🚨Thrilled to share our new @CFR_China report with CFR Global Health's @TomBollyky, @profyadav, @OliviaWKosloff, & Elena Every: "The Pharma Choke Point." The US is dependent on Chinese production for essential medicines, creating a "rare earths" problem in this sector. Seven hundred medicines approved for use in the United States depend on at least one chemical produced solely in China. For the last year, our study group of pharma and biotech specialists, China scholars, and industrial policy experts came together to: 1⃣ Use commercial data to map the dependencies 2⃣ Devise a typology of three unique "archetypes" of these dependencies 3⃣ Craft solutions to address these dependencies A few key points follow below: ➡️China's Leverage is real — Beijing doesn't need a wartime crisis to exploit it. It can slow shipments, delay licenses, or reroute flows through "peacetime weaponization." That's the playbook it has already run on rare earths. ➡️Current dependence is structural — It's the product of decades of Chinese state investment and Western pursuit of the low-cost solution. China controls the raw/starting materials for 94% of US amoxicillin, 74% of heparin, and 70% of acetaminophen. It's dominating preclinical work in biotech. And diversifying downstream offers no real protection from upstream dependence. ➡️Archetype 1: Upstream Dependence — Roughly 700 medicines Americans depend on at least one chemical made only in China, including antibiotics, blood thinners, ER drugs. Solutions include: - building a strategic reserve of critical medicines - building "allied scale" to create diversified production - mix various long-term supply and demand interventions to change economic viability for KSMs, APIs, and other upstream inputs (more in the report) ➡️Archetype 2: Competitive Displacement of U.S. Biomanufacturing and Clinical Trial Capacity — For innovative biologics—medicines made from living cells—such as monoclonal antibodies, the risk is not a single upstream choke point but competitive displacement across every stage of the value chain: discovery, clinical development, contract manufacturing, and market access. The U.S. is losing a critical capability: now, WuXi alone handles nearly half of US clients' development programs. China alone is more than half of all late-stage monoclonal antibody programs. Lock-in deepens at every stage. Solutions include: - accelerating first-in-human clinical trials in the United States - funding and incentivizing the adoption of advanced biologics manufacturing technologies (e.g., low-cost capital from the USG) - building contract research alternatives in allied countries like South Korea - bolstering the U.S. biomanufacturing workforce - creating a system to secure artificial intelligence (AI)–ready biodata and digital chemistry, manufacturing, and controls. ➡️Archetype 3: Dependence on PRC Infrastructure — Here, the vulnerability is not disruption in the supply of an existing product, but Chinese control over the research-and-development (R&D) infrastructure underlying future pharmaceutical innovation. Growing reliance on China for DNA synthesis is just one example. Solutions include: - improving DNA supply chain security - enhancing transparency and disclosing provenance - increasing federal investment in next-generation DNA synthesis technologies - and bolstering allied cooperation on standard-setting and procurement to encourage the adoption of these technologies. ➡️Key Takeaway: China has both the tools and demonstrated willingness to weaponize U.S. pharmaceutical dependence: the structural conditions enabling it run through nearly every tier of the pharmaceutical supply. The question is not whether to act, but if the United States will manage to do so before a crisis makes the cost of decades of inaction unavoidable. I am so grateful to Tom, Prashant, Elena, Olivia, Chloe, Ben, Aarya, CFR's publications team, and so many others who made this possible. It was tremendously educational to work together on this project.