Europe and the United States should begin where cooperation costs nothing politically. They could start by fixing their lack of visibility into their own upstream flows of key starting materials. Joint mapping, which builds on the work of the Health Emergency Preparedness and Response Authority and its U.S. counterparts, is a technical exercise that produces shared information and nothing else. It changes no tariff, no procurement rule, and no market access, so neither side has to concede anything to take part. They should also undertake joint stress-testing on a shared methodology that measures not just how much production sits in China but how long replacement would take if production stopped. In particular, NATO should incorporate the defense-relevant subset of the stress-testing—demand for antibiotics, analgesics, and anesthetics under mobilization conditions—into its resilience work.
Europe should also lock in the existing carve-out under the 2025 United States-European Union Framework—which already grants near-zero treatment to generic medicines, their ingredients, and chemical precursors—and press to make it permanent, including for biosimilars, the lower-cost follow-on versions of biologic drugs whose patents have expired, before the U.S. review of generics concludes.
Europe should legislate its own rules on sensitive biotech and health-data cooperation with China rather than importing American ones through contractual reach. But the U.S. approach warrants careful study. In principle, a plurilateral critical-medicines arrangement modeled on the allied approach now emerging for critical raw materials would make sense. That would include giving preferential treatment to ally-produced ingredients and precursors, mutually recognizing the validity of the other side’s inspections, and establishing common resilience criteria in public procurement. The United States and Europe should establish such a framework with India, Japan, South Korea, Switzerland, and the United Kingdom, among others. The idea would be to coordinate demand: agreeing to long-term purchase commitments that give investors enough certainty to finance new Western production. The binding constraint on that capacity is not technology but price, with European ingredients running up to 40 percent more than Chinese ones. Only guaranteed demand closes that gap. Currently, however, transatlantic relations lack the trust required for such a comprehensive plurilateral arrangement.
The United States’ and Europe’s dependency on Chinese pharmaceutical ingredients was built over decades, and it will not be undone quickly. Europe should start with what can be done now: mapping the upstream flows neither side can currently see, testing how long replacement would actually take, and locking in the generics carve-out before the review closes it. None of that requires trust that does not exist. All of it would make a larger arrangement possible later, if the politics allow.
What Europe should not do is trade away control over its own pharmaceutical market to gain access to America’s. The purpose of reducing dependence on China is to widen Europe’s room to maneuver, not to narrow it again from a different direction. Washington should recognize that each tariff on European medicines cuts against the very alliance it says it wants.
This report was informed by a Council on Foreign Relations (CFR) meeting convened in cooperation with the Mercator Institute for China Studies (MERICS) as part of a project on transatlantic cooperation on China policy. The author thanks the members of the Council on Foreign Relations working group on transatlantic cooperation for the discussion from which this brief emerged, and Martin Catarata, David Francas, Jasmina Kirchhoff and Fearghal Raison, his coauthors on the underlying study. That study, Strategische Abhängigkeiten bei wichtigen Arzneimitteln von China, was conducted at the German Economic Institute and commissioned by Pro Generika, the German generics association. The views expressed here are the author’s own.
Tim Rühlig is the senior analyst for global China at the European Union Institute for Security Studies.