RE — access to higher standards of prevention/care than other members of local communities

This can indeed be a very trick question.  Culture and political will can be very strong, but education at all levels can help bring a new level of understanding to stakeholders.  In all cases the minium standard of care needs to be enforced, but in cases where there are newer/more advanced options/standard of care it is important bring this information to the stakeholders so that it can openly and honestly discussed.  Change may not be immediate, but it beholden upon the trial team to be involved with the advancement of care.