With more than 270 ongoing drug shortages and increasing global instability, the United States needs to safeguard itself against a deteriorating crisis in cancer treatment. The tenuous supply of generic chemotherapy medications such as cisplatin, crucial for managing bladder, lung, and testicular cancers, could falter if geopolitical conflicts escalate between India and Pakistan. To sustain this dwindling supply, the U.S. must curtail its excessive dependence on Indian pharmaceutical production and diversify its sourcing to prevent inevitable patient distress.
The U.S. dependence on Indian drug manufacturers
The U.S. allocates only around twenty percent of overall prescription spending on generics primarily produced in countries like India. Nonetheless, these medications constitute over ninety percent of prescriptions. Our heavy reliance on these low-cost generics renders our pharmaceutical supply chain exceedingly susceptible to disruptions like geopolitical conflicts between India and Pakistan.
Drug shortages in the U.S. are not unprecedented, yet they are increasingly perilous. These shortages can delay treatment, elevate costs, lead to medication errors, and compel patients to use unfamiliar alternatives. Generic chemotherapy drugs are particularly at risk. So, why don’t we just manufacture generics in the U.S.? In 2019, the CEO of Teva Pharmaceuticals remarked, “Nobody is making money on generics in the U.S.” Manufacturers confront razor-thin profit margins, elevated labor expenses, and regulatory burdens. Competing with India’s low prices is nearly unfeasible without substantial government backing. Consequently, U.S. companies have minimal motivation to produce drugs like cisplatin domestically, despite their crucial role in patient care.
To maintain profitability, many pharmaceutical companies outsource production to nations with lower labor and operational expenses. Indian manufacturers take advantage of economies of scale, with hubs in cities like Hyderabad enabling high-volume production and efficient processes that lower per-unit costs. This specialization has rendered India vital to the global drug supply, yet perilously central to U.S. pharmaceutical stability.
Current political instability in India and its potential impacts
Tensions between India and Pakistan extend back to 1947, when the division of British India created two separate nations: India, predominantly Hindu, and Pakistan, predominantly Muslim. Disputes over the culturally and strategically crucial region of Jammu and Kashmir have prompted numerous conflicts, notably in 1965 and 1971, further exacerbated by the addition of nuclear capabilities to both nations’ arsenals. The most recent flashpoint occurred on April 22, 2025, when militants killed twenty-five Indian citizens and one Nepalese tourist in Kashmir. Following the assault, trade routes have contracted, border tensions have surged, and diplomatic relations have deteriorated.
While we can only speculate on the ramifications of political instability on supply trade, history has demonstrated the impact of trade disruptions. In 2023, Intas Pharmaceuticals halted cisplatin production at its facility in Western India. With merely four major global producers of the drug, U.S. oncologists rushed to locate alternatives. The shortage underscored the fragility of the system and how swiftly it can disintegrate.
When political instability interferes with trade, pharmaceutical supply chains are affected, ultimately impacting U.S. consumers. Manufacturing priorities may shift inward, with nations concentrating on domestic demands during periods of conflict. This nationalism can lead to export limitations or tariffs on essential drugs. Although aimed at stabilizing a local economy or asserting political influence, these policies can unintentionally cripple the global supply chain for critical medications like cisplatin. The U.S., significantly reliant on imports of generic cancer drugs, particularly from India, becomes a collateral casualty of conflict occurring thousands of miles away.
Consequences and solutions for supply trade disruptions
The repercussions of this inaction are evident. Drug shortages continue to remain alarmingly high, and the tension between India and Pakistan shows no indication of easing. A 2023 study published in the European Journal of Operational Research projected how export bans could result in global shortages. The conclusions were unambiguous: pharmaceutical companies that prepared in advance were better positioned to mitigate supply chain risks. Governments that bolstered domestic capabilities could cushion the impact. The most efficient strategy involved employing multiple factors like regulation, trade policy, supply and demand, manufacturing capacity, and geopolitical risk within an all-encompassing preparedness framework.
The U.S. cannot afford to consider global drug supply chains as stable or resilient. With emerging political and military hazards escalating in South Asia, especially between India and Pakistan, America must regard access to cisplatin and other generic cancer drugs as a national security concern. We must take action now to ensure patient protection in the future.
Adwait Chafale is a medical student.