From fellows to leaders: lessons learned from the WHO/TDR Clinical Research and Development Fellowship (1999–2021)

BACKGROUND Strengthening research leadership in low- and middle-income countries (LMICs) is essential for addressing diseases of poverty. Since 1999, World Health Organization (WHO) Special Programme for Research and Training in Tropical Diseases (TDR) has supported this through the Clinical Research and Development Fellowship (CRDF), but evidence on its long-term impact remains limited. We therefore assessed the leadership trajectories of CRDF fellows trained between 1999 and 2021. METHODS An online cross-sectional survey of CRDF alumni (1999–2021) used a structured questionnaire capturing career progression, productivity, leadership roles, collaborations, institutional contributions, and challenges. RESULTS Of 116 fellows contacted, 88 responded (75.8%). More than half had secured competitive funding (55.7%), with a median grant value of USD 512,320 (interquartile range: 111,629–1,200,000; range: USD 700–70,000,000), including multiple national and international awards. Career advancement was notable: 43.2% served as principal investigators and nearly 80% supervised research staff. Many led developments of infrastructure and operating procedures (63.6%). Re-entry grants strengthened institutional capacity for respondents. Collaborations were sustained nationally (77.3%) and through South–South partnerships (71.6%). Almost all fellows (98.9%) continued applying TDR-acquired leadership skills. One third contributed to policy documents. Persistent barriers included difficulty accessing funding, limited institutional support, scarce national funding, and heavy workloads. CONCLUSION CRDF alumni reported substantial engagement in research leadership, scientific productivity, and institutional capacity strengthening in LMICs.