By Wania Tahir
A recent study by the U.S. Pharmacopeia (USP) has reignited debate over the United States’ pharmaceutical vulnerability. According to the report, nearly 700 American active pharmaceutical ingredients (APIs) — the essential compounds that make drugs effective — depend on at least one chemical sourced entirely from China. These range from antibiotics and heart medications to cancer and HIV treatments. Even the humble antihistamine found in everyday cold medicine traces its molecular origins back to Chinese factories.
Pharmaceutical manufacturing is not a single process but a complex chain spanning continents. It begins with Key Starting Materials (KSMs), the building blocks of APIs. China has become the world’s largest producer of these materials, providing cost-efficient, high-quality compounds that underpin global medicine production. The USP’s data reveals that 58 percent of KSMs used in U.S.-approved APIs rely on a single-country source — China accounts for 41 percent, while India supplies around 16 percent. In some cases, dependence is near-total: roughly 17 percent of APIs rely exclusively on materials from one country, with 12 percent completely sourced from China.
This dependency isn’t a recent phenomenon. Over the past two decades, rising environmental standards and labor costs have driven Western companies to offshore the most polluting and resource-intensive phases of production. China’s industrial clusters, supported by state incentives and chemical expertise, filled the gap efficiently. Dr Cheung Ching-peng of the University of Hong Kong’s Li Ka Shing Faculty of Medicine noted that China’s policies since the early 2000s created specialized hubs that reduced costs while maintaining quality. That, he said, is what makes China an ideal partner in pharmaceutical production under an open trade environment.
Yet, what began as an efficiency-driven shift has evolved into a strategic dilemma. The COVID-19 pandemic revealed how disruptions in one country could ripple across the global supply chain. Shortages of basic medicines, from antibiotics to painkillers, underscored how concentrated the early stages of drug production had become. The U.S., for all its pharmaceutical innovation, produces very few of these raw materials domestically. The reason is simple: manufacturing APIs and KSMs is expensive and polluting, requiring stringent environmental controls. American companies long ago determined it was cheaper to import from China and India than to produce at home.
Now, as Washington seeks to reduce its reliance on Beijing, that very logic poses a challenge. Policymakers want to “reshore” essential manufacturing, but doing so would require billions of dollars in investment, years of infrastructure development, and overcoming deep-seated economic inertia. USP’s CEO Ronald Piervincenzi warned that even moderate tariffs could disrupt the supply of generic drugs in the U.S., observing that this is a low-margin industry where any added cost makes it harder for manufacturers to survive.
U.S. President Donald Trump’s renewed tariff threats on Chinese imports have only deepened pharmaceutical industry anxiety. Earlier plans to impose duties of up to 100 percent on medicines from certain regions were postponed, but the uncertainty has already spurred major drug companies to announce multibillion-dollar investments in U.S.-based facilities. Yet these new plants mostly handle the final formulation stages of production, not the raw materials themselves. The groundwork of the supply chain — the synthesis of chemical intermediates — remains largely dependent on Chinese suppliers.
Ironically, the very attempt to reduce dependence may heighten costs for consumers and strain global supply chains. Analysts caution that tariffs on Chinese pharmaceutical ingredients could trigger shortages or drive smaller firms out of business, ultimately undermining the resilience Washington seeks to build. Cameron Johnson, a Shanghai-based supply chain consultant, observed that if China moved against pharmaceuticals or chemical exports tomorrow, the U.S. economy could grind to a halt — and there is very little it could do about it.
While the geopolitical narrative often paints this issue as a zero-sum game, the pharmaceutical sector underscores the reality of mutual reliance. China, too, benefits from access to the American market and advanced biotechnological research. Similarly, India — the world’s largest supplier of generic medicines — imports nearly 70 percent of its APIs from China, illustrating how globalized production has blurred the boundaries of national control. This interdependence has fostered both competition and cooperation. In 2023, Chinese and Indian pharmaceutical firms jointly invested in green chemistry initiatives to reduce environmental impacts and diversify regional production. Moreover, multinational companies continue to operate research centers in Shanghai and Suzhou, recognizing the value of Chinese innovation and talent in advancing global drug development.
The pandemic served as a global stress test. When lockdowns in China temporarily slowed production, drug shortages rippled worldwide. However, rather than an act of deliberate restriction, the disruption stemmed from a shared vulnerability — over-concentration in certain supply hubs and the lack of redundancy in production networks. Instead of framing the issue as dependency on China, several analysts advocate for building redundancy and transparency across the global supply chain. Kelly Harnish of USP emphasized that better data could support targeted interventions to protect patient access to medicines and strengthen resilience. That means diversifying sources, investing in new synthesis routes, and promoting sustainable, localized production — not severing links entirely. Such cooperation could also serve broader public health goals, particularly as climate change, population growth, and antimicrobial resistance put additional pressure on medicine supply chains.
Portraying China’s dominance in pharmaceutical raw materials as a threat risks overlooking the deeper economic logic at play. China’s rise as a pharmaceutical hub did not emerge through coercion but through competitive efficiency, scale, and policy-driven industrial organization. Its success reflects not the exploitation of others’ weakness but the mastery of cost, chemistry, and logistics in a sector where margins are notoriously tight. Moreover, the notion of weaponizing medicine — withholding essential ingredients for strategic leverage — remains largely hypothetical. Beijing’s own interest in maintaining global trade stability and its reputation as a reliable supplier discourages such drastic measures.
The real challenge lies in balancing security with cooperation. For the United States, achieving pharmaceutical resilience does not mean severing ties with China but ensuring that no single point of failure endangers patient access to essential medicines. The future of global medicine will likely depend on collaboration, not confrontation. Emerging technologies such as continuous-flow synthesis and AI-assisted chemical modeling offer pathways to decentralize production without dismantling existing partnerships. Joint ventures, regulatory alignment, and environmental innovation could turn what is now a geopolitical flashpoint into a model of sustainable global cooperation.
About the Author:
The author is associated with the Global Strategic Institute for Sustainable Development – GSISD and can be reached at waniatahir23@gmail.com
