AMERICA'S MEDICAL FRIENDSHORING SOLUTION
Establishing a Middle East Staging Ground for Collaboration
USIEA Fellows Chart a New Strategy for America’s Pharmaceutical Security
Two leading USIEA voices are helping shape the national conversation over one of America’s most consequential economic and national security challenges: the resilience of our pharmaceutical supply chain. In a new article published by the Journal of the Academy of Public Health, USIEA Senior Fellows Peter J. Pitts, a former FDA Associate Commissioner, and Cathy McMorris Rodgers, former Chair of the House Energy and Commerce Committee, argue that protecting Americans from critical drug shortages requires looking beyond simply bringing manufacturing back to the United States. They call for a comprehensive national resilience strategy built around advanced manufacturing, stronger supply-chain visibility and diversified partnerships with trusted allies. Significantly, they point to the Abraham Accords as a model for how the United States and its partners can combine their scientific, regulatory, and manufacturing strengths to build a more secure pharmaceutical network. Read an excerpt below, followed by a link to the full article.
Drug shortages rarely begin with a single failure. By the time a medicine disappears from hospital shelves, the immediate trigger (a contaminated line, a delayed shipment, a hurricane, or an unexpected demand surge) is usually identifiable. The more important question is why the system had so little capacity to absorb the shock. FDA's shortage program documents the recurring operational manifestations, while broader analyses have traced shortages to market concentration, quality problems, weak incentives for redundancy, and limited visibility across supply networks. The policy challenge is therefore not simply to respond faster when a shortage occurs. It is to design a pharmaceutical enterprise that can continue delivering medicines when events unfold differently than expected.
For decades, pharmaceutical policy has centered on safety, effectiveness, and quality. Those principles remain foundational, but recent experience has added another practical objective: resilience. Resilience does not mean stockpiling every medicine or relocating every factory to the United States. It means maintaining enough diversification, quality, adaptability, information, and trusted capacity that a disruption at one node does not become a national patient-access crisis. The National Academies has framed resilience as a supply-chain capability rather than a synonym for domestic production, and the U.S. Pharmacopeia's Medicine Supply Map likewise emphasizes the importance of understanding where vulnerability and concentration reside.
That perspective changes the central policy question. The debate should not be reduced to whether manufacturing is domestic or foreign. A supply chain concentrated in one American region can be as fragile as one concentrated overseas. Geography matters, especially when geopolitical risk, transportation, or emergency access is involved, but concentration and substitutability matter more. The objective should be a network in which strategically important medicines can be produced through multiple reliable pathways and in which institutions can recognize stress before patients experience it.
WHAT IS FRIENDSHORING?
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Friendshoring is the practice of relocating supply chains to countries where the risk of disruption from political chaos and geopolitical tension is low.
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America's Medical Friendshoring Solution is intended to help relieve geopolitical tensions by promoting alternative globalization solutions. Economically speaking, it is meant to promote supply chain resiliency and avoid business disruptions.
- Bonnie Glick, formerly USAID's deputy administrator, introduced the concept of ally-shoring roughly one year into the COVID-19 pandemic. Shortly after, Treasury Secretary Janet Yellen was credited for coining the term friendshoring.
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According to a recent survey conducted by Forbes and Zogby Strategies, approximately half of U.S. CEOs whose companies depend on external manufacturing to produce and deliver their goods have plans to reshore operations in 2023.
WHAT IS USIEA'S ROLE IN AMERICA'S MEDICAL FRIENDSHORING SOLUTION?
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The impetus behind America's Medical Friendshoring Solution was borne out of USIEA’s Congressional tour to Israel in August 2019 and has since gained favorable momentum among bipartisan members of Congress who are concerned about America’s overreliance on China.
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USIEA serves as an educational resource to bipartisan Congressional leaders about the recommended practical steps to establishing an FDA bureau in one of the Abraham Accord countries (Israel, UAE, Bahrain and Morocco).
WHY DOES THE U.S. NEED AMERICA'S MEDICAL FRIENDSHORING SOLUTION?
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The retail and technology industries have already made progress adapting to take on new and multiple suppliers; it’s imperative that America’s healthcare industry take a page from retail and tech’s playbooks.
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America is in an acutely vulnerable position relying so heavily on one supplier, and a disruption to America’s healthcare supply chain could lead to a potential national security crisis.
