Quantifying the carbon footprint of academic clinical trials: building the evidence base and hotspot identification

Abstract Background Clinical trials are fundamental to healthcare, however they also contribute to anthropogenic climate change. Following previous work to develop and test a method and guidance to calculate the carbon footprint of clinical trials, we have now applied the guidance to 10 further UK and international, academically-sponsored clinical trials to begin identification of hotspots and opportunities for lower carbon trial design. Methods 10 collaborating Clinical Trial Units (CTUs) self-identified and a trial was selected from their portfolio to represent a variety of designs, health areas and interventions. Trial activity data was collated by trial teams across 10 modules spanning trial set up through to closure, then multiplied by emission factors provided in the guidance to calculate the carbon footprint. User feedback was collected on the process of applying the draft guidance. Results Six completed and four ongoing trials (two in follow up, two recruiting) were footprinted across a variety of interventions (6 IMP trials, one nutritional, one surgical, one health surveillance and one complex intervention trial). The carbon footprint of the 10 trials ranged from 15 to 765 tonnes CO2e. Common hotspots were identified as CTU emissions, trial-specific patient assessments and trial team meetings and travel. Hotspots for specific trial designs were also identified. Time taken to collate activity data and complete carbon calculations ranged from 5–60 hours. The draft guidance was updated to include new activities identified from the 10 trials, and in response to user feedback. Discussion There are opportunities to reduce the impact of trials across all modules, particularly trial specific meetings and travel, patient assessments and laboratory practice. A trial’s carbon footprint should be considered at the design stage, but work is required to make this common place.