U.S. drug shortages highlight dependence on China, gray supply chains

Illustration for The China Project

Democrats and Republicans both talk about punishing imports of Chinese ingredients and improving America’s ability to make key drugs at home. But right now, Americans need China for their meds, notes ‘The China Project’.

The U.S. Food and Drug Administration (FDA) is loosening restrictions to allow the Chinese company Qilu Pharmaceuticals to import cisplatin, a cancer medicine currently in short supply in America.

The FDA’s emergency import of medicine from China shows just how reliant America has become on Chinese manufacturers of active pharmaceutical ingredients (APIs) for a range of products from cancer therapeutics and antibiotics to the ingredients in the Adderall used to treat attention deficit hyperactivity disorder (ADHD).

“We’ve seen young moms frantically calling from pharmacy to pharmacy this past winter, even now, to get basic antibiotics for their child,” Charles Tabouchirani, a pharmacist in New York City, told The China Project.

The FDA’s decision to import cisplatin from China demonstrates the risk of banning drugs without first building the capacity to manufacture them in the U.S. — an expensive endeavor when China makes the drugs at a lower cost due partly to an overabundance of labor.

Cisplatin is just one of many drugs in short supply in the U.S. this year. Many Americans have had a difficult time finding the ADHD drug Adderall and common antibiotics like amoxicillin.

Cisplatin is used to treat various types of cancer, and has caused a two-thirds drop in deaths from testicular cancer since 1978.

The recent shortage of cisplatin occurred when the FDA found quality control problems at an Indian factory that makes the drug and other cancer-fighting drugs.

“Some of those shortages have created other shortages,” Erin Fox, a professor at the University of Utah College of Pharmacy, told The China Project.

During the COVID-19 pandemic, when world supply chains were disrupted, U.S. reliance on the import of drugs from China deepened despite a recent rise in tensions between Washington and Beijing. In 2020, the U.S. sourced around 2.5% of its finished pharmaceuticals from China. By 2022, that number had jumped to more than 6%. 

When looking at drug ingredients, the reliance on China is even higher. For the last decade, the U.S. has imported an average of 17% of its APIs from the People’s Republic.

China’s role in the supply chain varies drug by drug. In the case of antibiotics such as penicillin G benzathine, which is currently in short supply in the U.S., China plays a critical role. Three of the four factories producing the medication are in China. Pfizer, the sole supplier of the drug in the U.S., didn’t respond to a query about the cause of the current shortage.

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