When the covid-19 pandemic erupted, the world discovered something public health experts had been warning about for years: the production of essential medicines depends on a handful of countries. Today, in 2026, that dependence has turned into a silent crisis threatening to overwhelm health systems across the planet.
Nearly 80% of the active pharmaceutical ingredients for generic drugs are produced in India and China, according to the World Health Organization.
The fragility of the global supply chain
Shipping disruptions, seasonal demand spikes and geopolitical conflicts have caused shortages of antibiotics, painkillers and treatments for chronic diseases to increase over the past three years. In low- and middle-income countries, the problem is worsened by a lack of foreign currency for imports.
What is an active ingredient?
It is the substance responsible for the pharmacological effect of a medicine. Its production requires specialized facilities and raw materials that mostly come from Asia.
The role of governments and industry
Several countries have begun promoting pharmaceutical nearshoring policies, moving part of the production closer to home or to strategic allies. The United States approved a tax incentive law in 2025 for domestic generic manufacturing, while the European Union is negotiating agreements with Morocco and Egypt to set up vaccine and essential drug plants.
Experts warn, however, that decentralization is neither simple nor cheap. Building an active ingredient factory can cost hundreds of millions of euros and require years of certifications. Meanwhile, global demand for medicines keeps rising, driven by aging populations and the increase in non-communicable diseases such as diabetes and hypertension.
Access as a right and a business
The crisis in medicine access is not just a logistical problem but also a matter of social justice. Patents and high prices for innovative drugs continue to leave millions of people in countries without robust health systems behind. The World Trade Organization has failed to reach an agreement to relax patents in health emergencies, facing resistance from pharmaceutical companies and their governments.
TRIPS flexibilities
These are legal mechanisms that allow countries to produce or import generic versions of a patented drug without the patent holder's consent, in emergencies or for non-commercial public use.
Looking ahead: toward a new model?
Some voices propose a system of cooperative regional production, where several countries share costs and technologies to manufacture essential medicines. Initiatives like the Medicines Patent Pool, which facilitates voluntary licenses for generics in low-income countries, have proven effective but limited in scale. The debate is open, and the health of millions depends on finding solutions before the next crisis hits.
