For some 100 critical drugs, the US supply comes from one factory in China

Globalization has been unraveling for years. Less obvious is what has been replacing it. With Donald Trump’s return to the White House, it’s now clear: We’re living in an Age of Economic Warfare.

During the era of globalization, economic relations were seen as win-win. US companies eagerly offshored their supply chains to drive down costs and boost profits. But today, the world economy is a battlefield. Sanctions, tariffs, and export controls are now the primary way great powers compete with one another. They are a feature of our world, not a bug.

Despite Trump’s penchant for economic warfare, the United States by no means has a monopoly on the practice. China, Russia, and even US allies such as the European Union and Japan have dramatically expanded their ability to leverage economic power against rivals. In this environment, we have to do more than wield our own economic might wisely — we must also mount a robust defense.

The Biden administration recognized this imperative. The CHIPS and Science Act poured over $50 billion into domestic semiconductor production to reduce US dependence on Taiwan in case of a Chinese invasion. The Inflation Reduction Act, coupled with steep tariffs on Chinese electric vehicles, aimed to prevent Beijing from dominating America’s next-generation energy and transportation sectors.

But there’s one major area where we remain worrisomely exposed: our access to life-saving medicines.

Last year, US imports of pharmaceuticals surged to over $200 billion — putting them on pace to overtake cars as our top imported consumer good. Many of the high-priced branded drugs that Americans rely on are made either in Europe or domestically. But roughly 80 percent of all generic drugs — the backbone of the American health care system, accounting for 9 in every 10 prescriptions — are produced overseas, with China playing an outsized role.

Even when medications come from other countries, they often contain essential ingredients made in China. India, for example, is America’s top source of generic drugs, yet 70 percent of the active pharmaceutical ingredients in those drugs originate in China. As a result, the United States is dangerously dependent on our main geopolitical rival for everything from antibiotics to cancer treatments.

How did we get here? The story is familiar: In pursuit of lower costs, we outsourced production to China. American manufacturers couldn’t compete with Chinese firms benefiting from state subsidies and looser environmental regulations. One by one, US factories closed. Today, for roughly 100 critical drugs, the entire US supply comes from a single factory in China.

Under the logic of globalization, this was good business. In today’s Age of Economic Warfare, it’s a glaring vulnerability. Dating back to Trump’s first-term trade war, Chinese officials and state-controlled media have repeatedly floated the idea of cutting off pharmaceutical exports to the United States. In medical supplies — another sector China dominates — we’ve already seen how disruptive Beijing’s export curbs can be: In the early months of the COVID-19 pandemic, China nationalized its mask factories and halted exports just as global demand soared. American health care workers were left to reuse N95 masks — or go without them.

The national security implications of our dependence on China extend beyond the obvious. Even if Beijing never cuts off our pharmaceutical supply, the mere possibility could embolden Xi Jinping’s geopolitical ambitions. Xi has ordered China’s military to be ready for a potential invasion of Taiwan by 2027. If he believes the United States would hesitate to intervene for fear of losing access to critical medicines, that perception alone could undermine America’s ability to deter an invasion.

Fixing this problem won’t be easy. Decades of globalization have left supply chains deeply entangled, making vulnerabilities hard to spot, much less mitigate. But with the right mix of policy and diplomacy, Trump can put the United States in a far stronger position.

As a first step, the US needs a CHIPS Act-style initiative for generic drugs. Trump has proposed tariffs on imported pharmaceuticals, but duties alone won’t revive domestic production. The generics industry operates on razor-thin margins, and broad tariffs could backfire — driving up costs and triggering shortages. Instead, the US must offer powerful economic incentives, including tax breaks and subsidies, to spur manufacturing at home.

Congress has already introduced bipartisan proposals to boost domestic drug production, with support from figures as ideologically diverse as Massachusetts Senator Elizabeth Warren and Senator Thom Tillis, Republican of North Carolina. Yet none gained enough traction to become law. Without a push from Trump, they likely never will.

Pursuing total self-sufficiency, however, would be a fool’s errand — it would be too costly and take too long. A smarter approach is to build resilient supply chains with trusted partners. Rather than threatening allies with tariffs, we should lower trade barriers with the EU and Canada while forging pharmaceutical partnerships in Latin America. Countries such as Mexico and Argentina already have strong drug industries; with targeted investments in infrastructure and workforce training, the region could become a key US supplier of essential medicines — and lessen our reliance on China.

Globalization as we knew it is over. Economic warfare is the new normal. America is already adapting in technology and energy. Now, we must do the same for medicine. Otherwise, when the next crisis hits, we won’t just be short on iPhones and Teslas — we’ll be scrambling for the medicines we need to survive.

Edward Fishman is a senior research scholar at Columbia University’s Center on Global Energy Policy. His new book, Chokepoints: American Power in the Age of Economic Warfare, will be published on February 25. Send comments to magazine@globe.com.