While China continues to dominate clinical trial activity across Asia-Pacific (APAC) and globally, other countries are rapidly emerging as significant players in driving innovation.
As US-China hostilities persist driven by measures such as the BIOSECURE Act and tariffs, many US partners are onshoring while exploring opportunities in APAC beyond China.
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Although Japan has historically been a key player in the region, other nations are increasingly contributing to the region’s innovative landscape.
“The APAC region has done well in the past five years, and I think it will continue to expand, simply because of the amount of investment that’s being pumped in,” says Priya Ravisekara, senior healthcare analyst at GlobalData, parent company of Clinical Trials Arena.
While all APAC countries are dwarfed by China’s clinical trial initiations, with 10,701 trials starting in 2024, equating to 61% of the total APAC region trial initiations, other countries are seeing a rise.
India’s patient population a major draw
India is a standout example of a rapidly growing market, having overtaken Japan in trial initiations in 2024 by a wide margin. According to GlobalData’s Pharmaceutical Intelligence Center, there were 1,710 trial initiations in India in 2024 compared with 741 in 2014.
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By GlobalDataThe primary reason for trial growth is due to a rise in contract development and manufacturing organisations (CDMOs), says Eyexora CEO Theresa Heah. Many of these CDMOs are providing funding and forging partnerships with biotech and pharma companies.
Ravisekara adds that cost efficiencies and access to a large patient pool are additional reasons why India is becoming an attractive base.
Elizabeth Thomson, founder of ETL, a clinical development consultancy for early-stage biotech, who has been working in the APAC region for 30 years, says that accessing India’s large patient population, as well as its skilled workforce and cost advantages, are major draws.
Thomson explains: “The population is highly educated. You have people who are significantly more qualified for the roles, and compared to the West, the cost of salaries is relatively lower. On a European budget, for example, you could have two clinical research coordinators in India for the same cost as one in London or New York.”
She adds that when seeking marketing approval for a global therapeutic, clinical study populations must be representative of the target patient population, making India an attractive region for regulatory purposes.
These factors mean that growth in India is likely to continue, notes Bain & Company partner Fabio La Mola, who has authored a report about biotech innovation in APAC. He says that while sites in China are more organised with recruitment, the volume of patients available in India is significant.
Cost and regulation are responsible for Japan’s decline
While many experts believe that innovation is pouring out of Japan, the country has seen a drop in clinical trials in the past decade. In 2014, there were 1,834 trial initiations, compared to 1,115 in 2024.
Thomson, who is also head of clinical strategy at Australian biotech Lixa, believes that this drop is due to the country having had an “early start”, but due to high costs and lower patient numbers, it may not be the most attractive location for sponsors.
She says: “In Japan, sites provide patient enrolment estimates and consistently meet it – unlike sites in other countries, particularly the West.”
While Japan has ceded its dominance in APAC – having been a larger player than China in 2014 – it remains a key player in the sector, say Ravisekara and Heah. The country is both well-established and well respected by the sector, especially in cell and gene therapies (CGT).
“They’ve been pioneers in that field, in fact, various regulatory agencies leverage and learn from that,” Heah says.
Japan’s focus on early-stage rare disease and oncology candidates is also notable, Ravisekara adds, noting that this is a place where the country shows strength.
Support for academic institutions through agencies such as the Agency of Medical Education (AMED) is also a key driver for growth in Japan.
“The agency is also trying to support companies that are entering Japan to in-license the asset,” Heah adds.
Japan’s decline has also affected the market, says La Mola, noting that because trials have traditionally needed to be conducted domestically for approval, innovation has slowed due to the challenges of meeting regulatory requirements.
“Therefore, Japan is thinking about relaxing the requirements for clinical trials so that as long as you have Japanese patients within the study, they will accept the data, even though the trial may not have been run fully in Japan,” La Mola explains.
“It will probably remain stable or potentially decline slightly, but I think the quality of trials that you can run in Japan is extremely high.”
Smaller nations experiencing growth
Additional markets experiencing growth include Singapore, South Korea, Thailand and Australia.
Eyexora has set up its co-headquarters in Singapore, with Heah noting: “Singapore serves as a gateway to the growing activities across the APAC region.
“In Singapore, they speak English, which means business meetings are all conducted in English. It is also geopolitically very safe and stable. On top of this, over the past decade, the government has provided a lot of non-diluted funding grants, and there is a very strong STEM programme.”
La Mola also sees Singapore as a growing market but highlights Malaysia and Thailand as areas to watch for growth. He adds that Malaysia, specifically, has had a greater centralisation of clinical trial registration and patient recruitment.
In addition, he notes that Thailand’s strong infrastructure and centralised point of entry for clinical trials allows sponsors the ability to shorten timelines to first dose – an extremely important advantage.
South Korea is one market that has seen slight numerical growth, with 881 trial initiations in 2014 compared to 1,151 in 2024.
This growth could be due to a collection of developments in the country over the past decade, including an advanced hospital network, an efficient regulatory environment and a reputation for generating high quality trial data, suggests Ravisekara.
Heah agrees that South Korea is an interesting country due to some “amazing innovations”.
La Mola believes that government funding initiatives for biotech have been a reason why it has seen an increase, as this has bolstered a homegrown biotech industry over the past decade.
However, Thomson believes this is more of a natural evolution of clinical trials growing on a global scale rather than the country specifically seeing growth. This may be due to the regulators being satisfied with rare disease data from other markets, making it a less attractive region for these studies.
“As far as I understand, if it’s not a rare disease, you need patients in South Korea, but if it’s rare, you don’t. If you have patients in Japan, China, India and Australia, and you can largely get licensure across the whole APAC region,” she explains.
While Australia has not seen a significant increase, La Mola classifies it as a key region, especially for early-stage biotech, due to the tax break for conducting research.
“That tax rebate on Phase I trials becomes a cash rebate after several years, so a young biotech with limited funds is keen to run the clinical trials in Australia. Australia also has the advantage that the data it produces is accepted by the FDA. A young biotech can run a Phase I trial in Australia and use the data for the US Food and Drug Administration (FDA) to file for Phase II.”
How China tensions could impact APAC
Due to escalating tensions between China and the US, experts believe growth will continue across the APAC region. And there is time for companies to strategise as bills such as the Biosecure Act take time to be implemented.
“Drug development is a long-term play, and the Biosecure Act won’t come in for another few years, so companies have time to get creative and look into how drugs are being developed and the business,” Heah explains.
This growth can be further bolstered by strong STEM programmes in a lot of APAC countries.
According to La Mola, geopolitical tensions are having little impact on China – let alone elsewhere in APAC – highlighting that 2025 has been a strong year for China-US M&A activity.
“This speaks to the fact that it is difficult to contain biotech within borders, because good science is good science. Therefore, I don’t see an impact from what is happening between China and the US across APAC. I think these markets act rather distinctly and they have their own dynamics,” La Mola concludes.
