Ireland’s medtech sector is internationally recognised as a leading global cluster characterised by a deeply evolved ecosystem, encompassing leading multinationals, specialised research and clinical capabilities and a dynamic start-up and indigenous base. In this article, Sheila O’Loughlin from Enterprise Ireland explains how it is that an island of just over 4.7 million people emerged as one of the world’s top five medical technology hubs over the last 20 years, rivalling key clusters such as Minnesota and Massachusetts.