How Trump’s trade war will break global medicine supply chains

Abstract

The supply chains that deliver drugs to patients around the world are surprisingly brittle. Donald Trump’s trade war—with both allies and rivals—could break them. Flynn Murphy reports When hurricane Helene flooded a North Carolina plant that made 60% of the US’s intravenous fluids in October 20241 it was a grimly familiar situation. The damage worsened a shortage that had lingered since hurricane Maria hit the same company’s production in Puerto Rico in 2017. Medical procedures had to be altered to reduce the use of IV products. Fluids were rationed and surgeries postponed, and some patients had to get by with sports drinks.2 It took three months to bring the crisis under control. A broader, more intractable crisis has replaced it. Trump’s aggressive reconfiguration of US trade relations and a pledge to make all of the country’s essential drugs and their inputs at home is threatening the stability of medical supply chains that have only just recovered from covid. Additionally, tariffs targeting both traditional US allies and rivals are likely to hamper progress already made on relocating some medical sourcing from key exporter China to other countries. ### Trump’s China beef “Our enemy” is what President Donald Trump has called China. Yet China holds an intractable position in global healthcare supply chains—particularly for generic drugs, medical devices and supplies, and even some emerging treatments like antibody drug coagulates. China is also a key source of many of the materials required to manufacture and test drugs, such as those used to make active pharmaceutical ingredients (APIs), APIs themselves, and excipients such as binders, fillers, and lubricants. Years of US efforts to mitigate reliance on China has created room for Canada, Costa Rica, India, Ireland, Mexico, and others to grow their own export industries. But they are now in Trump’s tariff crosshairs too. And most …