The piece argues that Europe and the US are increasingly dependent on China and India for APIs, key starting materials, and potentially finished medicines, creating a resilience challenge that goes beyond simple diversification.

China and India are expanding capabilities in finished pharmaceutical products, raising the risk that Europe could become dependent on finished medicines as well as APIs, widening strategic vulnerabilities.

Policy uncertainty, such as tariff trends, has already driven inventory pull-forwards in pharma, showing how policy can affect flows and trade value even when volumes aren’t rising.

Resilience requires collaboration between industry and government to redesign networks with redundancy, strategic inputs, and multi-tier sourcing, rather than chasing the lowest-cost supplier.

Policy responses like the BIOSECURE Act and tariffs on synthetic opioids are steps, but critics say they’re insufficient without stronger domestic manufacturing capacity.

A practical path proposed is to build domestic pharma manufacturing capacity, using Ohio as a model for regional production that combines investment, infrastructure, and a skilled workforce to create secure jobs and reduce dependence.

Policy perspectives differ: the US treats pharmaceutical supply chains as a national-security issue favoring domestic or regional production, while Europe focuses on resilience by design through regulatory measures and strategic investments.

Maintaining patient access requires understanding and managing dependencies across the entire supply chain, including inputs from China and India, to prevent systemic disruptions.

Historically, US production of pharmaceutical ingredients has declined from about a quarter of world supply in 1981 to heavy dependence on China, reflecting decades of offshoring.

Geopolitical tensions, tariffs, and disruptions push a shift from cost-focused sourcing to strategic optionality and supply security, emphasizing resilience, alternative sources, and multi-tier visibility.

The dependence is framed as a loss of sovereignty that could allow adversaries to disrupt or weaponize access to medicines, with wide implications for military, government, and civilian health.

Citing the Council on Foreign Relations, the piece links Chinese chemical networks to illicit drug supply chains as evidence of systemic vulnerability and potential supply-chain weaponization.