Making the FDA Great Again Requires Rebuilding America's Scientific Infrastructure

In a recent JAMA Health Forum commentary, Former FDA Commissioner Scott Gottlieb warns that politicizing the US Food and Drug Administration's (FDA) medical product centers risks eroding the agency's scientific credibility and surrendering its role as the global regulator of reference. He warns that turning regulatory decisions into political tools could cause the United States to lose its long‑standing role as the world's standard‑setting authority, as, at the very moment, China is positioning itself to assume that influence. While his diagnosis is correct, it does not capture the full scope of the challenge. The FDA's fragility is not an isolated political phenomenon; it reflects a broader, self‑inflicted weakening of US scientific and regulatory capacity across the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the United States Agency for International Development (USAID), and global health partnerships. At the same time, China's rapid ascent in pharmaceutical innovation is structural, not merely geopolitical, and US institutional erosion accelerates this shift. Drawing on recent analyses of China's innovation ecosystem and the importance of institutional memory in public health systems, this editorial argues that restoring FDA leadership requires rebuilding the entire scientific infrastructure that supports it. We propose a whole‑of‑system strategy centered on predictable, inflation‑adjusted funding, protection of workforce memory, and renewed engagement with global regulatory and public health networks.