Last year, we unveiled a landscape of increasing complexity, culminating in an unprecedented decline of clinical trial initiations. The biopharma industry weathered post-pandemic adjustments, endured economic hardships and slowed growth in major markets, met regulatory pressures to incorporate diversity, equity, and inclusion (DE&I), and suffered the impacts of geopolitical conflicts. Last year, we concluded with a cautiously optimistic outlook, anticipating the industry's imminent breakthrough in clinical trial innovation. 

Over the last three editions of Clinical Trials Roundup, we have surveyed trial initiations with and without COVID trials to get a sense of how the pandemic impacted trial initiations in other therapy areas, namely the "COVID effect." The decline in 2020 (-4%) made sense, while 2021 enjoyed a surprising comeback at +22%. Then, trial initiations dipped back down to -6% in 2022, due in part to the harsh economic environment in biopharma. The yo-yo has swung back up in 2023, exhibiting 13% growth excluding COVID-19 trials, also a cut above the average growth rate of 7% for non-COVID trials during 2017–23. Will the oscillating cycles between growth and decline continue, or is the biopharma industry on track to full recovery? 

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