Japan on Edge as Dependence on China for Essential Medicines Raises Strategic Fears

Summary:

Amid worsening relations with China, Japanese experts warn that Beijing could restrict exports of pharmaceutical ingredients critical to Japan’s healthcare system....

Rising geopolitical risk in healthcare supply chains

Japanese policymakers and medical experts are increasingly alarmed that China may use pharmaceutical exports as a tool of economic pressure as bilateral tensions deepen. While global attention has focused on China’s controls over rare earths, specialists argue that restrictions on medicines and drug ingredients would pose a far more immediate and severe threat to Japan.

Professor Kazuhiro Tateda, president of the Japanese Association for Infectious Diseases and a former member of Japan’s Covid-19 advisory panel, has warned that Japan remains highly vulnerable. He notes that Japan relies heavily on China for active pharmaceutical ingredients, particularly antibiotics, meaning Beijing could exert significant pressure if it chose to do so.

Structural dependence built over decades

Before 2019, many Japanese pharmaceutical companies stopped producing common antibiotics such as penicillin and streptomycin, as well as key active ingredients, due to low profitability. Over time, China emerged as the dominant supplier, offering scale and cost advantages that domestic producers could not match.

This dependence was exposed dramatically in 2019, when China tightened environmental regulations and shut down a factory producing cefazolin, a critical antibiotic widely used in surgery. The disruption triggered a nationwide crisis in Japan’s hospital system, forcing surgery delays and the use of less effective substitutes. The so-called “cefazolin shock” became a turning point in Japan’s understanding of pharmaceutical supply chain risk.

Government response and its limits

In response, the Japanese government launched policies to encourage domestic drug manufacturing, including a 55 billion yen support package aimed at rebuilding pharmaceutical production capacity by 2024. These measures marked a strategic shift, recognizing pharmaceuticals as part of national security rather than purely commercial goods.

However, trade data show that Japan still imported medical ingredients worth about $122.5 million from China in 2024. This underscores the scale of the challenge: rebuilding a mature pharmaceutical ecosystem takes years, not policy announcements alone.

Tensions reignite old fears

Concerns intensified again after bilateral frictions escalated in November, when China’s Ministry of Commerce announced tighter export controls on so-called “dual-use” goods to Japan. Many analysts see this as a potential precursor to broader restrictions that could eventually include pharmaceuticals.

Medical experts stress that while rare earths dominate headlines, medicine shortages would have a more direct and destabilizing impact on society. A widely shared article in President magazine captured public anxiety, with readers arguing that dependence on foreign sources for drug ingredients is more dangerous than reliance on rare earths, given the immediate consequences for public health.

Strategic lessons and the road ahead

Some commentators have called on Japan to adopt tougher industrial policies, similar to those pursued by U.S. President Donald Trump, to pressure companies into reshoring production. Others emphasize diversification rather than full self-sufficiency, arguing that spreading supply across multiple countries could reduce vulnerability.

Professor Tateda acknowledges ongoing risks but believes Japan is better prepared than it was in 2019. Hospitals have learned to use alternative medicines, and the government has become more aware of supply chain fragility. Still, he stresses that these improvements are only a foundation, not a solution.

Ultimately, Japan’s situation highlights a broader global dilemma: efficiency-driven supply chains have created deep strategic dependencies. As geopolitical tensions rise, Japan’s experience suggests that rebuilding resilience in essential sectors like pharmaceuticals will be slow, costly, but unavoidable if the country is to reduce its exposure to external pressure.

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