HOW IS AMERICA'S NATIONAL SECURITY AT RISK?
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As witnessed firsthand during the COVID-19 pandemic, relying primarily on one main supply source for critical life-saving medications, healthcare devices, and pharmaceuticals is extremely risky.
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American military troops and hospital resources are in most immediate need of these medical and pharmaceutical supplies. Relying on one main supply source places them and the American population in a vulnerable position that could lead to devastating shortages and skyrocketing costs if anything were to disrupt this fragile supply chain.
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China currently holds a manufacturing monopoly on American healthcare needs, including medical devices, pacemakers, saline solution, tubing, contrast agents and more.
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In 2019, China was responsible for 95% of U.S. imports of ibuprofen, 91% of hydrocortisone, 70% of acetaminophen, 40–45% of penicillin, and 40% of U.S. imports of heparin.
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According to the Atlantic Council, since 2020, U.S. imports of Chinese pharmaceuticals (including packaged medicaments, vaccines, blood products, organic cultures, bandages, and various medical devices) have surged by 485 percent, from $2.1 billion in 2020 to $10.3 billion in 2022. This significant growth has more than doubled China’s share of US pharmaceutical imports, from under 2.5 percent of total US pharmaceutical imports in 2020 to more than 6 percent in the following years.
IS AMERICA'S MEDICAL FRIENDSHORING SOLUTION TIME SENSITIVE?
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Escalating tensions between the United States and China continue to place America in a vulnerable position as China remains the primary supplier of our essential medical and pharmaceutical goods.
WHO WILL AMERICA FRIENDSHORE WITH?
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Thanks to the 2020 Abraham Accords agreement brokered by the U.S., peace, economic growth, and medical innovation have flourished among these strategic and amicable partners.
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The Abraham Accords countries – Israel, UAE, Bahrain and Morocco - offer an opportunity for the U.S. to diversify and fortify our essential medical and pharmaceutical supply chain, shifting our over-dependence away from China.
WHY ARE THE ABRAHAM ACCORDS COUNTRIES THE IDEAL PARTNERS?
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Israel is already a strong ally of America, and both Israel and the UAE are on the cutting edge of some of the world’s leading technology and healthcare solutions. They also boast robust biopharmaceutical industries that would greatly benefit the U.S.
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The UAE has already invested billions of dollars to attract, build, and expand both physical and intellectual infrastructure for medical technology development. According to a November 2021 report, the UAE intends to boost investments in the pharmaceutical industry by 20% and widen its export reach in the region.
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Morocco is also well suited because of its strategic location, price competitiveness, and developed infrastructure compared to the rest of Africa. Firms from Europe, Asia-Pacific, and the United States are already investing millions of dollars in bolstering and expanding their clinical trial programs and drug production facilities in Morocco.
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Projections indicate the pharmaceutical sector in the UAE will reach a value of $4.7 billion by 2025. This increase is underscored by a notable rise in local production facilities, from just four in 2010 to 23 in 2021, which now contribute to over 2,500 locally produced medicines.
IS THERE ANY LEGISLATION ON THE TOPIC OF FRIENDSHORING?
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The United States-Abraham Accords Cooperation and Security Act of 2024 (H.R. 7155) was introduced in the House of Representatives on January 31, 2024.
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USIEA has been educating bipartisan members of Congress on this issue since 2019 and has made great strides in building relationships and earning their support for this proposed legislation.
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This act will authorize the establishment of an FDA bureau in the Abraham Accords region to:
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Create a staging ground for the United States to friend-shore to the Abraham Accords countries.
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Secure critical pharmaceutical supply chains and support improved public health solutions.
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Shift America’s medical supply chain dependence away from adversarial countries to more amicable and strategic allies.
WHY IS AN FDA BUREAU IN THE MIDDLE EAST NECESSARY?
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If an FDA bureau is established in one of the Abraham Accords countries, it will be strategically positioned to help the U.S. resolve its healthcare supply chain crisis.
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The creation of an FDA Abraham Accords bureau would accelerate research and development of new healthcare and biomedical technologies. The FDA’s regulatory advice would facilitate the USFDA review of clinical trials, scientific design, and provide advice pertinent to agency guidance documents and regulatory trends.
