America’s biotechnology leadership is in jeopardy due to China rapidly closing the gap as clinical trials and manufacturing migrate abroad. That’s among the findings of the Cure Innovation Index and a new survey of 117 senior U.S. industry and academic leaders. The results were presented on Monday in a session at the 2026 BIO International Convention in San Diego.

In the Cure U.S.-China Biotech Competitiveness Survey, respondents were asked to assess the two countries across 35 metrics in six dimensions of end-to-end innovation. China received decisive leads in two dimensions — clinical development and supply chain infrastructure — according to a press release announcing the results.

The survey’s supply chain dimension included six metrics: manufacturing scale and capacity; active pharmaceutical ingredient (API) and raw material sourcing; advanced manufacturing capabilities; supply chain resilience; biomanufacturing and contract development and manufacturing organization (CDMO) capacity; and fill-finish infrastructure.

The resulting competitiveness scorecard characterized China as having achieved “manufacturing dominance” over the U.S. — based on leading all six supply chain metrics — with CDMO capacity called out as a “structural” advantage. Among the top threats to U.S. biotech leadership are China’s supply chain capacity and manufacturing scale, the report said.

“The next era of biopharma innovation will not be defined by geography, but by the ability to combine the best capabilities across ecosystems,” Yan Ling, executive director, head of research innovation China at Takeda, said in a statement. “The U.S. brings science, capital, regulatory credibility, commercialization, with global access. China brings speed, scale, clinical execution, manufacturing depth, and a growing innovation pipeline.”

With Chinese biopharmaceutical companies now accounting for about one-third of new compounds entering the U.S. pipeline, America must make modernizing clinical trial infrastructure and strengthening domestic manufacturing and supply chains top priorities, the report concluded.

As China aggressively pursues a strategy to become the world’s biotechnology leader, the U.S. government must invest a minimum of $15 billion over the next five years, according to a report to Congress last year from the National Security Commission on Emerging Biotechnology (NSCEB). The commission warned that China has made biotech a strategic priority for the last 20 years, with its 2026 Five Year Plan doubling down on efforts to achieve dominance in priority areas including biomanufacturing.

“China is pursuing biomanufacturing to eliminate foreign supply chain dependencies,” NSCEB said. “In 2025, the government announced public-private partnerships with 43 companies to build biomanufacturing pilot plants nationwide.”

America’s API, CDMO dependency

If no structural changes are made in the U.S. and without “deliberate” domestic manufacturing investment, the Cure report warned that by 2031 America’s supply chain vulnerability will deepen with API and CDMO dependence growing — while Chinese companies are projected to secure 35% of FDA approvals by 2040.

Grand View Research estimates that the China CDMO market generated $18.9 billion in 2024, and predicts it will reach $39.5 billion by 2033 — a compound annual growth rate of 8.6% — with API positioned as the most lucrative and fastest growth segment during the forecast period.

China has built a CDMO and contract research organization (CRO) infrastructure of “staggering scale and sophistication” that “now rivals, and in many cases surpasses, its Western counterparts,” according to a panel held in April at the 2026 INTERPHEX conference in New York City.

Brian Scanlan, managing partner of Freedom Bioscience Partners and moderator of the panel, warned that China’s biotech ecosystem is rapidly evolving — mirroring the meteoric rise of its CDMOs and CROs — with the shift raising “profound” questions, including where the development and manufacturing will take place for such highly complex modalities as antibody-drug conjugates and multi-specific antibodies.