By Kritika Agarwal
At a recent Council on Foreign Relations event on United States-China relations, Pfizer CEO Albert Bourla warned that “for the first time in history or in recent decades … U.S. dominance in biotech technology is [being] challenged by a competitor, and that’s China.”
Bourla noted that China has “done all the right things over decades in a long-term strategic plan” that now threatens to leave the United States behind in biomedical innovation. If the United States is to maintain its edge, he argued, the country must strengthen its biotech innovation ecosystem, including by investing in science and university research.
What the United States Did Right in the Past
Bourla reminded the audience that the United States was not always the leader in biotech innovation. In the 1980s and 1990s, he said, “it was all in Europe” – in fact, Pfizer’s main research center back then was in the United Kingdom. Things changed in the early 2000s, Bourla said, when Congress doubled the budget of the National Institutes of Health.
“That created a situation that they were giving a lot of grants to universities” to conduct basic research, he said. Those universities then would “discover something new and interesting” and “spin it off into a separate company” that could raise venture capital to pursue “highly risky opportunities.” Eventually, Bourla noted, big pharmaceutical companies would acquire the smaller companies and close the loop by manufacturing and selling the discoveries. “So, this is what created the whole thing,” he said.
Later in the conversation, Bourla pointed out that the majority of the costs for pharmaceutical companies are in research and development, not manufacturing. “The cost of our medicine, it is the R&D,” he noted.
Bourla added that strong investments in the NIH and university research in the United States were complemented by a “stellar regulator” in the form of the FDA, which could be counted on to make decisions only based on good science, as well as strong intellectual property protections.
“Meteoric Rise” in China’s Scientific Capabilities
In recent years, however, China has strategically built up its biotech innovation ecosystem through long-term national planning, regulatory reform, and enormous investment in university research and talent. For the first time in decades, the United States faces a serious rival in biomedical research – and the gap is narrowing fast.
Bourla noted that China has seen a “meteoric rise of their scientific capabilities.” He pointed out that eight of the top 10 global research institutions on the 2025 Nature Index, which tracks “contributions to research articles published in high-quality natural-science and health-science journals,” are now Chinese. Harvard University, in second place, is the only American institution in the top 10, Bourla noted. (China has invested heavily in their research institutions, which has led to them surging in global rankings; in the United States, meanwhile, investments in basic research at universities have grown more slowly.)
In addition, Bourla said that China has been working to repatriate scientific talent, while U.S. visa policies have made it harder to attract global talent. Similarly, they have worked to improve regulations, which have made it easier for hospitals to run studies or to use AI to design and execute studies, and they have strengthened their IP system.
“So, this is where we need to become better,” Bourla noted, adding: “They operate in a very different league.
How the United States Can Catch Up
Instead of taking actions aimed at slowing down Chinese innovation, the United States needs to step up its investments in innovation, Bourla argued. The U.S. needs to become better if we want to compete, he said.
“Our biggest problem … is that we are watching a superpower developing super scientific capabilities and our whole effort is how to slow them down rather than how to become better than them,” he said. “And the only way to be able not to lose the edge that we have … [is to make] changes inside our American economy ecosystem of biotech, of science, of academia, of pharmaceuticals, of capital markets,” he added.
The United States, Bourla said, must “create the incentives here that will accelerate the investments, which is exactly what [the] Chinese did.” Given recent news that China has officially surpassed the United States in R&D spending, Bourla’s warning that the United States is losing ground in biotech innovation is a stark one.
The United States built the world’s most innovative biomedical sector by treating federal research funding as a down payment on future prosperity. Slowing the pace of investment, now, as Bourla’s comments suggest, risks surrendering that advantage just as global competition is intensifying.
Kritika Agarwal is assistant vice president for communications at AAU.