How does China's dominance in amoxicillin supply chains affect global markets?

How does China's dominance in amoxicillin supply chains affect global markets?
China controls roughly 60% of global amoxicillin capacity, a position built on upstream integration. The critical intermediate 7-APA is almost entirely produced by Chinese firms, and 6-APA supply is likewise concentrated domestically. This leverage extends beyond amoxicillin: lidocaine, propofol and other anesthetics rely on Chinese intermediates, with China supplying over 65% of global API capacity for lidocaine and about 30% of all APIs. Japan's 2024 attempt to localize production, backed by 55 billion yen, failed to reduce imports, which still totaled $122.48 million that year. India, often cited as an alternative source, imports 90% of its amoxicillin precursors from China, meaning US efforts to shift orders from China to India merely lengthen the supply chain without changing the ultimate origin. Any disruption at Chinese plants—whether environmental shutdowns or export controls—ripples through global antibiotic availability within weeks.