China holds a choke point on the global pharmaceutical supply chain, being the sole source for key ingredients in hundreds of US medicines. This leverage could be used to restrict supply, creating shortages and price hikes, opening a new, sensitive front in geopolitical tensions.

The push for supply chain diversification and reduced reliance on China is not a new phenomenon. The COVID-19 pandemic first exposed the critical risks of single-source dependency. Recent tariff threats are not the origin of this strategic realignment but rather a powerful accelerant, forcing companies to act on plans already in motion.

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.

Driven by significant government investment, China is rapidly becoming a leader in biotech R&D, licensing, and outsourcing. This shift is a top-of-mind concern for US biotech and pharma executives, with China now involved in a majority of top R&D licensing deals.

The massive 9.1% global production surge in 2025 was a deliberate stockpiling effort to preempt tariff disruptions. The expected 2026 contraction is a natural and healthy rebalancing as companies work through this excess inventory, not a sign of industry weakness.

Morgan Stanley projects a dramatic increase in China's contribution to global medicine, with assets developed in China expected to represent about a third of all new US FDA approvals by 2040, a significant rise from just 5% today.

In a major strategic shift, large pharmaceutical companies are increasingly sourcing their M&A pipeline from China. Chinese assets now account for 30-40% of Big Pharma's early-stage acquisitions, up from single digits just a few years ago, primarily because they are significantly cheaper than US or European equivalents.

The next decade in biotech will prioritize speed and cost, areas where Chinese companies excel. They rapidly and cheaply advance molecules to early clinical trials, attracting major pharma companies to acquire assets that they historically would have sourced from US biotechs. This is reshaping the global competitive landscape.

Despite US-China tensions threatening innovation, the likely outcome is 'coopetition'—a blend of competition and collaboration—as global pharmaceutical firms navigate the dual imperatives of advancing innovation and ensuring supply chain resilience.