The next great competition between the United States and China won’t be decided only in artificial-intelligence labs or semiconductor fabrication plants. It may instead be won in pharmaceutical laboratories, clinical trial networks, and advanced manufacturing facilities. The nation that discovers, develops, and manufactures tomorrow's medicines will gain far more than commercial success. It will command investment, attract scientific talent, strengthen national security, and provide better healthcare for its citizens.
China understands this. For more than a decade, Beijing has treated biotechnology as a strategic industry, pairing sustained government investment with industrial policy to build a fully integrated and now growing biopharmaceutical ecosystem. From basic research and clinical trials to large-scale manufacturing, China has pursued leadership with the same determination it has applied to electric vehicles, batteries, and advanced telecommunications.
The results are becoming impossible to ignore. According to a 2026 National Bureau of Economic Research working paper, China accounted for less than 8% of the world’s clinical trials in 2010. By 2020, it had surpassed the United States in annual registered clinical trial volume. That shift is more than a statistical milestone. Clinical trials attract investment, generate scientific expertise, and accelerate the discovery of new therapies. They are the engine that drives the innovation flywheel. As more research moves abroad, so does capital, talent, and the industries that grow around them.
China has also become deeply embedded in the global pharmaceutical supply chain. It is a leading producer of active pharmaceutical ingredients (APIs) and an increasingly indispensable manufacturing partner for many of the world’s largest pharmaceutical companies. America’s dependence on Chinese production is no longer simply a commercial concern. It is also a strategic vulnerability. The COVID-19 pandemic exposed the dangers of relying on fragile global supply chains. The next disruption may not be caused by a virus but by geopolitical conflict.
Recognizing these stakes, the Trump administration has begun treating biopharmaceutical innovation as an issue of economic competitiveness and national security rather than simply healthcare policy. The emerging strategy is straightforward: make the United States the best place in the world to discover, develop, and manufacture new medicines.
Several recent initiatives move in that direction. One recent proposal would modernize FDA oversight of distributed pharmaceutical manufacturing by allowing coordinated manufacturing networks to register as a single establishment rather than requiring separate registrations for every production site. Although technical in appearance, the reform could significantly reduce administrative costs while making it faster to expand domestic manufacturing capacity.
The Trump administration has also launched Operation Trialblazer, an effort to modernize early-stage drug development by simplifying Phase 1 clinical research, reducing regulatory complexity, shortening review timelines, and enhanced communication between sponsors and regulators. These reforms seek to reverse one of the most troubling trends in global biotechnology: the migration of early-stage drug development to China. Every clinical trial conducted in America strengthens the broader ecosystem of scientists, entrepreneurs, manufacturers, investors, and skilled workers that sustain long-term innovation.
Clinical trials rarely make headlines, but they are the invisible infrastructure of biomedical leadership. Wherever trials go, investment, talent, and innovation tend to follow. Recognizing the need to protect this critical asset, the Trump administration is also seeking the support of Congress to codify these trial reforms into law. Next year’s user fee reauthorization offers policymakers across the Executive Branch and Capitol Hill, a unique opportunity to take this important step. HHS looks forward to working with the Congress to execute this objective.
Manufacturing deserves equal attention.
Roughly 90% of the prescriptions dispensed in the United States are generic medicines, yet much of the production supporting those drugs occurs overseas. Recognizing this vulnerability, the administration has proposed an FDA pilot program affording an opportunity for expedited review of certain generic-drug applications tied to domestic manufacturing, creating incentives to produce active pharmaceutical ingredients, finished dosage forms, and conduct bioequivalence testing within the United States. Rebuilding this manufacturing base will not happen overnight, but restoring domestic capacity is essential to improving supply-chain resilience and reducing strategic dependence on foreign producers.
In April, FDA and HHS announced another domestic manufacturing initiative: the Precheck Pilot Program. This initiative allows developers to engage and communicate with the FDA earlier to resolve questions and expedite review. According to the FDA, the program “aims to reduce delays, improve regulatory predictability, and accelerate the availability of U.S. manufactured medicines.”
These two manufacturing proposals are critical because scientific leadership eventually follows manufacturing capacity as surely as manufacturing capacity follows investment.
These initiatives are only first steps. Winning the biotechnology race will require sustained investment in scientific research, modernized regulation, advanced manufacturing, workforce development, and policies that encourage private-sector innovation. Unlike election cycles, scientific leadership is measured in decades. China understands that reality and has planned accordingly.
For years, Washington has rightly warned that semiconductor manufacturing represents a strategic vulnerability. Biotechnology deserves the same sense of urgency. Advanced chips power the digital economy. Medicines protect public health, military readiness, and economic resilience. Both industries are foundational to American strength.
The country that invents tomorrow’s medicines won’t merely improve health. It will attract capital, command talent, strengthen national security, and shape the global economy. The race for biotechnology leadership has already begun. These important new steps by the Trump administration signal the United States is serious, engaged, and striving to win.
The writer is the Assistant Secretary for Legislation at the U.S. Department of Health and Human Services.
