The rise of China and India, combined with protectionist pressure from the Trump administration, is redrawing the global map of the pharmaceutical industry. The Europe-wide deindustrialization that began in the 2000s is now accelerating.

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For example, in the production of active ingredients, Europe’s market share by value has slumped. While it exceeded 80% at the end of the 1990s, it had fallen to 48% by 2014. “Today, it’s closer to 30%, and it’s likely to drop further,” noted Vincent Touraille, president of SICOS, France’s union of players in the organic chemistry and biochemistry industries. Meanwhile, China and India have soared to reach respective market shares of 35% and 20%.

A study conducted by German generic drug industry association Pro Generika found that at least three commonly used antibiotics – doxycycline, clarithromycin and cefaclor – now have only one or two manufacturers left in Europe. More broadly, 80% of the active ingredients in medicines consumed on the continent now come from India or China.