This past year, oncologists across the United States faced an agonizing choice: Which cancer patients would receive their full, life-saving chemotherapy regimen and which would face delays or substandard alternatives? Widespread shortages of essential drugs like cisplatin and carboplatin—workhorse medicines that form the backbone of countless cancer treatments—left doctors scrambling and put hundreds of thousands of American patients’ lives at risk.
This crisis was not a natural disaster; it was a self-inflicted wound, the predictable outcome of a decades-long strategic failure. While Washington focuses on areas like semiconductors and AI, we have quietly ceded control over the very foundation of modern medicine to our primary geopolitical rival: China. The American biotech ecosystem, long considered the world's engine of innovation, is now dangerously dependent on China at every level of the supply chain.
When Americans pop an ibuprofen for a headache or take their daily blood pressure medication, they're unwittingly participating in one of the most dangerous dependencies in modern geopolitics. The active pharmaceutical ingredients—the actual medicine that treats your condition—increasingly come solely from China. Beijing didn't stumble into controlling 40 percent of the world's Active Pharmaceutical Ingredients (APIs) by accident. Through systematic state subsidies and predatory pricing, Chinese manufacturers have methodically destroyed Western competitors, then jacked up prices once the competition was eliminated. The result? When COVID hit and China briefly restricted pharmaceutical exports, American patients faced immediate shortages of a wide variety of drugs, from antibiotics to heart medications. We've essentially handed Beijing a kill switch for American healthcare.
Equally troubling is the dependency on Key Starting Materials and chemical precursors. These foundational chemicals are needed to manufacture both active ingredients and the supposedly "inactive" components that make pills work. Through systematic investment, China has come to dominate the global bulk chemical industry used in the pharmaceutical industry, meaning that even when we think we're buying "American-made" drugs, we are often just assembling components sourced from Chinese precursors.
It's like building fighter jets with high-performance alloys that only one adversary can manufacture. Beijing could tomorrow announce new "environmental regulations" that halt precursor exports, and American pharmaceutical production would face catastrophic disruptions almost immediately. We've built our entire healthcare system on a foundation controlled by our strategic rival.
Over three decades, leading pharmaceutical executives have made a series of individually rational decisions that collectively have gutted our independence. First, they moved basic manufacturing offshore to cut costs by 30 to 40 percent. Then they outsourced research services to access cheaper lab work. Finally, they began licensing entire drug pipelines from Chinese companies rather than investing in domestic R&D and manufacturing capacity. Each move looked smart on a quarterly earnings report; together, they equaled handing Beijing the keys to American medicine.
Meanwhile, Beijing executed a comprehensive national strategy to dominate biotechnology. This decades-long effort was highlighted at a hearing of the U.S.-China Economic and Security Commission on “Made in China 2025,” where one witness described China's strategy not just as a "whole-of-government" approach, but a "whole-of-nation" approach that fuses state capital, academic research, and corporate ambition toward a single goal.
The consequences now extend to the very root of future innovation: the talent pipeline. Consider the International Genetically Engineered Machine (iGEM) competition, an initiative born at MIT to inspire the next generation of synthetic biologists. Each fall, students gather for the annual Grand Jamboree to present their breakthroughs. Look closely at the winners' podium: In recent years, Chinese teams have frequently excelled in the competition. This is the canary in the coal mine, signaling that the next generation of top-tier innovators is increasingly being cultivated by our chief competitor. We are witnessing a “great inversion,” where the next generation of breakthrough innovations may well come from Beijing, not Boston or Silicon Valley.
Washington is only beginning to grasp the scale of this problem. The BIOSECURE Act, which aims to prevent US taxpayer funds from flowing to certain Chinese biotech entities, is an important effort and should be passed as soon as possible. But we must act more comprehensively.
Fixing this crisis requires more than good intentions—it demands comprehensive action and an all-of-the-above approach. This strategy must launch a national initiative to leapfrog outdated foreign production methods, investing in next-generation manufacturing technology to make domestic production faster, cheaper, and more secure.
To protect this new ecosystem, we should establish an industry partnership similar to Sematech, which helped America regain competitiveness in semiconductors in the 1980s, to ensure a reliable US supply of essential raw materials and excipients. Simultaneously, we must create financial incentives for domestic sourcing, paying hospitals and suppliers more when they choose drugs manufactured domestically or in allied nations. We should also require clear country-of-origin labeling on all prescription medications, giving doctors and patients the information they need to make informed choices about their healthcare supply chains. These measures illustrate the scale of commitment needed to restore US medical independence.
This is not just an economic vulnerability; it is a profound national security threat. The Department of Defense relies on the same fragile commercial supply chains to treat wounded soldiers as hospitals use for cancer patients. A dependency that causes drug shortages in peacetime becomes a crippling strategic liability in a conflict, trade dispute, or other negotiation where leverage is required. We cannot allow the health of our citizens and the readiness of our military to be held hostage by decisions made in Beijing.
Mike Kuiken is a distinguished visiting fellow at the Hoover Institution and formerly served as the national security advisor to Senate Democratic Leader Charles E. Schumer
