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As concern mounts over the global pharmaceutical supply chain, more fingers are being pointed at India and China due to increasing quality-control infractions at manufacturing facilities. Such problems have led to shortages of key medicines — notably, the lower-cost generics that account for 89% of all prescriptions filled in the U.S. But Rosemary Gibson, a health care and patient safety expert at The Hastings Center, a bioethics nonprofit, argues that developments in China pose an even greater risk. As the key supplier of active pharmaceutical ingredients, China ultimately threatens the national security of the U.S., which was the theme in her April 2018 book, “China Rx: Exposing the Risks of America’s Dependence on China for Medicine,” written with Janardan Prasad Singh. Last week, she testified before a House committee on supply chain issues and we subsequently chatted about the problem. This is an edited version of the conversation.

Pharmalot: What is the exact role that China now plays in the global supply chain? And why should we be more concerned about what happens in China than in India?


Gibson: What China does is control about 80% of the world’s supply of the active pharmaceutical ingredients and it also controls the dominant global share of raw materials and chemical building blocks to make those active ingredients. It’s an untold story, but once you see it, you can’t un-see it. And it’s so compelling for our system of health care — for hospitals, for the military, for everyone. I hear from CEOs of companies that make medicines, largely generics, that if China turns off the supply, our pharmacy shelves will be empty.

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