US Biotech Edge Holds as China Surges in Trials and Scale, New Survey Shows

SAN DIEGO — China now runs more clinical drug trials than the United States. Its share of early-stage drug development programs has climbed dramatically. Yet when senior American executives and academics size up the global biotech race, they still hand the overall lead to the US.

The findings come from a fresh poll by the Cure Innovation Index, an initiative tied to investment firm Deerfield Management. Presented here this week at the Biotechnology Innovation Organization’s annual gathering, the survey asked leaders to rank six key areas. China took clear first place in clinical development and supply chain. The US held advantages in technology transfer, access to capital, commercialization, and talent. Scientific discovery came out even.

Reuters first reported the results on June 22, 2026. Seema Kumar, CEO of Cure, captured the mood. “The U.S. is still leading, but confidence is eroding,” she said. “Most said they see China as an existential threat.”

Those words land with force. They reflect real shifts on the ground. Multinational drug companies have rushed to license Chinese molecules. Upfront payments can start as low as $80 million. The bet is that these assets can become blockbuster products. Costs in China run lower. Regulators move faster. Government support, critics argue, tilts the field.

Data back the perception. By 2024 the US share of early drug development programs had slipped to 37 percent from 48 percent in 2015. China’s portion jumped to more than 32 percent from just 8 percent, a Georgetown University study found. ICON plc’s 2025 China biotech survey report goes further. It states outright that China has overtaken the US for new drug development and now drives 23 percent of the global innovative drug pipeline.

But volume tells only part of the story. Quality, intellectual property strength, and the ability to bring products to profitable markets still favor American companies. Kumar put it plainly. “China has speed, scale, manufacturing, development, execution. The U.S. is better at scientific quality, talent, some work on the tech transfer, and most important of all, it has access to the world’s most valuable healthcare market. Commercialization is America’s superpower. The buyer is in the U.S.”

The numbers support her point. The US captured 53 percent of the global pharmaceutical market in 2025, up from 49 percent in 2021, according to Iqvia. Europe held steady at 24 percent. Asia-Pacific slipped to 11 percent from 13 percent.

Concern inside the Beltway has grown louder. A December 2025 analysis from the National Security Commission on Emerging Biotechnology warned that China had built a vertically integrated biotechnology system positioned to challenge US leadership. The report, which followed the commission’s major April 2025 recommendations to Congress, described an inflection point. China is outpacing the US in certain biopharmaceutical innovation domains. Without swift policy moves, the damage to American security and economic strength could prove lasting.

Congress responded in part. Late last year President Donald Trump signed the Biosecure Act. It bars federal agencies from doing business with certain non-US biotechnology firms. The measure aims to reduce dependence on Chinese capabilities in critical areas.

Yet the Cure survey revealed something striking. Respondents worried less about Beijing’s advance than about potential cuts to US research funding. “The U.S. has all of the right ingredients, but the way we have been funding probably needs to change,” Kumar said. She pointed to the National Institutes of Health and the need to update clinical development rules untouched since the Bayh-Dole Act nearly 50 years ago.

The tension sits at the heart of today’s debate. America retains the ecosystem that turns discoveries into approved therapies and profitable enterprises. Venture capital still flows predominantly to US startups. Top scientific talent competes for spots in American labs and companies. But the infrastructure for running trials has not kept pace. Patient recruitment grows harder. Costs climb. Meanwhile China offers large, treatment-naive patient populations, centralized oversight, and rapid enrollment.

Industry leaders watch the licensing wave with mixed feelings. Chinese assets, particularly in antibody-drug conjugates and multispecific antibodies, drew heavy interest at this year’s JPMorgan Healthcare Conference. Some reports from January 2026 noted Chinese firms closing more deals than their US counterparts during the event. SynBioBeta called 2026 the year China surpassed the US in deal value and clinical output in certain categories.

Still, many US executives insist the gap in true breakthrough innovation remains wide. Early discovery tied in the Cure poll. Yet translating bench science into approvable drugs demands regulatory sophistication, manufacturing rigor, and payer acceptance. Those strengths cluster in the US. And they matter. A molecule that clears trials in China still must navigate the FDA and secure reimbursement from American insurers to achieve peak sales.

The picture grows more complicated when national security enters the frame. The NSCEB report from December 2025 urged Congress to treat biotechnology as a strategic domain on par with semiconductors or artificial intelligence. Bipartisan commissioners argued that dual-use potential in biotech — from advanced materials to synthetic biology — makes leadership a matter of military as well as economic primacy. Senator Todd Young, the commission chair, stated the US needs a clear strategy so that “America — not Beijing — leads.” Vice Chair Michelle Rozo added that the Chinese Communist Party leads in specific biopharma areas and that Washington requires a coordinated response.

Private sector voices echo parts of that alarm. A PwC analysis noted that one-third of molecules in-licensed by US pharma giants now originate from China, up from near zero in 2019. The trend reflects both opportunity and vulnerability. Companies gain access to novel chemistry and faster development timelines. They also increase exposure to supply chain risks, intellectual property disputes, and future regulatory decoupling.

Funding realities add pressure. US biotech still commands the lion’s share of global venture capital. Yet public research budgets face scrutiny. If Washington trims NIH support or fails to modernize clinical trial infrastructure, the very advantages that sustain American leadership could erode. Respondents in the Cure survey ranked that domestic risk above the competitive threat from China.

So the race stands in uneasy balance. China excels at execution at scale. It produces large numbers of scientific papers and PhDs. Its clinical trial apparatus runs at high velocity. The US retains primacy in turning ideas into products that patients and payers value. Commercialization muscle, deep capital markets, and an unmatched healthcare economy give it staying power.

But confidence is not what it was. The Cure poll shows erosion. The NSCEB analysis demands action. Industry leaders see both promise in Chinese science and peril in over-reliance. They want sustained federal commitment to basic research and smarter rules for clinical development.

Whether Washington delivers remains the open question. Biotech does not wait for policy. Molecules move forward. Capital allocates. Talent chooses laboratories. The next wave of therapies — in oncology, immunology, neurology — will reveal who truly leads. For now the US holds the edge. The margin, however, looks narrower than it did a decade ago. And the clock, many in San Diego this week agreed, is ticking.