Hungary and Spain are both success stories in the global clinical trials ecosystem. As Hungary leads Spain in terms of trials per capita, this could mean Hungary has limited space for growth and learning. However, Spain recently strengthened its position in clinical research, while Hungary shows some signs of stagnation. One hypothesis for these differing fortunes is the phased, comprehensive planned approach involving all key stakeholders that Spain has taken towards achieving a robust clinical trials ecosystem. Regardless, recent examples demonstrate ecosystems that experience new low-cost competitors or other signs of obsolescence must act, and act quickly. This paper explores how Spain and Hungary have sought to enhance their clinical trials ecosystems. In the case of Spain, highly engaged public institutions and agencies, and a series of strategic plans accompanying targeted investments in capabilities and infrastructure were accompanied by active partnerships between government, industry and academic and research institutions. In the case of Hungary, while the government provided a positive overall innovation framework for innovation, academic institutions and others have been more proactive in building a clinical trials ecosystem. There are some lessons from Spain from which Hungary can benefit. Finally, clinical trials in Hungary and Spain play an important role in addressing national health priorities, providing patients with access to highly innovative treatments and practitioners with experience. There is some scope to better align the clinical trials ecosystem with these national priorities. However, the scope is limited in both countries by the disproportionate focus on oncology and neurology.  Kulcsszavak: Clinical trials ecosystem - Public-private partnerships - Innovation - National health priorities - Stakeholder engagement - Government health policy