This year has already been defined by major instability and potential long-term damage to global supply chains, which has raised critical questions about how we secure supply lines for our most vital needs.
While European and American leaders obsess over securing vital components and resources for technologies and munitions of the future – as demonstrated this past week at the Trump-Xi summit in Beijing, where rare earths and semiconductors dominated the agenda – they are ignoring another critical vulnerability. Modern militaries, as well as societies, rely on uninterrupted access to frontline antibiotics as much as they do ammunition or fuel – and right now, Beijing controls that supply.
Antibiotics are the bedrock of modern medicine; without them, healthcare systems as we know it would effectively collapse. Each year, roughly four million operations are carried out in England alone. Without antibiotics to prevent and treat infections, modern healthcare would become highly dangerous. They’re prescribed for everything from strep throat to routine wisdom tooth removals, from treating sexually transmitted infections to managing cuts and safeguarding mothers and babies during childbirth.
Before the widespread use of antibiotics in the 1940s, roughly 30 to 43 per cent of all deaths were caused by infections. A severed antibiotic supply line could lead to chaos in hospitals and painful decisions.
To understand the sheer scale of our modern reliance, consider this: the NHS dispenses more than 30 million antibiotic prescriptions a year.
Despite this, the UK has sleepwalked into a dangerous dependency on foreign supply chains to provide these drugs. Medications such as amoxicillin, penicillins and cephalosporins are entirely dependent on a fragile network anchored in Asia.
As a recent Coalition for a Prosperous America and Council on Geostrategy report, authored by Andrew Rechenberg, shows, the threat is not just from our import reliance, but also the highly concentrated structure of that reliance.
Today, China accounts for between 80 and 90 per cent of global active pharmaceutical ingredients (APIs) production for antibiotics, granting it near-total upstream dominance. Five of the world’s seven manufacturing sites for the essential ingredient in modern penicillins are located in China.
Xi Jinping and Donald Trump in Beijing this week (Photo: Kenny Holston/Pool/AFP via Getty Images)The finished drugs follow a similar pattern. While the UK and its allies import vast quantities of these medicines from India, which along with China supplies more than 75 per cent of the European market, this only creates an illusion of resilience. A closer look reveals that the ability of the NHS to purchase finished antibiotics is entirely tied to Chinese inputs, as Beijing provides a staggering 91.3 per cent of India’s active ingredient imports.
This transforms a medical supply chain into a geopolitical weapon, giving Beijing immense leverage over Westminster, should it choose to use it.
If the UK were to cross China – such as defending Taiwan or allied interests in the Indo-Pacific, or restricting access to Chinese technology – it could quietly impose a ‘health blockade’. By simply squeezing India’s supply of active ingredients, China would starve Britain and others of finished drugs, likely sparking political panic.
We are already seeing the economic edge of this sword: recent allegations out of India accusing Chinese firms of dumping active antibiotic ingredients at artificially low prices highlight China’s desire to maintain its monopoly through aggressive pricing.
While short-term emergency stockpiling would offer a temporary buffer against such disruptions, true national security requires a structural solution. Re-establishing manufacturing takes foresight and investment, which is precisely why Westminster must act now, from a position of relative stability – rather than waiting for a crisis to force its hand.
Staff and students line up to receive antibiotics at the University of Kent after an outbreak of meningitis earlier this year (Photo: Carl Court/Getty Images)Fortunately, this is a manufactured vulnerability, and it can be undone through strategic policymaking. The UK and its European neighbours must move fully away from a ‘lowest cost’ procurement model, which punishes domestic producers, and instead align government purchasing to reward supply reliability. This may cost more, but by integrating antibiotic security into national and Nato readiness planning, we can guarantee long-term demand for allied manufacturing.
We must also invest together in essential infrastructure, such as capital-intensive fermentation and synthesis facilities, backed by financial incentives. To protect these from being undercut by subsidised Chinese dumping, Western nations should deploy targeted tariff-rate quotas to stabilise the market and create a predictable environment.
We already have the proof-of-concept that allied manufacturing can survive and scale. Drug company Sandoz’s Kundl facility in Austria is the only remaining fully integrated penicillin production base in either Europe or the United States and proves that large-scale penicillin manufacturing can be sustained at economically viable levels outside of China, if the right conditions are met. Kundl provides one in every two penicillin boxes in Europe.
Antibiotics are a strategic infrastructure and must be treated as such. Modern technologies and ammunition will always be vital for our defence, but so too is the health of the British public. As global tensions grow, the chokehold that China has over our supplies of antibiotics should be something that politicians are deeply worried about.
A nation can only project strength abroad if its citizens are secure, resilient and safely treated at home. Anything that can disrupt that is a national threat.
James Rogers is a co-founder and director of research at the Council on Geostrategy
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