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On June 25th, 2020 Tucker Carlson claimed during his show:

The most powerful nation on earth no longer makes antibiotics.

He's obviously referring to the USA. Is the USA no longer manufacturing antibiotics? And is that absolutely true or just the domestic production is very low compared to imports?

According to a 2017 Bloomberg piece

Are U.S. drugs made abroad?

For the most part, no. About 75 percent of U.S. spending on drugs is for products that are manufactured domestically.

That does not include the raw ingredients though, which may be imported, nor does that article break it down by drug type. Antibiotics are generally not very favored by manufacturers because of the low profits involved, so maybe Calrson is correct on that category.

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    For those wondering if he meant that the US is no longer developing new antibiotics: I don’t think that’s what was meant, instead he’s talking about literally manufacturing known antibiotics. – Andrew Grimm Jun 28 at 12:08
  • Are you after drugs or antiobiotics? An antibiotic is a drug, but a drug is not necessarily an antibiotic. I tried answering both, but if only drugs, then the most reliable answer would be the 2019 FDA statistic that only 28% of drugs are manufactured in the US. – Charlie Crown Jun 29 at 17:30
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    @CharlieCrown Carlson explicitly says "antibiotics". Whether that's an intentional distinction is impossible to say. Some people are in the habit of calling all drugs "antibiotics". Unfortunately, precision in speech is not really a goal in this pundit shows. – fredsbend Jun 29 at 23:15
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    That "75% of US spending" is potentially very misleading. Most of the drugs people take are low value and out of patent (e.g. aspirin) and that probably includes most of these antibiotics. As a result manufacturing tends to happen in the cheapest possible place, which often means abroad. However some drugs cost vastly more drugs.com/slideshow/top-10-most-expensive-drugs-1274# , and these are much more likely to be made in America. This skews the statistics. If you measure it per tablet the proportion made in the USA is going to be much lower. – Paul Johnson Jun 30 at 7:45
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Yes and No... mostly yes, most manufacturing sites are outside the US.

Pharmaceutical drugs in general

Looking first at pharmaceutical drugs in general there is the FDA Safeguarding Pharmaceutical Supply Chains in a Global Economy from October 30, 2019.

To quote:

The United States, through its investment in biomedical research, has become a world leader in drug discovery and development, but is no longer in the forefront of drug manufacturing. Historically, the production of medicines for the U.S. population has been domestically based. However, in recent decades, drug manufacturing has gradually moved out of the United States. This is particularly true for manufacturers of active pharmaceutical ingredients (APIs), the actual drugs that are then formulated into tablets, capsules, injections, etc. As of August 2019, only 28 percent of the manufacturing facilities making APIs to supply the U.S. market were in our country. By contrast, the remaining 72 percent of the API manufacturers supplying the U.S. market were overseas, and 13 percent are in China. (See Figure 1) FDA’s data show that the number of registered facilities making APIs in China more than doubled between 2010 and 2019.

and here is an image they show

enter image description here

According to the above congressional testimony, 28% of manufacturing is currently done in the US, but manufacturing is trending towards other countries doing the manufacturing.

Antibiotic drugs specifically

This is a bit harder to find good sources.

According to drugs.com the 10 most common Generic Antibiotics are

  1. Amoxicillin
  2. Doxycycline
  3. Cephalexin
  4. Ciprofloxacin
  5. Clindamycin
  6. Metronidazole
  7. Azithromycin
  8. Sulfamethoxazole
  9. Amoxicillin and clavulanate
  10. Levofloxacin

The following section is to provide references, I have not fleshed them out. I will try when I have some more time.

In regards to Amoxicillin: drugbank.ca Manufacturers Not Available

This paper from 2015 compares quality of Amoxicillin purchased in different locations, that were originally manufactured in 6 countries (China, Ghana, India, Ireland, Nigeria, and the United Kingdom). It is striking that despite 1.34 billion prescriptions being dispensed in the US, no manufactures from the US were tested - this leads me to thinking there is no manufacturing of Amoxicillin in the US.

In regards to Doxycycline: drugbank.ca lists 35 manufacturers.

In regards to Cephalexin drugbank.ca lists 20 manufacturers.

In regards to Ciprofloxacin drugbank.ca lists 39 manufacturers

In regards to Clindamycin drugbank.ca lists Manufacturers as Not Available

In regards to Metronidazole drugbank.ca lists 33 manufacturers

In regards to Azithromycin drugbank.ca lists 17 manufacturers

In regards to Sulfamethoxazole drugbank.ca lists 7 manufacturers

In regards to Amoxicillin and clavulanate Not found on drugbank.ca

In regards to Levofloxacin drugbank.ca Manufacturers Not Available

Where does big pharma manufacture

There are several companies that seem to make almost all of these antibiotics, namely Pfizer, Pliva, Teva pharmaceuticals and Mylan pharmaceuticals.

