Two years after expanding its clinical trial management services to South Africa, site management organization (SMO) Synexus Clinical Research is doubling its late stage clinical trial capacity within the country.

The Manchester, England-based SMO plans to expand its existing facility as well as open two others by early next year. The first facility in Pretoria, one of South Africa’s three capital cities, is being refurbished and expanded into an abutting facility. New sites will open in Soshanguwe and Mamelodi, two townships about a 30-minute drive from Pretoria.

Synexus first moved into South Africa two years ago with the acquisition of South African SMO Clinical Research Centers (CRC). Synexus’ success with that acquisition—and with South Africa as whole—has been somewhat surprising, even to company CEO Michael Fort, who said he’d never really considered South Africa as a strategic target until, while working on a multi-site international trial, he saw South Africa emerge as one of the strongest sites.

“From an industry perspective, there’s not a huge presence [in South Africa], which on the one hand is sort of slightly worrying because you think, ‘I’ve got to attract people to South Africa,’” Fort said. “On the other side of the coin, it’s not too busy and you don’t get lost in the crowd. For a relatively small company like Synexus, that was quite important.”

South Africa has a large patient population and not a lot of clinical trial activity, which made it perfect for the SMO’s expansion, Fort said.

There are between 3 and 4 million people in Soshanguwe and Mamelodi alone. Synexus already manages phase III trials in these two townships using its Pretoria facility as a base. Rather than having trial participants travel to clinical trial sites, doctors and nurses travel to the participants—creating a sort of web of traveling clinical trials.

“Because we have this sort of hub and spoke arrangement, there’s no real limit to the number of what we call ‘satellite sites’ that we can add there because, clearly, with a population that dense, that could probably support two to three more sites,” Fort explained.

The biggest hurdle for Synexus and other SMOs conducting work in the country is persuading international sponsors that South Africa is a viable place to carry out clinical trials, Fort said. Some large pharmaceutical companies have developed a presence in the country, but there are very few contract research organizations or smaller pharma companies. Fort hopes that the investment of large pharmaceutical companies such as GlaxoSmithKline and Merck, which are already in the area, will attract the attention of smaller ones. Of course, with more activity comes more competition, but Fort isn’t worried about competing SMOs moving into the region.

“If they did, there’s enough population and room in South Africa for the foreseeable future for us all to live together quite happily side by side,” he said.

Synexus has four major trials ongoing in South Africa as part of larger international studies, as well as 30 local phase I to phase III trials. They have inquiries in for another 30 to 40 trials.

“We’re not going to win all of them,” Fort said, “but the fact that we’re getting that level of inquiry is one of the key reasons why we’ve basically been forced to fund this expansion.”