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The unprecedented speed of clinical trial set up and execution in response to the covid-19 pandemic was only possible because of long established and experienced clinical trial capacity in almost exclusively high income settings such as the US and Europe. As a result, data from many global populations could not be accommodated in time for emergency use authorisation and the subsequent large scale deployment of vaccines that ultimately resulted in the safe end to the pandemic. The key lesson is the need to strengthen and sustain clinical trial capacity in sub-Saharan Africa to the level of demand experienced in 2020.