The United States, despite being the richest country in the world and a biopharmaceutical powerhouse, has long struggled with drug shortages. At any given time, up to 100 or more — sometimes many more — drugs are not readily available to American patients, largely because drug manufacturing operates with very little slack that leaves it vulnerable to disruptions. Sometimes, these are specialty drugs for, say, cancer patients who have certain genetics — potentially devastating for those individuals. Other times, as with the recent ADHD medication shortages, it can involve widely prescribed drugs with health impacts that can affect millions of people.

There are moments when these shortages can’t be helped. As I wrote in 2022, the pandemic’s supply chain disruption was the kind of natural emergency that creates unavoidable, acute drug shortages. Americans found it harder to find drugs like Tamiflu or inhalers with albuterol because the manufacturers were having a harder time getting their hands on the raw ingredients for those medicines, which can come from all over the world.

But those Covid-induced bottlenecks have largely subsided. The US saw a decline in drug shortages over the course of 2024, from 321 drugs to 271, closer to their pre-pandemic levels. The number of new drug shortages, each of which can last for years, fell to the second-lowest total since 2007.

A little good news, right? Here’s the bad news: President Trump’s tariffs on China could erase that progress.

Why tariffs are a problem for generic drugs

Drug shortages are usually accidental. A pandemic. A factory machine needs repair. Ingredients become tainted. But this time, it would be engineered.

The potential for disruption is enormous: China, which this week has been hit with a 10 percent across-the-board tariff, is the largest supplier of drug or drug ingredients to the US. Pharmaceutical drugs and their components are still the single largest American import from around the world, as longtime health care journalist Merrill Goozner wrote on Monday.

Generic drug makers, which produce 90 percent........

© Vox