My time at the Pentagon clearly demonstrated that national security isn’t just about missiles and military readiness. It’s about the people and critical systems that keep Americans safe and healthy. Today, one of our greatest vulnerabilities doesn’t come from the incredible risk posed by foreign military capabilities or a rogue state’s nuclear program. It comes from our medicine cabinets.
China controls a staggering portion of the United States’ pharmaceutical supply chain, producing or supplying the active pharmaceutical ingredients for up to a quarter of all drugs available to Americans. From common over-the-counter medications like Tylenol and Advil to life-saving antibiotics and critical heart medications, we have handed our adversary leverage over the health and survival of millions of American citizens.
This is a national security crisis hiding in plain sight.
The scope of this dependence should alarm every American. China supplies 70-74 percent of acetaminophen (Tylenol) imports to the United States, 95 percent of ibuprofen, and 91-96 percent of hydrocortisone. These aren’t exotic drugs – they’re medications sitting in millions of American homes right now.
Even some of the most recent attempts to improve drug access are trapped in this dependency. Direct-to-consumer (DTC) drug sales platforms, which have been gaining traction thanks to TrumpRx, are significantly reliant on Chinese supply chains. Billionaire Mark Cuban’s company, Cost Plus Drugs, lists numerous medications whose active ingredients have high exposure to Chinese manufacturing. It even publicly announced the addition of a Chinese-made medication for chronic inflammatory diseases.
Frequently prescribed antibiotics, including amoxicillin, ciprofloxacin, azithromycin, and doxycycline are heavily dependent on Chinese inputs. China is the leading supplier of 6-APA, a critical ingredient for these antibiotics. Production of amoxicillin, for instance, relies heavily on China for raw materials, with estimates suggesting around 80 percent dependence.
Cardiovascular medications tell an equally troubling story. Commonly prescribed drugs for high blood pressure, heart disease, and high cholesterol, like losartan, atenolol, and atorvastatin, are significantly tied to Chinese manufacturers. HealthWarehouse offers these cardiovascular drugs, as well as Blink Health, another DTC platform that is well-known thanks to Donald Trump Jr.’s involvement.
These examples clearly demonstrate China’s deep penetration into portions of our pharmaceutical supply chain. Tens of millions of Americans take these medications every day. If China decided to limit exports, cardiovascular disease risks would skyrocket, and Americans would die from preventable heart attacks and strokes.
The irony is painful: in the name of lowering prescription drug prices, these companies resort to Chinese-made products to keep costs down. But what good are affordable medications if the supply can be cut off at Beijing’s whim?
China didn’t stumble into this dominant position. Beijing deliberately developed this control through decades of strategic industrial policy, government subsidies, and lax environmental regulations that allowed Chinese manufacturers to systematically undercut Western competitors. While U.S. pharmaceutical companies prioritized short-term profits, China played the long game – and won.
The history of Chinese pharmaceutical manufacturing should give us pause. In 2009, Zhejiang Huahai Pharmaceuticals’ heparin, a blood thinner offered by Cuban’s Cost Plus Drugs, caused American patient fatalities. This incident forced the U.S. Food and Drug Administration to do a major recall for Chinese-made heparin due to carcinogen contamination. These aren’t isolated incidents; they’re predictable outcomes when cost-cutting trumps quality control and when an authoritarian government faces no meaningful accountability.
From a national security perspective, pharmaceutical dependence creates multiple vectors of vulnerability. In peacetime, China can leverage this control for diplomatic concessions. During a crisis – whether over Taiwan, the South China Sea, or any future flashpoint – Beijing could weaponize U.S. pharmaceutical dependence, denying Americans access to essential medications. Even without explicit threats, supply chain disruptions during a conflict would devastate American healthcare.
The solution requires treating pharmaceutical manufacturing as critical national infrastructure. We need strategic investments in domestic pharmaceutical manufacturing, particularly for active pharmaceutical ingredients. We need regulatory reforms that incentivize reshoring production and penalize excessive foreign dependence. We need procurement policies that prioritize supply chain security alongside cost.
Most importantly, we need political leadership willing to acknowledge that the United States’ healthcare system cannot be dictated by China or other foreign markets. True healthcare affordability means nothing if the medications we need are controlled by an adversary. National security and healthcare security are inseparable – and right now, we’re failing at both.
After nearly three decades in defense policy, I’ve seen many threats to U.S. security. Few are as insidious as the one we’ve willingly created by outsourcing our pharmaceutical production to China. It’s time we treated this crisis with the urgency it deserves – before Beijing reminds us exactly how vulnerable we’ve become.
Image credit: Shutterstock ID: 1646689891. This article was originally published in The Diplomat.
Jason Forrester
Jason Forrester has worked in the Washington, D.C., policy community since the late 1990s. He's been a senior staffer in the U.S. Senate, a Deputy Assistant Secretary of Defense, and worked for the Brookings Institution, the Center for Strategic and International Studies, and the Carnegie Endowment for International Peace. He's a life member of the Council on Foreign Relations.