America’s overdependence on foreign drug manufacturers—particularly in China and India—is putting national health and national security at risk.
A new report from Exiger, a leading risk management company, reveals that U.S. pharmaceutical supply chains are highly vulnerable to geopolitical disruption, ethical violations including forced labor, and serious quality control breakdowns.
With the majority of essential medications and ingredients sourced from adversarial nations like China or low-regulation environments like India, the nation faces growing risks of shortages, contaminated drugs, and foreign leverage over public health.
Key Facts
- The U.S. imports approximately 75% of its essential medicines, with a majority sourced from India and China, creating severe supply chain vulnerabilities.
- Exiger’s investigation found that 504 generic drugs, including 10 essential medicines, rely on a single country for their APIs—creating systemic risks if that source is disrupted.
- Quality and safety issues are rampant: 33% of new FDA import alerts were for Chinese manufacturers, and 16% for Indian sites. Incidents include contamination, unsanitary conditions, and falsified records.
- 2023’s mass recall of contaminated eye drops from India-based Kilitch Healthcare exposed severe public health risks, including permanent vision loss, due to lapses in oversight.
- Policy recommendations include expanding strategic stockpiles, strengthening FDA oversight, eliminating forced labor exposure, and boosting domestic pharmaceutical manufacturing through incentives and R&D investment.
The Rest of the Story: How the U.S. Became Dangerously Dependent on Chinese Drugs
In its sweeping April 2025 report, Exiger exposes a national security and public health crisis happening quietly inside America’s medicine cabinets.
“A Bitter Pill” shows how the U.S. has tethered its pharmaceutical survival to strategic rivals and ethically compromised suppliers—especially in China and India—leaving critical medical supply lines vulnerable to contamination, coercion, or collapse.
The U.S. now imports three out of every four essential medications, and 60% of global active pharmaceutical ingredients (APIs) come from just two countries: China and India.
While India dominates the U.S. generic drug market, it in turn depends on China for 80% of its APIs—creating a layered dependency that amplifies geopolitical risk.
Alarmingly, 90% of all U.S. antibiotic APIs originate in China, giving Beijing a powerful potential pharmaceutical chokehold, especially in time of war.
Even absent deliberate sabotage, the system is failing.
Exiger documented a surge in FDA import alerts tied to quality issues—often involving carcinogenic impurities, counterfeit drugs, or tainted raw materials.
The 2023 recall of Indian-manufactured eye drops linked to vision loss and blindness illustrates just how dangerous these quality failures can become.
The ethical implications of sourcing pharmaceuticals from China are equally dire.
The report highlights how forced labor from Uyghur detention regions in Xinjiang is embedded deep in U.S.-bound pharmaceutical ingredients.
Major Chinese companies like Sinopharm and Zhejiang Chemicals—still registered with the FDA—were flagged for using slave labor to manufacture drug APIs later sold to U.S. markets via India or other third-party nations.
These findings are not theoretical.
Aurobindo Pharma Ltd., the top Medicaid drug supplier in the U.S., sourced APIs from at least six Chinese entities implicated in forced labor.
Despite multiple FDA violations for contaminated products and carcinogenic substances like NDMA, Aurobindo continues to dominate the antibiotic market, now holding a 31% share.
Lupin Ltd., the third-largest Medicaid supplier, also maintained procurement ties with forced labor-linked manufacturers.
Drugs like metronidazole and epinephrine, listed as essential medicines by the FDA, are now caught in these ethically compromised networks.
The fentanyl crisis adds another dimension.
Chinese chemical companies were shown to be manufacturing piperidone, a common precursor for illicit fentanyl.
Shipments often travel through India before reaching the U.S.—revealing how gray-market chemicals blur into legitimate supply chains.
Compounding the crisis is the geographic clustering of drug manufacturing.
More than 500 generics, including six experiencing shortages, have only one country or company producing their APIs.
This includes treatments for heart disease and diabetes—conditions that affect over 16% of U.S. adults.
The implications are chilling.
Should diplomatic tensions flare—or Beijing decide to “weaponize” the drug supply as some Chinese state controlled media commentators have called for—millions of Americans could be left without critical treatments.
The U.S. imports 90% of its pharmaceuticals from overseas. If China cut us off, our supply would vanish in TWO weeks.
We’re lucky to have a @POTUS who sees the danger and is finally bringing manufacturing back where it belongs. pic.twitter.com/MFbhhemaCB
— Congressman Pat Harrigan (@RepPatHarrigan) April 12, 2025
Commentary: What the U.S. Must Do About Its Dangerous Dependence on Chinese Drugs
This report lays bare a dangerous contradiction at the heart of America’s healthcare system: the world’s richest nation is utterly dependent on two countries—one a strategic adversary, the other heavily reliant on that adversary—for its most basic drug needs.
The free-market logic of globalized drug production has yielded short-term savings.
But the long-term costs—quality failures, human rights violations, and the threat of foreign leverage—are now impossible to ignore.
Aurobindo and Lupin aren’t outliers; they are the face of a broken procurement system that rewards cost-cutting over compliance, access over accountability.
America’s pharmaceutical policy, long treated as a health issue is now a national security issue.
With supply disruptions mounting and global tensions simmering, this report serves as a wake-up call: the time for a strategic reset is now.
The Bottom Line: Why the U.S. Can’t Afford to Stay Dangerously Dependent on Chinese Drugs
Exiger’s A Bitter Pill paints a damning portrait of a U.S. pharmaceutical system overexposed to foreign powers, undermined by regulatory blind spots, and tainted by ethical failings.
The report demands immediate reforms: reshore essential manufacturing, diversify foreign sourcing, expand FDA oversight, and eradicate forced labor from every link in the chain.
America’s drug supply is not just a health issue—it’s a national security imperative.
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