China is a minority of the finished-dose invoice and the majority of antibiotic kilograms. In 2024 U.S. HS 3004 imports were 94,855,411.94 thousand U.S. dollars and 640,176,000 kilograms. India was 12,254,978.06 thousand dollars. China was 6,137,587.16 thousand dollars and 33,781,900 kilograms. Calculated from the printed thousand-dollar values, India was 12.9 percent of finished-dose import value. Calculated from the printed thousand-dollar values, China was 6.5 percent of finished-dose import value. A China customs stop removes the China line. It does not, on this table, remove India, Switzerland, Ireland, Italy, or Germany.
wits.worldbank.org
Antibiotic HS 2941 is the concentrated loss. World imports were 715,703.00 thousand U.S. dollars and 10,798,500 kilograms. Italy was 247,665.53 thousand dollars and only 97,715 kilograms. China was 225,252.57 thousand dollars and 8,229,080 kilograms. India was 38,361.89 thousand dollars and 175,016 kilograms. Calculated from the printed thousand-dollar values, Italy was 34.6 percent of antibiotic import value. Calculated from the printed thousand-dollar values, China was 31.5 percent of antibiotic import value. Calculated from the printed kilograms, China was 76.2 percent of antibiotic kilograms. Calculated from the printed kilograms, India was 1.6 percent of antibiotic kilograms. Italy keeps a high-value, low-weight line. It does not replace China's kilograms.
wits.worldbank.org
FDA site counts are not those kilograms. The ANDA pilot page says more than half of pharmaceuticals distributed in the U.S. are manufactured overseas, and as of 2025 only 9% of API manufacturers are in the U.S., compared to 22% in China and 44% in India. The onshoring meeting page repeats that sentence and adds that approximately 53% of brand drug products and 69% of generic drug products are manufactured outside of the United States. India is where a large share of API manufacturer sites sit, so those sites are outside a China customs stop. Brookings prints the upstream limit: India's imported-API dollar share from China has been hovering around 68% plus or minus 2%, and India supplies 65% of solid oral dose generics.
fda.govfda.govbrookings.edu
Domestic manufacture continues at private NAICS 3254: the 2024 QCEW national private row is 7,617 establishments, 347,742 employees, and total annual wages of 48,751,302,997 dollars. That row is own_code 5, private ownership only. It is not a volume share of doses.
data.bls.gov
Cash past the plant is large and mostly not China-invoice cash. CMS says prescription drug spending increased 7.9% to $467.0 billion in 2024. McKesson's fiscal-2025 exhibit says full-year U.S. Pharmaceutical Revenues were $327.7 billion, an increase of 18%. Private pharmacies and drug retailers were 62,507 establishments and 701,230 employees. Private hospitals were 15,795 establishments and 5,454,513 employees. Hospital expenditures grew to $1,634.7 billion. That hospital figure is all hospital spending, not an inpatient drug ledger.
cms.govsec.govdata.bls.govdata.bls.gov
Low-exposure proof. The four opened U.S. WITS partner tables, HS 30, HS 3004, HS 3003, and HS 2941, name no partner Taiwan. No Taiwan medicine row is filled. Other Asia, nes is not Taiwan and is not used. A foundry-revenue share is not a medicine share and is not used. A chip or excipient share inside a dose stays unpublished.
wits.worldbank.orgwits.worldbank.orgwits.worldbank.org
Step 1, customs. HS 30 world imports were 212,481,653.26 thousand U.S. dollars. Ireland was 50,317,062.59. Switzerland was 19,013,514.18. Germany was 17,227,577.45. Singapore was 15,265,731.46. India was 12,726,204.56. Belgium was 12,390,672.78. Italy was 11,576,169.82. China was 7,829,007.69. Calculated from the printed thousand-dollar values, Ireland was 23.7 percent of pharmaceutical-product import value. Calculated from the printed thousand-dollar values, China was 3.7 percent of pharmaceutical-product import value. Calculated from the printed thousand-dollar values, India was 6.0 percent of pharmaceutical-product import value. Ireland, Switzerland, Germany, Singapore, India, Belgium, and Italy are the non-China lines on this table.
wits.worldbank.org
Step 2, separate the pack from the ingredient. Finished-dose partners ahead of or beside China include Switzerland at 11,888,990.82 thousand dollars, Ireland at 11,701,628.92, Italy at 6,620,864.97, and Germany at 5,807,910.20. Calculated from the printed thousand-dollar values, Switzerland was 12.5 percent of finished-dose import value. Calculated from the printed thousand-dollar values, Ireland was 12.3 percent of finished-dose import value. Calculated from the printed thousand-dollar values, Italy was 7.0 percent of finished-dose import value. Calculated from the printed thousand-dollar values, Germany was 6.1 percent of finished-dose import value. Bulk HS 3003 is a different bill: world 2,422,804.39 thousand dollars and 18,182,800 kilograms, Portugal 829,685.20 thousand dollars, China 101,692.79 thousand dollars and 5,207,730 kilograms, India 80,944.51 thousand dollars. Calculated from the printed thousand-dollar values, China was 4.2 percent of bulk-medicament import value. Calculated from the printed kilograms, China was 28.6 percent of bulk-medicament kilograms.
wits.worldbank.orgwits.worldbank.org
Step 3, India is not a clean substitute. FDA places 44% of API manufacturers in India and 22% in China. Brookings says 65% of solid oral dose generics and that the dollar share of Chinese imports relative to all imported API has been hovering around 68%. A China stop can still interrupt Indian finished doses that depend on Chinese API. Brookings also says its review suggests Chinese API is included in perhaps a quarter of drug volume sold in the U.S., and that 3% of branded extended units have Chinese API and 8% of generic extended units for drugs excluding IV fluids, with more units where the country is unclear. A quarter and the extended-unit percents are Brookings' review, not a Census volume share, and they are not the FDA manufacturer percents.
fda.govbrookings.edu
Step 4, Taiwan. Low-exposure proof: the opened 2024 WITS partner tables for HS 30, HS 3004, HS 3003, and HS 2941 contain no row named Taiwan. No Taiwan medicine row is filled. No pharma-relevant Taiwan export statistic was on those pages. The scenario's Taiwan export restriction is an explicit limit. A foundry-revenue share is not used, and a chip or excipient share inside a dose stays unpublished.
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Step 5, a sterile plant can fail in weeks without a China customs line. The October 11, 2024 FDA roundup is the short-horizon analog: Helene led FDA to add Dextrose 70% IV solution, Lactated Ringers IV Solution, and Peritoneal Dialysis Solution to the shortage database.
fda.gov
Step 6, cyber. Volt Typhoon is described as pre-positioning on IT networks for disruptive or destructive activity against U.S. critical infrastructure in a major crisis or conflict. Healthcare and Public Health is a critical infrastructure sector and HHS is the sector risk management agency. A port, power, or hospital-system hit is Wave 1. A wholesaler or claims-platform hit is Wave 2. A community-pharmacy hit is Wave 3. That order is the planning model. The measured incident is separate. Change Healthcare, a health payment processor, had estimated losses of $874 million. For repayment, providers will have 30 days to return the funds. That 30 days figure is the payer's funding term, not an outage duration and not a drug-plant loss.
cisa.govcisa.govgao.govunitedhealthgroup.com