The National Interest | Michael Schiffer, Jennifer Hendrixson White
The United States faces a critical strategic vulnerability due to its profound dependence on Chinese pharmaceutical supply chains, particularly for essential drugs like heparin. Approximately 70% of the US heparin supply, vital for hemodialysis and cardiac procedures, originates from Chinese porcine intestinal mucosa, with the two US-based API plants now Chinese-owned subsidiaries. This dependence is not hypothetical; a 2007-2008 contaminated Chinese heparin incident killed 149 Americans, with Beijing refusing Food and Drug Administration (FDA) access for investigation. China's 15th Five-Year Plan explicitly targets biomanufacturing for "decisive breakthroughs," aiming to reinforce control over value chains, as evidenced by recent rare earth and fertilizer export controls. A future event, such as an African Swine Fever outbreak or a diplomatic dispute, could disrupt heparin supply, impacting hundreds of thousands of American dialysis patients. Current US federal initiatives like the Strategic Active Pharmaceutical Ingredients Reserve (SAPIR) and the Phlow-BARDA program are inadequate for biologically derived drugs, and bovine-sourced heparin alternatives remain unapproved. The article urges elevating pharmaceutical supply chain resilience to the same strategic priority as critical minerals and semiconductors, emphasizing the direct link between Chinese export decisions and American lives.
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