25 July 2025

America’s Pill Problem


Nearly 25 years ago, Americans discovered just how critical the antibiotic ciprofloxacin could be. Commonly prescribed for bacterial infections, “cipro” is also the first-line treatment for anthrax exposure. In September 2001, 

just one week after the 9/11 terror attacks, the American public found itself contending with yet another nightmare: someone was sending anthrax through the U.S. Postal Service to media companies and congressional offices—ultimately killing five people and infecting 17 others. Those with even the smallest risk of exposure lined up for treatment.

Today, anthrax remains one of the deadliest and easiest biological weapons to produce. Yet 80 percent of the U.S. supply of ciprofloxacin is still imported. Moreover, most of those imports, whether from Europe, India, or Jordan, rely on key starting ingredients made in China.

It’s not just cipro. The United States is alarmingly dependent on imports for many of its critical medicines and their ingredients. Over the last two decades, according to U.S. Census Bureau data, U.S. pharmaceutical imports have grown by an average of nine percent annually. Over the last 12 months, the value of U.S. 

pharmaceutical imports has ballooned 40 percent, to $315 billion; the pharmaceutical sector, which U.S. manufacturers once dominated, was the fifth-largest U.S. import category in 2024. By volume, China and India are the largest suppliers of drugs and their ingredients to the United States, including common antibiotics, 

statins, and other older low-cost generic medicines. By value, Germany, Ireland, and Switzerland dominate the U.S. pharmaceutical trade, largely through their exports of top-selling branded drugs such as Viagra and Botox and patented medicines such as new weight-loss treatments and Keytruda, 

the top-selling cancer drug. The United States has long dominated the production of innovative medicines, but even that market segment is at risk: in 2024, one-third of the new compounds licensed by U.S. pharmaceutical companies reportedly were made by Chinese biotechnology firms.

No comments: