Explore the top 10 European countries for clinical trials in 2025. Discover key trends, regulatory reforms, and why these nations lead in medical research.
While Europe no longer dominates the global landscape of clinical trials as it once did, it continues to serve as a robust and innovative hub for medical research. The continent’s standing has been challenged in recent years—its global share dropped from 22% in 2013 to just 12% in 2023. This decline has been largely driven by the rise of China and sustained dominance of the United States. However, a coordinated effort led by the European Commission and national agencies is reshaping Europe’s clinical trial ecosystem.
Now three years into the Accelerating Clinical Trials in the EU (ACT EU) initiative, and with the Clinical Trials Regulation (CTR) in effect since 2022, Europe is advancing toward a more harmonized, efficient, and competitive clinical research framework. Several member states have made marked progress in adapting regulatory environments and streamlining approvals to attract investment and speed up execution.
Below, we examine the Top 10 European countries for clinical trials in 2025, based on their volume of active trials, regulatory reforms, infrastructure, and strategic positioning in global medical research.
1. Spain
Active Trials: 3,451
Spain leads the European continent in clinical trials, owing to its proactive regulatory stance and consistent industry support. It was the first country in Europe to fully adopt the CTR, positioning itself as a regulatory model for others. Its strong public healthcare system and vibrant hubs like Barcelona have attracted both academic and commercial research.
Investment in pharmaceutical R&D has grown by nearly 74% over a decade, from €479 million in 2012 to €834 million in 2022. Initiatives like Farmaindustria’s BEST Project have fostered collaborative networks between hospitals, academia, and sponsors.
2. France
Active Trials: 3,312
France follows closely, with an established track record in oncology research, which accounts for 41% of its ongoing trials. Aiming to bolster its position, France has worked to reduce startup delays—cutting the average time to first patient inclusion from 204 days in 2019 to 160 in 2024.
Despite ongoing concerns from industry stakeholders about remaining inefficiencies, the Health Innovation 2030 plan signals strong national commitment to clinical trial excellence. France’s dense network of research institutions and patient populations adds to its appeal.
3. Germany
Active Trials: 2,774
Germany remains a clinical research heavyweight despite facing structural challenges. Bureaucratic hurdles and stringent data privacy laws have affected trial startup times and contributed to an 8% decrease in commercial trials since 2018.
In response, Germany introduced the Medical Research Act (MRA), a transformative legislative package aimed at expediting processes. One of its most impactful reforms is the reduction of the authorisation period from 45 to 26 days—a critical step toward regaining momentum in clinical research.
4. Italy
Active Trials: 2,653
Italy continues to be a significant player in early-phase oncology trials, especially Phase I. However, concerns persist about the country’s declining volume of post-marketing studies.
To reinvigorate its competitiveness, Italy introduced compliance reforms in 2023 aligning with the EU’s Clinical Trials Application (CTA) processes. Moreover, its exploration of decentralised trial models could pave the way for greater adaptability and patient-centric design in the coming years.
5. Poland
Active Trials: 1,892
Poland has emerged as a Central European clinical research leader, driven by cost advantages, regulatory agility, and a well-trained scientific workforce. Clinical trials in Poland can be 30% cheaper than in the US, without sacrificing quality.
The Medical Research Agency (MRA), launched in 2019, has been pivotal in fostering a mature research ecosystem. It not only regulates trials but actively supports researcher training and infrastructure development, ensuring sustainable growth.
6. The Netherlands
Active Trials: 1,847
With short trial startup timelines and high research impact, the Netherlands punches well above its weight in the clinical trial arena. Approval times of less than 30 days, a culture of innovation, and strong international research collaborations make it a preferred destination.
Recent improvements, including updates to the Site Suitability Declaration and integration with the Clinical Trials Information System (CTIS), demonstrate the Netherlands’ proactive stance on trial modernization and harmonization with EU standards.
7. Belgium
Active Trials: 1,734
Belgium’s long-standing reputation for high-quality early-phase trials and therapeutic excellence in oncology and rare diseases remains intact. It ranks among the top EU nations in trial authorisations per capita.
In response to a gradual decline in global trial share, Belgium has announced measures to streamline regulation and create a national Clinical Trial Network and a Biopharma R&D Concertation Platform, indicating renewed political will to maintain its strategic relevance.
8. Denmark
Active Trials: 1,075
Denmark has built a reputation for speed and transparency in clinical trial operations. The Trial Nation Platform, a public-private partnership, has significantly increased trial volumes by simplifying startup procedures.
The Life Science Strategy 2024 aims to further entrench Denmark as a top-tier research destination. Of note is the plan to process Phase I applications in just 14 days, bolstered by a newly established ethical committee focused solely on these trials.
9. Czech Republic
Active Trials: 1,028
The Czech Republic has seen rapid growth in its clinical trials sector, particularly in oncology, with cancer drug studies rising by 40% in 2023. A combination of centralised healthcare, experienced clinicians, and accessible patient populations make it an attractive locale.
Its regulatory authority, SÚKL, is recognised for its efficiency, with trial approvals typically processed within 60 days. Ongoing efforts to increase public and institutional engagement with clinical research are also bearing fruit.
10. Hungary
Active Trials: 882
Hungary rounds out the list with a strong regulatory and infrastructural base. The National Center for Public Health and Pharmacy ensures compliance with EU standards while promoting swift patient enrolment through its national health system.
Key reforms include improved SUSAR reporting processes and updated clinical trial regulations aimed at reducing administrative burden and increasing transparency. Hungary’s low cost and high quality of trial implementation remain major draws.
Conclusion: Europe at a Turning Point
Europe’s clinical trials landscape in 2025 reflects a continent in transition. While its global share has diminished, internal reforms, strategic investments, and the harmonizing force of the ACT EU initiative are helping to re-establish its competitive edge.
The Top 10 countries profiled here are not only leaders in clinical research volume but are also laying down regulatory and operational frameworks that could guide the next wave of medical innovation. As Europe aligns more closely across borders, its collective potential in clinical trials is far from exhausted.
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