Israel has established itself as an important center for cancer drug development, with advanced hospitals, experienced investigators and an active biotechnology industry. However, changes in the way new cancer medicines are developed could pose a challenge that deserves greater economic attention.
Increasingly, pharmaceutical companies are developing treatments for patients whose cancers have particular genetic characteristics, sometimes found in only a small proportion of people with the same disease. Although this approach allows treatments to be developed for more precisely defined groups of patients, it also makes clinical trial recruitment more challenging. For a relatively small country such as Israel, the question is whether the growing difficulty of identifying suitable patients could eventually affect its ability to compete for international clinical research investment.
Patient recruitment and the economics of clinical trials
The economic implications arise from the way pharmaceutical companies select hospitals and countries for clinical trials. Beyond scientific expertise and infrastructure, companies need confidence that participating hospitals can recruit sufficient numbers of eligible patients within the required timeframe. When recruitment takes longer than expected, research costs may increase, clinical results may be delayed and companies may reconsider how they distribute future clinical trial activity.
A McKinsey analysis of pharmaceutical research productivity identifies patient recruitment as an important factor influencing clinical trial timelines and development efficiency. For Israeli hospitals, the commercial implications could include fewer opportunities to participate in internationally sponsored studies and the associated research income, while Israeli biotechnology companies developing their own medicines could face additional costs and delays in generating the clinical evidence needed to attract investors and partners.
This does not mean that Israel currently faces a widespread recruitment problem, and there is insufficient evidence to conclude that its relatively small population has already caused significant economic losses. Nevertheless, as more cancer treatments are developed for increasingly narrow patient groups, Israel has good reason to examine whether this trend could affect its future competitiveness.
A useful starting point would be to assess the recruitment performance of specialized oncology trials conducted in Israel over the past five years, including how frequently hospitals achieved their enrollment targets, how long recruitment took and whether difficulties identifying suitable patients influenced decisions by pharmaceutical sponsors. Such an assessment could help determine whether additional investment in patient identification and recruitment infrastructure is economically justified.
Cooperation with Palestinian healthcare providers
One opportunity worth examining is whether Israeli hospitals could expand their access to potentially eligible patients through a structured referral network involving Palestinian healthcare providers. According to figures released by the Palestinian Ministry of Health, 3,926 new cancer cases were recorded in the West Bank in 2024. Only a fraction of these patients would qualify for any particular clinical trial, but for studies seeking relatively uncommon tumor characteristics, even a small number of additional eligible participants could be valuable. From a business perspective, the question is whether closer coordination between Palestinian oncologists and Israeli clinical research centers could improve recruitment efficiency sufficiently to justify the additional organizational and financial costs.
Such cooperation could initially be tested through a relatively modest pilot program rather than an expensive new institution. The Israel Cancer Association already maintains a searchable database of oncology clinical trials, which could provide a starting point for connecting participating Palestinian oncologists with Israeli hospitals conducting specialized studies. Physicians could securely share relevant medical information to determine whether patients might be suitable for particular trials before arranging further screening, potentially reducing unnecessary visits and expenses. The pilot would need to establish practical arrangements for travel, ongoing medical monitoring and responsibility for additional costs, while ensuring that participation remained voluntary and medically appropriate. Its commercial value would depend on whether any improvement in recruitment efficiency outweighed these expenses.
Competitive advantage
The results should be measured against clear economic criteria, including the number of eligible patients identified, their eventual enrollment, the effect on recruitment timelines and the total additional cost per enrolled patient. These findings should also be compared with alternative approaches, particularly strengthening referral networks and access to diagnostic testing within Israel. If the benefits prove limited, there would be little justification for expansion, but if the model demonstrates that broader access to suitable patients improves recruitment at a reasonable cost, it could offer Israeli hospitals and biotechnology companies an additional competitive advantage while giving Palestinian patients access to clinical research opportunities that might otherwise remain unavailable.
Ultimately, the question is not whether Israel already faces a recruitment crisis, but whether the changing economics of cancer drug development could create new competitive pressures in the coming years. Israel has invested in building a strong clinical research industry, and understanding how increasingly selective trials may influence future pharmaceutical investment is a sensible next step. Examining the economic risks and testing practical opportunities to expand patient recruitment would allow Israel to strengthen its competitive position on the basis of evidence rather than assumptions.
Prof. David Adler is Chief Scientific and Medical Officer at the PATHORA Institute of Pathology & Tissue Medicine in Germany, and holds academic appointments at the Hebrew University of Jerusalem, Ben-Gurion University of the Negev, and the University of Bonn. He previously served in a senior position at Bayer AG.
Published by Globes, Israel business news - en.globes.co.il - on November 2, 2026.
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