The high cost and time required for US clinical trials create a rational economic incentive for companies and investors to move operations to China. The solution isn't to match China's low costs, but to significantly improve US efficiency to make domestic investment more competitive.

US biotechs increasingly use sites like Australia to accelerate development, as Create Medicines did by moving from concept to clinic in under 12 months. What was once viewed with suspicion is now a key strategy to generate data faster and more cheaply, competing with the speed of China's ecosystem.

An ideologically driven and inconsistent FDA is eroding investor confidence, turning the U.S. into a difficult environment for investment in complex biologics like gene therapies and vaccines, potentially pushing innovation to other countries.

Through massive government investment in biotech infrastructure, China has become the global hub for early-stage clinical drug development. Both Chinese and Western companies now conduct initial human trials there to move much faster and at a significantly lower cost, giving China a strategic foothold in the pharma value chain.

China's ability to accelerate biotech development stems from faster patient recruitment for clinical trials. With a large, treatment-naive patient population willing to participate in studies, early-stage oncology trials can be completed in about half the time it takes in the US. This provides a significant strategic advantage for de-risking assets more quickly and cheaply.

To de-risk clinical programs from recruitment and activation hurdles within the UK's strained NHS, companies like Resolution Therapeutics run an equal number of trial sites in other countries, like Spain. This geographic diversification provides a valuable real-time benchmark and a hedge against single-country operational delays.

U.S. FDA requirements for early-stage trials, particularly safety margins, are considered ill-suited for genetic medicines, prompting companies to look abroad. The UK is emerging as a preferred destination, with its regulator, the MHRA, actively creating incentives and faster pathways to attract these innovative clinical programs.

Top biotech VC Bob Nelsen contends the U.S.'s competitive edge is eroding because of slow, burdensome FDA processes. He points to Australia's model, where human trials can be approved in days, as the standard the US must adopt to compete with agile global players like China.

Amidst growing uncertainty at the US FDA, biotech companies are using a specific de-risking strategy: conducting early-stage clinical trials in countries like South Korea and Australia. This global approach is not just about cost but a deliberate move to get fast, reliable early clinical data to offset domestic regulatory instability and gain a strategic advantage.