Since the Pfizer-BioNTech, Moderna, and Janssen COVID-19 vaccines were authorized for emergency use by the US FDA, millions of people in the United States have been vaccinated. However, finding reputable and high-quality sites for new Covid-19 vaccine and drug clinical trials can be a significant challenge. As the COVID-19 vaccine becomes more widely available in the West, new trials are facing challenges in meeting their enrolment targets. As a result, more clinical trials are being shifted to the global south, with sponsors determined to meet ambitious development timelines looking towards internal sites, including Africa. The traditional pre-COVID-19 approaches to clinical site assessment are not keeping up with the increase in Covid-19 trial complexities observed across the industry. Additionally, the COVID-19 pandemic has introduced unique challenges at clinical sites and highlighted new barriers to performance at previously high-performing international [...]