India, April 17 -- The global pharmaceutical industry rests on an uncomfortable paradox. The world has never been more dependent on medicines and yet the supply chains that sustain them have rarely been more fragile.

At one level, the numbers are reassuring. The global Active Pharmaceutical Ingredients (API) market today sits somewhere between $150 billion and $250 billion depending on how one defines its boundaries and it continues to grow steadily, powered by ageing populations, chronic diseases and the expansion of healthcare access. This is not a declining industry. It is foundational to modern life.

But beneath that growth lies a structural concentration that should worry policymakers.

China today sits at the centre of the global ...