Scientist conducting medical research in her lab

Within the last decade, the province has become a hive of clinical trials activity that outranks other global jurisdictions

Susan Marlin, President and CEO of Clinical Trials Ontario
By Susan Marlin,
President and CEO of
Clinical Trials Ontario

Ontario has long been an attractive jurisdiction for conducting high-quality clinical trials. We have all the right ingredients: world-class talent, cutting-edge infrastructure, a diverse patient population and programs to support industry. But within the last decade, Ontario has hit a new stride, becoming a hive of clinical trials activity that outranks other global jurisdictions.

The number of clinical trials in Ontario has increased by over 160%, with more than 4,600 trials underway at any given time. That’s the highest number in Canada and two times more trials per capita compared to the U.S. Every major pharmaceutical company in the world is running trials here in all fields of health research, sponsoring at least 50% of Ontario’s active clinical trials.

We are conducting more trials than ever before, more quickly and efficiently, with more industry players, to get the best therapeutics and devices into the hands of people who need them sooner. So what’s our secret? It’s simple. We’ve got the right ingredients and the right recipe.

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The right ingredients: Ontario’s competitive advantages for clinical trials

Ontario is Canada’s hub for health research talent, with Canada’s largest and most diverse population and the largest concentration of clinical trial sites. We are home to 140 hospitals with over 200 unique sites, including 19 of Canada’s top 40 research hospitals that are leading ground-breaking trials on local, national and international levels. These sites include the Princess Margaret Cancer Centre, one of the top five cancer research centres in the world, SickKids, Canada’s largest child-health research centre, and the Population Health Research Institute, a world leader in large-scale clinical trials. These are globally recognized institutes, and they draw and develop talent that sets our province apart. Our research-intensive hospitals employ over 22,000 researchers and research staff who are leading clinical trials in a wide range of key areas, including cancer, nervous system disorders, cardiovascular disease, immunological illnesses, infectious diseases and more.

Cancer research, in particular, is a core strength of this province. Starting with the discovery of multipotent stem cells by James Till and Ernest McCulloch in 1961, Ontario researchers have been leading in this area for decades. Our clinical trials infrastructure is set up to support world-class cancer trials, with a dedicated cancer research ethics board (OCREB), a provincially-funded cancer research institute (OICR) and many cancer research facilities, networks and innovation organizations dedicated to supporting translation and commercialization of therapeutics. In 2021, there were over 1,500 active cancer trials in Ontario, and 32% of all Ontario trials were targeting cancers.

Ontario is also highly invested in training the next generation of scientific talent, with over 65,000 annual STEM graduates and 18 clinical research programs at Ontario colleges and universities. But we don’t just have the schooling, we have the jobs, too. Life Sciences Ontario reports that the province supports over 30,000 jobs in the drug and pharmaceutical industry and over 26,000 jobs in the medical device industry.

With world-leading advantages like these, it’s easy to see why industry chooses to come to Ontario to conduct clinical trials. But it’s not only our ingredients that make this province special—it’s how we bring them together.

Creating a connected, collaborative environment for clinical trials

The clinical trials sector is a vital contributor to Ontario’s economy, and there has been strong commitment from government, institutions and industry to capitalize on our clinical trials assets by creating an environment that is more streamlined and collaborative.

As one of Canada’s first dedicated, non-profit clinical trials organizations, Clinical Trials Ontario (CTO) is an example of this commitment. Established in 2012 by the Government of Ontario, we develop and support programs that reduce administrative burdens and help get trials running quickly and efficiently while maintaining the highest ethical standards.

Our flagship program, CTO Stream, enables a single research ethics review for all participating sites in a study, with an average approval time of 10 days. With over 7,700 users, this program is now the gold standard for research ethics review in Ontario. CTO QuickSTART helps get trials started faster, with trial activation in just 90 days. Through CTO’s Industry Concierge Service, prospective companies can be connected with resources and researchers in Ontario’s clinical trials ecosystem, including warm introductions to over 200 sites. CTO’s work in patient and public engagement is also improving participant recruitment by helping people find trials and make informed decisions while supporting industry with resources to improve the participant experience.

As we come out of the COVID-19 pandemic, government has also strengthened commitments to the clinical trials and life sciences sector. In 2022, Ontario announced its first-ever Life Sciences Strategy, which aims to establish the province as a global biomanufacturing and life sciences hub. This followed a 2021 announcement of a Federal Biomanufacturing and Life Sciences Strategy. In 2023, Canada also saw the creation of a federally-funded clinical trials consortium—the Accelerating Clinical Trials (ACT) Consortium—a 250-member team that will accelerate, optimize and facilitate national clinical trials and Canadian participation in international trials.

Investments like these make businesses more efficient and cost effective. According to McDougall Scientific, Canada has the second lowest cost among G7 nations for managing clinical trials.

The proof is in the pudding: Industry is choosing Ontario

In March 2023, AstraZeneca announced plans to create a new Rare Disease Development Hub in Ontario and expand its existing Ontario-based Research & Development Hub, which focuses on leading global clinical studies in areas including breast, lung and prostate cancer, COVID-19 and chronic kidney disease. The pharmaceutical giant credited the province’s network of world-class research sites, diverse scientific talent pool and strong government support for the life sciences sector as key factors in the decision to invest in Ontario.

AstraZeneca isn’t the only company capitalizing on Ontario’s clinical trials advantages. There are more than 340 pharmaceutical firms in Ontario, including all market leaders: Johnson & Johnson, Roche, Novartis, Merck, Pfizer, Bayer, AbbVie, GSK, Bristol-Myers Squibb, Sanofi, Eli Lilly and others.

More than half of Canada’s pharmaceutical R&D investment is in Ontario, contributing $8.7 billion to Ontario’s economy and representing over 50% of the total economic contribution across Canada. And as a result of Ontario’s efforts to streamline and improve our clinical trials environment, these investments have only increased. In 2021, the number of industry-sponsored trials was more than double what it was a decade before.

Companies scouting for a clinical trials location should look no further than Ontario. We’ve shown the world that we are a competitive, cost-effective jurisdiction that has the talent, infrastructure and programs in place to help industry tackle some of the biggest challenges in medicine today.

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