Tanker traffic through the Strait of Hormuz reached 114 transits during the week of Aug. 17, up from 80 the week before. Richard Meade, editor-in-chief of Lloyd’s List, told USNI News that shipping is still operating “under crisis conditions rather than anything approaching a return to normality.”
The distance between recovering and recovered is where the pharmaceutical industry now sits. Six months after the waterway effectively closed, the trade in medicines has become the clearest measure of how much of modern healthcare rides on a handful of chokepoints staying open.
Leen Kawas, chief executive of EIT Pharma and managing general partner of the Los Angeles biotechnology investment firm Propel Bio Partners, took up that subject this week during an appearance on Al Jazeera Media Network’s Economic News Bulletin. Medicines prescribed in the United States, she said, often depend on raw materials sourced in the Middle East and intermediate manufacturing performed across Asia. A prescription filled in Ohio can carry a supply history spanning three continents before it reaches the pharmacy counter.
A system with limited substitutes
India accounted for 48% of all active drug master file filings for active pharmaceutical ingredients in 2023, according to U.S. Pharmacopeia’s analysis of global manufacturing capacity. European Union countries held 17%, China 16%, and the United States 9%. American filers accounted for just 4% of new API filings that year, well under the 9% they already hold. Whole categories of chemistry have been consolidated into a handful of industrial corridors, and the shift happened gradually enough that few people outside procurement noticed.
That geography becomes a problem when the sea lanes serving it stop functioning. India shipped 4,922 tons of finished pharmaceuticals through Middle East sea routes in 2025, and Gulf Cooperation Council countries rely on imports moving through regional airspace and the strait itself for roughly 80% of their pharmaceutical supply. Both figures come from Prashant Yadav and Anya Hirschfeld, global health researchers who mapped the region’s exposure for the Council on Foreign Relations in March.
Their reporting draws one line worth keeping in view. The 32% of U.S. active pharmaceutical ingredient supply that came from India the year before travels mostly through the Red Sea, not Hormuz. The vulnerability is regional rather than concentrated at a single waterway. Air cargo rates from Asia to Europe rose 45% after the conflict began. Gulf air-cargo capacity fell 79%.
Kawas has spent her career on the science end of this business rather than the logistics end. She trained as a pharmacist at the University of Jordan before earning a doctorate and moving into drug development. Her firm now backs early-stage biotechnology companies, many of them founded by women and minority entrepreneurs. She has seen both ends of the distance between a promising molecule and a patient who can actually obtain it.
When inventory protection fades
Pharmaceutical companies carry deep buffers. The same Council on Foreign Relations analysis notes that manufacturers hold roughly 180 days of finished-goods inventory on average, EU member states mandate essential-medicines stockpiles covering two to six months, and distributors sit on another 25 to 30 days of stock. The first months of disruption were absorbed largely out of public view.
They are finite. Pharmaceutical Commerce reported in June that sustained disruption would take four to six weeks to reach consumers as visible generic drug shortages, a short window given that 47% of U.S. generic prescriptions and 15% of biosimilar volume come from India. A shortfall of that kind would surface first in routine maintenance prescriptions, blood pressure regimens and antibiotics among them, rather than in specialty therapies.
Leen Kawas has argued that resilience “isn’t a luxury” but rather “the foundation of every promise we make to patients.” A therapy that cannot be manufactured and delivered on schedule is, from the patient’s perspective, a therapy that does not exist.
On how that exposure registers inside a company, Kawas said:
At the company level, supply-chain fragility is rarely experienced as an abstract geopolitical issue. It appears as a delayed input, a constrained manufacturing slot, a difficult sourcing decision, or a question of whether a patient-facing timeline can still be protected. The lesson is that resilience must be designed into development and manufacturing strategy before a disruption occurs.
From dependence to infrastructure
Leen sees the crisis as an opening to build more durable capacity rather than merely a warning about what can go wrong. The most practical response starts with reducing unnecessary concentration.
That includes:
- Building regional manufacturing hubs in the United States and in the Middle East and North Africa.
- Diversifying API and intermediate-material sourcing rather than relying on a single country, route, or supplier.
- Developing public-private partnerships that combine government planning, long-duration capital, and biotechnology expertise.
- Applying real-time analytics and artificial intelligence to identify supply vulnerabilities before they become shortages.
- Investing in local scientific talent, research infrastructure, and manufacturing capability so the region can progress from medicine consumer to medicine creator.
The Gulf already has incentives to act. The region combines substantial reliance on imported medicines with long-term national strategies to expand life sciences, clinical research, local manufacturing, and health-care infrastructure. At the same time, its pools of sovereign capital are better suited than many public-market manufacturers to finance facilities whose strategic value may exceed their near-term operating margin.
Some of that capital has already moved. Lupin is putting $250 million into a new production facility in Coral Springs, Florida. Across the Gulf, BioSpace counted roughly 400 life-science transactions between 2021 and April 2025, with 92% concentrated in the United Arab Emirates and Saudi Arabia.
Building domestic or regional API, fill-finish, and advanced-therapy capacity will not make every supply chain local. Nor should it. The goal is not autarky; it is redundancy, visibility, and the ability to respond when a major route or supplier fails.
Anticipating disruption rather than absorbing it
Analytics is the item on that list with the shortest path to implementation. Pharmaceutical procurement has historically run on quarterly forecasts and confirmed purchase orders, a cadence that assumes the shipping lanes behave predictably. Systems that ingest vessel-tracking data, port congestion figures, and single-source supplier concentration can flag a vulnerability while alternatives remain available rather than after a shipment has already been rerouted.
Kawas has written extensively about artificial intelligence in drug development, where computational methods have compressed discovery timelines and improved trial design. The same tooling points straight at logistics, and the industry has been slow to turn it there. Forecasting tools built for demand planning were never meant to watch a shipping lane. The obstacle has been organizational rather than technical: supply chain teams rarely sit close enough to R&D to inherit its analytics culture.
From buyer to builder
The move from medicine consumer to medicine creator is the most ambitious item on that list, and the slowest to deliver. Gulf states importing about 80% of their pharmaceutical supply have a plain incentive to build the scientific workforce and institutional base for originating therapies of their own. That capacity takes a decade or more to assemble. It tends to lose funding arguments to projects with faster returns.
On what has to come first, Kawas said:
Moving from consumer to creator begins with people: scientists, clinicians, entrepreneurs, and operators who can build enduring institutions. Capital and facilities matter, but the honest obstacle is that research ecosystems take years to compound; they cannot be assembled through a single investment announcement or a short-term policy cycle.
Leen Kawas comes to that argument from both sides of the map. She grew up in Amman, trained in Jordan, and built her career in American biotechnology, and her published commentary has returned repeatedly to the gap between what the science can do and what patients actually receive. The chemistry behind the medicines stuck outside the Strait of Hormuz was never the constraint.
The industry has absorbed shocks before and returned to the cheapest available sourcing once conditions allowed. This time the arithmetic landed in front of finance committees and health ministries at once, and the region with the deepest reserves of patient capital turns out to be the one with the most exposure to fix. Leen Kawas has cast the next chapter of biotechnology as the work of companies and countries that convert current disruption into permanent infrastructure. Transit counts through Hormuz are climbing again, and the facilities going up in Coral Springs and across the Gulf will still be standing when they do.
Editor’s Note: The opinions expressed here by the authors are their own, not those of Impakter.com
