America is facing a growing crisis in its medical system — not from a lack of talent or innovation, but from a breakdown in the control, safety and supply of essential medicines. Our growing reliance on imports is now driving serious drug shortages, destabilizing supply chains and increasingly making medications unsafe.
At the root of it is a hard truth: We no longer have control of the medicines we depend on every day.
In 2002, America manufactured 83.7 percent of the pharmaceuticals it consumed. By 2024, that number had dropped to just 37.1 percent. Meanwhile, the U.S. pharmaceutical trade deficit has soared, reaching a record $118.3 billion in 2024. We didn’t just outsource manufacturing — we outsourced the sovereignty and safety of our health care system.
This means that nearly two-thirds of America’s pharmaceutical supplies are now imported. Most critical medications, such as generic drugs, now come from China and India.
China controls 80 to 90 percent of the global supply of active pharmaceutical ingredients — the chemical building blocks of modern medicine. Even drugs labeled “Made in the USA” often chemically originate in China. And India, which produces about half of America’s finished generic drugs, relies on China for up to 80 percent of its active pharmaceutical ingredients.
That’s not a supply chain — it’s a ticking time bomb.
When something goes wrong, American patients suffer. In 2023, the Food and Drug Administration shut down a single Indian plant responsible for 50 percent of the U.S. supply of cisplatin, a critical chemotherapy drug, after uncovering a “cascade of failure” in safety practices and shredded documents soaked in acid. With no domestic backup, patients nationwide had their treatments delayed.
That wasn’t a fluke. 40 percent of U.S. generic drugs have only one FDA-approved manufacturer. Because of that single chokepoint, when one factory fails, the whole system can crack.
We are now seeing widespread drug shortages across the medical system. Hospital pharmacists report an average of 301 critical drug shortages at any given time. And 85 percent say these shortages are moderately or critically affecting care. Doctors often lack crucial medicines such as antibiotics, sedatives and cancer drugs. These aren’t obscure drugs. They’re foundational medicines. But America no longer makes them.
Even when imported drugs do arrive, they’re not always safe. A 2025 study found that Indian generics are 54 percent more likely to cause serious side effects than their U.S.-made counterparts. Indian factory violations have also been tied to at least eight U.S. patient deaths. China’s record is equally disturbing. In 2008, dozens of Americans died after receiving contaminated heparin from Chinese suppliers.
This isn’t what the American people want. In a national survey, 85 percent of hospital pharmacists said they would pay more for safer generics. But under today’s rules, price overshadows quality. Hospitals have little oversight of drug quality — and foreign producers face few consequences for cutting corners.
Even the federal government is flying blind. A 2023 Department of Defense review found that 22 percent of essential military-use drugs had unknown ingredient sourcing. That’s a national security problem.
In April, the Trump administration took a necessary step by launching an investigation into generic pharmaceutical imports that correctly frames the issue as a national security threat. But that recognition alone isn’t enough.
To address this crisis, Washington should impose targeted tariffs on generic drugs from adversarial nations. It must also rebuild domestic pharmaceutical production through tax credits and long-term contracts.
America urgently needs full transparency in drug labeling to disclose where drugs and their ingredients are made. The FDA must step up — with stronger enforcement abroad and a ban on imports from repeat safety violators. And to secure critical ingredients during market disruptions, Washington must pursue a long-term vision that includes a “strategic pharmaceutical reserve.”
This isn’t just protectionism. It’s a restoration of America’s medical security. No nation can call itself sovereign if it can’t produce its own medicines, and no patient is safe if their health care depends on quality control in a factory 8,000 miles away.
For decades, we were told that offshoring production would make things cheaper, smoother and more efficient. But America can no longer depend on unstable foreign suppliers. It’s time to restore our pharmaceutical independence and take back control of our medicine cabinet.
Andrew Rechenberg is an economist at the Coalition for a Prosperous America.
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