This panel will present and discuss critical challenges for governance and policy, including how to secure regulatory oversight across borders, how national regulators can balance concerns of conservation and resistance with ensuring timely access, and how international cooperation can align standards for manufacturing, quality surveillance, and environmental controls to safeguard global antibiotic supply.
Programme
Moderator: Unni Gopinathan, Scientist, Norwegian Institute of Public Health
Introductory presentations (45 min)
- Antibiotics at the Crossroads: How the China–India Nexus Shapes Global Supply, Access, and Resistance. Lise Bjerke, PhD candidate, University of Osl, Mingyuan Zhang, postdoctoral fellow, University of Oslo.
- Pharmaceuticals: Global trade and the challenge from China and India. Emeritus Arne Melchior, Senior Scientist, Norwegian Institute of International Affairs.
- Regulation Under Pressure: Tanzania’s Experience Confronting Global Antibiotic Supply and Resistance Dynamics. Peter Mangesho, Social Science Researcher, National Institute for Medical Research, Tanzania (digital)
Panel discussion and questions from the audience (1h 15min)
- Representative with a Norwegian pharmaceutical policy perspective (TBC)
- Christine Årdal, senior advisor, Norwegian Institute of Public Health
- Maarten van der Heijden, lawyer & social scientist, London School of Hygiene and Tropical Medicine
- Arne Melchior, Senior Scientist, Norwegian Institute of International Affairs
The panel will address the following topics, in dialogue with each other and the audience:
- European collaboration to manage supply of life-saving antibiotics while also maintaining regulatory oversight and compliance with quality and environmental standards.
- Global governance and international collaboration to manage the access-conservation trade-off for antibiotics
- Implications for Norwegian pharmaceutical policy and preparedness
Background
Antibiotic production and supply are highly opaque, especially at the active pharmaceutical ingredient and intermediate levels. There has been significant global speculation regarding a reliance on highly concentrated supply chains, especially in specific geographic regions. Large emerging economies such as China and India play a central role, as they are the largest exporters of antibiotic active pharmaceutical ingredients (APIs). China’s share, for instance, rose from 9% in 2002 to about 44.5% in 2021, positioning the country at the core of the upstream segment of the antibiotic supply chain (Yang et al., 2024). Yet this is based largely on trade data measured in kilograms, which includes veterinary antibiotics. Animals consume an estimated 70% of all antibiotics (O'Neill, 2016). Other analyses point to a significant European production base of both finished product and active pharmaceutical ingredients for human antibiotics (Panteli et al., 2024), as well as other pharmaceuticals (Melchior, 2020). Global antibiotic supply is also shaped by geopolitical contestation and competition, particularly between China and India, where fierce trade disputes over antibiotic ingredient production—such as accusations of dumping—reflect how emerging market dominance in APIs influences access, cost, and resilience in global supply chains (Zhang and Bjerke, 2023).
The concentration of power and reliance creates different systematic vulnerabilities that can have large knock‐on effects for many countries that depend on Chinese and Indian manufacturing. These dynamics can, on the one hand, lead to shortages and access barriers when factory shutdowns, policy shifts, or environmental regulations tighten supply and make the delivery of key antibiotics less predictable (Skender and Zhang, 2024); on the other hand, they can create greater challenges for local resistance through the dumping of antibiotics subsequently used in human and animal sectors. Of particular importance are cross-border flows, where resistance risks arise in settings with limited regulatory capacity and antibiotic stewardship, as differences in manufacturing standards, quality surveillance, and environmental controls allow poor-quality or inappropriately used antibiotics to circulate. During crises, these vulnerabilities are amplified by export controls and demand surges, raising critical questions about realistic levels of local or regional capacity, how interdependence is managed in emergencies, and how equity is safeguarded when powerful buyers secure supply first.