A recent poll of senior leaders from U.S. industry and academia shows China has surpassed the United States in the sheer volume of clinical drug trials, yet respondents still view the U.S. as superior in several critical aspects of biotechnology innovation.
The Cure Innovation Index survey, presented on Monday at the Biotechnology Innovation Organization's annual meeting in San Diego, asked participants to assess where each country stands across six domains of biopharma activity. China emerged as the clear leader in two areas: clinical development and supply chain. The U.S. was rated ahead in three domains - technology transfer, capital and commercialization - and in talent. For scientific discovery, respondents judged the two nations to be on par.
Seema Kumar, CEO of Cure, an affiliate of investment firm Deerfield Management, summarized the tension in the responses: "The U.S. is still leading, but confidence is eroding. Most said they see China as an existential threat." Those remarks accompanied the presentation of the survey findings to a conference audience of industry stakeholders.
Survey participants pointed to several trends that help explain China's ascent in trial activity. Multinational drugmakers have increasingly incorporated development candidates that originated in China into their pipelines. Factors cited by industry observers include lower costs, more streamlined regulatory processes and government subsidies that some view as conferring an unfair competitive edge.
Quantifying the shift, a Georgetown University study referenced in the survey materials shows the U.S. share of early drug development programs declined to about 37% in 2024 from 48% in 2015, while China’s share climbed to over 32% from 8% over the same period. The study also noted growing licensing activity, with pharmaceutical companies increasingly taking rights to molecules from China and wagering that relatively modest upfront payments can be transformed into treatments worth billions.
Those developments have drawn attention from U.S. policymakers. The National Security Commission on Emerging Biotechnology warned in a December report that "China has systematically built a vertically integrated biotechnology ecosystem that is now in prime position to challenge U.S. leadership." Legislative action followed: the Biosecure Act, signed into law by President Donald Trump late last year, places limits on federal agencies’ business relationships with non-U.S. biotechnology firms.
Kumar distilled the comparative strengths identified by survey respondents: "China has speed, scale, manufacturing, development, execution, and the U.S. is better at scientific quality, talent, some work on the tech transfer, and most important of all, it has the access to the world’s most valuable healthcare market. Commercialization is America’s superpower. ... The buyer is in the U.S."
The market footprint underlines that point: Iqvia data cited in the survey shows the United States accounted for 53% of the global pharmaceutical market in 2025, up from 49% in 2021. Europe’s share was steady at 24%, while the Asia-Pacific region’s share decreased to 11% from 13%.
Beyond geopolitical competition, the Cure survey identified another major concern among respondents: domestic funding pressures. Many senior leaders ranked possible cuts to U.S. research financing as a greater threat than competition from China. Kumar argued that although the U.S. still possesses many of the essential ingredients for biotech leadership, the methods and levels of funding may need to evolve.
She urged renewed attention to financing at the National Institutes of Health and to modernization of the nation’s clinical development infrastructure, which remains rooted in frameworks established decades ago. The survey respondents’ views suggest industry leaders see both external competition and internal policy and funding choices as central to the future trajectory of U.S. biotech innovation.
Clear summary
The Cure Innovation Index survey finds China leads in clinical development and supply chain capability, while the U.S. maintains advantages in commercialization, capital, technology transfer and talent; respondents also flagged cuts to U.S. research funding and outdated clinical development infrastructure as key concerns.