Opinion: The U.S. pharmaceutical supply chain problem is not about China

OpinionFirst Opinion The U.S. pharmaceutical supply chain problem is not about China The immediate risks to securing pharmaceuticals are regulatory, not geopolitical Manage alerts for this article Email this article Share this article By Pooja YerramilliJuly 24, 2026 Yerramilli is a clinical assistant professor at NYU Grossman School of Medicine and Council on Foreign Relations term member. In 2025, there were 216 active drug shortages in the U.S., impacting Americans’ access to lifesaving medications. The resilience of our pharmaceuticals supply chains has been increasingly framed as a national security issue, including by the White House — and rightly so, as Covid-19 magnified the massive costs of a health system ill-equipped to care for its population. But this national security framing has heavily skewed toward a U.S.-China competition lens, distracting from the real root causes of our pharmaceuticals supply chain vulnerabilities: inadequate regulation of an industry that tends to prioritize profit over America’s health.Advertisement The United States’ disproportionate dependence on China’s pharmaceuticals certainly poses risks to our supply chains, but not for the reasons national security experts emphasize. Whether upstream inputs or the end-products themselves, China dominates nearly every step in the pharmaceuticals production process. A recent Council on Foreign Relations (CFR) report, for instance, warns that China may “deliberately withhold essential pharmaceutical inputs as a tool of economic or political coercion” — drawing from risk analyses of other supply chains like rare earth and critical minerals. This analogy is specious at best. Unlike critical minerals, pharmaceutical inputs are not inherently limited by exhaustibility, such as extraction costs, capacities, or being limited natural resources. Instead, their scarcity reflects the industry’s focus on profit margins, which is what drove its migration to China in the first place. Moreover, while there is no evidence of China’s intentional manipulation of pharmaceuticals, there is historical evidence that inadequate FDA regulation of products made both abroad and domestically has threatened American lives — for example, in 2008, when contamination of Baxter’s heparin product, with ingredients sourced from China, led to more than 150 adverse events, including severe allergic reactions and death, and, in 2012, when contaminated methylprednisolone acetate, due to unsanitary manufacturing practices by New England Compounding Center in Massachusetts, led to a nationwide fungal meningitis outbreak that affected over 750 patients and led to 64 deaths.Advertisement While there have been significant reforms in the intervening decades, problems remain, making the immediate risks to securing our pharmaceuticals regulatory, not geopolitical. And the overemphasis on U.S.-China relations has significant implications on the solutions put forth. The cornerstone of policy proposals to reduce the U.S. pharmaceutical industry’s dependency on China is onshoring or friend-shoring production of select pharmaceutical inputs and products domestically or to allies. But without a cohesive approach to our overall health policies and infrastructure, onshoring or friend-shoring will only expose us to more health, economic, and security risks. First, diversifying production requires strong public health and regulatory infrastructure. Chief among these is the Food and Drug Administration, which among many other things, tracks drug supplies, monitors sources and quality of imported pharmaceutical inputs and products, and regulates the standards of domestically produced pharmaceuticals. Indeed, weaknesses in FDA regulatory capacities were key drivers of the 2008 heparin crisis. Yet, the FDA continues to fall short on transparency, efficacy, and safety standards — set to be exacerbated by agency’s staffing turnover and reductions over the past 18 months, and further exacerbated by proposals, as in the CFR report, to prioritize speed without adequate attention to standards. Meanwhile, reductions in National Institutes of Health funding, coupled with politicization of federal research grant approval processes, will threaten the publicly funded research and development that drives pharmaceutical innovation, as much if not more than industry R&D investments, in this country. New initiatives like HHS’ Operation Trialblazer, which aims to improve U.S. R&D competitiveness through reforms across divisions spanning FDA and NIH will fail if they neglect these underlying structural challenges. Second, onshoring will not solve our domestic supply chain vulnerabilities — including consolidation within the U.S. itself. Few, and sometimes even single, companies or plants based in the U.S. are responsible for the majority of the supply of health products that health systems across the country depend on.Advertisement Under the section header “A Brief History of the U.S. Response to Pharmaceutical Dependence on China,” the CFR report references President Biden’s invocation of the Defense Production Act after Hurricane Helene, implying that this disruption, among the others listed, were caused by our dependence on China. It does not specify that this response was actually to a critical IV fluid shortage after the hurricane damaged a Baxter plant in North Carolina, which supplied 60% of the nation’s IV fluid supplies. Nor does it acknowledge that the U.S. also resorted to temporarily importing IV fluids from other countries as a stopgap measure, including the U.K., Canada, and China. Securing the U.S. supply chain is as much an issue of corporate consolidation as it is China’s consolidation — and more attention ought to be paid to reducing our reliance on single companies or plants for medicines and supplies, whether domestically or internationally. Finally, onshoring or friend-shoring will inevitably increase the costs of medications, when U.S. health care is already unaffordable — in large part driven by pharmaceuticals. The U.S. government’s pharmaceutical tariffs, which are scheduled to take effect July 31, intend to incentivize onshoring — and while analyses like the CFR report support tariffs as levers against China, studies suggest that even a 55% tariff may increase prices for affected drugs by 11% on average. The CFR report further suggests these costs be absorbed by Medicare Part B, “through more generous hospital reimbursement rates for domestically sourced products.” This completely sidesteps current debates plaguing Medicare Part B — namely, rapidly mounting medication spending has driven higher premiums and out-of-pocket payments for beneficiaries. Divorced from meaningful policies to make health care more affordable — from systematizing government drug price negotiation to expanding health coverage — isolated proposals to absorb higher costs of medications through public finance or out-of-pocket payments are untenable, and will only exacerbate barriers to health care access, population and public health, and vulnerability to health security threats. Advertisement To be sure, China’s dominance of health product supply chains may indeed pose national security risks, insofar as excessive reliance on any single country can jeopardize resilience. Particularly in the context of broader geopolitical tensions, governments cannot simply assume that other countries, friend or foe, will act in their best interests. But anchoring on this premise, without contextualizing it within the overall domestic health systems landscape, will not guarantee the quality, safety, and accessibility of health products both during and outside of moments of crises. Our pharmaceutical supply chain resilience will not come from a siloed focus on geopolitics. It will come from regulatory reforms that safeguard our collective health above corporate profit. Pooja Yerramilli, M.D., is a clinical assistant professor at NYU Grossman School of Medicine and Council on Foreign Relations term member. She has previously worked at the World Bank, World Health Organization, and various nongovernmental organizations on improving affordable access to high-quality, resilient health systems and health security. Her views represent her own and not those of her current and former employers, and she was not involved in the CFR report cited in her op-ed. Letter to the editor Have an opinion on this essay? Submit a letter to the editor. Pharmaceuticals, Policy Submit a correction requestReprints Pooja Yerramilli Newsletter The smartest thinkers in life sciences on what's happening — and what's to come Recommended First Opinion July 24, 2026 I may be one of the last middle-class medical students who could afford to become a doctor First Opinion July 23, 2026 New billing codes likely to raise maternity care costs Advertisement First Opinion July 23, 2026 Good riddance to bundled ‘global’ maternal care billing First Opinion July 22, 2026 What Argentina’s World Cup loss should teach American hospitals The Workup July 22, 2026 STAT Plus: I’m a cardiologist. I’m not sure the new cholesterol drug enlicitide is a game-changer Subscriber Picks