America is dealing with a rising disaster in its medical system — not from a scarcity of expertise or innovation, however from a breakdown within the management, security and provide of important medicines. Our rising reliance on imports is now driving critical drug shortages, destabilizing provide chains and more and more making drugs unsafe.
On the root of it’s a onerous fact: We not have management of the medicines we rely on each day.
In 2002, America manufactured 83.7 % of the prescription drugs it consumed. By 2024, that quantity had dropped to simply 37.1 %. In the meantime, the U.S. pharmaceutical commerce deficit has soared, reaching a file $118.3 billion in 2024. We didn’t simply outsource manufacturing — we outsourced the sovereignty and security of our well being care system.
Which means that nearly two-thirds of America’s pharmaceutical provides at the moment are imported. Most crucial drugs, similar to generic medicine, now come from China and India.
China controls 80 to 90 percent of the worldwide provide of energetic pharmaceutical elements — the chemical constructing blocks of recent medication. Even medicine labeled “Made within the USA” usually chemically originate in China. And India, which produces about half of America’s completed generic medicine, depends on China for as much as 80 percent of its energetic pharmaceutical elements.
That’s not a provide chain — it’s a ticking time bomb.
When one thing goes unsuitable, American sufferers endure. In 2023, the Meals and Drug Administration shut down a single Indian plant liable for 50 % of the U.S. provide of cisplatin, a crucial chemotherapy drug, after uncovering a “cascade of failure” in security practices and shredded paperwork soaked in acid. With no home backup, sufferers nationwide had their therapies delayed.
That wasn’t a fluke. 40 percent of U.S. generic medicine have just one FDA-approved producer. Due to that single chokepoint, when one manufacturing facility fails, the entire system can crack.
We at the moment are seeing widespread drug shortages throughout the medical system. Hospital pharmacists report a mean of 301 critical drug shortages at any given time. And 85 percent say these shortages are reasonably or critically affecting care. Docs usually lack essential medicines similar to antibiotics, sedatives and most cancers medicine. These aren’t obscure medicine. They’re foundational medicines. However America not makes them.
Even when imported medicine do arrive, they’re not at all times protected. A 2025 research discovered that Indian generics are 54 percent extra more likely to trigger critical unwanted side effects than their U.S.-made counterparts. Indian manufacturing facility violations have additionally been tied to at least eight U.S. patient deaths. China’s file is equally disturbing. In 2008, dozens of People died after receiving contaminated heparin from Chinese suppliers.
This isn’t what the American individuals need. In a nationwide survey, 85 percent of hospital pharmacists stated they’d pay extra for safer generics. However beneath at this time’s guidelines, value overshadows high quality. Hospitals have little oversight of drug high quality — and overseas producers face few penalties for chopping corners.
Even the federal authorities is flying blind. A 2023 Division of Protection evaluation discovered that 22 percent of essential military-use drugs had unknown ingredient sourcing. That’s a nationwide safety drawback.
In April, the Trump administration took a crucial step by launching an investigation into generic pharmaceutical imports that accurately frames the difficulty as a nationwide safety menace. However that recognition alone isn’t sufficient.
To handle this disaster, Washington ought to impose focused tariffs on generic medicine from adversarial nations. It should additionally rebuild home pharmaceutical manufacturing by way of tax credit and long-term contracts.
America urgently wants full transparency in drug labeling to reveal the place medicine and their elements are made. The FDA should step up — with stronger enforcement overseas and a ban on imports from repeat security violators. And to safe crucial elements throughout market disruptions, Washington should pursue a long-term imaginative and prescient that features a “strategic pharmaceutical reserve.”
This isn’t simply protectionism. It’s a restoration of America’s medical safety. No nation can name itself sovereign if it may’t produce its personal medicines, and no affected person is protected if their well being care depends upon high quality management in a manufacturing facility 8,000 miles away.
For many years, we had been advised that offshoring manufacturing would make issues cheaper, smoother and extra environment friendly. However America can not rely upon unstable overseas suppliers. It’s time to revive our pharmaceutical independence and take again management of our medication cupboard.
Andrew Rechenberg is an economist on the Coalition for a Affluent America.