Ara Darzi – surgeon, Labour peer and author of the 2024 review of the NHS – has written in the Financial Times that the West has handed China “the keys to the medicine cabinet”, warning of the “peacetime weaponisation” of pharmaceutical supply chains. China supplies around 94 percent of the key raw materials for amoxicillin and nearly half of global antibiotic ingredient exports.
The following article by Carlos Martinez takes the sinophobic framing apart. China has never withheld medicine from anyone, while the United States is currently obstructing medical supplies to Cuba, Iran and Venezuela, and held up ventilator and PPE shipments during a pandemic. However, what Darzi concedes along the way is of interest.
Darzi’s own diagnosis is that antibiotics are a permanent market failure: a drug whose value rises the less it is used cannot recoup its research costs, so Novartis, AstraZeneca and Sanofi have all quit the field, and the company that brought a new antibiotic to market in 2018 was bankrupt within a year. As former British Chief Medical Officer Sally Davies put it, a medicine that cures you in a week is a worse business proposition than one you must take for life. Meanwhile some 4.71 million deaths were associated with antibacterial resistance in 2021, with the heaviest burden falling on South and Southeast Asia and sub-Saharan Africa – precisely where the market is least likely to step in.
Darzi’s conclusion is that antibiotics should be treated not as a commodity but as critical infrastructure, planned and publicly supported. The article agrees, and observes that when China applies exactly that logic – to antibiotics, solar panels, batteries, electric vehicles, high-speed rail or semiconductors – it is denounced as overcapacity and distortion, and met with tariffs. Darzi has written a very persuasive argument for socialism, and appears not to have noticed.
Ara Darzi – surgeon, Labour peer, author of the 2024 review of the NHS – has written a recent op-ed for the Financial Times, under the headline “The west has given China the keys to the medicine cabinet”.
The framing is the usual anti-China rhetoric: China supplies around 94 percent of the key raw materials for amoxicillin and nearly half of global antibiotic ingredient exports; some 700 medicines approved in the US depend on at least one chemical made only in China; a Council on Foreign Relations report calls this a threat equal to the rare earths challenge, with potential for “peacetime weaponisation”.
Darzi’s concern echoes that of the US House Select Committee on the CCP, which recently held a hearing titled “From the Science Lab to the Medicine Cabinet: How China is Cornering the Market on Our Medicines”. A British peer writing in a British newspaper is recycling the talking points of a US congressional committee established for the express purpose of manufacturing hostility towards China.
This notion of weaponisation is some combination of profound paranoia and cynical slander. China has never withheld medicine from anyone. The country that actually weaponises medical supply chains is the one currently blocking Cuba’s access to medical equipment and obstructing insulin and cancer drugs reaching Iran and Venezuela; the one that held up ventilator and PPE shipments during a pandemic. Projection remains the governing principle of Western commentary on China.
An admission dressed as a warning
However, setting the sinophobia aside, the substance of Darzi’s article inadvertently dismantles the Western case against Chinese industrial policy.
His diagnosis is that antibiotics will always be a market failure. An antibiotic is that rare product whose value rises the less it is used: the best new ones must be held in reserve to preserve their potency, which means minimal sales and no way to recoup research costs. As a result, Western drug companies have simply deserted the scene. Novartis, AstraZeneca and Sanofi all exited antibiotic research. Achaogen brought a new antibiotic to market in 2018 and was bankrupt within a year – the reward for solving a public health problem was liquidation. The money went to anti-obesity drugs, where the returns are better. The World Health Organisation (WHO) now counts fewer than a dozen genuinely innovative antibiotics in the global pipeline.
Darzi is not the first establishment figure to highlight this issue. In her 2013 book The Drugs Don’t Work, Sally Davies – then Chief Medical Officer for England – set out the arithmetic plainly: no new class of antibacterial has been discovered since 1987, it costs over £1 billion to bring a medicine to market, and “the return on investment is likely to be much higher for other therapeutic areas, such as cancer, arthritis, diabetes and other chronic diseases”, because treatment for a chronic disease “can last for months or years – as opposed to relatively short courses for antimicrobials”.
The uncomfortable fact is that a drug that cures you in a week is a worse business proposition than a drug you have to take for the rest of your life. This is not a distortion of the market; it is capitalism working exactly as designed, allocating human ingenuity according to the duration of the revenue stream rather than the urgency of the need. It is the reflection of an economic system oriented to the production of exchange values rather than use values.
The public health consequences are not merely hypothetical. There were 4.71 million deaths associated with bacterial resistance in 2021, and the Lancet’s Global Research on Antimicrobial Resistance (GRAM) project forecasts more than 39 million deaths attributable to resistant infections between 2025 and 2050, rising to some 1.91 million a year by mid-century. The heaviest burden falls on South and Southeast Asia and sub-Saharan Africa.
Which is to say: the burden falls hardest precisely where the market is least likely to step in. The history of malaria treatment is instructive: Davies observes that at the turn of the century the antimalarial pipeline was empty and old drugs were failing, but “it made no commercial sense for drug companies to invest in new drugs since malaria is a disease most common in the world’s poorest countries, whose citizens would not be able to afford the medication”.
The eventual solution was the Medicines for Malaria Venture, established by several governments and working “like a non-profit pharmaceutical company” in a rare departure from the neoliberal consensus. It had delivered more than 171 million treatments by the end of 2012.
Thankfully China is still manufacturing antibiotics
The West is dependent on China for antibiotics not because anyone cheated, but because Western capital did precisely what capital does: it went where it could make a quick buck, and it declined to manufacture something humanity cannot live without, because keeping people alive turns out to be unprofitable. Darzi points out that amoxicillin is so cheap there is little incentive to make it. Chinese companies are making it anyway, and apparently this makes them a threat.
Nor is China merely producing the cheap generics that others have abandoned. Chinese researchers have built an AI platform that screens genomic data for new antimicrobial compounds, and they are sharing it. A researcher at Egypt’s National Research Centre has identified more than 30 promising antibiotic leads; screening and validation work that “used to take two years”, she reports, “can now be completed in a few months”.
A persuasive argument for socialism
Darzi concludes that antibiotics are not a commodity to be sourced at the cheapest price, but critical infrastructure, and should be treated that way. Absolutely. And the same case can and should be made for solar panels, batteries, electric vehicles, high-speed rail and semiconductors. The things a society actually needs should be planned and publicly supported rather than surrendered to whoever can extract the highest margin.
When Beijing does this, it’s called overcapacity, distortion and non-market practice, and it’s met with tariffs. But it seems it’s fine for Western countries to spend billions of pounds of public money bombing Iran. The capitalist system is incapable of spending public money on a public good unless a private rent is attached to it, or unless it’s connected to the sustenance and expansion of imperialist hegemony.
As Davies points out, the great collapse in deaths from infectious disease in the industrialised countries largely predated antibiotics: more than half of it had occurred before 1931, and the main causes were better nutrition, improved sanitation and less crowded housing. The biggest gains in human health in modern history came not from products sold at a profit but from public works, public health and public housing – from precisely the kind of collective provision that half a century of neoliberalism has been dedicated to dismantling.
Darzi has written a very persuasive argument for socialism, and appears not to have noticed.
