For many patients across Asia, trial access has hinged on proximity, not eligibility. Asia is one of the most compelling frontiers for clinical research, with growing trial activity and significant unmet need. Southeast Asia was the only World Health Organization region not to see a decline in trial registrations since the peak of COVID-19. Yet thousands of studies fail to reach patients at scale.
Thailand’s 12,781 studies from 1999 to 2024 show that while more than 6,200 patients enrolled, each trial saw fewer than 100 participants. The reason lies not in patient disinterest, but in geography, especially for those in rural areas, along with economics and infrastructure gaps that traditional trial models cannot bridge. For many, repeated travel to centralized sites is not merely inconvenient — it’s unfeasible.
While trial sites remain out of reach for many, mobile phones are not. Asia is home to one of the world’s fastest-growing digital populations. Mobile technologies and services are projected to contribute $1.4 trillion to Asia Pacific’s economy by 2030 through 5G and artificial intelligence expansion.
To help bridge this gap, the region can build flexible trial models on existing digital infrastructure, bringing trials to patients rather than the other way around, while accelerating drug development.
What holds patients back from enrolling
When patients are presented with the opportunity to join a trial, their questions rarely center on the science. They center on the practicalities: How far is the site, how long will each visit take, how much will it cost, and who will look after the children.
The practicalities add up quickly, creating what has been described as an “administrative toxicity” that compounds the clinical burden of participation. It covers the physical toll of traveling while managing disease symptoms, the financial strain of lost wages and transportation costs, and the emotional weight of repeated long journeys for what are often brief interactions.
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Research sites have historically acted as central hubs. The repeated journeys required by patients are a barrier that falls hardest on those in geographically dispersed regions across the continent. When underrepresented groups are structurally excluded, trial data fails to reflect the populations these treatments are ultimately meant to serve.
Asia’s infrastructure as an advantage
While these barriers exist, Asia is also uniquely positioned to overcome them. It has already demonstrated its ability to leapfrog legacy infrastructure, most visibly in telehealth, driven by necessity rather than choice. Governments across Asia are now actively investing in the digital health foundations that make a different model of trial delivery possible.
Singapore’s Ministry of Health and Health Sciences Authority’s Artificial Intelligence in Healthcare Guidelines 2.0 guides AI deployment to augment and empower healthcare professionals. Beyond regulatory frameworks, there are also end-to-end, AI-powered solutions available that can integrate patient engagement, remote monitoring, data capture, and adaptive analytics onto one platform.
It is not a future ambition. The infrastructure for flexible clinical trial models already exists in Asia. The opportunity now is for the industry to fully leverage it.
Decentralization without losing human connection
Decentralized clinical trials (DCTs) change the access equation by offering remote, hybrid, and in-clinic options, reducing the logistical burden that has historically been a barrier. While in-person visits keep trials high-touch, digital tools enable flexibility. Wearables, electronic Clinical Outcome Assessment, remote monitoring, and mobile options shift trials to patients’ familiar devices and daily lives, while boosting data accuracy.
In central nervous system and rare disease trials, this flexibility is critical as it can significantly improve participation and quality of life. For individuals with neurological or neurodegenerative disorders like dementia and Alzheimer’s, memory loss represents a devastating erosion of identity. More than 3 billion people worldwide are affected by neurological disease, and across the region, dementia is the seventh most prevalent health condition affecting older people.
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Yet a Phase III Alzheimer’s trial averages $370 million to run, may take up to eight years to complete, and carries a 95{7729880385ace00763d744956af66a2dd6156639dea227c3bc209fe61f7ca481} failure rate. Trial design challenges compound this urgency — such as complex and subjective endpoints, high screen failure rates, and high placebo response rates — alongside patient accessibility barriers including geography, mobility challenges, and isolation from specialist care.
DCTs remove the accessibility constraint, expanding the pool of participants who can realistically enroll. What’s key to DCTs is putting participants at the center of design from the start. Tools must function in local languages, on lower-end devices, and within existing patient behaviors. Underlying all of this, AI-enabled tools can quietly process the continuous data streams that these trials generate, flagging at-risk participants early.
Full decentralization is not the goal, nor is it what patients want.
Empathy and human connection remain critical.
The optimal model is hybrid — strategically removing unnecessary burden while preserving the essential in-person touchpoints that build trust. When patients feel genuinely supported, they stay enrolled longer.
Countries in Asia have the opportunity to design clinical trials that work for patients, not despite them. By leveraging decentralized models and digital infrastructure, it can ensure that underrepresented populations — those in rural areas, with limited means, or managing complex diseases — are no longer excluded. When trials become more inclusive, more participants gain access, researchers gain representative data, and treatments reach those who need them most.