Trans-Pacific View | Economy | East Asia

US Drugmakers Are Dependent on Chinese Supply Chains

Analysts warn a disruption in Chinese sources of common antibiotics or blood thinners could leave American patients with no reliable alternative.

China controls the upstream production chemistry for many of the most widely used generic drugs in the United States, leaving few backup suppliers if that access were disrupted, according to a recent report by former U.S. government officials. The vulnerability is drawing fresh attention as Chinese leader Xi Jinping is expected to travel to Washington, D.C. for a state visit on September 24, the first trip by a Chinese leader to the U.S. capital in more than a decade.

American and Chinese officials have spent recent weeks preparing for the visit, and artificial intelligence and trade friction are expected to dominate the agenda. Still, pharmaceutical dependence carries the same kind of coercive potential Beijing has shown in other sectors, and it touches medicines that tens of millions of Americans take every week.

Beijing has used that kind of leverage before. It restricted rare-earth exports to Japan during a 2010 territorial dispute, imposed trade barriers on Australian barley and wine after Canberra called for a COVID-19 origins inquiry, and curtailed trade with Lithuania after Vilnius opened a Taiwanese representative office. In none of those cases did Chinese officials announce the move or explain the reasoning beforehand.

According to the recent report published on September 2 by Scalare Advisors, a consultancy based in Washington, D.C., China supplied more than 70 percent of the antibiotic active ingredients by volume imported into the United States in 2024, and three of the most commonly used outpatient antibiotic drugs – amoxicillin, azithromycin, and ciprofloxacin – all depend on Chinese-made ingredients. A simultaneous disruption in all three would leave doctors with no reliable outpatient antibiotic option that could be obtained at the necessary scale and speed.

One Chinese conglomerate, CSPC Pharmaceutical Group, produces both amoxicillin and azithromycin for the U.S. market, meaning a single company controls the fermentation-to-tablet chain for two of the three dominant outpatient antibiotic drugs. No equivalent domestic or allied producer exists for either drug.

Bristol-Myers Squibb announced the closure of its last U.S. penicillin fermentation plant in 2004 and ended production there the following year, eliminating domestic manufacturing of 6-aminopenicillanic acid, the building block for the penicillin-class drugs used to treat strep throat, ear infections, pneumonia, and Lyme disease. Today, no U.S. plant produces penicillin from scratch. This decision conceded penicillin production to China, which now makes about 90 percent of that ingredient worldwide.

Heparin – one of the most commonly used blood thinners – illustrates the same pattern. Pfizer has one heparin injection product on an active shortage list maintained by the Food and Drug Administration. The two remaining U.S.-based producers of the raw ingredient used to make it – Scientific Protein........

© The Diplomat