Top five countries running the most clinical trials

The war in Ukraine has shone a spotlight on the reliance of the pharmaceutical sector on certain countries when it comes to manufacturing and drug discovery. Before the war, Ukraine had around 2,500 clinical trial sites however a number of big pharma organizations including Merck, Abbvie and Sanofi have since halted their studies. Meanwhile, others have announced they have stopped conducting trials in Russia while the war is ongoing, raising further concerns in the industry over the potential consequences for drug development.

• While the conflict will undoubtedly have an impact, a new report has revealed the countries where the most clinical trials take place, which includes neither Ukraine or Russia within the top 10. Leading the pack is the US, with almost 150,000 clinical studies on record since 2008, placing it well ahead of France in second position which has just over 30,000. Meanwhile five out of the top 10 countries on the list are located in Europe. 
• The research also found that in 2020 more than US$6.5bn was spent on studies investigating treatments for cancer. This is significantly more than for any other disease – $2.6bn was spent on HIV/AIDS and more than $1.3bn on Alzheimer’s Disease.
• Here we take a look at the top five countries reporting the most clinical trials on record and why clinical trial sponsors find them so appealing.

1. US 

• Perhaps unsurprisingly due to the dominance and size of its pharmaceutical industry, the US tops the list with almost 150,000 clinical trials taking place since 2008. The state with the highest number of studies is California, in part due to its large tech sector and appetite for innovation. 
• The country’s history of clinical research dates back to 1905, when the American Medical Association (AMA) formed a council to approve drugs for general use. To gain approval from the AMA drug makers had to run a pre-clinical trial to prove their product was safe. 
• Today, the US is popular with clinical sponsors because of its large population pool, well-developed network of investigators and large healthcare market.  

2. France 

• France has the largest pharmaceutical sector in Europe. Oncology is the leading area for industry-sponsored clinical trials and in 2020 it had a 41.6 percent share of all trials. 
• Various French governments have pursued ambitious public policies to research oncology, as well as infectious and rare diseases, with attractive tax credits available for R&D companies (30 percent of R&D expenditure up to €100mn ($108.5mn) and 5 percent beyond this threshold). 

3. Canada 

• Canada’s leading position can partly be attributed to its academic prestige, with a number of universities that are world-famous for their scientific research including McGill University and the University of British Columbia. Additionally, it has cost advantages for clinical trial sponsors. A 2016 study by KPMG found that it was second on the list of countries with the lowest business costs. 
• In June 2021, spurred by the Covid-19 pandemic, the Canadian government decided to modernize the country’s framework for clinical trials to support the adoption of promising new therapies and advances in technology.
• It has also reduced the retention period for clinical trials records from 25 to 15 years, making Canada more appealing to sponsors due to reduced administrative work.

4. China 

• China’s inhabitants make up 20 percent of the world’s population. In addition, the country has a pattern of morbidity and mortality that is increasingly similar to that of Western countries. China’s potential to recruit a sufficient number of participants to conduct large studies is, therefore, significant.  
• There are 32 national centers for clinical medicine research in the country, and a collaborative network of more than 2,000 medical institutions in 260 cities.
• Clinical studies in China also cost significantly less to conduct compared to many European countries and the US, making it extremely appealing to clinical trial sponsors. 

5. Germany 

• Germany has an exceptional reputation for healthcare, along with generous governmental support for the pharmaceutical industry and a number of renowned universities that collaborate with the industry, such as Bayer-Schering Pharma with the University of Cologne. 
• Germany has had a leading presence in pharmaceutical R&D since the 1990s, when the government sponsored a contest in which 17 regions compete for funds to create biotech startups. This led to the creation of “BioRegions”, whole areas dedicated drug development. Today there are more than 30 of these, home to major corporations such as Bayer and Roche. 

In numbers: The 10 countries conducting the most clinical trials since 2008

1 United States: 148,736

2 France: 30,080

3 Canada: 24,581

4 China: 23,509

5 Germany: 22,215

6 United Kingdom: 21,163

7 Spain: 16,492

8 Italy: 16,140

9 South Korea: 12,693

10 Belgium: 11,345 

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