Marta Wosińska’s testimony before the House Select Committee on the Chinese Communist Party

Chairman Moolenaar, Ranking Member Khanna, and members of the Committee, thank you for the opportunity to testify.

My name is Marta Wosińska, and I am a senior fellow at the Brookings Institution. I am testifying today in my personal expert capacity. I am an economist with expertise in prescription drug markets, and I have been studying the resilience of generic drug supply chains for about 15 years.

Over those years, I have seen many policy ideas in this space fall short. Many ideas sound strong and intuitive, but they often fail to grapple with four key questions.

Today, I want to use those four questions to frame how we should think about de‑risking our generic drug supply chain dependence on China.

Question #1: What problem are we actually solving?

We often hear that about 80% of plants that make active ingredients for our drugs are outside the United States. If we treat that as the problem, then onshoring those plants sounds like the obvious fix.

But if our concern is China, we must recognize that China controls the chemical precursors that those plants need. If China shuts off those chemicals, it won’t help that an active‑ingredient plant sits on U.S. soil.

If we want to de‑risk from China, we need to de‑risk those chemical inputs.

Question #2: For the solutions to work, what else must happen?

Any serious effort to de‑risk from China will cost money. There is no free lunch.

To make progress, Congress must be willing to allocate funding for more secure chemical and generic manufacturing capacity—and to pay more for the products that come from it.

At this point, you might reasonably ask: aren’t we already spending too much on drugs? And you want us to spend more?

But please remember—I am only talking about generics. Generics account for more than 90% of prescriptions but only a small share of drug spending. A life-saving hospital medicine may earn a generic manufacturer less than a cup of coffee. A 30-day supply of a chronic generic drug sells to pharmacies for less than $1.50.

For these generic staples of American health care, we must be willing to pay more for supply chains that are not built on cheap Chinese inputs.

Question #3: What is the best use of limited dollars?

The scope of our dependence is so broad that we must prioritize which supply chains to secure first, recognizing that we must secure more than just the active ingredient and finished dosage form steps we normally call drug manufacturing.

If policymakers sprinkle taxpayer dollars across many drug supply chains without clear priorities, they risk spending a lot and changing very little.

The smart path is to reserve full, end‑to‑end onshoring for critical drugs for which we are likely to compete with China and others in a pandemic or major natural disaster. Think emergency room medicines, antibiotics, and intensive‑care sedatives.

For the widely used everyday medicines that treat hypertension, high cholesterol, and depression, we should lean on friendshoring. Friendshoring lets us leverage the fact that most of our exposure to Chinese chemicals is not direct but runs through India and Europe—countries that supply our market but rely on Chinese inputs. Those countries are also concerned about their own exposure to China and are working to decrease it, benefiting us along the way.

Question #4: How do we avoid unintended consequences?

Congress has a critical role here. If tariff policy, procurement rules, and payment reforms send weak or mixed signals, and purchasers keep paying only for the cheapest option, manufacturers at home and in allied countries will keep leaning on low‑cost Chinese inputs. We have already seen firms in allied countries shift critical manufacturing capacity toward China because buyers would not pay for de‑risked production. That is the opposite of what we need.

So, as you consider legislation, the question is not only whether a policy sounds tough on China and enhances onshoring, but also whether it enhances friendshoring. Congress can help by locking in clearer, long‑term signals in statute—on tariffs and on reliability‑based payments—so that our policies support our allies’ efforts to lower their dependence on China, and, in doing so, make our own drug supply more secure.

Read the full written testimony