While Europe has lost some of its global share of clinical trials to China and the US, it remains a clinical research stronghold. Three years into the Accelerating Clinical Trials in the European Union (ACT EU) initiative which aims to transform how trials are initiated, designed, and run across the EU, the bloc now has a more harmonised and – it hopes – more competitive offering. Individual member states are also introducing reforms to speed up approval times and create more efficient processes. We look at the top ten European nations for clinical trials.
European Competitiveness
The European Federation of Pharmaceutical Industries and Associations (EFPIA) lobby group together with IQVIA painted a rather negative picture of Europe’s clinical drug trial panorama in a report published late last year. With a drop to 12 percent of the world’s trials in 2023 from the 22 percent reported in 2013, Europe, the report lamented, is losing its competitiveness. A large part of this lost share of clinical studies has gone to China, which has doubled its number of commercial trials since 2018, and the US, the world’s leader.
Europe’s progress has been hampered by what EFPIA director-general Nathalie Moll calls “a slow and fragmented research ecosystem.” However, there are initiatives underway to address this by harmonising clinical research across the region. Notably, the Clinical Trials Regulation (CTR) introduced by the European Commission in 2022 under the ACT EU initiative was an important first step, creating a single authorisation portal that eliminated the need for separate applications to each member state. European nations have also boosted their efforts to attract research investment by speeding up and simplifying their processes.
As Europe as a whole strives for a more unified approach to clinical trial regulation, a few European countries have established themselves as the EU’s bastions of clinical research.
1. Spain
Current active trials: 3,451
Spain takes first place among Europe’s clinical trial powerhouses with 3,451 current active trials. As the first country in Europe to adopt the CTR, Spain has established itself as a regional leader in clinical trials with Barcelona as its most important hub.
Significant industry investment, which has risen at an average annual rate of 5.7 percent over the course of ten years and gone from EUR 479 million in 2012 to EUR 834 million in 2022, has promoted Spain’s status. The country’s solid universal healthcare system as well as industry initiatives to drive investment in research such as Farmaindustria’s Best Project have further cemented it.
2. France
Current active trials: 3,312
Following on the heels of Spain is France with 3,312 trials currently underway. France has a particularly strong position in oncology, which accounts for 41 percent of its clinical trials.
The country has made efforts to reduce regulatory timelines and in 2024, it took an average of 160 days to include the first patient in a clinical trial, as opposed to 204 days needed in 2019. Yet French pharmaceutical association Leem argues that these timelines are still too long. France’s Health Innovation 2030 plan set out to make France a leader in Europe for clinical trials and has helped it hold on to its position among the region’s top three.
3. Germany
Current active trials: 2,774
Despite a decline in clinical trials between 2018 and 2023, Germany remains among Europe’s top clinical trial destinations. With its lengthy negotiation processes between sponsors and institutions and strict data protection laws, Germany’s cumbersome patient recruitment may be behind an 8 percent decrease in Phase I to IV commercial clinical trials.
However, the country is striving to address these issues and strengthen its competitiveness with a new Medical Research Act (MRA), a large part of which came into effect at the end of 2024. In particular, the MRA aims to step up approvals, streamline contract negotiations and enhance coordination between authorities. Most importantly, an amendment to the Medicinal Products Act will reduce the assessment of authorisation applications from 45 days to 26 days.
4. Italy
Current active trials: 2,653
Italy is among Europe’s clinical trial leaders with the dominance of phase I oncology trials. However, it faces fierce competition. The Italian Medicines Agency (AIFA) has warned of the overall decline in the number of studies carried out in the country and the near disappearance of post-registration studies (phase IV).
In recent attempts to improve its competitiveness, Italy adopted new decrees in 2023 to fully comply with Europe’s CTA. The country is also exploring the use of decentralised methods in various stages of clinical trials.
5. Poland
Current active trials: 1,892
With its combination of economic advantages – costs average 30 percent lower than those in the US – as well as its highly skilled workforce, and supportive regulatory environment, Poland has emerged as a prominent clinical trials hub in Central and Eastern Europe.
Poland put itself on the clinical trials map with the creation of its Medical Research Agency (MRA), the central body managing clinical studies in the country, in 2019. The MRA has effectively reshaped Poland’s clinical research ecosystem and launched programmes to train researchers in study design, data analysis, and scientific publication. The country has also streamlined approval processes, with applications now being assessed within 45 days.
6. The Netherlands
Current active trials: 1,847
The Netherlands is yet another leading light in Europe’s clinical trial landscape. With its research excellence and competitive trial start-up times, it has become a strong contender among Europe’s top clinical trial hubs.
The Netherlands ranks third in Europe and seventh globally for Highly Cited Researchers, underscoring its commitment to advanced medical research. Another attribute is the country’s short approval time of under 30 days. Moreover, recent reforms and strategic initiatives such as the update to its Site Suitability Declaration and the integration of the EU’s Clinical Trials Information System (CTIS) for clinical trial submissions have also aimed to make it more competitive.
7. Belgium
Current active trials: 1,734
Belgium has long been recognised as one of Europe’s clinical trials centres of excellence thanks to its robust medical infrastructure and a solid tradition in medical sciences. Belgium consistently ranks among the top European countries in terms of clinical trial authorisations per capita, particularly excelling in Phase 1 trials and with a strong focus on oncology and rare diseases.
The country has seen a decline in its share of global clinical trials in recent years, prompting the Belgian government to introduce reforms. Prioritising clinical research, the new government has plans for regulatory adjustments to facilitate clinical trials, the creation of a Biopharma Research & Development Concertation platform, and the creation of a national Clinical Trial Network to streamline processes.
8. Denmark
Current active trials: 1,075
With its strong clinical trial ecosystem and speedy approval times, Denmark is another attractive European location for clinical trials. The Scandinavian nation has fostered clinical research in recent years with the creation of the Trial Nation Platform, which simplifies the start of clinical trials and has increased the number of trials 2.6 times.
The new Danish life science strategy, published at the end of 2024, is also focused on strengthening the conditions for conducting clinical trials in the country. One key initiative is the establishment of a fourth scientific ethical committee that will focus on processing applications for phase I trials within 14 days. The Danish National Life Science Council has also outlined recommendations to strengthen Denmark’s position as a leading life science nation by 2030.
9. Czech Republic
Current active trials: 1,028
The Czech Republic is building its clinical trial capacity and has gained a spot for itself among Europe’s key clinical research hubs, achieving a 40 percent increase in cancer drug studies in 2023.
The country’s centralised universal healthcare system with its large network of public hospitals as well as specialised centres have up until today facilitated the participation of over 16,000 patients in research efforts for new drugs and vaccines. The country’s efficient regulatory authority, the State Institute for Drug Control (SÚKL), carries out the approval process for clinical trials in an average of 60 days.
10. Hungary
Current active trials: 882
A robust regulatory framework and an advanced healthcare infrastructure have brought Hungary a spot on the list of Europe’s top centres for clinical trials. Under the jurisdiction of the National Center for Public Health and Pharmacy, clinical trials in Hungary are aligned with European Union standards while its centralized healthcare system enables the rapid recruitment of patients.
In recent steps to improve its clinical trials ecosystem, Hungary facilitated the reporting of Suspected Unexpected Serious Adverse Reactions (SUSARs) in 2022, eliminating the need for parallel reporting to national authorities. Additionally, it updated regulations governing clinical research to enhance efficiency.
Made with Visme Infographic Maker
These numbers correspond to the active trials per country as of 14 March, 2025 and are taken from the EU Clinical Trials website.