Pfizer claims to have some US manufacturing, however the website does not list any pfizer manufacturing plants.

Pliva appears to be Croatian and since their website is not English, I will conjecture this means they have no sites in the US.

Teva says this on their FAQ about Where are Teva products made

A. As the largest generic manufacturer in the world, Teva is able to offer more generic prescription medications than any other company. In fact, one out of every eight generic prescriptions in the United States is filled with a Teva product!2 We use approximately 30 different Teva facilities to manufacture our products. Many of our products are made in North America and by our parent company in Israel.3 The FDA inspects each of our facilities (inside and outside of the United States) to ensure our products meet the same FDA standards of good manufacturing practices as brand-name medications.

Mylan This Bloomsberg article shows pictures of manufacturing facilities in India and says

Mylan is the world’s second-largest manufacturer of generic drugs, and though it’s run from Canonsburg, Pennsylvania, its operations three hours inland from Mumbai exemplify the central role India has come to play in the global generic-drug industry.

Proof that some manufacture occurs in the US

If we look at the antibiotic drug azithromycin (generic name for the Zithromax name brand made by Pfizer), which was developed outside of the US in the 1980's but whose patent expired in 2005, meaning there are now generic drugs available from companies other than Pfizer, we see some have manufacturing facilities in the US.

Generic companies making suspension/oral doses azithromycin (zithromax):

  1. Amneal Pharms LLC, Headquarters: New Jersey, US. They have manufacturing facilities located in New York, New Jersey, California, as well as 4 in India amneal.com manufacturing
  2. Aurobindo Pharma LTD: Headquarters: Hyderabad, India. Marketing partners are AstraZeneca and Pfizer (Pfizer is the original patent holder of azithromycin).
  3. Epic Pharma LLC: Headquarters: Laurelton, New York. Operates a 100,000 square foot facility, which appears to be the Sandoz facility located also in Laurelton, NY. Also, they are looking for a chemist to work there right now.
  4. Pliva: Headquarters: Zagreb, Croatia (known being one of the largest producers of Adderall). Manufacturing facilites are located: (website is not in English, will assume in Croatia)
  5. Zydus Headquarters: Originally India, but has a US headquarters in New Jersey. Manufacturing facilities: Have manufacturing sites in both India and the US. I cannot tell which specific ones make antibiotics from their website.

The 5 above fall into the suspension/oral category. The list of manufacturers for the injectable generic drug is significantly longer.

Conclusions

It is not true that no drugs (antibiotics) are made in the US, however there is a very clear trend that drug manufacture is moving outside of the US. A lot of manufacturing is done in China and especially India. Drugs as a overarching umbrella are only 28% manufactured in the US. Antibiotics statistics are not as readily available as general "drugs" but there are clearly manufacturing done in the US, but it is rare that a company only manufacturers in the US.

From my research, companies seem quick to say they have a site in the US, but it is difficult to get information about what actually happens at the site. This seems to me anyways to give off the appearance of having "token" sites in the US for looks, while producing elsewhere, such as India, which is a common drug manufacture location.

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  • Much better. Good work, and thank you for contributing. – fredsbend Jun 29 at 4:57
  • Ok, so is there a simple example of an antibiotic that is manufactured in the US? Your answer seems to consists of examples that aren't manufactured in the US. – Fizz Jun 29 at 13:43
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    A caveat with the FDA statistic of 28% which I show at the start is that 28% of facilities does not necessarily mean 28% of produced goods. It could be that the sites in the US produce orders of magnitude less/more than the facilities overseas. – Charlie Crown Jun 29 at 18:25
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    @PaulJohnson I agree, they are very coy on their websites as well. It is very hard to actually tell what is going on. Not only that, but a 1000 sq foot facility counts as 1 facility, just as a 1,000,000 sq foot facility counts as 1 facility. – Charlie Crown Jun 30 at 7:49
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    That first quote has some terrible writing: "28% were in the US; by contrast, 72% were not in the US". That's not a contrast, that's just saying the same thing twice! As you point out in the comment, it's not really clear whether "percentage of manufacturing sites" is a useful measure; if 20 US factories are consolidated into one larger factory with higher output, it would show as a reduction in US percentage, and the doubling in China could be the result of a policy of decentralisation rather than a shift in market share. – IMSoP Jul 11 at 15:14

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