China's control of the base ingredients to make medicines gives the Asian giant leverage over the production of a coronavirus vaccine no matter who wins the global race to discover it.
A host of nations such as the United States, Britain, France and Australia - as well as Singapore and Malaysia - are desperately pursuing a vaccine for the Covid-19 disease, which has infected nearly six million people and killed more than 350,000 globally since it was discovered in the central Chinese city of Wuhan last December.
While there is no exact data on China's market share of the core components used in pharmaceuticals, New York-based bioethics research institute Hastings Centre's senior adviser Rosemary Gibson told The Straits Times that China controls about 80 per cent of global production of the raw materials and chemicals required to manufacture generic medicines.
This could give Beijing a crucial advantage even as tensions with Washington have intensified amid a blame game over the cause of the highly infectious disease that has put more than half of humanity into various levels of lockdown.
"That certainly gives you an advantage and a potential monopoly position over the manufacture of it," Ms Gibson said in an online briefing early yesterday by the Washington-based National Press Foundation (NPF).
She added that it was a huge problem for the US as, aside from a Covid-19 vaccine, the country "can't make antibiotics any more" for related respiratory illnesses like pneumonia and bronchitis.
"We depend on China largely for those core chemicals, as does the world," she said.
On paper, China has only 13 per cent of global manufacturing facilities for active pharmaceutical ingredients (API), which is less than half of America's share.
But according to US Senate Finance Committee chairman Chuck Grassley last year, 80 per cent of APIs used in drugs consumed by Americans are imported, largely from China and India.
Further upstream, China also holds a near-monopoly on thousands of key starting materials, such as chemical intermediates and ingredients from antibiotic fermentation plants and pigs.
The Asian superpower's pharmaceutical industry has benefited in the past from cornering the supply chain by increasing manufacturing capacity and by what Ms Gibson said were cartel-like practices such as price fixing.
The US stopped making penicillin antibiotics in 2004, with China winning a price war that Ms Gibson said was aided by government subsidies. China dominated over two-thirds of penicillin production in 2006 before prices more than doubled in 2007.
India may appear a viable alternative supplier, but even its huge generic drugs industry relies on China for 69 per cent of its raw materials.
But concerns over Beijing holding the world to ransom could be tempered by the inter-dependence in trade for healthcare goods used in fighting the coronavirus.
Senior trade policy analyst Sebastien Miroudot of the Organisation for Economic Cooperation and Development (OECD) said that during the pandemic, there have not been shortages in pharmaceuticals similar to those seen in goods such as protective gear, test kits, disinfectants and ventilators.
OECD data shows that no country in 2018 had more than 15 per cent of the global share of exports of these items. Singapore was 13th and Malaysia 17th behind global leader Germany.
"Indeed, while the United States and Germany tend to specialise in the production of medical devices, China and Malaysia are most specialised in producing protective garments," it said in a May 5 report that showed that the US and China were in the world's top four for both imports and exports of medical equipment needed during the coronavirus pandemic.
Mr Miroudot added during the NPF briefing that "countries are specialised in specific types of Covid-19 goods and depend on each other".
"The top exporter of face masks is China, but if we look at intubation kits, the top exporter is the US. If we look at surgical gloves, it is Malaysia. It is really a world of trade inter-dependencies," he said.