Policy Brief - Bringing Back Pharmaceutical Manufacturing is a National Security Priority
The United States is the world’s leader when it comes to creating breakthrough cures and life-saving prescription drugs. Maintaining that lead is a critical national security issue. Simply put, Americans cannot be dependent on an adversary like China to provide us with medicine.
China has aggressively jumped into the global pharmaceutical marketplace. The Chinese government’s concerted efforts to step up production of new medicines and antibiotics are showing results.
30% of clinical pharmaceutical trial starts are now conducted in China up from 9% in 2009. China has almost caught up to the U.S. which conducts 35% of new trials.
Chinese companies now lead the world with 39% of all clinical cancer treatment trials.
China developed 639 “first in class” drugs between 2022 and 2025. That was a 360% increase in Chinese pharmaceutical development compared to the previous three years.
Chinese companies have rapidly increased their production of antibiotics.
China controls 45% of the active pharmaceutical ingredients (APIs) for all antibiotics.
Between 2020 and 2025, China approved more drugs to treat cancer than the Food and Drug Administration (FDA).
Congress must take note of Chinese focused effort to take over the global supply of medicine. American policymakers cannot allow Chinese companies to take the lead in this critical strategic industry. It starts by ensuring that pharmaceutical supply chains run through the United States.
China Dominates the World’s Pharmaceutical Supply Chain
As a matter of industrial policy, the Chinese Communist Party (CCP) has pursued a strategy of undercutting competitors to gain a foothold in international markets before shutting down competition and taking control of critical supply chains. This strategy was laid bare in a 2020 speech by Chinese President Xi Jinping, whose vision was to “tighten international production chains’ dependence on China, forming a powerful countermeasure and deterrent capability against foreigners who would artificially cut off supply [to China].” In his testimony to the Senate Committee on Aging, USCC Commissioner Chris Slevin revealed how that policy impacts Americans through China’s stranglehold on the world’s pharmaceutical supply chain.
Slevin explained that up to a quarter of the Advanced Pharmaceutical Ingredients (APIs) used in American drugs trace directly back to China or indirectly back to China by way of India. That number only rises when including Key Starting Materials (KSMs), which are the component building blocks of APIs. According to Slevin, “If China sought to restrict access to APIs and KSMs used in generics production — both through direct exports and through India — Congress would have an emergency on its hands. It could threaten between one-quarter and one-half of the U.S. generics supply, and generics fill 90 percent of American prescriptions. For Americans managing chronic conditions, that's not an abstraction. Even a small disruption can lead to devastating shortages due to unavailability of one API source and long delays from the FDA having to approve new sources of raw materials [emphasis added].”
For specific drugs, China controls the APIs or KSMs for 94% of amoxicillin (a widely used antibiotic), 74% of heparin (a blood thinner), and 70% of acetaminophen (a pain reliever). Nearly 700 medicines used in the U.S. – including those used to treat seizures, cancer, and HIV - depend on one or more KSM only produced in China. This outcome is by design and not mere happenstance. When India – which manufactures roughly half of the generic drugs in the U.S. – attempted to wean itself off of China for APIs and KSMs and reshore production, China dropped the price of its own components to undercut Indian competitors and maintain control over the market. Ultimately, Americans who are reliant on pharmaceuticals to maintain their health are at the mercy of tightly controlled Chinese pharmaceutical supply chains and gamesmanship to retain a stranglehold on the pharmaceuticals market.
President Trump Is Prioritizing Domestic Drug Production
The Trump administration has recognized the importance of producing life-saving medicines and antibiotics in the United States. President Trump has worked with the private sector to secure over $2 trillion in new domestic investment in the American pharmaceutical industry. These investments are great first step and should be applauded, but more needs to be done to foster the medicine industry and produce more breakthrough drugs in the U.S.
Congress and agencies need to do more to support President Trump’s efforts to reshore medica production. Here are some steps that lawmakers and government officials should implement to stay number one:
Speed up drug approvals. Foreign companies look to conduct trials in China because they have less bureaucratic approval processes. The Food and Drug Administration (FDA) must be able to approve safe drugs in a faster and more efficient manner without jeopardizing public health. It can be done.
Invest in domestic production. Medicine is researched, developed, and produced on a global scale. To lead the world, America’s domestic investment in research and development must exceed our competitors. Policies should foster and increase domestic investment.
Make foreign countries pay their fair share. The United States dwarfs foreign countries in money spent on research to create new medicine. Foreign countries let the U.S. spend over $100 billion each year on research and then reap the benefit from our breakthroughs. Foreign countries should invest in American research efforts from which they benefit.
These are just a few ideas that would build on the pharmaceutical production reshoring plans that President Trump has already announced. The Protecting America Initiative will continue to develop model policies for Congress and state lawmakers.
The U.S. cannot afford to be dependent on the Chinese Communist Party for lifesaving medicines.