There’s an old parable about a frog that’s placed in a pot of cool water that’s gradually heated. The frog doesn’t notice the incremental temperature rise and fails to jump out, ultimately boiling to death. It’s a cautionary tale about the danger of ignoring slow-moving crises until they become catastrophic.
America’s pharmaceutical supply chain has gradually become more dependent on foreign suppliers. As this dependency has grown, it has slowly become recognized as a national security concern, though the warnings have been there — largely ignored — for nearly three decades. At a June 2025 House Energy and Commerce Health Subcommittee hearing titled “Made in America: Strengthening Domestic Manufacturing and the Health Care Supply Chain,” statistics illustrated the current scope of dependencies:
- In 2002, the United States manufactured 72% of the pharmaceuticals it consumed; by 2023, that dropped to just 37.5%
- More than 80% of key ingredients and raw materials used in U.S. medicines are manufactured abroad
- India supplies more than one third of U.S. prescription drug active pharmaceutical ingredients (APIs)
As Chairman Brett Guthrie noted during the hearing, China is “a dominant supplier of key starting materials” — the foundational chemical building blocks that feed into API production. This upstream dominance creates a deeper vulnerability: As of 2024, India sourced approximately 70% of its pharmaceutical raw materials from China. This creates a hidden chokepoint where many medicines labeled as coming from “friendly” suppliers like India remain vulnerable to Beijing’s supply-chain decisions.
Patrick Cashman, president of USAntibiotics, testified that essential generic drugs should be treated like critical national security assets, similar to weapon systems or strategic minerals. Currently, generic antibiotics lack recognition of their national security relevance, preventing manufacturers from accessing the same financing tools, tax incentives, and industrial-base support programs available to other domestic producers of critical goods.
A growing recognition of risk
The risks of this dependency on foreign suppliers have been documented in Congressional reports and hearings for decades. More recently, the characterization of these concerns has evolved from quality-control issues into national security threats.
Early Congressional and agency attention
1998: A General Accounting Office report documented that 80 percent of bulk pharmaceutical chemicals used by U.S. manufacturers were already imported, specifically highlighting China and India as countries with “large increases in pharmaceutical products exported to the United States.” However, this was framed as an inspection-and-quality-assurance challenge rather than a national security issue.
2002: The U.S.–China Economic and Security Review Commission’s first annual report warned of the growing dependence of U.S. defense industries on Chinese manufacturers. It noted that the United States may be “developing a reliance on Chinese imports that might in time undermine” national security, though this was not specific to pharmaceuticals.
2009: The Government Accountability Office added “protecting public health through enhanced oversight of medical products” as a high-risk area in its High-Risk Series update, focusing on the FDA’s inspection capabilities rather than flagging dependency on foreign suppliers as a national security concern.
The Cohn warning: a turning point
A pivotal moment came through Bob Woodward’s 2018 book Fear: Trump in the White House, which documented Gary Cohn’s stark warning during White House trade discussions. Cohn argued against escalating tensions by citing a Commerce Department study showing 97% of antibiotics consumed in the United States were sourced from China. “If you’re the Chinese and you want to really just destroy us, just stop sending us antibiotics,” he said, pressing further: “So when mothers’ babies are dying of strep throat, what are you going to say to them?”
Cohn’s figure has not been independently verified, and the specific study isn’t publicly available. Experts note such figures likely refer to Chinese dominance in precursor chemicals and APIs rather than finished products alone. Nonetheless, the core warning resonated with some policymakers: U.S. pharmaceutical supply chains for critical medicines depend heavily on Chinese inputs — creating significant national security vulnerabilities.
Congressional hearings intensify
Following the Cohn warning, Congressional action intensified through oversight hearings and legislative proposals.
July 2019: A US–China Economic and Security Review Commission hearing featured testimony by Rosemary Gibson, co-author of China Rx, that China dominates APIs used to produce about 80% of America’s generic drugs.
October 2019: Janet Woodcock, director of the FDA’s Center for Drug Evaluation, testified before a House Committee on Energy and Commerce subcommittee that “the number of Chinese facilities producing APIs for the U.S. market has increased over the past decade, as part of a massive movement of pharmaceutical production offshore.”
COVID-19 heats up concerns
February 2020: On February 27, the FDA announced the first U.S. drug shortage directly linked to the COVID-19 pandemic, caused by manufacturing disruptions at a coronavirus-affected facility in China.
March 2020: Just days before COVID-19 lockdowns began, Gibson testified before the Senate Small Business Committee that “90 percent of the chemical ingredients for generics in the U.S. to care for people with serious coronavirus infections and are hospitalized are sourced from China.” She highlighted China’s threat that it could “announce strategic control over medical products and ban exports to the United States,” potentially causing the U.S. to “fall into the hell of a new coronavirus epidemic.”
April 2020: Rep. Mike Gallagher and Sen. Tom Cotton introduced the “Protecting our Pharmaceutical Supply Chain from China Act” to prohibit federal purchases of drugs with Chinese APIs, attracting 11 House cosponsors and demonstrating growing Congressional concern about pharmaceutical dependency. Though not enacted, the bill reflected bipartisan recognition that America’s reliance on Chinese pharmaceutical manufacturing posed a national security risk.
September 2024: The BIOSECURE Act, which targeted Chinese biotechnology companies by prohibiting federal contracts with companies that are under the control of a foreign adversary, passed the House by a bipartisan vote of 306–81. It died for lack of action in the Senate.
The path forward: a call to action
Witnesses at the June 2025 House subcommittee hearing proposed solutions beyond incremental fixes. Immediate steps include creating long-term government purchasing commitments for domestic manufacturers, implementing “Buy American” policies for federal drug purchases, and using existing trade authorities to counter predatory pricing. Longer-term solutions involve investing in advanced manufacturing technologies, creating strategic reserves of essential medications, and building redundancy into supply chains.
The challenge we face is twofold: developing comprehensive solutions and finding leaders with the political will to implement them. While the June 2025 hearing offered valuable recommendations, critical gaps likely remain. For instance, policymakers have yet to consider whether the federal government and possibly other plan sponsors should pay a premium for domestically manufactured pharmaceuticals — a market-based approach that could accelerate onshoring without requiring new bureaucracies or overly complex regulations. But even if we identify the necessary policy tools, the core challenge remains unchanged after nearly three decades: finding leaders with the courage to act decisively.
Congressional hearings and White House discussions are no substitute for decisive action. We need leaders who will prioritize America’s pharmaceutical security over short-term cost savings and political convenience. Real leadership requires making hard choices, committing substantial resources, and sustaining effort across multiple election cycles — things our political system has consistently failed to do on this issue.
After nearly three decades of documented warnings, America’s pharmaceutical dependency has grown into a national security vulnerability. The temperature has risen significantly — and unlike the mythical frog that failed to recognize the danger until it was too late, our leaders still have time to make a choice: take decisive steps to rebuild domestic pharmaceutical capabilities or accept continued reliance on foreign suppliers in an increasingly uncertain world. The costs of achieving biosecure access will be significant — but the costs of inaction will be far greater.
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