Key Points
- China’s control over the global supply of medicine gives it a powerful “nuclear option” in its trade war with the U.S.
- The country dominates the production of both “active pharmaceutical ingredients” (APIs) and the raw materials needed to make them.
- U.S. officials are deeply concerned about this dependence on a geopolitical rival for essential medicines.
- Nearly 700 U.S. medicines contain at least one key ingredient sourced solely from China.
As the U.S. and China gear up for a high-stakes trade summit, the focus has been on China’s dominance in rare earth minerals. But Beijing holds an even more powerful and dangerous trump card: its chokehold on the global supply of medicine.
China’s power stems from its control over “active pharmaceutical ingredients” (APIs), the core components of most commercial drugs. This dominance extends all the way upstream to the raw chemicals used to make the APIs.
U.S. officials and analysts say this dependence on a geopolitical rival for life-saving medicines creates a massive, unacceptable risk. “China has shown it’s willing to weaponize economic leverage when it suits its interests. Medicines and their inputs are no exception,” said Representative John Moolenaar, the Republican chairman of the House Select Committee on China.
For now, China has been careful not to directly threaten the medicine supply. The global backlash would be immense. However, some analysts see a “real possibility” that Beijing could use this leverage if the trade war escalates.
The threat is particularly acute for the cheap, generic drugs that make up about 90% of all prescriptions in the U.S. Nearly 700 U.S. medicines contain at least one key ingredient sourced only from China.
President Trump is aware of the vulnerability and has vowed to bring pharmaceutical production back to the U.S. But reshoring this kind of manufacturing is extremely difficult and expensive. For now, this powerful leverage will be in the back pocket of Chinese negotiators as they sit down with their U.S. counterparts.
