Clinical trials can produce up to 100 million tonnes of CO2 each year. Although digital clinical trial technologies offer increased efficiency through improved patient recruitment and retention, increased access to remote and more diverse participants, and streamlined data collection, their environmental impact remains unknown. The Pistoia Alliance wants to establish an industry-wide standard for measuring the carbon footprint of digital tools, remote monitoring, and electronic patient-reported outcomes by collecting data from pharmaceutical companies and contract research organizations (CROs).
By incorporating these findings into a “carbon calculator”, clinical trial designers can then make informed, sustainable decisions when planning trials, without compromising efficiency. We spoke with Thierry Escudier, Portfolio Lead at the Pistoia Alliance, to find out how.
What currently concerns you about sustainability in conventional clinical trials?
Conventional clinical trials have a significant environmental footprint – from travel emissions to single-use materials and energy-intensive trial sites. Yet, the industry lacks robust, standardized data to quantify this impact, particularly when comparing traditional methods with digital alternatives. Digital tools, remote monitoring, and decentralized trial models offer a real opportunity to disrupt trials by reducing waste and emissions, but only if thoughtfully implemented.
The sustainability benefits aren’t guaranteed, and data on their true environmental impact is still lacking, but the Pistoia Alliance’s latest initiative aims to close this gap, helping the industry to move beyond assumptions and integrate sustainability-by-design in clinical trials – underpinned by standardized and transparent carbon measurement frameworks.
Where have traditional clinical trials done well in sustainability measures?
Traditional clinical trials, while resource-intensive, have some strengths when it comes to sustainability. Processes are well established, meaning there’s more experience and data to assess their carbon footprint.
Environmental impact data has supported progress in sustainability in areas such as improving local logistics, waste management, and energy efficiency. However, these efforts have often been isolated rather than systemic, and few companies have a comprehensive strategy for reducing emissions. The industry must build on early progress by integrating sustainability more holistically, using digital innovation, data sharing, and collaboration.
What are the challenges in improving sustainability in clinical trials?
Until recently, the major challenge has been the lack of reliable data and practical tools to perform accurate assessments of environmental impact. Without standardized metrics, it’s difficult for sponsors and CROs to compare digital and traditional trial models or identify the true carbon hotspots in their operations. This gap is precisely why we have contributed to the development of the Clinical Trial Carbon Calculator, launched in partnership with the Sustainable Healthcare Coalition and its industry Low Carbon Clinical Trials (iLCCT) group. This framework is a crucial step towards embedding sustainability-by-design in clinical trial planning, enabling more informed, data-driven decisions that support greener research.
What measurements are you looking for that will confirm that digital trials are more sustainable?
Thanks to the work already done on conventionals, we now have a good database to start building on by adding data on digital alternatives. Our aim is to collect operational data from pharmaceutical companies, CROs, and other stakeholders to create baseline measurements for the footprint of digital technologies and even the use of tablets/mobile devices in the trial setting. We’ll then use this bank of data to conduct a peer-to-peer comparison and ascertain which aspects of trials can be digitized to reduce overall carbon footprint.
How important is a sustainability advisor to a decentralized clinical trial?
Decentralized clinical trials are increasingly complex to measure the sustainability of, especially as the number of technologies available to run such trials increases. Without expert guidance, it’s easy to overlook the hidden carbon costs of digital infrastructure. Hidden costs include cloud computing and data storage, conducting remote consultations via video calls and telehealth platforms, and the device lifecycle. The footprint of a device’s lifecycle includes the manufacturing, distributing, and disposing of devices, as well as how often they need to be replaced.
A sustainability advisor brings the insight needed to navigate this complexity, helping teams assess trade-offs and make decisions that truly support more responsible trial design. For example, a “bring your own device” model allows participants to use their personal smartphones, tablets, or computers to take part in a trial. This approach has a very different environmental footprint compared to a provisioned device model, in which the trial sponsor or CRO supplies each participant with a dedicated device. Distributing devices can unnecessarily increase a trial’s carbon footprint, especially when participants could simply use their own device to download an app. These nuances can significantly affect a trial’s sustainability profile.
If decentralized clinical trials are shown to be more sustainable than traditional approaches, it could significantly accelerate their adoption. Until now, the main drivers have been improving patient experience and enhancing data quality through direct digital capture. Demonstrating a clear environmental benefit would add a powerful new incentive that aligns with the growing pressure on pharma companies to meet sustainability targets.
Tell me your hopes for the future of clinical trials in general…
My hope is that the future of clinical trials is both more patient-centric and more sustainable. Trials should be designed with participants’ needs at the forefront – making them easier to access, less burdensome, and more aligned with real-life routines. Embedding sustainability by design into trial planning will directly support this patient-centric mindset. Reducing redundant visits, sample collections, or examinations makes studies less burdensome for patients, improving both recruitment and retention. At the same time, these changes can significantly lower the environmental footprint of trials. Patient-centricity and sustainability aren’t competing priorities; when implemented thoughtfully, they can reinforce one another and help create a more responsible and effective research model.
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