Universities as Guardians of Ethics and Equity in Medical Research: Protecting the Rights of Vulnerable Populations, Ensuring Post-trial Access, and Advancing Transparency in Clinical Trials

Universities have historically been regarded as independent institutions for knowledge creation in service of the public good. However, increasing financial reliance on private sector funding has reshaped their role in medical research. This chapter examines universities' responsibility to uphold research integrity, transparency, and equitable access to health technologies, particularly in the context of contracted research with the private sector.

We argue that universities must actively serve as guardians of ethical standards in medical research by ensuring inclusive decision-making, mandating equitable post-trial access to interventions, and enforcing transparency in research design, clinical trial agreements, and reporting. Ethical review committees should broaden their mandate beyond procedural oversight to include proactive risk mitigation strategies, particularly in protecting vulnerable populations in low-resource settings. The latest revisions of the Declaration of Helsinki (DoH) must be leveraged to institutionalise stronger ethical safeguards in research partnerships, empowering universities to negotiate fairer agreements with third parties.

By embedding principles of accountability, justice, and equity into their research frameworks, universities can counterbalance private interests and reinforce the fundamental ethical commitments of the DoH. This chapter calls on universities to take a leadership role in shaping medical research practices that prioritise public health over commercial gain.