The U.S. Will Rely on China To Defend Against the Next Pandemic

Despite the lessons of the pandemic, America’s biodefense system increasingly relies on Chinese components. On October 14, the U.S. Pharmacopeia (USP), a body that sets domestic quality standards for medicines and supplements, released a study highlighting America’s dependence on China for key pharmaceuticals, including amoxicillin, the second-most prescribed oral antibiotic in the country.

The report, which comes amid unprecedented turmoil across federal health care agencies responsible for biodefense, highlights America’s growing and dangerous dependency on China for a range of critical medical supplies.

China Dominates Upstream Inputs Into Major Medications

The USP report traced the origins of key starting materials (KSMs), which serve as the basis for active pharmaceutical ingredients (APIs), the core components of medications. The report found that nearly 41 percent of KSMs used in U.S.-approved APIs are sole-sourced from China, a rate over twice as high as the next leading sole-source supplier, India.

Moreover, nearly 60 percent of KSMs are sourced from a single country, with the U.S. domestically producing only four of the potentially thousands of such components, in large part due to the environmental hazards associated with producing such compounds at scale. In contrast to finished pharmaceutical products, which often command high prices, KSMs are also relatively inexpensive, offering American firms limited financial incentive to invest heavily in domestic production.

Beijing Continues To Control American Medical Supply Chains

China’s role within the global pharmaceutical sector highlights Beijing’s growing dominance across both low and high-value American medical supply chains. Having invested billions into its medical supply manufacturing base, China provides nearly half of all medical personal protective equipment (PPE) that the United States imports, including face shields, gowns, and medical-grade gloves. Along with producing lower-cost items, major American pharmaceutical firms have increasingly turned to purchasing drug licensing rights from smaller Chinese pharmaceutical start-ups. This trend threatens to cut off a key source of income for small- to mid-sized American companies, which typically rely on selling their experimental treatments to larger firms with the financial capacity to take a medicine to market.

While offering lower costs for key inputs into the American health care system, China’s dominance poses a series of risks. America’s reliance on Chinese-produced PPE, along with domestic mismanagement, contributed, in part, to the U.S. failures in responding to the coronavirus pandemic; Chinese imports in short supply showcased significant gaps in America’s biodefense strategy. Moreover, Chinese medical devices may provide Beijing an avenue to conduct espionage and sabotage, with the Cybersecurity and Infrastructure Security Agency discovering a software vulnerability in a Chinese-produced heart monitor in January that would allow Chinese authorities to steal patient data and compromise the device’s effectiveness.

Washington Must Work With Allies and Partners To Build Secure Alternatives

In response, the United States must work to secure its medical supply chains, particularly those critical to biodefense. The FDA and National Institutes of Health should work to identify vulnerabilities within key pharmaceutical supply chains, along with coordinating with the Department of Defense and the Administration for Strategic Preparedness and Response to secure the country’s strategic stockpiles of PPE and critical pharmaceuticals.

These efforts should be paired with consistent outreach by Washington to key U.S. allies and partners, particularly India, to relocate KSM and API production away from China. The Trump administration should ensure that pharmaceutical production is a key part of any negotiated trade deal with New Delhi while also cementing stronger ties with European and Asian manufacturers, particularly in Germany and Japan.

Jack Burnham is a research analyst in the China Program at the Foundation for Defense of Democracies (FDD). For more analysis from Jack and FDD, please subscribe HERE. Follow Jack on X @JackBurnham802. Follow FDD on X @FDD. FDD is a Washington, DC-based, nonpartisan research institute focusing on national security and foreign policy.