Beyond Reshoring: A Call for Bold, Collaborative Policy to Secure the U.S. Pharmaceutical Supply Chain and Prevent Drug Shortages 

“But how can we be in two places at once?”  

This question, posed to me during a European pharmaceutical trade association meeting in February of this year, captured two concerns: the logistical challenge of meeting reshoring demands in multiple countries, and the deeper uncertainty around how to make long-term decisions amid shifting global policies.  

Even before the latest wave of trade policies, the pressure to secure the pharmaceutical supply chain and turn the tide on record-high drug shortages in the United States was mounting. The Office of the Assistant Secretary for Planning and Evaluation (ASPE)— the principal advisory group to the U.S. Secretary of the Department of Health and Human Services (HHS) on policy development—reported that the average drug shortage affects at least 500,000 people, with more than one-third of those impacted being between 65 to 85 years old.  

Like most industries with globally integrated operations, the pharmaceutical industry was right to be apprehensive. The push for domestic manufacturing—while well-intentioned—has proven disruptive and will be difficult to implement quickly in most cases. In recent months, U.S. policy has doubled down on reshoring, placing the burden squarely on pharmaceutical companies. But this approach is too narrow and won’t lead to relief for U.S. patients facing challenges to access medicines. 

There’s No Silver Bullet

The COVID-19 pandemic exposed vulnerabilities in the pharmaceutical supply chain in the United States, sparking bipartisan concern over drug availability and therefore, national security. Since then, Congress and federal agencies have issued bipartisan reports and recommendations. The consensus? There is no silver bullet. 

In fact, many of the proposed solutions in recent years are complex and require a collaborative approach between pharmaceutical companies and the U.S. government with coordination from other key players like hospital systems, pharmacists and regulatory bodies.  

Aside from the recognition that this will take a much larger effort, most solutions to improving access to medicines in the United States require time. Today, many pharmaceutical companies are announcing plans to reshore and invest hundreds of millions—or even billions—into new U.S. facilities. But the average time to build and operationalize a pharmaceutical plant in the United States is seven to 10 years.  

To truly strengthen the pharmaceutical supply chain and reduce drug shortages, the U.S. government must do more than issue mandates about moving facilities. It must become a proactive partner. 

Bold Action With Thoughtful Communications

While pharmaceutical companies are making significant investments in domestic manufacturing and R&D, these efforts alone won’t solve the persistent issue of drug shortages. What’s missing is a compelling, coordinated narrative that helps policymakers and other stakeholders understand the full scope of what’s needed to reliably deliver medicines across the country. 

Pharmaceutical companies must go beyond announcing investments in key markets—they need to articulate the systemic challenges they face, and the shared responsibility required to address them. This means closely communicating with policymakers and stakeholders to emphasize: 

1. The Complexity of the Supply Chain 

Policymakers and other stakeholders often underestimate how global and interdependent pharmaceutical supply chains are. Companies should proactively educate stakeholders on the time, regulatory hurdles and capital required to shift production. This is especially true for starter ingredients used for all medicines called active pharmaceutical ingredients (APIs), which are largely concentrated in China and India, creating a supply chain and geopolitical vulnerability that the U.S. has sought to solve for years.  

Visualizing the supply chain—from raw materials to finished products—can help make the case for diversified sourcing and international cooperation.  

2. The Need for Government Partnership 

Pharmaceutical companies should continue to position themselves as willing partners to reshoring or friendshoring efforts—ready to scale up domestic production if the right conditions are in place. This includes advocating for fast-tracked permitting, tax incentives, and U.S. government investment via long-term contracts that de-risk investment. 

Sharing case studies of existing or previous public-private partnerships or other innovative government initiatives that helped spur pharmaceutical manufacturing and solve drug shortages, such as Operation Warp Speed during COVID-19, can help spark ideas for future collaborations and offer key lessons.

3. The Shared Responsibility and Solutions

Drug shortages are not solely a manufacturing issue. However, to effectively collaborate on preventing drug shortages, pharmaceutical companies must also be open to discussing a major policy issue that often puts them at odds with policymakers, other stakeholders and the public—drug prices. There can and should be nuanced discussions with a willingness for shared responsibility and bolder solutions. For instance, generic drugs account for 90% of all prescriptions filled in the United States but receive only 13% of the dollars spent annually on medicines. Furthermore, a race to the bottom on pricing for generic medicines, is often cited as a reason that generic, especially more affordable injectable medicines used in hospitals, go into shortage. 

By framing the issue as a shared challenge, companies can build coalitions that raise awareness of broad solutions and highlight the shared responsibility. For instance, solutions can include incentives to maintain buffer inventories at hospitals, ensure last-mile delivery and enhance notification requirements to avoid shortages.  

4. The Risk of a One-Size-Fits-All Policy 

Reshoring is not a panacea. Companies should use data and case studies to show how geographic diversification—rather than concentration—can reduce systemic risk. In particularly, friendshoring to trusted allies can provide redundancy without sacrificing resilience. 

For example, in 2023, a tornado in North Carolina severely damaged a Pfizer facility, which made and stored about 150 medicines, temporarily causing a nationwide shortage of certain IV and pain medicines. Many of the medicines were already at risk of shortage and were on FDA’s essential medicines list. 

By shaping the narrative around collaboration, complexity and shared accountability, pharmaceutical companies can help policymakers craft smarter, more sustainable policies that could have more immediate impacts. This is not just about protecting business interests—it’s about ensuring patients across the United States have reliable access to the medicines they need.