forced to make major transformations. In an urgency to develop a vaccine, the long-standing inefficiencies had to be addressed. Decentralized clinical trials (DCTs) became a solution. Trials started to utilize telemedicine, wearable devices, and electronic consent formed to help streamline the process. Regulatory agencies such as the FDA and EMA also issued emergency guidance documents to streamline the clinical trials for the vaccine. Together, the development and distribution of safe and effective vaccines against COVID-19 was able to happen in under a year opposed to other drug development which could take 5-10 years. 

These changes led to a lasting transformation in the clinical trials landscape. DCTs are now more widely accepted, allowing participants to take part in clinical trials at homes which can lead to expand trial diversity and improve retention. Also, tools like wearable biosensors, mobile health apps, and AI-driven platforms allow for continuous, real-time data collection. This helped increase the accuracy of trial data while allowing for opportunities to create personalized medicine based on that patient's needs. In addition, eSource data and cloud-based trial management systems helped with documentation which led to reduced errors and administrative workload. 

However, while COVID-19 may have decreased the amount of obstacles in clinical trials, it also introduced new challenges. While the shift toward the use of technology has improved efficiency and accessibility, it also highlighted the disparities in digital access and literacy. This pandemic also put a spotlight on the clinical research workforce, highlighting the need for more staff and updated training protocols. 

Cost efficiency has also improved. Decentralized clinical trials help reduce site cost, physical infrastructure, and travel expenses. However, implementing and maintaining secure and interoperable digital systems requires significant upfront investment. With these new systems in place, patient privacy, cybersecurity, and data compliance introduced a new place for errors, requiring careful governance and new transparent policies. 

Conclusion

The COVID-19 pandemic was a catalyst for long-term change in clinical trials. While it highlighted flaws in the previous system, it showed adaptability. As seen by the pandemic, the success of clinical trials will depend on continuously balancing innovation, equity, and regulatory requirements to ensure effective and inclusive research. 

About Centrova

Centrova is committed to transforming the landscape of clinical trials by breaking down the barriers that traditionally limit access to research opportunities. Every patient, regardless of their location or the size of their healthcare provider, should have access to the latest clinical trial opportunities. Centrova is democratizing research participation and accelerating the development of effective treatments through the decentralized clinical trial model by facilitating the resources needed to engage in clinical trials. Our goal is to ensure that all patients, no matter where they are, have the opportunity to contribute to and benefit from the latest advances in medical research.

By Karena Brijlall

Doctor of Pharmacy Candidate 2026