A well-resourced small-island population with the network's lowest premature NCD mortality.

Why Antigua and Barbuda

Antigua and Barbuda combines a substantial chronic disease burden with the strongest health outcomes in the Eastern Caribbean — life expectancy of 77.8 years, the lowest out-of-pocket health spending in its group, and the network's lowest premature NCD mortality. For protocols that need a stable, well-supported patient population rather than sheer numbers, it works. For volume, it does not.

The disease burden

NCDs account for 87.3% of all deaths — joint highest in the network with Barbados — while premature NCD mortality is the lowest at 12.1%. In other words, chronic disease dominates the mortality profile but people are living with it longer. Adult obesity is 34.0% and diabetes 22.4% crude, both on wide intervals reflecting limited national survey data.

Sites and infrastructure

• Sir Lester Bird Mount St John's Medical Centre, St John's — approximately 185 beds, with oncology, dialysis, ICU and radiology
• Medical schools are offshore and international-student institutions: American University of Antigua College of Medicine (CAAM-HP accredited with conditions to 2028) and Metropolitan University College of Medicine (provisional accreditation to 2028)
• No national or public medical school, and no clinical research unit or epidemiology centre identified

Research heritage

None found. No documented national cohort, trial or research institution.

Regulatory & ethics

• Pharmaceutical Division, Ministry of Health, and the Pharmacy Council
• A Pharmacy Bill was at stakeholder-consultation stage in January 2026 — the statutory framework is not yet in force

The honest position: This is the central constraint and we are not going to dress it up. No medicines regulator, no clinical trial authorisation pathway and no national ethics committee could be identified, and PAHO has not published a Pharmaceutical Country Profile for Antigua and Barbuda. A sponsor has no obvious counterparty to file with and no local IRB of record. Any study here needs an imported ethics review — CARPHA-facilitated multi-country review is the available regional route — plus written Ministry and Chief Medical Officer no-objection. We arrange that; it is not fast.

Data quality: Moderate — WHO modelled estimates are complete but obesity and diabetes intervals are very wide, indicating little recent national survey input.

How this site fits the network

Network capacity — adds diversity and marginal enrolment to multi-country studies. Not a standalone proposition.

Our Antigua and Barbuda operation is contracted, trained and monitored under the same quality system as our UK and US sites. One master service agreement covers all three regions, one budget negotiation, one set of payment terms. Sites in this network can absorb enrolment from under-recruiting UK or US centres without a new vendor qualification cycle.