Tracking shifts in competitiveness: from scientific capability to medicine availability

Abstract Current United States pricing reforms have renewed debate about whether policies intended to improve medicine affordability may also influence pharmaceutical investment and development. We examine indicators of scientific capability, commercial conditions, regulatory performance, pharmaceutical research and development investment, and medicine availability across China, Europe, Japan, and the United States, using public and industry-derived sources. Pharmaceutical research investment grew rapidly in China and the United States but remained broadly stable in Japan. Between 2018 and 2023, commercial clinical-trial starts in China increased from 727 to 1,412, a cumulative increase of 94.2%. Trial starts increased from 472 to 546 in Japan but declined from 1,850 to 1,719 in the United States and from 1,253 to 920 in the European Economic Area. Among 460 medicines launched globally during 2012–2021, reported availability was 85% in the United States, 51% in Japan, 39% on average across European countries, and 24% in China. These patterns indicate shifts in relative pharmaceutical competitiveness but do not identify their causes or estimate the effects of individual policies. Evaluations of United States pricing reforms should consider government and patient savings alongside potential changes in investment, clinical development, launch decisions, and medicine availability.