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US Antibiotic Importation and Supply Chain Vulnerabilities
Mariana P Socal1,2, Yunxiang Sun1, Jeromie M Ballreich1
1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
JAMA Health Forum
|October 3, 2025
Summary
US antibiotic imports are diverse for finished forms but heavily reliant on China for active ingredients. Strengthening domestic production and diversifying sources are crucial for supply chain resilience and national security.
Area of Science:
- Pharmaceutical Supply Chain Analysis
- Global Trade in Medicines
- Public Health Policy
Background:
- Persistent antibiotic shortages in the US threaten patient care, public health, and national security.
- Understanding global antibiotic import sources is vital for enhancing supply chain resilience.
Purpose of the Study:
- To identify the global sources of US antibiotic imports, including finished dosage forms (FDFs) and active pharmaceutical ingredients (APIs).
- To analyze import trends from 1992 to 2024 to inform policy decisions.
Main Methods:
- Cross-sectional study utilizing US import records from USA Trade Online (1992-2024).
- Analysis of import volumes, costs, originating countries, and market concentration (Herfindahl-Hirschman Index).
Main Results:
- US antibiotic FDF imports increased significantly (2595.0%) by 2024, with India and Italy as leading sources.
- API imports are primarily sourced from China (62.6% volume), with highly concentrated markets (HHI >5000).
- Mean inflation-adjusted prices for both FDFs and APIs decreased substantially between 1992 and 2024.
Conclusions:
- US antibiotic supply chain relies on diverse FDF sources but is heavily dependent on China for APIs.
- Policies promoting domestic production and source diversification are essential to mitigate vulnerabilities.
- Enhanced traceability and targeted strategies are recommended to ensure public health and national security.
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