Why the UK medicine supply chain is dangerously exposed to global shocks

**Lead**

The United Kingdom’s medicine supply chain, long praised for its efficiency and low cost, has revealed a fragility that experts warn could prove catastrophic in the event of a major global emergency. Despite the lessons of the COVID‑19 pandemic, the UK still imports nearly 70% of its medicines and over 80% of the active pharmaceutical ingredients (APIs) used in manufacturing, leaving the country dangerously dependent on a handful of overseas suppliers. As geopolitical tensions mount and climate‑related disruptions become more frequent, the question is no longer whether a shock will hit the system, but when – and how many lives will depend on a just‑in‑time model that has no backup.

**Context**

The UK pharmaceutical market is one of the largest in Europe, yet its manufacturing base has steadily eroded over the past three decades. Between 1990 and 2020, domestic production of generic medicines fell by more than 40%, according to industry reports, as companies offshored production to countries with cheaper labour and looser environmental standards. India and China now supply over 60% of the world’s APIs, and the UK is heavily reliant on both. China alone produces about 40% of the world’s paracetamol and a significant share of antibiotics, while India supplies nearly half of the insulin used globally. The Department of Health and Social Care has acknowledged that a sudden disruption in either country could cause “significant shortages” within weeks.

Brexit added another layer of complexity. While the Trade and Cooperation Agreement with the EU provides tariff‑free trade, new customs checks and regulatory divergence have already caused delays and stockpiling costs. The government’s own internal audits, leaked in 2023, warned that the UK’s medicine stockpiles would last only six weeks in a crisis – far less than the six months recommended by international bodies. The pandemic tested these assumptions: at the height of COVID‑19, there were shortages of essential drugs such as propofol and certain cancer treatments. The situation was only contained through emergency measures and a temporary relaxation of competition rules.

**Analysis**

Why does this matter now? The answer lies in the convergence of several trends. First, the global supply chain is becoming more volatile. The Russian invasion of Ukraine disrupted fertiliser supplies, which in turn affected the production of key chemicals used in pharmaceuticals. Climate‑related extreme weather – floods in China, droughts in South America – has already delayed shipments of raw materials. Second, geopolitical competition is intensifying. The US is pushing to onshore more drug production through legislation such as the CHIPS and Science Act, and the EU is similarly investing in its own “pharmaceutical autonomy”. The UK, by contrast, has no coherent strategy to reduce its dependence on foreign suppliers. The 2021 National Security and Investment Act allows the government to scrutinise foreign takeovers of key suppliers, but it does not address the underlying imbalance.

Furthermore, the just‑in‑time model that keeps costs low for the NHS is also its greatest vulnerability. Hospitals and pharmacies operate with minimal stockpiles, relying on rapid replenishment from a network of distributors. When a single factory in India or China shuts down – as happened with the Covid outbreak in 2020 and the more recent contamination scandals in Chinese heparin plants – the ripple effects are felt within days in British wards. The NHS, already under immense financial pressure, cannot afford to maintain large inventories, and private wholesalers have no incentive to do so. This leaves the entire system precariously balanced on a knife‑edge.

**Fontes**

This analysis is based on publicly available data and reports from the Department of Health and Social Care, the British Generic Manufacturers Association, the House of Commons Health and Social Care Committee, and independent studies published by the Centre for Global Development and the Nuffield Trust. No internal FORTIS NEWS sources were used.