China controls the upstream production chemistry for many of the most widely used generic drugs in the United States, leaving few backup suppliers if that access were disrupted, according to a recent report by former U.S. government officials.
According to the recent report published on September 2 by Scalare Advisors, a consultancy based in Washington, D.C., China supplied more than 70 percent of the antibiotic active ingredients by volume imported into the United States in 2024, and three of the most commonly used outpatient antibiotic drugs – amoxicillin, azithromycin, and ciprofloxacin – all depend on Chinese-made ingredients. A simultaneous disruption in all three would leave doctors with no reliable outpatient antibiotic option that could be obtained at the necessary scale and speed.
One Chinese conglomerate, CSPC Pharmaceutical Group, produces both amoxicillin and azithromycin for the U.S. market, meaning a single company controls the fermentation-to-tablet chain for two of the three dominant outpatient antibiotic drugs. No equivalent domestic or allied producer exists for either drug.
Bristol-Myers Squibb announced the closure of its last U.S. penicillin fermentation plant in 2004 and ended production there the following year, eliminating domestic manufacturing of 6-aminopenicillanic acid, the building block for the penicillin-class drugs used to treat strep throat, ear infections, pneumonia, and Lyme disease. Today, no U.S. plant produces penicillin from scratch. This decision conceded penicillin production to China, which now makes about 90 percent of that ingredient worldwide.
Heparin – one of the most commonly used blood thinners – illustrates the same pattern. Pfizer has one heparin injection product on an active shortage list maintained by the Food and Drug Administration. The two remaining U.S.-based producers of the raw ingredient used to make it – Scientific Protein Laboratories in Wisconsin and Smithfield BioScience in Ohio – are both now owned by Chinese parent companies. The broader supply of crude heparin traces back to China, leaving roughly 550,000 Americans who rely on the anticoagulant for dialysis with no clinical substitute if that supply were interrupted.
Hydrocortisone, a prescription drug essential for treating inflammation, is manufactured by Pfizer in Michigan but still depends on a Chinese supplier – a state-owned enterprise named Tianjin Tianyao Pharmaceuticals – for the drug’s active ingredients, according to the same review of federal drug-safety programs.
Way to go Pharma industry! Going to the lowest cost producers has put US citizens at risk. Though I expect CEOs profit driven renumeration has benefited.