Why is penicillin still in short supply in Japan during peacetime?

I think World War III is unlikely to break out—perhaps because the global active pharmaceutical ingredient (API) supply chain is overly dependent on China. What does 'overly dependent' mean? What percentage does it represent? The lifeline of the penicillin-class antibiotic supply chain is a key precursor called 6-aminopenicillanic acid (6-APA). China currently controls approximately 90% of global 6-APA production capacity. Additional data indicate that China’s share rises to as high as 94% when considering a broader range of related molecules. Among EU and NATO countries, only Sandoz’s Kundl plant in Austria remains capable of fermenting 6-APA—and its share accounts for merely about 8%. Between 2020 and 2024, China supplied 62.6% of the total volume of antibiotic APIs imported by the United States. Roughly 45% of U.S. penicillin imports came directly from Chinese manufacturing facilities. The United States Pharmacopeia (USP) found that nearly 700 approved drugs rely on at least one chemical raw material produced exclusively in China. A Brookings Institution study noted that nearly 41% of the upstream critical starting materials used in U.S. pharmaceuticals are sourced entirely from China.

China is the only country with a complete industrial chain. If war breaks out, how much advantage would such a full industrial chain confer?

Let’s use an analogy: recently trending online is ‘Syphilis Day.’ Japan doesn’t actually lack penicillin. Seventy percent of penicillin sold on the Japanese market is manufactured in Indonesia—of which 95.5% of the precursor material originates from China. Fifteen percent of finished penicillin sold in Japan is directly produced in China. Although Japan relies entirely (100%) on China for penicillin precursors, China has not—as some internet commentators jokingly suggested months ago—‘choked off Japan’s penicillin supply’ as a form of coercion. Japan’s current penicillin crisis stems not from geopolitical pressure, but from its own mismanagement: all penicillin used nationwide specifically for syphilis treatment was purchased exclusively from a single Pfizer factory—which collapsed 14 months ago and cut off supplies to Japan 11 months ago. Regrettably, current dependency on Chinese-produced penicillin APIs among the U.S., the EU, and India exceeds 97% across the board. Should war erupt, the impure or substandard finished drugs many netizens jokingly refer to as ‘Dongda brand’ could indeed leave wounded soldiers worldwide without access to antibiotics. In peacetime, major economies facing a complete cutoff would generally require around six months to restore even minimal supply levels—but in wartime, those six months could well be forever.

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